How will Medicaid Florida stack up vs. Georgia in 2026. Everything you need to know.

Medicaid is a joint federal-state health coverage program for low-income individuals and families. Although federally guided, each state administers its own program, resulting in distinct eligibility rules, coverage scope, benefit structures, and enrollment outcomes. Florida and Georgia — geographically adjacent southeastern states — illustrate two very different Medicaid approaches as of 2026. This article compares their eligibility, coverage, benefits, administration, costs, and real-world impact for residents and policy researchers alike.

1. Medicaid Expansion Status

Florida

Florida has not adopted Medicaid expansion under the Affordable Care Act (ACA) as of 2026. This means coverage is limited to traditional eligibility categories (e.g., children, pregnant women, elderly, disabled) and does not cover most low-income adults without dependent children regardless of how low their income may be.

• Florida remains one of the non-expansion states, leaving an estimated ~388,000 residents in the coverage gap — too poor for marketplace subsidies but not eligible for Medicaid.

A ballot initiative to expand Medicaid in Florida has delayed its push to 2028 due to legislative changes in how ballot measures can qualify, with legal challenges underway.

Georgia

Georgia also has not fully expanded Medicaid to cover adults up to 138 % of the federal poverty level under the ACA. However, it operates a partial alternative, “Georgia Pathways to Coverage”, approved as a Section 1115 demonstration waiver that extends eligibility to some low-income adults who meet additional conditions.

• Pathways currently provides coverage to adults with incomes up to 100 % of the federal poverty level (FPL) who complete at least 80 hours of qualifying activities per month (e.g., work, school, volunteering).

Pathways would generally function as a conditional expansion, but differs sharply from traditional expansion in eligibility restrictions and renewal requirements.

2. Eligibility Criteria

Basic Eligibility Requirements

Category	Florida	Georgia
Medicaid Expansion Adults	❌ Not available	❌ Traditional expansion, but Pathways offers conditional access for some adults
Children	Eligible	Eligible
Pregnant Women	Eligible	Eligible
Elderly & Disabled	Eligible	Eligible
Low-income Parents	Eligible (very restrictive)	Eligible
Childless Adults	❌ Generally not eligible	Eligible with Pathways conditions
Work/Activity Requirement	❌ No	✔ Pathways requires 80 hours/month of work/qualifying activity

Florida eligibility remains strictly limited without expansion. Adults without children typically cannot qualify, even at very low incomes.

Georgia Pathways eligibility requires income under 100 % of the FPL, U.S. citizenship or legal residence, Georgia residency, age 19–64, and completion of qualifying activities at least 80 hours per month.

Income & Asset Thresholds

Income limits vary by category (elderly/disabled, children, pregnant women), but states’ basic Medicaid income rules show similar structures for long-term care and regular Medicaid categories. For aged/disabled programs in 2026, Florida’s limit is roughly $1,149/month for an individual, while Georgia’s is about $994/month, with similar institutional limits for both states.

Non-expansion gives Georgia the theoretical ability to cover more adults via Pathways than Florida covers through traditional Medicaid, but the added hurdles significantly constrain access.

3. Coverage & Benefits

Traditional Medicaid Benefits

Both states provide core Medicaid services: hospital care, physician visits, prescription drugs, preventive care, and long-term support services. Coverage is jointly funded by states and the federal government, with each state adopting a version of managed care for most enrollees.

Georgia’s Medicaid managed care system encompasses a range of plans including medical, behavioral, and specialized coverage through managed care organizations (MCOs).

Services in Florida are delivered through statewide Medicaid Managed Care, with specialized long-term care and medical plans.

Optional & Waiver Services

Both states offer optional long-term care waivers and home/community-based services with waiting lists or caps.

Georgia Pathways Coverage

Pathways beneficiaries receive most traditional Medicaid services, but maintaining eligibility requires meeting non-health criteria (hours of activity). Federal approval changes have reduced reporting burdens, but the underlying conditions persist.

4. Work & Activity Requirements (Georgia Only)

Georgia’s model differs significantly because of work or qualifying activity requirements.

• Adults must complete at least 80 hours per month of approved activities (work, education, caregiving, etc.) to be eligible.

• Recent federal modifications allow hours to be verified primarily at application and annual renewal, easing monthly administrative burdens.

This requirement is unique in the U.S.; Florida does not impose similar conditions on most Medicaid beneficiaries.

Critics, including federal watchdog reports, highlight that administrative costs have been high and enrollment remains low relative to the potentially eligible population.

5. Enrollment & Coverage Impact

Florida

• Florida’s Medicaid enrollment has fluctuated following the end of continuous enrollment, with about 4.2 million beneficiaries in 2025–26.

• Lack of expansion contributes to a higher uninsured rate and large reliance on ACA marketplace subsidies for uninsured low-income adults.

Georgia

• Georgia’s traditional Medicaid enrollment covers ~2.3–2.4 million individuals.

• Pathways enrollment has been modest relative to potential demand, with tens of thousands enrolled in contrast to estimates of hundreds of thousands who could qualify.

High uninsured rates persist in Georgia compared with states that have fully expanded Medicaid.

6. Cost & Federal Funding (FMAP)

Medicaid funding is shared between the federal government and states via the Federal Medical Assistance Percentage (FMAP).

• Florida’s standard FMAP is among the lowest nationwide (~57 %).

• Georgia’s FMAP is higher (~66 %).

Non-expansion states forgo additional enhanced funding tied to ACA expansion populations, potentially leaving federal dollars on the table.

Health spending growth and enrollment trends show constrained growth in 2026 nationally, with states navigating post-pandemic redeterminations and cost pressures.

7. Barriers & Policy Debates

Florida

• Expansion is politically blocked and faces new procedural hurdles to reach the ballot.

• Advocates argue expansion would significantly reduce the uninsured population and bolster state healthcare stability.

Georgia

• Pathways demonstrates a controversial model that ties eligibility to work/training.

• Reports show the administrative burden may outweigh enrollment gains and that many eligible individuals fail to enroll due to procedural complexity.

Both states may be affected by national policy changes, including expanded work requirements under federal law from 2027 onward, though the impacts are debated.

8. Key Differences at a Glance

Feature	Florida Medicaid	Georgia Medicaid
Expansion under ACA	❌ No	❌ Traditional, but Pathways is a partial alternative
Coverage for Childless Adults	❌ Very limited	✔ Through Pathways with conditions
Work/Activity Requirement	❌ No	✔ Yes (Pathways)
Administrative Complexity	Standard	Higher due to compliance reporting
Enrollment Access	Broader for children/elderly	Partial for adults plus standard categories
Uninsured Rate Impact	High	Moderately high

Conclusion

Florida and Georgia serve as contrasting models of Medicaid policy in the Southeast in 2026: Florida sticks with traditional eligibility limits and resists expansion, while Georgia attempts a conditional expansion that ties benefits to work or qualifying activities. The net result is that both states leave substantial gaps in low-income coverage compared with expansion states.

For consumers, this means navigating tighter eligibility limits in Florida and additional administrative hurdles in Georgia. For policymakers, the comparison underscores the consequences of partial vs non-expansion strategies — particularly in federal funding and uninsured rates.

Disclaimer

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