Medicaid expansion rejected, largest coverage gap population in the nation
Enacted9/10
Texas · State decision not to expand Medicaid under ACA · Effective Jan 1, 2014
Impact 9/10
Texas has declined to adopt the ACA Medicaid expansion since it became available in January 2014 and remains one of ten non-expansion states as of 2026. KFF estimates about 1.2 million uninsured adults nationwide fall into the coverage gap, earning too much for traditional Medicaid but too little for marketplace subsidies, and the majority live in Texas, Florida, and Georgia. Texas has the nation's lowest Medicaid income limit for parents, at 15 percent of the poverty level.
HealthcareWorking-age adultsLow-incomeRural residentsImmigrants
Sources
✓ Verified against primary sources 2026-08-16