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State Medicaid Expansion Approaches

Current Status of State Medicaid Expansion Decisions

States Did the state expand Medicaid?* How did the state expand Medicaid? In non-expansion states:
Has there been legislative or administrative activity to pursue expansion in 2017?* How many uninsured adults could gain Medicaid if the state expanded?*
United States 32 Yes, 19 No 7 states have approved waivers in place; 3 states have waiver/waiver amendment applications pending; 2 states are preparing waivers/waiver amendments for submission*; 25 states expanded through SPAs 4 States with Activity in 2017 4,031,000
Alabama No 187,000
Alaska Yes (9/1/2015) SPA
Arizona Yes Approved waiver in place; Preparing waiver amendment for submission
Arkansas Yes Approved waiver in place; Waiver amendment application pending at CMS
California Yes SPA
Colorado Yes SPA
Connecticut Yes SPA
Delaware Yes SPA
Florida No 746,000
Georgia No                                      431,000
Hawaii Yes SPA
Idaho No 50,000
Illinois Yes SPA
Indiana Yes (2/1/2015) Approved waiver in place; Waiver extension/amendment application pending at CMS
Iowa Yes Approved waiver in place
Kansas No Expansion legislation passed by the House and Senate was vetoed by Governor Brownback on 3/30/17. House vote to override the veto failed by three votes. 86,000
Kentucky Yes SPA; Waiver application pending at CMS
Louisiana Yes (7/1/2016) SPA
Maine No Expansion question will be put to voters on the ballot in November 2017. N/A
Maryland Yes SPA
Massachusetts Yes SPA
Michigan Yes (4/1/2014) Approved waiver in place
Minnesota Yes SPA
Mississippi No 151,000
Missouri No 139,000
Montana Yes (1/1/2016) Approved waiver in place
Nebraska No 36,000
Nevada Yes SPA
New Hampshire Yes (8/15/2014) Approved waiver in place
New Jersey Yes SPA
New Mexico Yes SPA; Preparing waiver for submission
New York Yes SPA
North Carolina No Governor Cooper announced plans to expand Medicaid through executive action shortly after taking office in January 2017. Litigation is pending between legislators and the Governor over whether the Governor has the authority to expand without the General Assembly’s approval. 341,000
North Dakota Yes SPA
Ohio Yes SPA
Oklahoma No 127,000
Oregon Yes SPA
Pennsylvania Yes (1/1/2015) SPA
Rhode Island Yes SPA 201,000
South Carolina No
South Dakota No 24,000
Tennessee No 174,000
Texas No                                    1,023,000
Utah No 55,000
Vermont Yes SPA
Virginia No Governor McAuliffe requested a budget amendment on 3/27/17 that would give him the authority to expand. Republican-led General Assembly rejected the amendment on 4/5/17. 201,000
Washington Yes SPA
West Virginia Yes SPA
Wisconsin No N/A
Wyoming No 14,000
NOTES:  *Coverage under the Medicaid expansion became effective January 1, 2014 in all states that have adopted expansion unless otherwise noted. States counted as having legislative or administrative activity on expansion in 2017 include those in which the governor is directly pursuing Medicaid expansion, a bill to expand Medicaid has been approved in at least one house of the legislature, or the decision to expand will be up to voters in a state referendum. States counted as preparing waivers/waiver amendments for submission include states in the range of the waiver development process between beginning work on drafting a waiver and officially submitting the waiver to CMS. Number of uninsured adults who could gain Medicaid coverage if non-expansion states expand includes both individuals currently in the coverage gap (<100% FPL) and those who currently may be eligible for Marketplace coverage (100-138% FPL); US total is for all non-expansion states (including those marked as N/A in the table); state values may not sum to national total due to rounding. SPA: State Plan Amendment. N/A: Sample size too small for reliable estimate.

SOURCES: Kaiser Family Foundation tracking of state Medicaid expansion activity; MaryBeth Musumeci, Elizabeth Hinton, and Robin Rudowitz, Key Themes in Section 1115 Medicaid Expansion Waivers (Washington, DC: Kaiser Family Foundation, March 2017),


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