How do 2026 Medicaid and marketplace eligibility thresholds differ for Alaska and Hawaii vs the lower 48?
Executive summary
Alaska and Hawaii use higher federal poverty guideline dollar amounts than the 48 contiguous states, so any eligibility rule tied to a percent of the Federal Poverty Level (FPL) — Medicaid expansion at 138% FPL, Marketplace premium tax credit ranges (commonly 100%–400% FPL) and cost‑sharing reduction bands (e.g., 250% FPL) — translates into higher dollar thresholds in Alaska and Hawaii than in the lower 48 (ASPE; healthinsurance.org) [1] [2]. Marketplace rules for coverage effective in 2026 are calculated using the 2025 FPL numbers until November 2026, while Medicaid/CHIP eligibility shifts to the published 2026 FPL figures in early 2026 [2].
1. Why the numbers differ: separate FPL amounts for Alaska/Hawaii
The federal government publishes distinct poverty guidelines for the contiguous U.S., Alaska and Hawaii because the guidelines are indexed to local cost differences; the January 2026 updates use CPI adjustments and were published by HHS/ASPE in the Federal Register with separate tables for Alaska and Hawaii [1]. Reporting repeatedly underscores the simple mechanics: Alaska and Hawaii have higher dollar‑value FPLs, so an eligibility rule expressed as “138% of FPL” or “250% of FPL” becomes a larger dollar amount in those states (healthinsurance.org; ASPE) [2] [1].
2. How this works in practice for 2026 Marketplace coverage
For Marketplace coverage effective in 2026, the Marketplaces used the 2025 poverty guidelines to calculate subsidy eligibility (because open enrollment for 2026 occurred before the 2026 FPL was adopted), meaning the higher Alaska/Hawaii FPLs for 2025 already produced higher subsidy‑eligibility cutoffs there; HealthInsurance.org and related calculators note that the 2025 FPL figures determine 2026 Marketplace subsidies until the 2026 figures are activated for 2027 coverage [2] [3]. Practically, the policy architecture — eligibility bands at 100%, 138%, 250% and 400% of FPL — is uniform nationwide, but the dollar‑values differ by location because the underlying FPL does obamacarefacts.com/2026-obamacare-eligibility-chart-and-subsidy-calculator/" target="blank" rel="noopener noreferrer">[4] [2].
3. Medicaid expansion and dollar examples
Medicaid expansion eligibility is typically described as 138% of the applicable FPL in expansion states; because Alaska and Hawaii have higher base FPLs, the 138% threshold equals a higher annual income in those states. Using the published figures that applied for 2025/early 2026 planning, a single adult’s 100% FPL was about $15,960 in the contiguous U.S., $19,550 in Alaska and $17,990 in Hawaii, and most expansion calculations use 138% of those amounts — roughly $22,025 in the lower 48, about $27,000 in Alaska and about $24,825 in Hawaii (base numbers and the 138% rule are in government and industry sources) [5] [6] [2].
4. Marketplace subsidy bands and practical effects
Because Marketplace premium tax credits and cost‑sharing reduction eligibility are keyed to percentages of FPL (with common thresholds at 100%, 250% for CSR tiers, and 400% for traditional premium credit cutoffs), residents of Alaska and Hawaii can qualify for assistance at higher absolute incomes than peers in the contiguous states; industry guides and subsidy calculators emphasize that the FPL tables for Alaska and Hawaii simply raise the dollar ceilings used to compute credits and CSRs (obamacarefacts; healthinsurance.org; dulcineainsurance) [4] [2] [7]. It is important to note that which FPL year is used depends on timing: Marketplace subsidy calculations for 2026 coverage used 2025 FPLs, while Medicaid/CHIP eligibility moves to the 2026 FPL numbers during early 2026 adoption [2].
5. State variation, asset tests and caveats
Beyond the geography‑adjusted FPLs, individual states set many operational Medicaid rules — asset limits, medically needy “spend‑down” options, and long‑term care thresholds — which can further widen effective eligibility differences beyond the raw FPL math; CMS and state trackers show differing asset and SSI‑related dollar standards across states, and some states apply special figures for categories like long‑term care or dual eligibles (McKnight’s; Jarvis; medicaid.gov) [5] [8] [9]. Reporting limitations: while federal FPL tables and the percent rules are clear in the cited sources, precise year‑by‑year dollar amounts in every state can