Since the ACA's biggest coverage expansions went into effect in 2014, Medicaid has contributed to a reduction in the number of uninsured people from 45 million to 29 million. Most of the tens of millions of Medicaid members would be uninsured if Medicaid did not exist. The ACA required that states submit plans for approval that included any changes made since 2012. Many conservative states rejected these plans because they wanted to get out of providing Medicaid coverage. As a result, about 14 million people were prevented from becoming covered under Medicaid or the Children's Health Insurance Program (CHIP). But many other states accepted the federal funds available under the ACA to expand their Medicaid programs, so now nearly all adults with income below 138% of the poverty line ($16,753 for an individual and $34,071 for a family of four in 2016) are covered. The share of Americans without health insurance has dropped from 13% in 2013 to 4.5% in 2016. Children of low-income families could also become eligible for Medicaid or CHIP if their states chose to do so. About 7 million children already receive coverage through these programs, which allow families who meet certain requirements to be enrolled in state-sponsored health plans.