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The Supreme Court's 2012 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.
In 2017, the fate of Medicaid expansion remains uncertain amid the debate over whether to repeal and replace the Affordable Care Act. The Trump administration also may be more likely than the Obama administration to approve requests by conservative states to change eligibility criteria, such as requiring enrollees to be employed.
The Daily Briefing and American Health Line editorial teams have been tracking where each state stands on Medicaid expansion, combing through lawmakers' statements, press releases, and media coverage. In this latest iteration of our Medicaid map, we've determined each state's position based on legislative or executive actions to expand coverage to low-income residents using ACA funding.
We will continue to update this map as more information becomes available. Send us news, tips, and feedback by commenting below or emailing firstname.lastname@example.org.
A state-by-state look at expansion
EXPANDING COVERAGE (31 STATES AND THE DISTRICT OF COLUMBIA)
- Alaska: Gov. Bill Walker (I) on July 16, 2015, announced he would use his executive power to expand Medicaid to about 40,000 additional residents. The governor sent a letter to Alaska's Legislative Budget and Audit Committee, giving it the required 45-day notice that he planned to accept federal funding to expand the program. The state's Medicaid expansion went into effect on Sept. 1, 2015.
- Arizona: On June 17, 2013, Gov. Jan Brewer (R) signed into law legislation that will expand Medicaid to an additional 350,000 people in the state. The signing came after Brewer called a surprise special session on the 2014 budget and Medicaid to try to resolve a deadlock among lawmakers on the two issues.
- Arkansas: Gov. Mike Beebe (D) on April 23, 2013, signed the state's expansion plan into law. Under the plan, Arkansas would accept the federal money for Medicaid expansion provided through the ACA but would use it to buy private insurance for about 250,000 eligible low-income residents. The federal government approved the plan in September 2013. In January 2015, newly-elected Gov. Asa Hutchinson (R) said Arkansas will keep its "private option" Medicaid expansion through the end of 2016—and then reconsider it.
- California: Gov. Jerry Brown (D) on June 27, 2013, signed legislation that would expand the state's Medicaid program, Medi-Cal, to more than 1.4 million additional residents under the ACA.
- Colorado: Gov. John Hickenlooper (D) signed the expansion into law on May 13, 2013. He says that the expansion will save the state $280 million over 10 years and help cover an additional 160,000 adults.
- Connecticut: Gov. Dannel Malloy (D) was among the first governors to sign up for the Medicaid expansion after the ACA was enacted. The state was one of five states that opted to expand eligibility early.
- Delaware: Gov. Jack Markell (D) in January 2013 reiterated his support for the Medicaid expansion, including an additional $35.8 million for Medicaid in his FY 2014 spending plan. On July 1, 2013, Markell signed a FY 2014 budget plan that includes $29.8 million to "fund the State's Medicaid commitment."
- District of Columbia: D.C. Mayor Vincent Gray (D) in a statement on June 28, 2012, said, "The District is not at risk of losing any Medicaid funding as a result of [the Supreme Court] ruling, because District officials have already begun implementation of the ACA's Medicaid-expansion provisions and will continue to implement the expansion." D.C. sought permission from the federal government to expand its Medicaid program on May 13, 2010. The move expanded Medicaid to an additional 35,000 residents.
- Hawaii: Gov. Neil Abercrombie (D) has said his state will participate in the expansion. In a statement on June 28, 2012, Abercrombie said, "The Affordable Care Act is our ally in this effort" to "to support a healthcare system that ensures high quality, safety and sustainable costs." According to the Department of Human Services, the state is expanding Medicaid eligibility through the ACA.
- Illinois: Gov. Pat Quinn (D) signed Medicaid expansion into law on July 22, 2013. Approximately 342,000 low-income Illinois residents will be newly insured under the expansion.
- Indiana: The federal government on Jan. 27, 2015, approved Indiana's alternate Medicaid expansion plan, known as Healthy Indiana Plan 2.0. In a major concession, federal authorities will allow Indiana to lock residents out of the program for six months if they fail to pay premiums.
- Iowa: On Dec. 12, 2013, Gov. Terry Branstad (R) announced that his administration and the White House had agreed on the final details of his plan to expand Medicaid. Two days earlier, CMS approved Iowa's alternate expansion proposal, which would allow the state to use federal funding under the ACA to help more than 100,000 low-income residents purchase private health coverage through the new Iowa Health and Wellness Plan. Branstad also proposed a small additional premium for certain beneficiaries. Under the agreement, Iowa will levy the additional premium on individuals with incomes exceeding 50% of the federal poverty level beginning in 2015. The state promised that it will not drop individuals' coverage if they fail to make payments.
