The Medicaid coverage gap exists in 11 states where state leaders have refused to expand Medicaid under the Affordable Care Act. Many adults with income below the poverty level are not eligible for Medicaid in these states. And they're also not eligible for premium subsidies in the marketplace, because the ACA called for them to have Medicaid instead. More than 2 million people are ineligible for financial assistance with their health coverage due to the coverage gap in those 11 states. (While Wisconsin has not expanded Medicaid, there is no coverage gap in that state due to other factors.)