The percentage of Americans covered by the Medicaid public health insurance plan increased from **** percent in 2020 to around **** percent in 2023. However, the percentage of those insured through Medicaid remains lower than the peak of **** percent in 2015. The expansion of Medicaid The Affordable Care Act (ACA) provided the option for states to expand Medicaid eligibility to people whose income was below a particular threshold. The ACA’s major coverage expansion came into force in 2014, and the number of individuals estimated to be enrolled in Medicaid has since surpassed ** million. More than ** million children were enrolled in the program in 2018, representing ** percent of overall Medicaid enrollment. State Medicaid coverage Initially, the ACA mandated that all state Medicaid programs would have to be extended to provide medical coverage to nearly all low-income groups. However, the Supreme Court rejected that part of the act in 2012, leaving the door open for states to make their own decision on whether they expand their plans. As of September 2021, ** states plus the District of Columbia have adopted the Medicaid expansion.

Over ** million Americans were estimated to be enrolled in the Medicaid program as of 2023. That is a significant increase from around ** million ten years earlier. Medicaid is basically a joint federal and state health program that provides medical coverage to low-income individuals and families. Currently, Medicaid is responsible for ** percent of the nation’s health care bill, making it the third-largest payer behind private insurances and Medicare. From the beginning to ObamacareMedicaid was implemented in 1965 and since then has become the largest source of medical services for Americans with low income and limited resources. The program has become particularly prominent since the introduction of President Obama’s health reform – the Patient Protection and Affordable Care Act - in 2010. Medicaid was largely impacted by this reform, for states now had the opportunity to expand Medicaid eligibility to larger parts of the uninsured population. Thus, the percentage of uninsured in the United States decreased from over ** percent in 2010 to *** percent in 2022. Who is enrolled in Medicaid?Medicaid enrollment is divided mainly into four groups of beneficiaries: children, adults under 65 years of age, seniors aged 65 years or older, and disabled people. Children are the largest group, with a share of approximately ** percent of enrollees. However, their share of Medicaid expenditures is relatively small, with around ** percent. Compared to that, disabled people, accounting for **** percent of total enrollment, were responsible for **** percent of total expenditures. Around half of total Medicaid spending goes to managed care and health plans.

According to a survey done in March 2024, long wait times on the phone was the most common problem reported by 44 percent of Americans who tried to renew their Medicaid coverage last year before Medicaid unwinding. Another 26 percent mentioned that they did not know what documents were needed to complete re-enrollment. This statistic illustrates the types of problems Medicaid enrollees experienced when they tried to renew their coverage in 2023.

The percentage of people in the United States with health insurance has increased over the past decade with a noticeably sharp increase in 2014 when the Affordable Care Act (ACA) was enacted. As of 2023, around ** percent of people in the United States had some form of health insurance, compared to around ** percent in 2010. Despite the increases in the percentage of insured people in the U.S., there were still over ** million people in the United States without health insurance as of 2023. Insurance coverage Health insurance in the United States consists of different private and public insurance programs such as those provided by private employers or those provided publicly through Medicare and Medicaid. Almost half of the insured population in the United States were insured privately through an employer as of 2021, while **** percent of people were insured through Medicaid, and **** percent through Medicare . The Affordable Care Act The Affordable Care Act (ACA), enacted in 2014, has significantly reduced the number of uninsured people in the United States. In 2014, the percentage of U.S. individuals with health insurance increased to almost ** percent. Furthermore, the percentage of people without health insurance reached an all time low in 2022. Public opinion on healthcare reform in the United States remains an ongoing political issue with public opinion consistently divided.

The number of people enrolled in Medicaid decreased by *** percent in 2024, while expenditure increased by *** percent. Due to Medicaid unwinding in 2025 Medicaid enrollment is projected to decline by *** percent, while the spending is expected to grow by *** percent. Impact of COVID-19 on Medicaid Approximately ** percent of Americans were covered by Medicaid in 2020. The total number of Medicaid enrollees continues to increase each year and is projected to surpass ** million in 2019. A steadily improving economy in the United States is one reason for the slower enrollment growth experienced in recent years. However, unemployment numbers surged due to the COVID-19 pandemic, and Medicaid enrollment is expected to rise over the coming months as millions of people lose their employer-based health insurance. Medicaid expenditure set to increase Medicaid expenditure in 2019 was projected to *** billion U.S. dollars, an increase year on year. Medicaid spending rose by *** percent in 2020, but the economic downturn caused by COVID-19 is likely to significantly increase both state and federal expenditures. More people are now eligible for Medicaid because they have lost income, and the costs of coronavirus testing and treatment are escalating. Many states may not have the budget to pay for it all, especially at a time when tax revenues are declining.

