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Medicaid Expansion
The ACA provision that allowed states to extend Medicaid to adults earning up to 138% of the Federal Poverty Level.
Full Definition
The Affordable Care Act included an optional provision for states to expand Medicaid eligibility to nearly all adults under 65 with incomes up to 138% of the Federal Poverty Level ($20,783/year for a single person in 2026). The federal government pays 90% of expansion costs; states pay 10%. As of 2026, 41 states plus DC have expanded Medicaid. In non-expansion states, there is often a 'coverage gap' — people earn too much for traditional Medicaid but too little for ACA subsidies (which start at 100% FPL). The Supreme Court's 2012 ruling in NFIB v. Sebelius made expansion optional for states.
Real-World Example
A 35-year-old in an expansion state earns $18,000/year (about 120% FPL). They qualify for Medicaid expansion coverage with minimal or no premiums. The same person in a non-expansion state earning $18,000 falls into the coverage gap — too much for traditional Medicaid, too little for marketplace subsidies.
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