Medicaid Expansion Coverage for Adults Ages 50

Tobey Oliver, AARP Public Policy Institute

Published August 20, 2026

Female doctor in scrubs consulting with senior woman in exam room

Forty-one states, including the District of Columbia, have expanded their Medicaid eligibility an option provided under the Affordable Care Act (ACA), to include many low-income adults. About 5 million older adults ages 50–64 who otherwise would not be eligible depend on this coverage for critical services such as cancer screenings, primary care, and behavioral health care.

Midlife Medicaid enrollees, counties and state legislative districts around the country, will be affected by new community engagement requirements beginning on January 1, 2027, with some states choosing to start sooner. To maintain coverage, they will need to work, volunteer, or be in school for 80 hours a month, unless they qualify for an exemption. AARP Public Policy Institute, with KNG Health Consulting (KNG), estimate that these community engagement requirements will affect about 19.5 million Medicaid enrollees, including about 5 million 50-64 year-olds.

GRAPH - Data Vis: Older Adults Ages 50-64 Who Rely on Medicaid Expansion

The law exempts certain groups including those who are caregivers or “medically frail,” However, the burden to prove eligibility for the exemption may be challenging for many to meet. These administrative hurdles could place access to needed health care at risk, particularly for older adults, who are more likely to live with disabilities and chronic health conditions.

Using the data graphic

Click on a state to view data on how many people will be subject to the new eligibility requirements, including the number and percentage of adults ages 50–64. Once in a state profile, use the drop-down box to select county, state senate district, or state house district for data breakdowns. Click the U.S. map outline in the upper-right corner to return to the national map.

Medicaid Expansion Analysis Methodology

Estimating the 2026 state enrollment

When estimating 2026 Medicaid Expansion enrollment, KNG Health used the most recently available monthly enrollment data from the Centers for Medicare & Medicaid Services (April to June 2025) Medicaid Beneficiary Enrollment System (MBES).

To project 2026 enrollment estimates, KNG Health calculated each state’s percentage change in Medicaid Expansion enrollment between August 2024 and June 2025 and applied to each state’s 2025 values. KNG Health then used the CBO’s estimate of the ratio of Medicaid Expansion enrollment in 2026 to 2025 (-1.9%) to scale the state level results to match CBO’s national estimated change.

Estimating the share of 50–64-year-olds

To calculate the share of Medicaid Expansion enrollees between the ages of 50 and 64, KNG Health multiplied the state's 2026 estimated Medicaid Expansion enrollment by the share of a state’s Medicaid population that is between the ages of 50 and 64, obtained from the American Community Survey (ACS) data.[i]

Estimating the county and legislative district enrollments

To calculate the county Medicaid Expansion enrollment, KNG Health calculated the county-level share of residents that were low-income and insured using the Small Area Health Insurance Estimates (SAHIE) and then multiplied that percentage by the state’s 2026 Adjusted Estimated Medicaid Expansion enrollment among 50 to 64-year-olds.[ii]

To calculate the state house and senate district Medicaid Expansion enrollment, KNG Health used resources available from the Missouri Census Data Center.[iii]

Notes on results

KNG Health suppressed enrollee counts of less than 11 and excluded the house summary for Nebraska due to its unicameral legislature. State totals across sheets may not match as a result of rounding and suppression of values less than 11.

_{[i] KNG Health used the five-year 2024 ACS data and limited survey responses to those who were between the ages of 19–64, enrolled in Medicaid, not enrolled in Medicare, and had incomes less than 138% of the federal poverty level (FPL).}

_{[ii] Each county's low-income and insured percentage was calculated as the ratio of its insured population between the ages of 50 and 64 with incomes less than or equal to 138% the Federal Poverty Level (FPL) divided by the state’s insured population between the ages of 50 and 64 with incomes less than or equal to FPL.}

_{[iii] The crosswalk indicates the percentage of a county that falls within each legislative district. For example, 100% of county A could fall within legislative district A, while 70% of county B falls within legislative district A and 30% falls within legislative district B. KNG Health multiplied the county level enrollment estimates by the legislative district share and then summed the estimates by legislative district to estimate a total enrollment for each house and senate district.}

Suggested Citation:
Oliver, Tobey. Data Visualization: Older Adults Ages 50-64 Who Rely on Medicaid Expansion. Washington, DC: AARP Public Policy Institute, August 20, 2026.