The ACA allows states to expand Medicaid eligibility to all non-Medicare eligible individuals under age 65 with income up to 138% of the federal poverty level. In 2012, the US Supreme Court ruled that expansion is not required, but many states still chose to expand in 2014 and the years immediately following. More recently, ballot initiatives have helped enact Medicaid expansion efforts in certain holdout states (e.g., Missouri, Oklahoma, South Dakota). The American Rescue Plan (H.R.1319), passed in March 2021, provides remaining states with new financial incentives to expand their Medicaid programs by temporarily offering a 2-year, 5-percentage-point increase in the federal medical assistance percentage for that state’s traditionally eligible (i.e., non-expansion) Medicaid beneficiaries.

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