Medicaid is designed to help more adults with low incomes in the U.S. pay for essential healthcare products and services. If your state adopted Expanded Medicaid, your eligibility and coverage may have changed.
About 40 states, including Washington, D.C., have adopted Medicaid Expansion — an Affordable Care Act (or “Obamacare”) provision.
If you live in one of the states with Expanded Medicaid and meet the qualification criteria for the program, then you might want to know more about your Expanded Medicaid coverage.
Medicaid Expansion also gives the adopting states an enhanced federal matching assistance percentage (FMAP) for the populations served by the expansion. States with Medicaid Expansion receive 90% FMAP while those without Medicaid Expansion receive nothing.
Expanded Medicaid is a provision of the Affordable Care Act (ACA) designed to provide health insurance coverage to more Americans with low incomes.
Generally speaking, people under age 65 with household incomes equaling 138% of the Federal Poverty Level (FPL) or less may be eligible for Medicaid, though this varies by year, state, household status, and income.
For example, households with two parents and one child in New York State may qualify for Medicaid if they make under about 138% of the FPL, or about $31,000 annual income. (Technically, the limit is 133% FPL plus 5% of income that the government disregards, making the effective income limit 138% FPL.)
This provides a pathway to coverage for millions of low-income adults in America.
Although the ACA proposed Medicaid expansion across the nation, the Supreme Court ruled in 2012 that states could decide whether to expand their own Medicaid programs.
So far, 38 states and Washington, D.C., have adopted Expanded Medicaid. Some states have special eligibility rules to increase coverage.
For example, in Connecticut, parents with an income of up to 160% FPL are eligible. And in Washington, D.C., you’re eligible for Medicaid if you have an income of up to 215% FPL.
Other states that have adopted Medicaid Expansion are:
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Rhode Island
- West Virginia
States that have not adopted Expanded Medicaid include:
- North Carolina
The remaining states have peculiar circumstances:
- Georgia: Partial expansion in mid-2023 along with a work requirement.
- South Carolina: No coverage gap for parents with minor children.
- South Dakota: Medicaid expansion will take effect from July 2023.
- Tennessee: Very little coverage gap for parents of minor children.
- Wisconsin: No coverage gap.
In a state with Expanded Medicaid, you may be eligible for Medicaid coverage as a low-income, non-disabled adult between the ages of 19 and 65.
It’s designed to reduce the number of insured Americans and reduce disparities in health coverage from state to state.
You may be eligible if:
- Your income is 138% of the FPL or less.
- You’re a non-disabled adult between 19–65 years old.
- You live in a state that has adopted Expanded Medicaid.
You may not be eligible if:
- You live in a state that hasn’t adopted Expanded Medicaid.
- You’re younger than 19 or older than 65 years
- Your income is higher than 138% of the FPL.
- You don’t meet citizenship requirements.
However, if your income is between 100%–400% of the FPL, you can get health insurance through health exchanges with discounted cost-sharing and premiums.
Medicaid Expansion is a provision of the ACA designed to increase coverage for non-disabled adults under 65 who have low incomes. Currently, this program is only available in about 40 American states.
To qualify, you need to be in a state that has adopted it and to have an income of 138% of the FPL or less. If you don’t qualify, you can explore other coverage methods, such as health exchanges.