Texas Coverage Gap Project

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Fact sheet: The Texas coverage gap

One-page summary as of 2026-10-24. Sources follow on the next page.

605,000Texas adults in the coverage gap, about half of the U.S. total1
16.7%Texans uninsured in 2024, the highest rate of any state (U.S.: 8.2%)2
$22,025Expansion income limit for one person in 2026 (138% of poverty)3
90%Federal share of costs for expansion adults (vs. 58.54% federal for most Texas Medicaid)4

What the evidence shows

Costs and tradeoffs

West Texas

About one in five residents under 65 is uninsured. 25 of 71 counties have no listed hospital, and 69 have a primary-care shortage designation.20,21,22

Texas Coverage Gap Project, an independent project: https://texascoveragegap.org

Sources for this page

  1. KFF, Cervantes, Bell, Tolbert, Damico, 'How Many Uninsured Are in the Coverage Gap...' (2026-07-27). https://www.kff.org/medicaid/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/ [evidence L2]
  2. U.S. Census Bureau, ACS Brief ACSBR-024 (Health Insurance Coverage by State: 2023 and 2024) (2025-09). https://www2.census.gov/library/publications/2025/demo/acsbr-024.pdf [evidence L4]
  3. HHS 2026 Poverty Guidelines, 91 FR (FR Doc 2026-00755) (2026-01-15). https://www.govinfo.gov/content/pkg/FR-2026-01-15/html/2026-00755.htm [evidence L1]
  4. Federal Register FMAP notice for Oct 1, 2026-Sep 30, 2027 (2025-11-28). https://www.federalregister.gov/documents/2025/11/28/2025-21332/federal-financial-participation-in-state-assistance-expenditures-federal-matching-shares-for [evidence L10]
  5. Miller, Johnson, Wherry, 'Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data', QJE 136(3):1783-1829, doi:10.1093/qje/qjab004 (2021). https://academic.oup.com/qje/article-abstract/136/3/1783/6124639 [evidence H1]
  6. Borgschulte & Vogler, 'Did the ACA Medicaid expansion save lives?' J Health Econ 72:102333, doi:10.1016/j.jhealeco.2020.102333 (2020). https://doi.org/10.1016/j.jhealeco.2020.102333 [evidence H2]
  7. Black, Hollingsworth, Nunes, Simon, NBER w25568 'The Effect of Health Insurance on Mortality: Power Analysis...' (2019 (rev.)). https://econpapers.repec.org/RePEc:nbr:nberwo:25568 [evidence H4]
  8. Baicker et al., 'The Oregon Experiment', NEJM 2013;368:1713-22, doi:10.1056/NEJMsa1212321 (2013-05-02). https://www.nejm.org/doi/full/10.1056/NEJMsa1212321 [evidence H5]
  9. Finkelstein et al., 'The Oregon Health Insurance Experiment: Evidence from the First Year', QJE 127(3):1057-1106 (2012). https://pmc.ncbi.nlm.nih.gov/articles/PMC3535298/ [evidence F1]
  10. Brevoort, Grodzicki, Hackmann, J Public Econ 187:104203, doi:10.1016/j.jpubeco.2020.104203 (2020). https://doi.org/10.1016/j.jpubeco.2020.104203 [evidence F2]
  11. Baicker, Finkelstein, Song, Taubman, AER P&P 104(5):322-28, doi:10.1257/aer.104.5.322 (2014). https://pmc.ncbi.nlm.nih.gov/articles/PMC4145849/ [evidence W1]
  12. Leung & Mas, Industrial Relations 57(2):206-234, doi:10.1111/irel.12207; Kaestner et al., JPAM 36(3):608-42, doi:10.1002/pam.21993 (2018; 2017). https://doi.org/10.1111/irel.12207 [evidence W3]
  13. Baicker et al. NEJM 2013 (Oregon) (2013). https://www.nejm.org/doi/full/10.1056/NEJMsa1212321 [evidence S1]
  14. Taubman et al., Science 2014, doi:10.1126/science.1246183; Finkelstein et al., NEJM 2016, doi:10.1056/NEJMp1609533 (2014; 2016). https://www.nejm.org/doi/full/10.1056/NEJMp1609533 [evidence H8]
  15. CMS Interim Final Rule CMS-2454-IFC, 91 FR 33348 (FR Doc 2026-11094); CMS fact sheet (2026-06-03). https://www.govinfo.gov/content/pkg/FR-2026-06-03/html/2026-11094.htm [evidence L5]
  16. KFF, 'Health Provisions in the 2025 Federal Budget Reconciliation Law' (P.L. 119-21) (2025-08-22). https://www.kff.org/medicaid/health-provisions-in-the-2025-federal-budget-reconciliation-law/ [evidence L6]
  17. CMS Dear State Medicaid Director letter on OBBBA sections 71115/71117 (2025-11-14). https://www.medicaid.gov/medicaid/downloads/providertax_dcl_11142025.pdf [evidence L7]
  18. Legislative Budget Board staff estimate (Mar 4, 2013); HB 3376 fiscal note (Apr 16, 2013) (2013). https://capitol.texas.gov/tlodocs/83R/fiscalnotes/html/HB03376I.htm [evidence P3]
  19. Fritz, Pitts & Pitts (Sept 2020); Dague & Hughes, Texas A&M Bush School (Sept 2020), both for Episcopal Health Foundation (2020-09). https://episcopalhealth.org/wp-content/uploads/2020/09/Fritz-Pitts-Pitts-Sept-2020-Impact-of-Medicaid-Expansion-on-State-Budget-1.pdf [evidence P4]
  20. U.S. Census Bureau Small Area Health Insurance Estimates (SAHIE) 2024, county file; regions = Texas Comptroller High Plains (41 counties) + West Texas (30 counties) (2026-08). https://www2.census.gov/programs-surveys/sahie/datasets/time-series/estimates-acs/sahie-2024-csv.zip [evidence WT1]
  21. CMS Provider Data Catalog, Hospital General Information (modified 2026-07-22); county lists per Texas Comptroller regions (2026-07-22). https://data.cms.gov/provider-data/dataset/xubh-q36u [evidence WT2]
  22. HRSA Health Professional Shortage Areas, primary care detail file (BCD_HPSA_FCT_DET_PC), status 'Designated' (accessed 2026-10-24). https://data.hrsa.gov/data/download [evidence WT3]

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