Medicaid is an important public health insurance for individuals with a low income, those that are pregnant, disabled or are children. It was projected that by 2020 there would be approximately **** million Medicaid enrollees. By 2027 that number is expected to increase to ** million individuals covered.

Medicaid in the focus

Medicaid has recently been in the news for several reasons. A proposed Medicaid expansion was announced with the implementation of the Affordable Care Act in 2010. According to the expansion, all states were given the option to expand Medicaid programs to help provide insurance coverage to millions of U.S. Americans. As of 2019, ** states have accepted federal funding to expand their Medicaid programs. Medicaid, after Medicare and private insurance, provides a significant proportion of the total health expenditures in the United States. In general, Medicaid expenditure, like the number of enrollees, has been growing over time.

Medicaid demographics

A significant proportion of Medicaid enrollees in the U.S. are children and low-income adults. Despite children accounting for most of the enrollees in the Medicaid program, the largest percentage of expenditures for Medicaid is dedicated to those enrolled as a disabled individual. Expenditures for the program also vary regionally. The states with the highest Medicaid expenditures include California, New York and Texas, to name a few.

In 2021, 18 percent of Americans in Medicaid non-expansion states were uninsured, this was twice the share of uninsured people in Medicaid expansion states. Individual-market health insurance coverage was higher among Americans in non-expansion states. In general, health insurance coverage was higher among Americans residing in Medicaid expansion states compared to non-expansion states between 2013 and 2021.

California has more Medicaid and CHIP enrollees than any other state in the United States. As of April 2023, approximately 13 million Americans were enrolled in the Medicaid health insurance programs in California, which accounted for approximately 15 percent of the total number of Medicaid enrollees nationwide (94.4 million).

Blow to Medicaid expansion plans California is one of many states that has expanded its Medicaid program under the Affordable Care Act (ACA) to encourage more low-income adults to sign up for health coverage. One of the original aims of the ACA was to limit some of the variations in state Medicaid programs, but the Supreme Court ruled that the expansion should be optional. Governors of the states that did not expand said they were concerned about long-term costs. California is the leading state for Medicaid expenditure, spending approximately 97.8 billion U.S. dollars in FY2020.

Health coverage for children The Children’s Health Insurance Program (CHIP) was created as a complement to Medicaid, expanding the reach of government-funded health coverage to more children in low-income families. As of May 2021, over five million children were enrolled in Medicaid/CHIP programs in California, more than any other state. As of January 2021, the median Medicaid/CHIP eligibility level for children was 255 percent of the federal poverty level.

Medicare is an important public health insurance scheme for U.S. adults aged 65 years and over. As of 2023, an estimated 18.9 percent of the U.S. population was covered by Medicare, an increase from the previous year. As of 2021, California, Florida, and Texas had the largest number of adults aged 65 years and older. The Medicare program Medicare has two primary parts: Medicare Part A covers hospital care and Medicare Part B covers medical and preventative services. Both parts of Medicare are available to those aged 65 years and older under certain conditions. Medicare premiums are variable and depend on the enrollee’s income. Despite a majority of the Medicare enrollees being above the federal poverty line, there are still several programs in place to help cover the costs of healthcare for the elderly. Opinions on elderly care in the U.S. It is estimated that about 23 percent of Medicare enrollees are in fair/poor health. But there are lots of questions about who should pay for or help with elderly care long-term. In a recent survey of U.S. adults, about half of the respondents said that health insurance companies should pay for elderly care. However, a majority of adults also supported a long-term government sponsored health plan like Medicaid. The issue is still hotly debated and politicized in the United States.

