Short answer
No. Texas is one of 10 states that have not adopted the Affordable Care Act's Medicaid expansion [1][2]. Expansion would cover nearly all adults under 65 earning up to 138% of the federal poverty level, with the federal government paying 90% of their cost [3]. Using 2024 data, KFF estimates 605,000 uninsured Texas adults are in the resulting coverage gap [4].
Where Texas stands
As of October 2026, KFF, a health policy research organization, counts 41 states including the District of Columbia that have adopted the Medicaid expansion, and 10 states that have not [2]. KFF lists the non-expansion states as Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming [1].
Without expansion, Texas covers few low-income adults. As of January 2026, Texas's Medicaid income limit for parents in a family of three was 15% of the federal poverty level, and adults without dependent children were not eligible at any income [5]. KFF reports that the median parent limit in non-expansion states is 33% of the poverty level [3].
What expansion would do
The Affordable Care Act expanded Medicaid to nearly all adults under 65 with incomes up to 138% of the federal poverty level, which KFF puts at $21,597 a year for an individual in 2025 [3]. The expansion group is financed with a 90% federal match, with states paying the remaining 10% [3]. A 2012 Supreme Court ruling made the expansion effectively optional for states [3].
Expansion would reach adults who now fall in a "coverage gap": their incomes are above Texas's Medicaid limits but below the poverty line, too low to qualify for subsidized Marketplace coverage [4]. Using 2024 data, KFF estimated 605,000 Texas adults ages 19 to 64 were in this gap, the most of any state and about half of the 1.2 million nationwide [4]. About 66% of them were in a working family, and about 71% were adults without dependent children [4].
Coverage in expansion and non-expansion states
Texas had the highest uninsured rate of any state in 2024, at 16.7% for all ages, according to the Census Bureau [6]. The Census Bureau noted that nearly half of the 15 states with uninsured rates above the national average had not expanded Medicaid [6]. KFF reported that in 2024 the uninsured rate for people under 65 was 14.5% in non-expansion states and 8.0% in expansion states [1].
Federal changes since 2025
The American Rescue Plan Act offered states a temporary financial incentive to newly adopt the expansion [3]. The 2025 federal tax and spending law eliminated that incentive, effective Jan. 1, 2026 [3]. The same law requires work requirements for expansion adults starting Jan. 1, 2027, or sooner at a state's option, and more frequent eligibility checks [1][3].
Separately, enhanced federal premium tax credits for Marketplace coverage were not extended and expired at the end of 2025 [1].
Common questions
- Is Texas a Medicaid expansion state?
- No. Texas is one of 10 states that had not adopted the ACA expansion as of 2026 [1][2].
- Who would qualify under Medicaid expansion?
- Nearly all adults under 65 with incomes up to 138% of the federal poverty level, or $21,597 for an individual in 2025 [3].
- Who pays for Medicaid expansion?
- The federal government pays 90% of the cost for the expansion group, and the state pays 10% [3].
- Can childless adults get Medicaid in Texas?
- Generally no. KFF lists Texas's income limit for adults without dependent children as 0% of the poverty level as of January 2026 [5].
Sources
- Key Facts about the Uninsured Population, KFF, 2026-06-16
- Status of State Medicaid Expansion Decisions, KFF, 2026-10-16
- Medicaid 101 (Health Policy 101), KFF, 2025-10-08
- Characteristics of Poor Uninsured Adults Ages 19-64 in the ACA Coverage Gap, KFF, 2024
- Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, KFF, 2026-01
- Health Insurance Coverage by State: 2023 and 2024 (ACSBR-024), U.S. Census Bureau, 2025-09