The Medicaid coverage gap affects nearly 1.4 million low-income adults in nine states that have not expanded Medicaid under the ACA. These individuals earn below the poverty level, making them ineligible for both Medicaid and ACA premium subsidies. The gap exists because the ACA assumed Medicaid expansion would cover those below 138% of the poverty level, but the Supreme Court allowed states to opt out. Most affected states are in the South, with limited options for affordable coverage.
