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Where each state stands on ACA's Medicaid expansion

A roundup of what each state's leadership has said about their Medicaid plans

Topics: Health Policy, Market Trends, Strategy, Medicaid, Reimbursement, Finance

June 14, 2013


IMPORTANT NOTE FOR READERS
July 26, 2013

We are no longer updating this version of the Medicaid map, which tracked each governor's stance on the Medicaid expansion.

Check out our new Medicaid Map (Beyond the pledges: Where the states stand on Medicaid), which tracks executive and legislative action taken to achieve—or totally rule out—expansion in each state.

The Supreme Court's ruling on the Affordable Care Act (ACA) allowed states to opt out of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.

Based on lawmakers' statements, press releases, and media coverage, the Daily Briefing and American Health Line editorial teams have rounded up where each state currently stands on the expansion.

We will continue to update this map and list as more information becomes available. Send us news, tips, and feedback by commenting below or emailing dailybriefing@advisory.com.

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A state-by-state look at governors' stances

Text last updated on June 14, 2013. States are categorized based on statements from governors or enacted state laws.

 * indicates a state's participation in the multistate lawsuit against ACA

NOT PARTICIPATING (13 states)

  • Alabama*: Gov. Robert Bentley (R) on Nov. 13 announced that Alabama will not participate in the Medicaid expansion because the state "simply cannot afford it" (Gadsden Times, 11/13).
  • Georgia*: Gov. Nathan Deal (R) in an Atlanta Journal-Constitution/Politico/11 Alive interview on Aug. 28 said, "No, I do not have any intentions of expanding Medicaid," adding, "I think that is something our state cannot afford." When asked about the insurance exchanges, Deal said "we do have a time frame for making the decision on that I think, especially on the exchanges," adding that "we have just a few days after the election in order to make a final determination on that" (Wingfield, "Kyle Wingfield," Atlanta Journal-Constitution, 8/28/12).
  • Idaho*: Gov. C.L. Otter (R) in his 2013 State of the State address delivered on Jan. 7 said that while "there is broad agreement that the existing Medicaid program is broken," the state "face[s] no immediate federal deadline" to address the situation. He added, "We have time to do this right … [s]o I'm seeking no expansion of" the program. Otter said he’s instructed the state Health and Welfare director to "flesh out a plan" that focuses on potential costs, savings and economic impact, which he plans to introduce in 2014 (Ritter Saunders, Boise State Public Radio, 1/7/13; Young, Huffington Post, 1/7; Petcash, KTVB, 1/7/13).
  • Louisiana*: Gov. Bobby Jindal (R) in an NBC "Meet the Press" interview on July 1 said, "Every governor's got two critical decisions to make. One is do we set up these exchanges? And, secondly, do we expand Medicaid? And, no, in Louisiana, we're not doing either one of those things" (Barrow, New Orleans Times-Picayune, 7/2/12).
  • Maine*: Gov. Paul LePage (R) on Nov. 16 said that Maine will not participate in the Medicaid expansion. He called the expansion and the state-based insurance exchanges a "degradation of our nation’s premier health care system" (Mistler, Kennebec Journal, 11/16/12).
  • Mississippi*: Gov. Phil Bryant (R) on Nov. 7 said Mississippi will not participate in the Medicaid expansion, reiterating previous statements that he had made about the ACA provision (Pender/Hall, Jackson Clarion-Ledger, 11/7/12).
  • North Carolina: Gov. Pat McCrory (R) on Feb. 12 announced that his state will not expand Medicaid or establish its own health insurance marketplace under the Affordable Care Act. McCrory said state officials conducted a comprehensive analysis to determine the advantages and disadvantages of expanding Medicaid and the right type of exchange option in the state, and concluded that it is "abundantly clear that North Carolina is not ready to expand the Medicaid system and that we should utilize a federal exchange." He said the review included discussions with other governors, White House officials, health care providers, and leaders in the state Legislature (Binker/Burns, "@NCCapitol," WRAL, 2/12/13; Cornatzer, Raleigh News & Observer, 2/12/13).
  • Oklahoma: Gov. Mary Fallin (R) on Nov. 19 said Oklahoma will not participate in the Medicaid expansion. "Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid," she said in a statement. She noted that the program would cost the state as much as $475 million over the next eight years (Greene, Tulsa World, 11/19/12).
  • Pennsylvania*: Gov. Tom Corbett (R) on Feb. 5 sent a letter to HHS saying he "cannot recommend a dramatic Medicaid expansion" in Pennsylvania because "it would be financially unsustainable for Pennsylvania taxpayers." He noted that the expansion would necessitate "a large tax increase on Pennsylvania families" (Tolland, Pittsburgh Post-Gazette, 2/5/13).
  • South Carolina*: Gov. Nikki Haley (R) on July 1 announced via Facebook that South Carolina "will NOT expand Medicaid, or participate in any health exchanges." The state Legislature is expected to make a decision on the Medicaid expansion during the 2013 session (Gov. Haley Facebook page, 7/1/12; Holleman, Columbia State, 11/9/12).
  • South Dakota: Gov. Dennis Daugaard (R) in his annual budget address on Dec. 4 said he does not plan to participate in the Medicaid expansion. "I really think it would be premature to expand this year," he said, adding that he hoped for more flexibility for the state program (Montgomery, Sioux Falls Argus Leader, 12/4/12).
  • Texas*: Gov. Rick Perry (R) in a statement on July 9 said, "If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under ObamaCare." Perry also sent a letter to HHS Secretary Kathleen Sebelius on July 9 asserting this position. The Dallas Morning News reported that on Nov. 8, Perry reiterated his opposition to the expansion, saying, "Nothing changes from our perspective" (Office of Gov. Perry release, 7/9/12; Gov. Perry letter, 7/9/12; Garrett, Dallas Morning News, 11/11/12).
  • Wisconsin*: Gov. Scott Walker (R) on Feb. 13 announced his rejection of the Medicaid expansion. He proposed an alternative plan that would expand coverage to low-income state residents through private health care exchanges (Spicuzza, Wisconsin State Journal, 2/13/13).