This data is pulled from the U.S. Census website. This data is for years Calendar Years 2009-2014. Product: SAHIE File Layout Overview Small Area Health Insurance Estimates Program - SAHIE Filenames: SAHIE Text and SAHIE CSV files 2009 – 2014 Source: Small Area Health Insurance Estimates Program, U.S. Census Bureau. Internet Release Date: May 2016 Description: Model‐based Small Area Health Insurance Estimates (SAHIE) for Counties and States File Layout and Definitions

The Small Area Health Insurance Estimates (SAHIE) program was created to develop model-based estimates of health insurance coverage for counties and states. This program builds on the work of the Small Area Income and Poverty Estimates (SAIPE) program. SAHIE is only source of single-year health insurance coverage estimates for all U.S. counties.

For 2008-2014, SAHIE publishes STATE and COUNTY estimates of population with and without health insurance coverage, along with measures of uncertainty, for the full cross-classification of: •5 age categories: 0-64, 18-64, 21-64, 40-64, and 50-64

•3 sex categories: both sexes, male, and female

•6 income categories: all incomes, as well as income-to-poverty ratio (IPR) categories 0-138%, 0-200%, 0-250%, 0-400%, and 138-400% of the poverty threshold

•4 races/ethnicities (for states only): all races/ethnicities, White not Hispanic, Black not Hispanic, and Hispanic (any race).

In addition, estimates for age category 0-18 by the income categories listed above are published.

Each year’s estimates are adjusted so that, before rounding, the county estimates sum to their respective state totals and for key demographics the state estimates sum to the national ACS numbers insured and uninsured.

This program is partially funded by the Centers for Disease Control and Prevention's (CDC), National Breast and Cervical Cancer Early Detection ProgramLink to a non-federal Web site (NBCCEDP). The CDC have a congressional mandate to provide screening services for breast and cervical cancer to low-income, uninsured, and underserved women through the NBCCEDP. Most state NBCCEDP programs define low-income as 200 or 250 percent of the poverty threshold. Also included are IPR categories relevant to the Affordable Care Act (ACA). In 2014, the ACA will help families gain access to health care by allowing Medicaid to cover families with incomes less than or equal to 138 percent of the poverty line. Families with incomes above the level needed to qualify for Medicaid, but less than or equal to 400 percent of the poverty line can receive tax credits that will help them pay for health coverage in the new health insurance exchanges.

We welcome your feedback as we continue to research and improve our estimation methods. The SAHIE program's age model methodology and estimates have undergone internal U.S. Census Bureau review as well as external review. See the SAHIE Methodological Review page for more details and a summary of the comments and our response.

The SAHIE program models health insurance coverage by combining survey data from several sources, including: •The American Community Survey (ACS) •Demographic population estimates •Aggregated federal tax returns •Participation records for the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp program •County Business Patterns •Medicaid •Children's Health Insurance Program (CHIP) participation records •Census 2010

Margin of error (MOE). Some ACS products provide an MOE instead of confidence intervals. An MOE is the difference between an estimate and its upper or lower confidence bounds. Confidence bounds can be created by adding the margin of error to the estimate (for the upper bound) and subtracting the margin of error from the estimate (for the lower bound). All published ACS margins of error are based on a 90-percent confidence level.

Trend in no health insurance coverage and Medicaid coverage by marital status, sex, and state Medicaid expansion status, American Community Survey 2010–16, N = 3,874,432 Medicaid eligible respondents.

Children accounted for 36.5 percent of Medicaid enrollees in 2021, which was the largest share of all enrollment groups. The elderly and persons with disabilities had the smallest shares, but together they accounted for more than half of all Medicaid expenditure.

Medicaid expenditures per enrollee Medicaid is a joint federal and state health care program in the United States. The program provides medical coverage to millions of Americans and supports a variety of enrollment groups, particularly senior citizens and individuals with disabilities. Medicaid per enrollee spending is significantly higher for these two groups because they require more frequent and costly long-term care in the community and nursing homes. In 2022 of the total U.S. health expenditure on home health care, Medicaid paid one-third.

Millions of Americans are uninsured The United States has a multi-payer health care system, meaning that some Americans will be covered by private health insurance, and others will be covered by a government program such as Medicaid. However, approximately 27.6 million people in the U.S. had no health insurance in 2021, and should they require health care, they would have to pay the full price out of their own pocket. This becomes a real problem for many because the United States has the most expensive health care system in the world.

