The hardest states to get Medicaid are primarily those that have not expanded coverage under the Affordable Care Act (ACA), including Texas, Florida, Georgia, Mississippi, Alabama, Wyoming, Tennessee, South Carolina, Kansas, and Wisconsin. These states often have strict income limits and limited eligibility for non-disabled adults without children.
The worst, in order from 50th to 41st, are in Mississippi, Idaho, Texas, Oklahoma, South Dakota, Indiana, South Carolina, Colorado, Alabama, and Missouri.
In comparison, the 10 worst states for healthcare were:
Ten states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—have not expanded Medicaid eligibility under the Affordable Care Act to individuals with incomes up to 138% of the federal poverty level.
So each state runs its own Medicaid program and can set its own rules and requirements for eligibility — within various parameters established by the federal government. As such, transferring your Medicaid coverage from one state to another isn't always possible.
Follows are the most common reasons for denial.
There isn't one single #1 state; it depends on the ranking source, but Hawaii, Massachusetts, and New Hampshire consistently appear at the top for overall healthcare performance, with Hawaii leading for outcomes (life expectancy, low uninsured) in U.S. News, Massachusetts for access/affordability in Commonwealth Fund reports, and New Hampshire often ranking high in metrics like access and quality in WalletHub's analysis.
Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
While children and low-income adults make up the largest share of Medicaid enrollees, people eligible due to age (65+) or disability account for over half of all Medicaid spending, due to higher healthcare needs and use of costly long-term care services. Children are the biggest group by enrollment numbers, while low-income adults (especially through ACA expansion) and the elderly/disabled are key populations.
New Mexico had the highest percentage of residents enrolled in Medicaid in 2022, while Utah had the lowest, according to new data released by the Census Bureau Sept. 14 as part of its American Community Survey.
If you or your loved ones don't qualify for Medicaid, you have other options, including CHIP for people under 18 years, Tricare for military personnel and their families, and Medicare for people ages 65 years and older. You can also consider state-based programs that may offer healthcare plans at a lower cost.
According to WalletHub, the top 10 best states for doctors were:
Leading our rankings for 2025 are Massachusetts, Hawaii, New Hampshire, Rhode Island, and the District of Columbia. These states outperformed others in health system performance overall. Still, even these states are not performing as well as other states in certain areas.
The saddest states in the U.S., often indicated by high rates of depression, poor well-being, and economic struggles, consistently include West Virginia, Kentucky, Louisiana, Arkansas, and Alabama, with other states like Oklahoma, Tennessee, Mississippi, and Oregon also appearing in top rankings. These states often face challenges such as poverty, limited access to mental healthcare, unemployment, and high rates of chronic diseases, contributing to lower overall happiness and higher reported depression levels.
The Medicare 2-Midnight Rule is a Centers for Medicare & Medicaid Services(CMS) guideline for hospital admissions, stating that if a doctor expects a patient to need hospital care crossing at least two midnights, the stay generally qualifies for Medicare Part A inpatient payment;