LEANING TOWARD NOT PARTICIPATING (6 states)

  • Alaska*: Gov. Sean Parnell (R) on Feb. 28 expressed opposition to the Medicaid expansion. He said he will not ask the state Legislature to consider expansion this session, but he will continue to examine the issue (Bohrer, AP/Alaska Journal of Commerce, 3/1/13).
  • Kansas*: Gov. Sam Brownback (R) has punted the decision on Medicaid expansion to Kansas' Republican-controlled legislature. Lawmakers have not reached consensus on the issue, and a state budget amendment that is expected to pass would prohibit Brownback from expanding the program without the support of the legislature (Celock, Huffington Post, 5/6/13).
  • Nebraska*: Gov. Dave Heineman (R) in a statement on his website on June 28 said, "As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased. If some state senators want to increase taxes or cut education funding, I will oppose them." Heineman on July 11 sent a letter to state lawmakers saying the state could not afford the expansion, but he stopped short of saying that the state will not participate in the expansion, according to Reuters (Office of Gov. Heineman release, 6/28/12; Wisniewski, Reuters, 7/11/12).
  • Utah*: Gov. Gary Herbert (R) has not yet announced a decision on Medicaid expansion. He has asked the state health department to convene a workgroup to examine cost-effective alternatives that would expand coverage for low-income residents (Dobner, Salt Lake Tribune, 4/23/13).
  • Virginia*: Although Gov. Bob McDonnell (R) has not made an official announced on the Medicaid expansion, he has expressed opposition to the ACA provision, according to the Virginian-Pilot. However, the Pilot notes, the future of the state's Medicaid expansion will likely depend on the outcome of the November gubernatorial election: Democrat Terry McAuliffe support expansion, but Republican Ken Cuccinelli opposes it (Walker, Virginian-Pilot, 4/11/13).
  • Wyoming*: Gov. Matt Mead (R) on Nov. 30 recommended that Wyoming not participate in the Medicaid expansion, but added that his position could change in the future and urged "everyone to keep an open mind on this." The state legislature will make the final decision on whether to expand the program, the AP/Jackson Hole Daily reports (Brown, Wyoming Tribune Eagle, 12/1/12; Graham, AP/Jackson Hole Daily, 12/1/12).