- Kentucky: On May 9, 2013, then-Gov. Steve Beshear (D) said that expanding Medicaid is the right choice for Kentucky, noting that it would halve the number of uninsured in the state. Beshear expanded Medicaid in Kentucky via executive order. On Sept. 3, 2013, a federal judge ruled that the governor had the authority to expand Medicaid. In November 2015, state voters elected Matt Bevin (R) to be Kentucky's next governor. Gov. Bevin in August 2016 submitted to HHS a proposal to alter the state's Medicaid expansion, including by implementing new cost-sharing requirements and eliminating coverage for dental and vision services.
- Louisiana: On Feb. 6, 2013, then-Gov. Bobby Jindal (R) reiterated his opposition to expanding Medicaid in Louisiana. But in June 2015, the Louisiana state Legislature passed a veto-proof bill to create a funding plan for Medicaid expansion, in part by allowing the Louisiana Hospital Association's members to pay for a portion of the state's costs. In November 2015, Louisiana voters elected state Rep. John Bel Edwards (D) to be the state's next governor. On his second day in office—Jan. 12, 2016—Edwards signed an executive order to expand Medicaid in the state. In February 2017, the Louisiana Department of Health announced that more than 400,000 individuals had enrolled in coverage under the state's Medicaid expansion.
- Maryland: On May 5, 2013, Gov. Martin O'Malley (D) signed into law HB 228 to fully implement the Affordable Care Act.
- Massachusetts: On July 5, 2013, Gov. Deval Patrick (D) signed into law HB 3452, requiring Massachusetts to come into compliance with new federal regulations under the ACA. On July 12, 2013, Patrick signed into law the state's FY 2014 budget, which supports full implementation of the Affordable Care Act, including the Medicaid expansion.
- Michigan: On Sept. 3, 2013, the Michigan House voted 75-32 to grant final approval to a bill that would expand the state's Medicaid program beginning in April 2014. Gov. Rick Snyder (R) signed the bill into law on Sept. 16, 2013. The proposal contains cost-sharing provisions for Medicaid beneficiaries; it received federal approval in December.
- Minnesota: Gov. Mark Dayton (D) in February 2013 signed legislation that expanded Medicaid to an additional 35,000 childless, low-income adults in the state.
- Montana: Gov. Steve Bullock (D) on April 29, 2015, signed legislation that would expand eligibility for Medicaid to about 70,000 state residents. Montana on July 7, 2015, released its alternative Medicaid expansion plan for a 60-day public comment period prior to formally submitting a waiver to CMS for approval. On November 2, 2015, CMS approved Montana's alternative Medicaid expansion plan, which will require some beneficiaries in the expansion population to pay premiums equivalent to 2% of their income, as well as pay copayments. Coverage begins on Jan. 1, 2016.
- Nevada: Gov. Brian Sandoval (R) in December 2012 became the first GOP governor to commit his state to expanding Medicaid under the ACA. According to Sandoval's announcement, nearly 78,000 Nevadans would be covered by the expansion.
- New Hampshire: On March 27, 2014, Gov. Maggie Hassan (D) signed bipartisan legislation (SB 413) to expand Medicaid coverage to an estimated 50,000 low-income state residents. In April 2014, the state moved eligible residents into Medicaid programs. Under a waiver approved by CMS on March 4, 2015, New Hampshire will enroll those residents in private coverage through the ACA insurance exchange in 2016.
- New Jersey: Gov. Chris Christie (R) on June 28, 2013, signed a state budget that includes $227 million for Medicaid expansion in the state. However, he vetoed legislation that would have made the expansion permanent in the state.
- New Mexico: Gov. Susana Martinez (R) on Jan. 9, 2013, announced that the state would participate in the Medicaid expansion.
- New York: On June 28, 2012, in an announcement immediately following the Supreme Court's ruling on the ACA, Gov. Andrew Cuomo (D) said the state would participate in the expansion.
- North Dakota: Gov. Jack Dalrymple (R) in April 2013 signed legislation expanding Medicaid in the state.
- Ohio: The state's Controlling Board—a special bipartisan legislative panel—approved Medicaid expansion in 5-2 vote on Oct. 21, 2013, allowing Gov. John Kasich (R) to expand the program on Jan. 1, 2014, without approval from Ohio's Republican-controlled Legislature. Ohio in early 2016 sought to require adult Medicaid beneficiaries who do not have disabilities to pay into health savings accounts, but CMS rejected that proposal in September 2016.
