Alyssa Lane
The Patient Protection and Affordable Care Act (ACA) has brought about several changes to Medicaid, a government-funded health insurance program for low-income Americans. One of the most notable changes is the expansion of eligibility to include adults with incomes up to 133-138% of the federal poverty level. This expansion is optional for states to implement, but those that have done so have seen dramatic reductions in their uninsured rates. The ACA also streamlined the eligibility, enrollment, and renewal processes for Medicaid, and made it more accessible to young adults by allowing them to remain on their parents' insurance plans until the age of 26. Obamacare, synonymous with the ACA, is often compared to Medicaid as they are both government-funded programs aimed at providing affordable health coverage. However, Obamacare plans are offered by private health insurance companies and are typically easier to obtain than Medicaid.
| Characteristics | Values |
|---|---|
| ACA | Affordable Care Act |
| Medicaid | A government-funded health insurance program that provides coverage for low-income Americans |
| Obamacare | Synonymous nickname for the ACA; individual market health insurance plans sold in the health insurance exchanges |
| Enrollment | Obamacare plans are only available during limited special enrollment periods; Medicaid enrollees can register throughout the year |
| Eligibility | Obamacare is available to all legal US residents; Medicaid eligibility varies by state, but is generally means-tested |
| Cost | Obamacare plans often require significant payments from beneficiaries; Medicaid is free or requires little to no payment |
| Coverage | Obamacare provides basic coverage for all Americans; Medicaid provides more comprehensive coverage for those who cannot afford it otherwise |
| Racial Inequities | ACA's coverage provisions have narrowed racial inequities in health coverage |
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What You'll Learn
ACA and Medicaid eligibility requirements
The Patient Protection and Affordable Care Act (ACA) has made several changes to Medicaid, including expanding eligibility to adults with incomes up to 133% of the federal poverty level (FPL). This expansion is not mandatory, however, as the Supreme Court ruled in 2012 that it is up to individual states to decide whether to expand their Medicaid programs. As a result, some adults with incomes below 100% of the FPL do not qualify for Medicaid, as their incomes are too high to qualify in their state, but too low to qualify for savings on a Marketplace insurance plan.
Prior to the ACA, eligibility levels for children in Medicaid differed by age. The ACA aligned states' minimum Medicaid eligibility threshold for children at 133% FPL, requiring some states to shift older children from separate CHIP programs into Medicaid.
Medicaid is a joint federal and state program that provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are among the mandatory eligibility groups. Eligibility for individuals 65 and older, or who have blindness or a disability, is generally determined using the income methodologies of the SSI program. Certain eligibility groups do not require a determination of income by the Medicaid agency, and coverage may be based on enrollment in another program, such as SSI or a cancer treatment and prevention program.
States have the option to establish a "medically needy program" for individuals with significant health needs whose income is too high to otherwise qualify for Medicaid. These individuals can become eligible by "spending down" the amount of income that is above a state's medically needy income standard. Once an individual's incurred expenses for medical and remedial care exceed the difference between their income and the state's standard, they can be eligible for Medicaid.
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ACA and Medicaid enrollment processes
The Patient Protection and Affordable Care Act (ACA) and Medicaid are two government-funded programs that provide health insurance coverage to Americans. The ACA, also known as Obamacare, offers health plans through private health insurance companies, while Medicaid is a government program that provides coverage for low-income individuals and families.
The ACA has made significant changes to the Medicaid enrollment and renewal processes, aiming to simplify and streamline them. These changes include requiring a single application for Medicaid, CHIP, and subsidized exchange coverage, as well as expanding eligibility to adults with incomes up to 133% of the federal poverty level (FPL). The expansion of eligibility, however, is no longer a requirement due to a Supreme Court ruling in 2012, which made it optional for states to implement.
The ACA has also brought about other reforms in the health insurance sector. It has eliminated pre-existing condition exclusions and set annual limits on out-of-pocket expenses. The Act also allows young adults to remain on their parents' insurance plans until they turn 26.
In contrast to the ACA, Medicaid is a social welfare program similar to SNAP food stamps or Temporary Assistance to Needy Families. Enrollment in Medicaid is open throughout the year for eligible individuals, and in most cases, there are little to no payments required from enrollees in the form of copayments or deductibles. The criteria to qualify for Medicaid vary from state to state, and it is generally more challenging to obtain than an Obamacare plan.
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ACA and Medicaid funding
The Patient Protection and Affordable Care Act (ACA) has made several changes to Medicaid. The most notable change is the expansion of eligibility to include adults with incomes up to 133-138% of the federal poverty level (FPL). This expansion is optional for states to implement due to a 2012 Supreme Court ruling, but over three-quarters of states have opted to expand. The ACA also introduced provisions to streamline eligibility, enrollment, and renewal processes, requiring a single application for Medicaid, CHIP, and subsidised exchange coverage.
