Best and Worst States for Healthcare for Low-Income Individuals

Where you live can determine whether affordable healthcare is within reach or completely out of it.

HealthCare Insider ranked all 50 states and Washington, D.C. on the cost, access, and quality of Medicaid and CHIP coverage for low-income individuals and families. Our team of dedicated healthcare experts analyzed 13 separate metrics to identify where affordable coverage is easiest to get and where it still falls short. This 2026 ranking builds on our original research and reflects the most current state-by-state data available.

Why Your State Determines Access to Affordable Healthcare

Millions of Americans rely on public health coverage just to see a doctor, fill a prescription, or get their kids vaccinated.

More than 73.9 million people were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) as of April 2026, the most recent month reported by CMS, though that’s down about 5 million from a year earlier as pandemic-era continuous enrollment protections keep unwinding and new work requirements take effect in some states.

Both programs are jointly funded by state and federal governments, and both exist for the same basic reason: to provide coverage to people who can’t otherwise afford it.

But Medicaid and CHIP aren’t run the same way in every state.

Each state sets its own eligibility rules, benefit levels, and enrollment procedures within federal guidelines. Generally, whether you qualify comes down to how your household income compares to the Federal Poverty Level (FPL). Residency, immigration status, and age can also factor in, and those thresholds shift from state to state, sometimes dramatically.

We measured which states turn those rules into real, usable coverage and which ones leave residents with far fewer good options.

What to Consider Before You Apply for Medicaid or CHIP Coverage

Every state runs its own version of Medicaid and CHIP, but a handful of factors decide whether you’ll qualify no matter where you live.

Income is the biggest one. Eligibility is measured against the Federal Poverty Level (FPL), which the Department of Health and Human Services updates every year. For 2026, that baseline is $15,960 for a single person and $33,000 for a household of four. States then set their own income cutoffs as a percentage of that baseline, and those percentages can swing wildly from one state line to the next.

Four factors typically determine whether you qualify:

• Household income and size: Your income is compared against the FPL for your specific household size, not a flat dollar figure.
• Age: Children, pregnant women, and adults are held to different income thresholds within the same program.
• Residency: You generally need to live in the state where you’re applying, though most states don’t impose a minimum length-of-residency requirement.
• Immigration status: Lawfully present immigrants can qualify for Medicaid or CHIP, though some face a five-year waiting period depending on status and state. Undocumented immigrants generally aren’t eligible except for emergency Medicaid.

Age matters more than most applicants expect. A state might cap adult eligibility well below the poverty line while extending coverage to children and pregnant women at two or three times that level. That’s part of why the same household can qualify in one state and get turned away in another, with income that hasn’t changed at all.

How Medicaid and CHIP Coverage Varies From State to State

Two people with the exact same income can qualify for coverage in one state and get denied in the next. That’s not a glitch. It’s how the program was designed.

Medicaid is a federal-state partnership, which means Washington sets the floor and each state decides how much higher to build. The clearest example is Medicaid expansion under the Affordable Care Act. States that expanded Medicaid extend coverage to nearly all adults earning up to 138% of the FPL. In the 10 states that still haven’t adopted expansion, including Texas, Florida, and Georgia, eligibility for parents can sit at a median of just 40% of the FPL, and childless adults without disabilities often don’t qualify at all no matter how little they earn.

Children and pregnant women fare better almost everywhere. The median eligibility level for kids nationally sits around 255% of the FPL, and most states set the threshold for pregnant women at 200% of the FPL or higher. Even so, the exact cutoff still depends entirely on your zip code.

This is what the coverage gap looks like in practice. An adult who’d easily qualify in New York or California might earn too much for Medicaid and too little to qualify for subsidized marketplace coverage in a non-expansion state. Few things illustrate how much geography shapes access to basic healthcare in this country better than that.

Finding Localized Health Coverage in Your State

Because eligibility rules and enrollment portals differ by state, the fastest way to get an accurate answer isn’t a national search. It’s going straight to your state’s Medicaid agency.

Medicaid.gov’s state contact directory links out to every state’s application portal, phone line, and eligibility checker. If your household includes kids, InsureKidsNow.gov is built specifically to help families find CHIP coverage where they live, since children’s income limits are often far more generous than what adults in the same household qualify for.

If you apply and find out you earn too much for Medicaid, that’s not the end of the road. Applications submitted through Healthcare.gov or your state marketplace automatically check Medicaid and CHIP eligibility first, then route you to subsidized marketplace plans if you don’t qualify. Working with a licensed agent who knows your state’s specific rules can also save time, especially in states where Medicaid, CHIP, and marketplace subsidies overlap in confusing ways.

