Medicaid Expansion

Updated on June 18th, 2021

Reviewed by Charles Gaba

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As of February 2021, 38 states and Washington D.C. had expanded Medicaid

With the goal of increasing access to health insurance, the 2010 Affordable Care Act gave states the option to expand the U.S. government’s Medicaid health coverage to more low income people by offering states the required funding. The ACA boosted access by enlarging eligibility to individuals under age 65 in families with incomes below 133% of the federal poverty level (in practice, it actually extends up to 138% FPL).1 

Funding for the expansion began in 2014 when major provisions of the ACA came into effect. At the end of 2014, 28 states had opted to expand Medicaid eligibility, while 22 had not. Studies show that an estimated 17 million uninsured people gained health insurance in 2014, mostly via Medicaid expansion.2 Since the beginning of the COVID-19 pandemic, Medicaid enrollment via ACA expansion specifically has likely increased by more than 25%, from 15 million to 19 million.3 

States have each faced a decision about whether to adopt the Medicaid expansion since a 2012 Supreme Court decision. Some states have adopted the Medicaid expansion through legislation, while others have been forced to do so by state ballot measures. By 2021, the number of states expanding Medicaid had grown to 38 plus Washington D.C.

In addition, the Biden Administration’s boosted health insurance coverage through the American Rescue Plan, which increased the portion of Medicaid funding paid for by the federal government by an additional 5 percent for two years for any non-expansion state which agrees to expand the program under the ACA.4



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  1. Program History.” Medicaid. Accessed February 15, 2021.

  2. Pines, Jesse M., Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A. Farmer, Greg Hufstetler, Kevin Klauer, and Randy Pilgrim. “Medicaid Expansion in 2014 Did Not Increase Emergency Department Use but Did Change Insurance Payer Mix.” Northwestern Scholars. Project Hope, September 14, 2016.

  3. Sprung, Andrew, January 30, 2021: ACA Medicaid expansion enrollment may have grown 25% from February to December 2020

  4. Center on Budget & Policy Priorities, February 19, 2021: Health Provisions in House Relief Bill Would Improve Access to Health Coverage During COVID Crisis