- Oregon: The state moved forward on Medicaid expansion with the support of Gov. John Kitzhaber (D). State residents with annual incomes of up to 138% FPL began to qualify for Medicaid starting on Jan. 1, 2014.
- Pennsylvania: HHS on Aug. 28, 2014, reached a deal with Gov. Tom Corbett (R) to expand Medicaid coverage to as many as 600,000 Pennsylvania residents. The state obtained a waiver for an alternate expansion model, which included premiums for certain beneficiaries. The expansion began on Jan. 1, 2015. However, Corbett was defeated by current Gov. Tom Wolf (D) in the 2014 elections. Wolf in February 2015 announced plans to replace the alternate expansion plan with a traditional Medicaid expansion. The state completed the transition to traditional Medicaid expansion in September 2015.
- Rhode Island: On July 3, 2013, about one week before the state General Assembly adjourned for the year, Gov. Lincoln Chafee (I) signed a fiscal year 2014 budget measure that included a plan to expand Medicaid, which he endorsed in June 2012 and outlined in his 2014 budget proposal.
- Vermont: Health Care Access Commissioner Mark Larson in July 2012 said that Vermont would receive federal funds to expand its Medicaid program to a projected 47,000 additional state residents through the ACA.
- Washington: Gov. Jay Inslee (D) on June 30, 2013, signed a state budget that would expand Medicaid in the state.
- West Virginia: Gov. Earl Ray Tomblin (D) in May 2013 announced that the state would expand Medicaid, extending coverage to an additional 91,500 state residents.
CONSIDERING EXPANSION (2 STATES)
- Kansas: Gov. Sam Brownback (R) in 2013 declined to expand Medicaid. In February 2017, the Kansas House voted 81-44 to extend Medicaid coverage to adults under age 65 who are not pregnant and have annual incomes up to 133 percent of the federal poverty level. The expansion would take effect Jan. 1, 2018. On March 28, 2017, the Kansas Senate voted 25-14 to approve the Medicaid expansion bill. Brownback on March 30, 2017, vetoed the Medicaid expansion bill. Lawmakers may now attempt to override the governor's veto, although the measure did not originally pass with veto-proof majorities in the state House or Senate.
- North Carolina: In 2013, the state's General Assembly passed a bill banning Medicaid expansion, but then-Gov. Pat McCrory (R) in October 2014 said that he would consider expanding Medicaid to an estimated 500,000 state residents. The state ultimately did not expand the program under McCrory. However, Gov. Roy Cooper (D) took office in Jan. 2017 and shortly thereafter announced plans to expand Medicaid through executive action. Cooper has said the 2013 law banning Medicaid expansion violates the governor's "core executive authority" to accept federal funding and protect the public's health. However, a federal judge has put a temporary stay on Cooper's Medicaid expansion request.
NOT EXPANDING AT THIS TIME (17 STATES)
- Alabama: Gov. Robert Bentley (R) in November 2015 said his administration is "looking at" expansion but has not yet "made a final decision" on whether to expand Medicaid or "exactly how that would work." Bentley said he is interested in expansion because he is "concerned about the plight of the working poor," but noted that state funding for expansion could be a hurdle. The state has yet to move forward on expansion.
- Florida: The Florida Senate in 2015 approved a Medicaid expansion plan, but it was rejected by Gov. Rick Scott (R) and the state House. The state government almost shut down over a budget impasse linked to the issue, but state lawmakers in June 2015 reached an agreement on a final budget deal without an expansion. State lawmakers expect to debate Medicaid expansion again in 2016.
- Georgia: Gov. Nathan Deal (R) on Jan. 16, 2013, confirmed he does not support Medicaid expansion. On March 28, 2013, both the House and Senate adjourned for the 2013 session. A bill to encourage Deal to consider expanding Medicaid died in the House in February 2013. Deal in May 2013 signed legislation creating the Joint Study Committee on Medicaid Reform, but it was "for the purposes of determining an appropriate plan for Medicaid reform," not specifically expanding the program under the ACA.
- Idaho: Gov. Butch Otter (R) on Jan. 7, 2013, in his state-of-the-state address said Idaho would not expand Medicaid. The state House and Senate both adjourned on April 4, 2013.
- Maine: On June 17, 2013, Gov. Paul LePage (R) vetoed a bill (LD 1066) that would have expanded the state's Medicaid program. LePage objected to the cost of expansion and also noted that previous hikes to Medicaid eligibility—which he termed "a massive increase in welfare expansion"—have not worked to reduce the number of uninsured in the state. Two days later, on June 19, 2013, House lawmakers failed to gain the two-thirds majority necessary to override the veto.