In 2023, just four in ten Medicaid/CHIP enrollees were White, non-Hispanic. In comparison, roughly three-quarters of Medicare beneficiaries were White. The Affordable Care Act (ACA) Medicaid expansion in 2014, has helped reduce racial disparities in access to healthcare in the United States. Medicaid eligibility Medicaid provides health coverage to certain low-income individuals, families, children, pregnant women, the elderly, and persons with disabilities. Each state has its own Medicaid eligibility criteria in accordance with federal guidelines. As a result, Medicaid eligibility and benefits differ widely from state to state. Medicaid expansion provision under the Affordable Care Act (ACA) allows states to provide coverage for low-income adults by expanding eligibility for Medicaid to 138 percent of the federal poverty line (FPL). Medicaid coverage gap Uninsured individuals who live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA) are referred to as being in the Medicaid coverage gap. As of January 2021, 12 states have not adopted the Medicaid expansion provision under the Affordable Care Act (ACA). More than two million uninsured adults fall into this coverage gap, and among them, more than 60 percent are people of color.

Although the American Community Survey (ACS) produces population, demographic and housing unit estimates, it is the Census Bureau's Population Estimates Program that produces and disseminates the official estimates of the population for the nation, states, counties, cities, and towns and estimates of housing units for states and counties..Supporting documentation on code lists, subject definitions, data accuracy, and statistical testing can be found on the American Community Survey website in the Technical Documentation section.Sample size and data quality measures (including coverage rates, allocation rates, and response rates) can be found on the American Community Survey website in the Methodology section..Source: U.S. Census Bureau, 2021 American Community Survey 1-Year Estimates.Data are based on a sample and are subject to sampling variability. The degree of uncertainty for an estimate arising from sampling variability is represented through the use of a margin of error. The value shown here is the 90 percent margin of error. The margin of error can be interpreted roughly as providing a 90 percent probability that the interval defined by the estimate minus the margin of error and the estimate plus the margin of error (the lower and upper confidence bounds) contains the true value. In addition to sampling variability, the ACS estimates are subject to nonsampling error (for a discussion of nonsampling variability, see ACS Technical Documentation). The effect of nonsampling error is not represented in these tables..Logical coverage edits applying a rules-based assignment of Medicaid, Medicare and military health coverage were added as of 2009 -- please see https://www.census.gov/library/working-papers/2010/demo/coverage_edits_final.html for more details. Select geographies of 2008 data comparable to the 2009 and later tables are available at https://www.census.gov/data/tables/time-series/acs/1-year-re-run-health-insurance.html. The health insurance coverage category names were modified in 2010. See https://www.census.gov/topics/health/health-insurance/about/glossary.html#par_textimage_18 for a list of the insurance type definitions..Beginning in 2017, selected variable categories were updated, including age-categories, income-to-poverty ratio (IPR) categories, and the age universe for certain employment and education variables. See user note entitled "Health Insurance Table Updates" for further details..The 2021 American Community Survey (ACS) data generally reflect the March 2020 Office of Management and Budget (OMB) delineations of metropolitan and micropolitan statistical areas. In certain instances the names, codes, and boundaries of the principal cities shown in ACS tables may differ from the OMB delineations due to differences in the effective dates of the geographic entities..Estimates of urban and rural populations, housing units, and characteristics reflect boundaries of urban areas defined based on Census 2010 data. As a result, data for urban and rural areas from the ACS do not necessarily reflect the results of ongoing urbanization..Explanation of Symbols:- The estimate could not be computed because there were an insufficient number of sample observations. For a ratio of medians estimate, one or both of the median estimates falls in the lowest interval or highest interval of an open-ended distribution. For a 5-year median estimate, the margin of error associated with a median was larger than the median itself.N The estimate or margin of error cannot be displayed because there were an insufficient number of sample cases in the selected geographic area. (X) The estimate or margin of error is not applicable or not available.median- The median falls in the lowest interval of an open-ended distribution (for example "2,500-")median+ The median falls in the highest interval of an open-ended distribution (for example "250,000+").** The margin of error could not be computed because there were an insufficient number of sample observations.*** The margin of error could not be computed because the median falls in the lowest interval or highest interval of an open-ended distribution.***** A margin of error is not appropriate because the corresponding estimate is controlled to an independent population or housing estimate. Effectively, the corresponding estimate has no sampling error and the margin of error may be treated as zero.

