An official website of the United States Government -

Medicaid and the Affordable Care Act

Perhaps the most widely discussed change that the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) made to Medicaid was expanding eligibility to adults with incomes up to 138 percent of the federal poverty level (FPL). Originally a requirement, the June 2012 Supreme Court ruling in National Federation of Independent Business v. Sebelius effectively made the Medicaid expansion an option, and to date, more than half of states have opted to expand. The ACA also made a number of other significant Medicaid changes, such as preventing states from reducing children’s Medicaid eligibility until FY 2019; setting a uniform standard for children’s eligibility at 138 percent FPL; streamlining eligibility, enrollment, and renewal processes; and updating payments to safety-net hospitals.

Learn More about These Topics

Featured Publications

Transitions Between Medicaid, CHIP, and Exchange Coverage

July 19, 2022

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires states to coordinate eligibility and enrollment processes between Medicaid, separate State Children’s Health Insurance Programs (CHIP), and subsidized coverage on health insurance exchanges. These policies aim to reduce coverage gaps when a beneficiary experiences changes in income or other circumstances.
This brief summarizes […]

Testing New Program Features through Section 1115 Waivers

June 26, 2020

Section 1115 waivers allow states to test approaches to coverage that are not allowed under traditional Medicaid. Under Section 1115 of the Social Security Act, the Secretary of the U.S. Department of Health and Human Services can waive almost any Medicaid state plan requirement under Section 1902 of the Act to the extent necessary to […]

Premium Assistance: Medicaid’s Expanding Role in the Private Insurance Market

March 13, 2015

Premium assistance—the use of Medicaid funds to purchase private market plans—is one way that states may expand coverage to previously ineligible, low-income adults. Arkansas and Iowa have been using premium assistance to purchase plans on the exchange through Section 1115 research and demonstration waivers since January 2014, and other states have expressed interest in this approach.
While […]