- Mississippi: Republicans in the Legislature in June 2013 blocked plans to expand Medicaid to an additional 300,000 state residents under the ACA.
- Missouri: In February 2014, the state Senate defeated an effort to expand Medicaid in Missouri. However, at least one Republican lawmaker in the state says that the issue isn't over; State Senator Ryan Silvey says he has the support for an expansion proposal. Gov. Jay Nixon (D) favors expanding Medicaid.
- Nebraska: In May 2013, Republicans in the Legislature filibustered the Medicaid expansion, which was also opposed by then-Gov. Dave Heineman (R). The expansion could have extended Medicaid coverage to up to 80,000 residents. Another—more conservative—expansion act (LB 887) was introduced January 14, 2014, received a majority vote, but failed to meet the 33 votes needed to jump the filibuster and was indefinitely postponed on April 17, 2014.
- Oklahoma: Gov. Mary Fallin (R) rejected the Medicaid expansion in November 2012 and has not proposed an alternate model for expanding insurance coverage for low-income state residents.
- South Carolina: On March 12, 2013, the state House Republican majority rejected an expansion of Medicaid, opting instead to allocate $80 million in state and federal funding in South Carolina's budget for a hospital incentive payment program. Gov. Nikki Haley (R) announced in July 2012 that she opposes expansion.
- South Dakota: Gov. Dennis Daugaard (R) in Oct. 2013 said he was leaning against expanding Medicaid. Daugaard later proposed expanding the program during a budget address in December 2015. However, Daugaard in November 2016 announced he would no longer seek Medicaid expansion in his state amid then-President-elect Donald Trump's plans to repeal and replace the Affordable Care Act.
- Tennessee: Gov. Bill Haslam (R) on Dec. 15, 2014, announced an alternative plan to expand the state's Medicaid program under the Affordable Care Act. The plan would use federal funds to extend coverage to an additional 200,000 low-income state residents by helping them to purchase health plans offered by their employers or by placing them in the state's Medicaid program. State residents with annual incomes up to $16,100, or 138% of the federal poverty level, would be eligible for the program. The plan must be approved by the state's Republican-led Legislature and HHS to take effect, but Haslam said he already has received "verbal approval" from the administration. However, a key Senate committee in February 2015 voted against the proposal.
- Texas: Gov. Rick Perry (R) and the Republican majority in the state Legislature have unanimously rejected the Medicaid expansion, although Democrats have introduced legislation (HB 3791) that would establish a strategy to expand Medicaid. The bill is pending in the House.
- Utah: Gov. Gary Herbert (R) in December 2014 outlined his plan to expand Medicaid in his state, but the proposal was rejected by a Utah House committee in 2015. On July 17, 2015, Gov. Gary Herbert (R) and state Republican lawmakers announced an agreement on a broad framework for expanding Medicaid through the ACA. The state will ask hospitals, physicians, and drugmakers to fund the expansion after the federal government stops covering 100% of expansion costs. Under the proposal, the state would provide subsidized private coverage for as many as 126,500 newly eligible residents. Before the plan could be implemented, it would need to pass in the Legislature and be approved by HHS. However, state lawmakers in October 2015 firmly rejected a compromise plan, leaving the state without a "clear path forward" for expansion, Peter Sullivan reports for The Hill.
- Virginia: Gov. Terry McAuliffe (D) has pushed for Medicaid expansion in Virginia, but the Virginia Legislature in June 2014 passed a budget that did not include expansion. In December 2014, McAuliffe presented a budget proposal that included an expansion provision, but lawmakers are not expected to accept the provision.
- Wisconsin: Gov. Scott Walker (R) on Feb. 13, 2013, said Wisconsin will not participate in the ACA Medicaid expansion, but will pursue its own strategy to expand health coverage across the state. In addition, the legislature's Joint Finance Committee in June 2013 voted against the expansion.
- Wyoming: The state's Wyoming's Department of Health in November 2014 proposed an alternative Medicaid expansion plan that would extend the program to about 18,000 state residents with incomes up to 138% of the federal poverty level.The expansion plan, which has the support of Gov. Matt Mead (R), calls for a federal waiver to allow the state to charge monthly premiums and copayments to low-income individuals who choose to participate. However, the state Senate and House in February 2015 voted against the expansion plan, tabling the proposal for the rest of the legislative session.
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