The ACA has increased the number of Americans with health insurance by providing new premium tax credits for the purchase of private health insurance and making reforms to the private insurance market. For example, eliminating pre-existing condition exclusions and establishing annual limits on out-of-pocket costs. The ACA also allowed young adults to remain on their parents' insurance plans up to the age of 26.
Medicaid is a government-funded health insurance program that provides coverage for low-income Americans. It is a social welfare program similar to SNAP food stamps or Temporary Assistance to Needy Families. Obamacare, on the other hand, refers to individual market health insurance plans sold in the health insurance exchanges. These plans are offered by private health insurance companies, but they are regulated by the ACA. Obamacare plans are often more affordable than Medicaid plans, and they are available to all legal US residents who are not incarcerated and are not enrolled in Medicare.
The federal government and the states share responsibility for financing Medicaid, with the matching rate varying by state and between different eligibility groups. The ACA increased the matching rate for adults newly covered under the program, with the federal government paying 100% of state Medicaid costs for certain newly eligible individuals through 2016. This matching rate has declined slightly each year and reached 90% in 2020. States that expanded Medicaid coverage under the ACA have dramatically lowered their uninsured rates, and expansion has been shown to have positive economic impacts on healthcare providers and state budgets.
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ACA and Medicaid coverage
The Patient Protection and Affordable Care Act (ACA) made several changes to Medicaid. The most notable change was the expansion of eligibility to adults with incomes up to 133% of the federal poverty level (FPL). This expansion was originally mandatory for states, but a 2012 Supreme Court ruling made it optional. As of 2025, over three-quarters of states have opted to expand their Medicaid programs.
The ACA also included provisions to streamline eligibility, enrollment, and renewal processes. For example, by requiring a single application for Medicaid, CHIP, and subsidized exchange coverage. These changes have led to increased enrollment and spending in Medicaid across all states, regardless of whether they expanded coverage to non-disabled adults.
The ACA's other Medicaid provisions include a maintenance-of-effort requirement that prevented states from reducing eligibility below that in place on the date the ACA was enacted. The ACA also aligned states' minimum Medicaid eligibility thresholds for children at 133% FPL, requiring some states to shift older children from separate CHIP programs.
In addition to the changes to Medicaid, the ACA sought to increase the number of Americans with health insurance by providing new premium tax credits for the purchase of private health insurance. The ACA also made several reforms to the private insurance market, such as eliminating pre-existing condition exclusions and establishing annual limits on out-of-pocket costs. The law also allowed young adults to remain on their parents' insurance plans up to age 26.
Obamacare, or the ACA, and Medicaid are two different government-funded programs that provide health coverage to Americans. Obamacare plans are offered by private health insurance companies, while Medicaid is a government program administered by states and often administered by private insurance companies that offer Medicaid managed care services. Obamacare was designed to provide basic coverage for all Americans, while Medicaid provides coverage for low-income Americans who cannot afford coverage otherwise.
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ACA and Medicaid: Obamacare
The Patient Protection and Affordable Care Act (ACA) is a comprehensive health care reform law enacted in March 2010. The ACA, also known as Obamacare, was designed to provide affordable health coverage to all Americans. Obamacare is a nickname for the ACA, and it is often used to refer to individual market health insurance plans sold in the health insurance exchanges.
Obamacare health plans are offered by private health insurance companies, while Medicaid is a government-funded program for low-income residents. As of early 2023, nearly 94 million Americans were receiving Medicaid and CHIP benefits, an increase of 37 million people since 2013. Medicaid is a social welfare program similar to SNAP food stamps or Temporary Assistance to Needy Families.
The ACA made several changes to Medicaid, including expanding eligibility to adults with incomes up to 133% of the federal poverty level (FPL). This expansion was initially a requirement, but a 2012 Supreme Court ruling made it optional for states to implement. To date, over three-quarters of states have opted to expand their Medicaid programs. The ACA also streamlined the eligibility, enrollment, and renewal processes for Medicaid, contributing to increased enrollment and spending in all states.
Another key difference between Obamacare and Medicaid is the variation in their enrollment periods. Enrollment in Obamacare plans is typically limited to specific windows, such as during the open enrollment period or special enrollment periods triggered by qualifying life events. In contrast, eligible individuals can enroll in Medicaid throughout the year. Obamacare plans also often require significant payments from beneficiaries, while Medicaid typically involves little or no out-of-pocket costs for enrollees.
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Frequently asked questions
Obamacare health plans are offered by private health insurance companies, while Medicaid is a government program. Obamacare plans are available to all legal US residents, while Medicaid is means-tested and intended for those who cannot afford coverage otherwise.
The ACA, or Affordable Care Act, made a number of changes to Medicaid. The most widely discussed is the expansion of eligibility to adults with incomes up to 133%-<138%> of the federal poverty level. Other changes include streamlining eligibility, enrollment, and renewal processes, and reductions in federal funds for disproportionate share hospital (DSH) supplemental payments.
If you are eligible for Medicaid, you can enrol at any time. You will need to end your Marketplace coverage when your Medicaid coverage starts, or you may have to pay back some or all of the premium tax credit you received.
