By the end of April 2014, 65 million people were enrolled in the Medicaid program. According to the Obama Adminstration in a Wednesday announcement, this number was up by six million compared with the number immediately before the Affordable Care Act (ACA) went into effect. A key aim of the ACA was to increase the number of those on Medicaid. However, debate surrounds whether the new number claimed by the Administration is reflective of fulfillment of the aim of the ACA or of other factors that dictate Medicaid enrollment.

Medicaid is a federally-mandated health insurance program for low-income individuals and families who cannot afford the costs of health care. The programs vary by state, and different states report their Medicaid data differently and at different times. This is one of the reasons that quantitative assessment of Medicaid is tricky. Other reasons include that eligibility for Medicaid fluctuates with income, pregnancy, and age of children. These variables fluctuate and change abruptly.

The implementation of Obamacare further complicates Medicaid tracking. The ACA created several new provisions that vary by state. Twenty-five states receive additional funding under the ACA to cover all adults earning up to one third of the federal poverty level income. The Urban Institute, a left-leaning non-profit research organization, estimated that 4.4 million people in these states became eligible for Medicaid as a direct result of the implementation of the ACA. The actual number will become available later this year after states bill the federal government for the additional enrollees.

The ACA requires most Americans to carry health care coverage or face a penalty. This year, many states saw an increase in Medicaid enrollment around the time the ACA went into effect, including among those that were eligible prior to the ACA implementation but that did not enroll.

The Center for Medicare and Medicaid Services stressed in their report that they are not claiming that all 6 million of the new enrollees added since the ACA went into effect are linked directly to the ACA. Rather, the report underscores that this number includes changes attributable to the ACA. As evidence, cited were that the states not receiving ACA funds saw only a 3.3 percent increase in Medicaid enrollment compared with the funded states’ 15.3 percent increase.