“The next-largest source of coverage among people under age 65 is Medicaid. In CBO and JCT’s estimates, a monthly average of 62 million noninstitutionalized people receive full Medicaid benefits in 2019.4 That number is unchanged from the number in 2018.

“By 2029, the number of people under age 65 receiving full Medicaid benefits is projected to grow to a monthly average of 64 million people, comprising:
“• 7 million people with disabilities,
“• 30 million children,
“• 14 million adults made eligible for Medicaid through the ACA’s expansion of Medicaid coverage at states’ option, and
“• 13 million adults otherwise eligible for Medicaid.

“CBO and JCT’s estimates of Medicaid enrollment over the next decade reflect the agencies’ expectation that, if current federal laws remained in place, additional states would expand eligibility for the program. Under the ACA, states are permitted to expand eligibility for Medicaid to adults under age 65 whose income is no more than 138 percent of the FPL. The federal government pays a larger share of the costs for those people than it pays for those who are eligible otherwise.

“In the agencies’ projections, most of the increase in enrollment during the 2019–2029 period stems from additional states’ expanding eligibility for the program, rather than from additional enrollment in states that have already expanded eligibility. Currently, about 65 percent of people who meet the eligibility criteria established under the ACA live in states that expanded Medicaid. CBO and JCT anticipate that, under current law, the share would increase annually at a rate based on the historical pace of expansion since 2014. By 2029, about three-quarters of the people who would meet the new eligibility criteria are projected to be in states with expanded Medicaid coverage.

“CBO and JCT project enrollment in CHIP to be relatively unchanged in the 2019–2029 period, with 7 million people, mostly children but also some pregnant women, enrolled in the program in each year. Together, Medicaid and CHIP are projected to provide insurance coverage for one-quarter of the population under age 65 in 2029.”

Source: Congressional Budget Office, “Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029” (May 2019), https://www.cbo.gov/publication/55085.