The Best and Worst States for Medicaid and CHIP Coverage in 2026

HealthCare Insider compared all 50 states and Washington, D.C. across 13 key metrics spanning three categories: cost, access, and quality.

Here’s how every state ranks, from best to worst, for overall Medicaid and CHIP coverage:

1. Connecticut
2. New York
3. California
4. Massachusetts
5. Minnesota
6. District of Columbia
7. New Mexico
8. Vermont
9. Washington
10. Hawaii
11. Rhode Island
12. Maryland
13. Colorado
14. Delaware
15. Pennsylvania
16. Arkansas
17. Maine
18. West Virginia
19. Illinois
20. Ohio
21. Oregon
22. Kentucky
23. New Jersey
24. Louisiana
25. New Hampshire
26. Michigan
27. Wisconsin
28. Iowa
29. Florida
30. Virginia
31. Alaska
32. Nevada
33. North Carolina
34. Indiana
35. Arizona
36. Montana
37. South Carolina
38. Utah
39. Nebraska
40. Tennessee
41. Missouri
42. North Dakota
43. Mississippi
44. Texas
45. Alabama
46. Wyoming
47. Idaho
48. Kansas
49. Georgia
50. Oklahoma
51. South Dakota

A few patterns stand out right away. States that expanded Medicaid under the Affordable Care Act dominate the top half of the list, while several of the states at the bottom are among the 10 that haven’t adopted expansion. Cost of living and state budget priorities play a role too, which is exactly what the category breakdowns below show.

Best and Worst States by Cost

Cost isn’t just about what a state spends. It’s about who’s footing the bill, and how much room that leaves in a state’s budget for everything else. We measured three separate cost metrics to capture the full picture.

Medicaid Spending Per Capita

Best: District of Columbia

Worst: Utah

Washington, D.C. spends more per Medicaid enrollee than anywhere else in the country, with per-enrollee costs that top $10,000 annually according to KFF. Higher costs of care in a dense urban market and a Medicaid population with more complex health needs both push that number up, and it works in beneficiaries’ favor by supporting a broader, more generous benefit package.

Utah lands at the opposite end. A younger population, strong employer-sponsored coverage rates, and a leaner overall program keep its per-enrollee spending well below the national average. That’s not necessarily a knock on quality, but it does tend to translate into a tighter benefit package and fewer supplemental services than states spending significantly more per person.

Federal Medicaid Contribution

Best: New Mexico

Worst: Wyoming

Every state’s Medicaid program is a partnership with the federal government, and the federal share, known as the Federal Medical Assistance Percentage (FMAP), isn’t the same everywhere. States with lower per capita income relative to the national average get a higher federal match, up to a statutory cap of 83%. New Mexico sits near the top of that scale, with a FY2026 FMAP of roughly 71.7%, meaning Washington covers most of the state’s Medicaid bill. Mississippi holds the top spot nationally at just under 77%.

Wyoming, on the other hand, sits at the federal minimum of 50% along with several higher-income states. That means Wyoming shoulders a much larger share of every Medicaid dollar spent in the state, which puts more pressure on its own budget to keep the program funded.

State Medicaid Contribution

Best: Wyoming

Worst: New Mexico

This metric flips the lens to look at Medicaid’s share of each state’s own budget, and the results run in the opposite direction from the federal contribution numbers. New Mexico has one of the highest shares of state spending going to Medicaid in the country, with Medicaid consuming close to a third of total state expenditures. A larger low-income population relative to the size of its overall budget means Medicaid takes up more room, even with a generous federal match offsetting part of the cost.

Wyoming again lands near the bottom of this metric, and for good reason. As one of the states that hasn’t adopted Medicaid expansion, its enrollment stays comparatively small, and Medicaid eats up a much smaller slice of an already modest state budget. Fewer dollars flowing through the program means less strain on the state’s finances, even though its residents shoulder a larger share of the cost per dollar spent.

Best and Worst States by Quality

Cost only tells part of the story. A state can spend generously and still deliver spotty outcomes if the underlying healthcare system isn’t built to support it. These three metrics illustrate that gap.

Child Immunization Quality

Best: Connecticut

Worst: Wyoming

Connecticut posts the highest kindergarten MMR vaccination rate in the country at 98.2%, well above the 95% threshold public health officials consider necessary for community immunity. Strong school-entry requirements and high provider density help keep that number up, and it translates directly into better protection for kids on Medicaid and CHIP, who make up a large share of Connecticut’s youngest residents.

States on the other end of the spectrum, including Wyoming, tend to share a common set of challenges: fewer pediatric providers per capita, longer travel distances to a clinic, and looser school-entry vaccination requirements. Rural access gaps like these hit Medicaid and CHIP families hardest, since they’re less likely to have the flexibility to travel for routine care.