LEANING TOWARD PARTICIPATING (1 states)

  • New York: Gov. Andrew Cuomo (D) in a statement on his website on June 28 said he was "pleased the Supreme Court upheld the [ACA]" and looks forward "to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers." On July 26, Danielle Holahan—project director for New York's health insurance exchange planning—said the state "largely meet[s] the federal required Medicaid levels already." Although Cuomo's office has not officially announced a decision, the Associated Press reported on Nov. 13 that New York will expand Medicaid (Office Gov. Cuomo release, 6/28/12; Grant, North Country Public Radio, 7/27/12).  

PARTICIPATING (26 states and the District of Columbia)

  • Arizona*: The Arizona Legislature on June 13 approved a fiscal year 2013-2014 budget blueprint that includes a plan to expand the state's Medicaid program under the Affordable Care Act. Gov. Jan Brewer (R)—who in January announced her support for the expansion, which would extend Medicaid coverage to about 300,000 additional state residents—is expected to the sign the budget measure (Viebeck, "Healthwatch," The Hill, 6/13; Schwartz, Reuters, 6/13/13; Christie/Silva, AP/Yahoo! News, 6/14/13).
  • California: Gov. Jerry Brown (D) in a statement on June 28 said the Supreme Court’s ruling “removes the last roadblock to fulfilling President Obama’s historic plan to bring health care to millions of uninsured citizens.” California got a head start on expanding its Medicaid program in November 2010 with its “Bridge to Reform” program, which aimed to bring at least two million uninsured Californians into Medicaid (Office of Gov. Brown release, 6/28/12; DeBord, “KPCC News,” KPCC, 6/28/12).
  • Colorado*: Gov. John Hickenlooper (D) on Jan. 3 announced that his state will participate in the expansion. In a news release, his office said the move would extend Medicaid coverage to about 160,000 low-income residents and save Colorado an estimated $280 million over 10 years without affecting the state's general fund (Stokols, KDVR, 1/3/13; Wyatt, AP/Denver Post, 1/3/13).
  • Connecticut: Gov. Dannel Malloy (D) was among the first governors to sign up for the Medicaid expansion after the ACA was enacted in March 2010. Soon after the Supreme Court ruling on June 28, Malloy said “it’s great … [and a] very important decision for the people of Connecticut. 500,000 people would have lost coverage if Republicans had their way” (Davis, WTNH, 6/28/12).
  • Delaware: Gov. Jack Markell (D) in a statement on June 28 said, "The Supreme Court's ruling enables Delaware to continue to implement provisions of the Patient Protection and Affordable Care Act to provide access to health care benefits for Delawareans." He added, "On the Medicaid front, Delaware already voluntarily expanded the state's Medicaid coverage program in 1996 to cover many Delawareans not previously covered" (Office of Gov. Markell release, 6/28/12).
  • District of Columbia: D.C. Mayor Vincent Gray (D) in a statement on June 28 said, "The District is not at risk of losing any Medicaid funding as a result of this ruling, because District officials have already begun implementation of the ACA's Medicaid-expansion provisions and will continue to implement the expansion" (Executive Office of the Mayor release, 6/28/12).
  • Florida*: Gov. Rick Scott (R) on Feb. 20 announced that the state will participate in the ACA’s Medicaid expansion, citing HHS’s conditional support for a waiver to shift most of the state’s Medicaid beneficiaries into a managed-care program. However, Scott said that Florida would only participate in the expansion for three years before reevaluating the decision. Supporters of the ACA heralded Florida’s shift as a major reversal; Scott mounted his successful campaign for governor in 2010, in part, by being one of the nation’s foremost critics of President Obama’s planned health reforms (Kennedy/Fineout, Associated Press, 2/20; Office of Gov. Scott release, 2/20/13).
  • Hawaii: Gov. Neil Abercrombie (D) in a statement on June 28 welcomed the Supreme Court's ruling and said the ACA "is our ally" in the effort to "support a health care system that ensures high quality, safety and sustainable costs." Pat McManaman, director of the state Department of Human Services, said Hawaii's Medicaid eligibility requirements in July would fall in line with the law' guidelines, meaning an additional 24,000 people will be eligible for the program by 2014 (Office of Gov. Abercrombie release, 6/28/12).
  • Illinois: Gov. Pat Quinn (D) on June 28 praised the court's decision and said he "will continue to work with President Obama to help working families get the healthcare coverage they need," including expanding Medicaid (Office of the Governor release, 6/28; Thomason, Rock River Times, 7/3/12; Ehley, Fiscal Times, 8/20/12).
  • Kentucky: Gov. Steve Beshear (D) on May 9 announced that Kentucky will participate in the Medicaid expansion. He called the decision "the single-most important decision in our lifetime for improving the health of Kentuckians" (Halladay, Louisville Courier-Journal, 5/9/13).
  • Maryland: Gov. Martin O'Malley (D) in a statement on June 28 said the Supreme Court's decision "gives considerable momentum to our health care reform efforts here in Maryland," adding that the state will move forward to implement the overhaul (Office of the Governor release, 6/28/12).
  • Massachusetts: Gov. Deval Patrick (D) in late June said Massachusetts is "an early expansion state as you know and we're expecting further resources from the federal government to sustain the experiment here in Massachusetts." Patrick called the ruling "good news for us" (Walker, YNN, 6/28/12).