Triple differences linear probability model for Medicaid coverage by marital status, sex, age, and state Medicaid expansion status, American Community Survey 2010–16.

Although the American Community Survey (ACS) produces population, demographic and housing unit estimates, it is the Census Bureau's Population Estimates Program that produces and disseminates the official estimates of the population for the nation, states, counties, cities, and towns and estimates of housing units for states and counties..Supporting documentation on code lists, subject definitions, data accuracy, and statistical testing can be found on the American Community Survey website in the .Technical Documentation.. section......Sample size and data quality measures (including coverage rates, allocation rates, and response rates) can be found on the American Community Survey website in the .Methodology.. section..Source: U.S. Census Bureau, 2018 American Community Survey 1-Year Estimates.Data are based on a sample and are subject to sampling variability. The degree of uncertainty for an estimate arising from sampling variability is represented through the use of a margin of error. The value shown here is the 90 percent margin of error. The margin of error can be interpreted roughly as providing a 90 percent probability that the interval defined by the estimate minus the margin of error and the estimate plus the margin of error (the lower and upper confidence bounds) contains the true value. In addition to sampling variability, the ACS estimates are subject to nonsampling error (for a discussion of nonsampling variability, see .ACS Technical Documentation..). The effect of nonsampling error is not represented in these tables..Logical coverage edits applying a rules-based assignment of Medicaid, Medicare and military health coverage were added as of 2009 -- please see .https://www.census.gov/library/working-papers/2010/demo/coverage_edits_final.html.. for more details. The 2008 data table in American FactFinder does not incorporate these edits. Therefore, the estimates that appear in these tables are not comparable to the estimates in the 2009 and later tables. Select geographies of 2008 data comparable to the 2009 and later tables are available at .https://www.census.gov/data/tables/time-series/acs/1-year-re-run-health-insurance.html... The health insurance coverage category names were modified in 2010. See .https://www.census.gov/topics/health/health-insurance/about/glossary.html#par_textimage_18.. for a list of the insurance type definitions..Beginning in 2017, selected variable categories were updated, including age-categories, income-to-poverty ratio (IPR) categories, and the age universe for certain employment and education variables. See user note entitled ."Health Insurance Table Updates".. for further details..While the 2018 American Community Survey (ACS) data generally reflect the July 2015 Office of Management and Budget (OMB) delineations of metropolitan and micropolitan statistical areas, in certain instances the names, codes, and boundaries of the principal cities shown in ACS tables may differ from the OMB delineations due to differences in the effective dates of the geographic entities..Estimates of urban and rural populations, housing units, and characteristics reflect boundaries of urban areas defined based on Census 2010 data. As a result, data for urban and rural areas from the ACS do not necessarily reflect the results of ongoing urbanization..Explanation of Symbols:..An "**" entry in the margin of error column indicates that either no sample observations or too few sample observations were available to compute a standard error and thus the margin of error. A statistical test is not appropriate..An "-" entry in the estimate column indicates that either no sample observations or too few sample observations were available to compute an estimate, or a ratio of medians cannot be calculated because one or both of the median estimates falls in the lowest interval or upper interval of an open-ended distribution, or the margin of error associated with a median was larger than the median itself..An "-" following a median estimate means the median falls in the lowest interval of an open-ended distribution..An "+" following a median estimate means the median falls in the upper interval of an open-ended distribution..An "***" entry in the margin of error column indicates that the median falls in the lowest interval or upper interval of an open-ended distribution. A statistical test is not appropriate..An "*****" entry in the margin of error column indicates that the estimate is controlled. A statistical test for sampling variability is not appropriate. .An "N" entry in the estimate and margin of error columns indicates that data for this geographic area cannot be displayed because the number of sample cases is too small..An "(X)" means that the estimate is not applicable or not available....

The number of older individuals – those aged 65 and older – enrolled in the Medicaid health insurance program was projected to be *** million in 2020. Enrollment is expected to increase year-on-year and is forecast to reach ***** million by 2027.

Which enrollment group is the largest? The percentage of people covered by Medicaid has notably increased since 2000, and enrollment has accelerated in recent years due to the program’s expansion under the Affordable Care Act. The elderly represent the smallest enrollment group, and this looks set to continue in the coming years. The number of disabled enrollees is projected to grow to nearly ****** million, while children are expected to remain the largest enrollment group.

