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The passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 gave states the option to cover able-bodied adults with income up to 133% of the federal poverty level (new adult group). The subsequent ruling by the Supreme Court that the federal government could not compel states to cover the new adult group resulted in further fragmentation of state Medicaid systems. There are now significant differences in the populations that state Medicaid programs cover and how they cover these individuals. Many states have adopted what are called non-traditional Medicaid expansions, which require the new adult group . . .

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