California leads the nation in enrollment in Medicaid, the national health program for low-income people, and has seen a 34 percent increase in enrollment since the Affordable Care Act took effect, according to a new report.

As the most populous state, it’s no surprise that California has the largest number of Medicaid enrollees — it did before the federal health law was enacted too.

California is one of 29 states that have opted to expand Medicaid to cover low-income adults. Called Medi-Cal in California, the program now has about 12.2 million adults and children enrolled each month, according to the Kaiser Family Foundation report.

Before the Affordable Care Act took effect, the state enrolled an average of 9.2 million people.

Although California has the highest number of Medicaid enrollees, it has not seen the most growth of any state health program in the nation. Kentucky, with an enrollment increase of 88 percent, and Oregon, with an increase of 73 percent, lead the nation there.

California has nearly twice as many Medicaid enrollees as the next highest state, New York, where 6.4 million are signed up for the program.

Meanwhile, the states with the lowest enrollment are Wyoming, North Dakota and South Dakota. North Dakota has decided to expand Medicaid to adults, but the other two states have not.