Home  >  Affordable Care Act  >  Provisions

Eligibility

The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states. Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges.

See current information on eligibility.

Medicaid and CHIP Eligibility and Enrollment: Creating a streamlined system of affordable coverage for Medicaid, CHIP, and the Affordable Insurance Exchanges (Effective 2014). On March 16, 2012, CMS released its eligibility and enrollment final rule to assist States in implementing the Affordable Care Act Medicaid coverage expansion. 

Early Option to Provide Medicaid to Adults Prior to 2014: Providing federal funding to states that expand Medicaid eligibility, between April 1, 2010 and January 1, 2014, to individuals with incomes below 133 percent of the FPL.

Maintenance of Effort: Maintaining existing coverage for adults until the implementation of coverage changes effective in January 2014 and for children through September 2019.

Former Foster Care Children: Establishing eligibility for children who have aged-out of the foster care system and had previously received Medicaid while in foster care, until they turn 26. Foster care children will remain eligible for the full scope of Medicaid benefits (Effective January 1, 2014).

Family Planning: Establishing a new Medicaid eligibility group and the option for states to begin providing medical assistance for family planning services and supplies.

Presumptive Eligibility in Hospitals: Permitting hospitals to make presumptive eligibility determinations for all Medicaid eligible populations.