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State Medicaid Expansion Approaches

Current Status of State Medicaid Expansion Decisions

State Medicaid Expansion Approaches
States Did the state adopt the Medicaid expansion?* How did the state expand Medicaid? In non-expansion states:
How many uninsured adults would be eligible for Medicaid if the state expanded?*
United States 33 Yes, 18 No Approved SPA
(24 states)*
Approved Section 1115 waiver in place (8 states) Section 1115 waiver/waiver amendment pending at CMS (5 states) 4,509,000
Alabama No 153,000
Alaska Yes  (9/1/2015) X
Arizona Yes X
Arkansas Yes X X
California Yes X
Colorado Yes X
Connecticut Yes X
Delaware Yes X
DC Yes X
Florida No 702,000
Georgia No                     463,000
Hawaii Yes X
Idaho No 43,000
Illinois Yes X
Indiana Yes  (2/1/2015) X X
Iowa Yes X
Kansas No 79,000
Kentucky Yes X (initially adopted expansion through SPA but received waiver approval on 1/12/18, implementation will start in 4/2018 with full implementation by 7/2018)
Louisiana Yes  (7/1/2016) X
Maine Yes (adopted 11/7/2017, implementation date TBD) Not counted:
State adopted expansion through ballot initiative but SPA not yet submitted/ approved
Maryland Yes X
Massachusetts Yes X X
Michigan Yes  (4/1/2014) X
Minnesota Yes X
Mississippi No 167,000
Missouri No 199,000
Montana Yes  (1/1/2016) X X
Nebraska No 34,000
Nevada Yes X
New Hampshire Yes  (8/15/2014) X X
New Jersey Yes X
New Mexico Yes X
New York Yes X
North Carolina No 339,000
North Dakota Yes X
Ohio Yes X
Oklahoma No 142,000
Oregon Yes X
Pennsylvania Yes  (1/1/2015) X
Rhode Island Yes X
South Carolina No 170,000
South Dakota No 29,000
Tennessee No 332,000
Texas No                    1,178,000
Utah No 91,000
Vermont Yes X
Virginia No 272,000
Washington Yes X
West Virginia Yes X
Wisconsin No 97,000
Wyoming No 15,000
NOTES:  *Coverage under the Medicaid expansion became effective January 1, 2014 in all states that have adopted expansion unless otherwise noted. Maine has adopted the expansion but is not included in the count of states that expanded through SPAs because it has not yet submitted a SPA to the federal government. Number of uninsured adults who would be eligible for Medicaid coverage if non-expansion states expand includes individuals currently in the coverage gap (<100% FPL), those who currently may be eligible for Marketplace coverage (100-138% FPL), and those who are currently eligible for Medicaid but not enrolled; US total is for all non-expansion states; state values may not sum to national total due to rounding. SPA: State Plan Amendment. CMS: Centers for Medicare and Medicaid Services.
SOURCES: Kaiser Family Foundation tracking of state Medicaid expansion and Section 1115 waiver activity. Uninsured adults who would be eligible for Medicaid if the state expanded is from Kaiser Family Foundation analysis based on 2017 Medicaid eligibility levels and 2017 Current Population Survey,

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.