Background: Health equity is one main goal of the Affordable Care Act. In early stages of pancreatic ductal adenocarcinoma (PDAC), multimodal treatment (MT)—surgical resection and chemotherapy—is the only potentially curative option that improves overall survival (OS). The goal of this study is to use the Kentucky Cancer Registry (KCR) to identify the impact of Medicaid expansion on the treatment and outcomes on PDAC. Methods: We identified patients between the age of 20 and 65 years old who were diagnosed with stage I and II PDAC between 2010 to 2021 using the KCR. Years 2010-2013 were considered pre-expansion and 2014-2021 post-expansion. Descriptive statistics and multivariable logistic regression is utilized to evaluate factors associated with receipt of MT. Results: We identified a total of 659 patients with PDAC: 242 in the pre-expansion and 417 post expansion groups. Medicaid expansion in Kentucky has led to a significant increase in receipt of MT among patient with stage II PADC and Medicaid coverage 10.7% vs 22.3%. The post-expansion number of uninsured PDAC patients decreased from 10.3% to 3.1%. Post expansion PDAC patients had higher odds of MT receipt, but this was not significant (OR, 1.374; 95% CI 0.97-1.94). No change in OS was noted between the two periods (HR 0.939, 95% CI 0.78-1.122). Conclusions: Medicaid expansion was associated with increased insurance coverage for patients with early-stage pancreatic cancer and higher odds of receipt of MT, though this was not statistically significant. Additional research is needed to identify the breadth of the impact of Medicaid expansion and additional drivers of PDAC disparities.