  • Michigan*: Gov. Rick Snyder (R), in a statement released on Feb. 6, announced that his fiscal year 2014 budget proposal includes a plan to expand the state’s Medicaid program under the Affordable Care Act. The plan would extend Medicaid benefits to about 320,000 eligible residents. Snyder said the plan contains safeguards that will ensure the financial stability of the program and protect against changes in the government’s financial commitment to the expansion (Office of Gov. Snyder release, 2/6/13).
  • Minnesota: Gov. Mark Dayton (D) said in a statement on June 28, 2012, said, "Today's ruling will be met with relief by the Minnesotans whose lives have already been improved by this law." On Feb. 19, 2013, Dayton signed a bill authorizing expansion the state (AP/KARE 11, 2/19/13).
  • Missouri: Gov. Jay Nixon (D) on Nov. 29 announced that Missouri will participate in the Medicaid expansion. Nixon said he will include the expansion in the state budget proposal he submits to lawmakers. "We're not going to let politics get in the way of doing the best thing for our state," he said (Crisp, "Political Fix," St. Louis Post-Dispatch, 11/29/12).
  • Montana: Gov. Steve Bullock (D) in January 2013 said he planned to expand Medicaid in Montana. However, the state Legislature defeated all bills that would expand the state health care program in 2013. On the last day of the legislative session, Bullock said, "Let me be clear, we will reform healthcare in Montana. We will do it with or without the Legislature's help" (Johnson, Billings Gazette, 1/5/13; KXLH, 5/2/13).
  • Nevada*: Gov. Brian Sandoval (R) on Dec. 11 announced that the state will participate in the Medicaid expansion. "Though I have never liked the Affordable Care Act because of the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care, the law has been upheld by the Supreme Court," Sandoval said in a statement, adding, "As such, I am forced to accept it as today’s reality and I have decided to expand Nevada’s Medicaid coverage" (Damon, Las Vegas Sun, 12/11/12).
  • New Jersey: Gov. Chris Christie (R) in his Feb. 26 budget address announced that New Jersey will participate in the Medicaid expansion. The ACA provision is expected to extended Medicaid coverage to about 300,000 uninsured New Jersey residents (Cheney, Politico, 2/26/13).  
  • New Hampshire: Gov. Maggie Hassan (D) in her Feb. 14 budget address said that New Hampshire will opt into the ACA's Medicaid expansion because "it's a good deal...[that will] allow us to save money in existing state programs, while increasing state revenues." A state report estimates that the expansion will cost New Hampshire about $85 million through 2020, but will bring in $2.5 billion in federal funds and help reduce the number of uninsured residents from roughly 170,000 to 71,000 (Ramer, AP/Seacoastonline.com, 2/14)
  • New Mexico: Gov. Susana Martinez (R) on Jan. 9 announced that her state will participate in the Medicaid expansion, which potentially could extend health coverage to nearly 170,000 additional low-income uninsured residents. Martinez noted that contingency measures will be established if federal funding for the expansion diminishes, which would mean scaling back the expansion by dropping newly covered beneficiaries from the Medicaid rolls (Schirtzinger, Santa Fe Reporter, 1/9/13; Reichbach, New Mexico Telegram, 1/9/13).
  • North Dakota*: Gov. Jack Dalrymple (R) in January said the politics associated with the ACA should not prevent North Dakota from participating in the Medicaid expansion. In April 2013, he signed a legislation that expanded Medicaid in the state (AP/Prairie Business Magazine, 4/16/13).
  • Ohio*: Gov. John Kasich (R) on Feb. 4 announced that the state will be participating in the Medicaid expansion, the Cleveland Plain Dealer reports. He made the announcement in his two-year budget announcement, but warned that Ohio would "reverse this decision" if the federal government does not provide the funds it has pledged to the expansion (Tribble, Cleveland Plain Dealer, 2/4/13).
  • Oregon: Gov. John Kitzhaber (D) said on June 28 that he is confident that the Oregon Legislature will approve a state Medicaid decision. In an interview with the Oregonian just hours after the Supreme Court issued its ruling on the ACA, Kitzhaber said, "We'll make a decision on whether or not to expand the Medicaid program really based on, I think, the resources we have available in the general fund for that purpose going forward" (Budnick, Oregonian, 6/28/12).
  • Rhode Island: Gov. Lincoln Chaffee (I) in a statement on his website on June 28 said, "I have fully committed to ensuring Rhode Island is a national leader in implementing health reform whatever the Supreme Court decision, and this just reinforces that commitment." According to Steven Costantino, the state's secretary of health and human services, "The expansion is easy to do and makes sense." Moreover, on July 12, USA Today reported that Chaffee planned to participate in the expansion (Chaffee statement, 6/28/12; Wolf, USA Today, 7/12/12; Radnofsky et al., Wall Street Journal, 7/2/12).
  • Vermont: Gov. Peter Shumlin (D) on June 28 said Vermont's Medicaid program already meets the requirements under the health reform law's Medicaid expansion (Steimle, WCAX, 7/1/12).
  • Washington*: In an email responding to a query by American Health Line, Karina Shagren—a deputy communications director in Gov. Chris Gregoire's (D) administration—in early July said "the governor supports the Medicaid expansion—and Washington will move forward." U.S. Rep. Jay Inslee (D)—who supports the expansion—was elected governor on Nov. 6 (Shagren email, 7/5/12; Washington Secretary of State website, 11/12/12).
  • West Virginia: Gov. Earl Ray Tomblin (D) on May 2 announced that West Virginia will participate in the Medicaid expansion. "At the end of the day, we have weighed the options and believe expanding Medicaid is the best choice for West Virginia," he said (Boucher, Charleston Daily Mail, 5/2/13).

