Under the Affordable Care Act, what option did states have regarding Medicaid expansion?

• A. Eliminate Medicaid in all states.
• B. Expand Medicaid eligibility to 133% of the federal poverty level.
• C. Require private insurance for all residents regardless of income.
• D. Cease all health insurance exchanges.

Answer: (B)

The policy idea being tested is that the Affordable Care Act gave states the option to expand Medicaid to cover more low‑income adults by raising eligibility to 133% of the federal poverty level. This expansion was voluntary for states after the Supreme Court ruling, with the federal government covering the vast majority of the costs—initially 100% of the expansion and eventually about 90%. That combination—an expanded eligibility threshold and strong federal funding—made expansion a feasible choice for many states. The other options don’t reflect what the ACA implemented: it didn’t eliminate Medicaid, it didn’t require private insurance for everyone regardless of income, and it didn’t halt the health insurance exchanges.