Public Hospital System Quality

Best: Hawaii

Worst: Louisiana

Hawaii consistently ranks among the top handful of states for healthcare system performance. The Commonwealth Fund’s 2025 scorecard puts Hawaii in the top five overall, with a nonelderly adult uninsured rate of just 3.9% and the lowest share of adults skipping care due to cost of any state, at 6.7%. A near-universal coverage rate and a well-integrated public hospital network both help explain why the state’s public system performs so well for Medicaid recipients.

Louisiana has landed near the bottom of most national health system scorecards for years, a pattern driven by higher rates of chronic disease, thinner provider networks in rural parishes, and persistent gaps in hospital funding. Those structural challenges show up directly in the CMS Adult Core Set measures used to grade this category, which track everything from preventive screenings to hospital readmission rates.

Medicaid Expansion Enrollment Per Capita

Best: Washington, D.C.

Worst: Maine*

As of 2026, 41 states and Washington, D.C. have adopted Medicaid expansion, extending coverage to adults earning up to 138% of the Federal Poverty Level. D.C.’s dense, urban population and higher concentration of lower-income residents relative to its size push its expansion enrollment per capita well above every state’s.

Maine expanded Medicaid later than most, adopting it through a 2017 ballot initiative that didn’t take effect until 2019. That later start, combined with a smaller and more rural low-income population, has kept its expansion enrollment per capita lower than most of its expansion-state peers even years later.

*Excluding states that did not participate in the Medicaid expansion program.

Best and Worst States by Access

Access measures whether the people who need Medicaid and CHIP coverage can actually get it. Eligibility thresholds and enrollment reach vary more here than in almost any other part of this analysis.

Pregnant Women Medicaid Eligibility Level

Best: Iowa

Worst: South Dakota

Iowa covers pregnant women up to 220% of the FPL, well above the national median of around 213%. That extra room matters most in the months before and after delivery, when consistent prenatal and postpartum care has the biggest impact on outcomes for both parent and baby.

South Dakota sets its threshold at 138% of the FPL, the federal minimum every state has to offer. That leaves a narrower band of income where a pregnant resident qualifies, and it means more people fall into the gap between Medicaid eligibility and being able to afford private coverage during pregnancy.

Adult Medicaid Eligibility Level

Best: Washington, D.C.

Worst: Texas

Washington, D.C. historically ran one of the most generous adult Medicaid programs in the country, covering parents and childless adults up to roughly 215% of the FPL, well beyond the standard 138% expansion threshold most states use. That changed on January 1, 2026, when D.C. lowered adult Medicaid eligibility to 133% of the FPL and launched a new Basic Health Program, the Healthy DC Plan, to cover residents between 133% and 200% of the FPL who lost Medicaid eligibility in the shift. On its own, D.C.’s new Medicaid threshold is now close to what most expansion states already offer. But combined with the Healthy DC Plan, D.C. still provides publicly funded coverage up to 200% of the FPL, a ceiling higher than nearly every other state reaches through Medicaid alone.

Texas sits at the opposite extreme. As one of the states that hasn’t adopted Medicaid expansion, Texas offers essentially no path to Medicaid for childless adults, regardless of how little they earn, unless they’re pregnant, disabled, or 65 or older. That gap leaves a large share of low-income Texans with income too high for traditional Medicaid and too low to qualify for marketplace subsidies.

Children Medicaid Eligibility Level

Best: Washington, D.C.

Worst: Wyoming

D.C. covers children up to 319% of the FPL across Medicaid and CHIP combined, one of the highest thresholds in the country. That generosity means far fewer working families in D.C. earn their way out of coverage for their kids.

Wyoming’s children’s eligibility tops out much lower, between 133% and 200% of the FPL depending on age. A family earning modestly above the poverty line in Wyoming can find their children ineligible for coverage that would still be available to a similar family in D.C. or many other states.

Total Medicaid Enrollment Per Capita

Best: New Mexico

Worst: North Dakota

Roughly 32% of New Mexico’s population is enrolled in Medicaid or CHIP, one of the highest shares of any state. A combination of higher statewide poverty rates, generous eligibility thresholds, and years of active outreach has pushed enrollment well above the national average.

North Dakota sits far below that, with enrollment closer to 13% of its population. A smaller share of residents living below the relevant income thresholds, combined with a smaller overall low-income population, keeps its per capita enrollment among the lowest in the country even though the state has adopted Medicaid expansion.

