The second major feature of the ACA was the provision that the Medicaid program would be expanded to cover individuals aged 19 through 64 with incomes below 138 percent of the FPL. A brief bit of context is necessary to understand the Medicaid expansion. Medicaid is a federal–state joint pro- gram that provides health insurance to multiple categories of individuals. As a result, in each state it is a set of programs covering somewhat different groups of people. The federal government sets broad provisions with respect to services covered and who is eligible for coverage. However, the states decide how generous the service provisions actually are and what level of income makes one eligible, all under review and approval from the federal govern- ment. The federal government pays 50 percent or more of the cost of the program. In a wealthy state such as Connecticut, the feds pay a low percent- age; in a poor state such as Mississippi, the federal government may pay three dollars or more for every one dollar provided by the state. The categories of covered individuals include pregnant women, children younger than 19, the disabled, and low-income individuals in nursing homes. Nondisabled folks aged 19 to 65 are covered at very low levels of income eligibility, occasionally as high as 45 percent of the FPL and sometimes as low as 17 percent.
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