Combining Medicaid and Medicare Aged individuals can qualify for Medicaid based on their low-income or via another eligibility pathway, such as receiving Supplemental Security Income. Some seniors may also qualify for both Medicaid and Medicare, and these dual-eligible beneficiaries receive a comprehensive range of medical support. Medicare is a health insurance program primarily aimed at individuals aged 65 and older – this group accounted for around ** percent of all Medicare enrollees in 2019.

Although the American Community Survey (ACS) produces population, demographic and housing unit estimates, the decennial census is the official source of population totals for April 1st of each decennial year. In between censuses, the Census Bureau's Population Estimates Program produces and disseminates the official estimates of the population for the nation, states, counties, cities, and towns and estimates of housing units and the group quarters population for states and counties..Information about the American Community Survey (ACS) can be found on the ACS website. Supporting documentation including code lists, subject definitions, data accuracy, and statistical testing, and a full list of ACS tables and table shells (without estimates) can be found on the Technical Documentation section of the ACS website.Sample size and data quality measures (including coverage rates, allocation rates, and response rates) can be found on the American Community Survey website in the Methodology section..Source: U.S. Census Bureau, 2023 American Community Survey 1-Year Estimates.ACS data generally reflect the geographic boundaries of legal and statistical areas as of January 1 of the estimate year. For more information, see Geography Boundaries by Year..Data are based on a sample and are subject to sampling variability. The degree of uncertainty for an estimate arising from sampling variability is represented through the use of a margin of error. The value shown here is the 90 percent margin of error. The margin of error can be interpreted roughly as providing a 90 percent probability that the interval defined by the estimate minus the margin of error and the estimate plus the margin of error (the lower and upper confidence bounds) contains the true value. In addition to sampling variability, the ACS estimates are subject to nonsampling error (for a discussion of nonsampling variability, see ACS Technical Documentation). The effect of nonsampling error is not represented in these tables..Users must consider potential differences in geographic boundaries, questionnaire content or coding, or other methodological issues when comparing ACS data from different years. Statistically significant differences shown in ACS Comparison Profiles, or in data users' own analysis, may be the result of these differences and thus might not necessarily reflect changes to the social, economic, housing, or demographic characteristics being compared. For more information, see Comparing ACS Data..The health insurance coverage category names were modified in 2010. See https://www.census.gov/topics/health/health-insurance/about/glossary.html#par_textimage_18 for a list of the insurance type definitions..When information is missing or inconsistent, the Census Bureau logically assigns an acceptable value using the response to a related question or questions. If a logical assignment is not possible, data are filled using a statistical process called allocation, which uses a similar individual or household to provide a donor value. The "Allocated" section is the number of respondents who received an allocated value for a particular subject..Estimates of urban and rural populations, housing units, and characteristics reflect boundaries of urban areas defined based on 2020 Census data. As a result, data for urban and rural areas from the ACS do not necessarily reflect the results of ongoing urbanization..Explanation of Symbols:- The estimate could not be computed because there were an insufficient number of sample observations. For a ratio of medians estimate, one or both of the median estimates falls in the lowest interval or highest interval of an open-ended distribution. For a 5-year median estimate, the margin of error associated with a median was larger than the median itself.N The estimate or margin of error cannot be displayed because there were an insufficient number of sample cases in the selected geographic area. (X) The estimate or margin of error is not applicable or not available.median- The median falls in the lowest interval of an open-ended distribution (for example "2,500-")median+ The median falls in the highest interval of an open-ended distribution (for example "250,000+").** The margin of error could not be computed because there were an insufficient number of sample observations.*** The margin of error could not be computed because the median falls in the lowest interval or highest interval of an open-ended distribution.***** A margin of error is not appropriate because the corresponding estimate is controlled to an independent population or housing estimate. Effectively, the corresponding estimate has no sampling error and the margin of error may be treated as zero.