Methodology

Our team of dedicated healthcare experts carefully analyzed data from trusted research agencies and federal sources to assess which states deliver the most affordable, accessible, and highest-quality Medicaid and CHIP coverage. We compared all 50 states and Washington, D.C. across 13 metrics, grouped into three equally weighted categories: cost, quality, and access, each worth 33.33 points toward a state’s overall score.

Cost metrics captured total Medicaid spending per capita, the federal and state shares of that spending, and Medicaid’s overall share of each state budget. Quality metrics measured child immunization rates, public hospital system performance using the CMS Medicaid Adult Core Set, and Medicaid expansion enrollment per capita. Access metrics covered income eligibility levels for pregnant women, adults, and children, along with total Medicaid enrollment per capita.

We sourced this data from the Centers for Medicare & Medicaid Services (CMS), the Kaiser Family Foundation (KFF), the Medicaid and CHIP Payment and Access Commission (MACPAC), and Opportunity Insights. Each state’s weighted average across all 13 metrics determined its final score and overall rank.

No carrier paid to be featured or ranked in this review.

Medicaid and CHIP: Frequently Asked Questions

What’s the difference between Medicaid and CHIP?

Medicaid and CHIP are both publicly funded health insurance programs, but they serve slightly different groups. Medicaid covers low-income individuals and families of all ages, while CHIP specifically covers children in families whose income is too high for Medicaid but still too low to afford private coverage. In many states, the two programs work together seamlessly, and a family might have some members on Medicaid and others on CHIP depending on age and income.

Some states also use CHIP funds to cover pregnant women who don’t qualify for Medicaid, which is worth checking if you’re pregnant and unsure where you land.

Which state has the best Medicaid and CHIP coverage in 2026?

Based on our analysis of 13 cost, quality, and access metrics, Connecticut ranked as the best state overall for Medicaid and CHIP coverage in 2026, followed by New York, California, Massachusetts, and Minnesota. States that adopted Medicaid expansion generally scored better across the board, since expansion widens eligibility and tends to correlate with stronger funding and infrastructure for the program.

How do I find out if I qualify for Medicaid or CHIP in my state?

The fastest way is to apply directly through your state’s Medicaid agency or through HealthCare.gov, which automatically checks Medicaid and CHIP eligibility as part of the marketplace application. Eligibility depends on your household income relative to the Federal Poverty Level, your household size, your age, and sometimes your immigration or residency status, and every one of those thresholds is set by your state, not a national standard.

What happens if I earn too much for Medicaid but can’t afford marketplace insurance?

This is known as the coverage gap, and it’s most common in the 10 states that haven’t adopted Medicaid expansion. In those states, adults without dependent children often can’t qualify for Medicaid no matter how little they earn, but if their income falls below 100% of the FPL, they also don’t qualify for marketplace subsidies, which were designed assuming Medicaid expansion would cover that population. If you’re in this situation, it’s worth talking to a licensed agent about any state-specific programs or community health center options that might apply.

Does Medicaid coverage transfer if I move to a different state?

No. Medicaid eligibility is state-specific, so moving means you’ll need to close your case in your old state and reapply in your new one, even if your income and household haven’t changed. Because eligibility rules vary so much, it’s possible to qualify in one state and not in another, so it’s worth checking your new state’s income limits before you move if Medicaid coverage is a factor in your decision.

Do CHIP plans charge premiums or copays?

Some do. Federal law caps total CHIP costs, including premiums and copays combined, at 5% of a family’s annual income, and many states waive costs entirely for families closer to the lower end of CHIP’s income range. Higher-income families within CHIP’s eligibility window are more likely to pay modest monthly premiums, which still tend to run well below the cost of private insurance for a child.

Finding the Best Medicaid and CHIP Coverage for Your Family in 2026

Where you live shapes almost every part of your experience with Medicaid and CHIP, from how much you’re allowed to earn and still qualify to how much of the bill your state actually covers.

Connecticut, New York, California, Massachusetts, and Minnesota led our 2026 rankings, largely because they pair strong eligibility thresholds with well-funded public health systems and high enrollment reach. States like Louisiana, Texas, and Wyoming landed near the bottom, weighed down by tighter eligibility rules, thinner provider networks, or the lack of Medicaid expansion altogether. The 10 states that still haven’t expanded Medicaid remain the clearest dividing line in this ranking, and that single policy decision explains more of the gap between top and bottom states than any other factor we measured.

If you’re trying to figure out where you stand, start with your own state’s specific income limits rather than a national average. Programs for children and pregnant women tend to be far more generous than programs for adults, so it’s worth applying even if you assume you’ll fall short. And if you earn too much for Medicaid, don’t assume you’re out of options. Marketplace subsidies, CHIP for your kids, and in some states, new programs like D.C.’s Healthy DC Plan can fill the gap.