What states are the hardest to get Medicaid?

Written by Editorial Team | Last Updated: August 2026

States that have historically maintained the strictest and most restrictive Medicaid eligibility guidelines are primarily those that chose not to implement the Affordable Care Act expansion for low-income adults. Jurisdictions such as Texas, Florida, Georgia, Mississippi, Tennessee, Alabama, and Wisconsin have traditionally kept very low income thresholds for non-disabled, non-parent adults, leaving a coverage gap. Consequently, obtaining non-elderly, non-disability Medicaid coverage in these non-expansion southern and southeastern states is significantly more difficult compared to expansion states.

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