The Affordable Care Act (ACA) extended Medicaid coverage to almost all people with incomes up to 138 percent of the federal poverty line ($17,609 for an individual in 2020). The law's architects expected that most states would expand their own Medicaid programs as well. However, only 18 states and the District of Columbia have done so as of 2014. Under the law, any adult without access to affordable health insurance through their employer or a private insurer can apply for Medicaid coverage. Eligible adults must meet certain financial requirements to be approved for Medicaid. Those who are approved will receive coverage starting at age 65 or younger if applying before then, or when they become eligible regardless of age. People usually think of Medicaid as providing coverage to poor individuals or families. However, under the ACA, all states were required to offer Medicaid coverage to anyone earning less than about $16,100 per year ($24,600 for a family of three). Above this level, many states chose to provide additional incentives such as reduced premiums or out-of-pocket costs for covering children or other groups not covered by Medicaid. In addition to these mandatory participants, 26 states plus D.C. also established health care exchanges where residents could purchase insurance policies. These policies could include Medicaid as one of their options.