Participating through an alternative expansion model (4 states)

  • Arkansas: Gov. Mike Beebe (D) in February announced that HHS had approved a plan to expand coverage to expansion-eligible residents through the health information exchanges. As with the Medicaid expansion, the federal government has agreed to cover 100% of the premiums for the first three years and 90% of the premiums after 2020 (Ramsey, "Arkansas Blog," Arkansas Times, 2/26/13).
  • Indiana*: Gov. Mike Pence (R) has proposed a plan to expand coverage to expansion-eligible residents through Indiana's Healthy Indian Plan (Sikich, Indianapolis Star, 4/1/13).  
  • Iowa*: Gov. Terry Branstad (R) on May 22 said he will support a compromise deal that would extend health insurance coverage to 150,000 low-income state residents through a new state plan or through the state's insurance exchange. The Senate approved the compromise deal on May 22, and the House approved it on May 23 (Lucey, AP/Modern Healthcare, 5/23/13; Petroski, Des Moines Register, 5/24/13).
  • Tennessee: Gov. Bill Haslam (R) on March 27 announced in an address to a joint session of the General Assembly that the state will not participate in the Medicaid expansion. Instead, he said he favors an alternative option, under which the state would use federal funds to shift Medicaid-eligible residents into private health plans (Humphrey, Knoxville News Sentinel, 3/27/2013; Goodnough, New York Times, 3/27/13).

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