Although the American Community Survey (ACS) produces population, demographic and housing unit estimates, for 2020, the 2020 Census provides the official counts of the population and housing units for the nation, states, counties, cities, and towns. For 2016 to 2019, the Population Estimates Program provides estimates of the population for the nation, states, counties, cities, and towns and intercensal housing unit estimates for the nation, states, and counties..Supporting documentation on code lists, subject definitions, data accuracy, and statistical testing can be found on the American Community Survey website in the Technical Documentation section.Sample size and data quality measures (including coverage rates, allocation rates, and response rates) can be found on the American Community Survey website in the Methodology section..Source: U.S. Census Bureau, 2016-2020 American Community Survey 5-Year Estimates.Data are based on a sample and are subject to sampling variability. The degree of uncertainty for an estimate arising from sampling variability is represented through the use of a margin of error. The value shown here is the 90 percent margin of error. The margin of error can be interpreted roughly as providing a 90 percent probability that the interval defined by the estimate minus the margin of error and the estimate plus the margin of error (the lower and upper confidence bounds) contains the true value. In addition to sampling variability, the ACS estimates are subject to nonsampling error (for a discussion of nonsampling variability, see ACS Technical Documentation). The effect of nonsampling error is not represented in these tables..Logical coverage edits applying a rules-based assignment of Medicaid, Medicare and military health coverage were added as of 2009 -- please see https://www.census.gov/library/working-papers/2010/demo/coverage_edits_final.html for more details. Select geographies of 2008 data comparable to the 2009 and later tables are available at https://www.census.gov/data/tables/time-series/acs/1-year-re-run-health-insurance.html. The health insurance coverage category names were modified in 2010. See https://www.census.gov/topics/health/health-insurance/about/glossary.html#par_textimage_18 for a list of the insurance type definitions..Beginning in 2017, selected variable categories were updated, including age-categories, income-to-poverty ratio (IPR) categories, and the age universe for certain employment and education variables. See user note entitled "Health Insurance Table Updates" for further details..The 2016-2020 American Community Survey (ACS) data generally reflect the September 2018 Office of Management and Budget (OMB) delineations of metropolitan and micropolitan statistical areas. In certain instances, the names, codes, and boundaries of the principal cities shown in ACS tables may differ from the OMB delineation lists due to differences in the effective dates of the geographic entities..Estimates of urban and rural populations, housing units, and characteristics reflect boundaries of urban areas defined based on Census 2010 data. As a result, data for urban and rural areas from the ACS do not necessarily reflect the results of ongoing urbanization..Explanation of Symbols:- The estimate could not be computed because there were an insufficient number of sample observations. For a ratio of medians estimate, one or both of the median estimates falls in the lowest interval or highest interval of an open-ended distribution.N The estimate or margin of error cannot be displayed because there were an insufficient number of sample cases in the selected geographic area. (X) The estimate or margin of error is not applicable or not available.median- The median falls in the lowest interval of an open-ended distribution (for example "2,500-")median+ The median falls in the highest interval of an open-ended distribution (for example "250,000+").** The margin of error could not be computed because there were an insufficient number of sample observations.*** The margin of error could not be computed because the median falls in the lowest interval or highest interval of an open-ended distribution.***** A margin of error is not appropriate because the corresponding estimate is controlled to an independent population or housing estimate. Effectively, the corresponding estimate has no sampling error and the margin of error may be treated as zero.

Medicaid and the Children’s Health Insurance Program (CHIP) provide medical coverage to millions of Americans, and one of the main criteria to determine eligibility is income. In states with expanded coverage, the minimum eligibility threshold for adults is 138 percent of the federal poverty level (FPL).

The impact of the Affordable Care Act The Affordable Care Act (ACA) created the opportunity for states to expand Medicaid to cover nearly all low-income adults. Most states chose to extend coverage, meaning adults are eligible if their household income is at or below 138 percent of the FPL. Before the ACA, applicants had to fit into one of several categories in order to be eligible. Each group had its own income rules, and they all differed from state to state. Most low-income adults without children were not eligible.

Medicaid income rules simplified The ACA established a new methodology to determine income eligibility that helped to align rules that previously varied nationwide. In general, an individual’s eligibility is now determined by their Modified Adjusted Gross Income (MAGI) and where it falls in relation to the FPL. In 2021, the FPL for a one-person household was set at 12,880 U.S. dollars, which was the minimum income a person had to earn to qualify for Medicaid. In expansion states, an individual would still be eligible if they earned up to 138 percent of that figure.