Status of State Medicaid Expansion Decisions: Interactive Map

To date, 39 states (including DC) have adopted the Medicaid expansion and 12 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

These data are available in a table format. The map may be downloaded as a PowerPoint slide.

Key States with Expansion Activity

States Summary of Activity
United States Coverage under the Medicaid expansion became effective January 1, 2014 in all states that have adopted the Medicaid expansion except for the following: Michigan (4/1/2014), New Hampshire (8/15/2014), Pennsylvania (1/1/2015), Indiana (2/1/2015), Alaska (9/1/2015), Montana (1/1/2016), Louisiana (7/1/2016), Virginia (1/1/2019), Maine (1/10/2019 with coverage retroactive to 7/2/2018), Idaho (1/1/2020), Utah (1/1/2020), Nebraska (10/1/2020), Oklahoma (planned for 7/1/2021), and Missouri (planned for 7/1/2021).

Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, Nebraska, New Hampshire, New Mexico, Ohio, and Utah have approved Section 1115 waivers to operate their Medicaid expansion programs in ways not otherwise allowed under federal law. Some of these Section 1115 waivers include work requirements, which the Biden Administration has recently begun the process of withdrawing.

STATES THAT HAVE ADOPTED AND IMPLEMENTED EXPANSION
Idaho Enrollment in Medicaid coverage under expansion began on November 1, 2019, and coverage for these enrollees began on January 1, 2020. Following a successful expansion ballot measure in November 2018, in 2019 Governor Brad Little signed a bill passed by the legislature that directed the Idaho Department of Health and Welfare to seek waivers for multiple changes to the expansion program and specified that if the waivers were not approved by January 1, 2020, then all individuals up to 138% FPL will be enrolled in Medicaid. The state submitted four waivers at direction from this legislation; however, only one has been approved to date.
Kentucky On December 16, 2019, newly elected Democratic Governor Andy Beshear signed an executive order rescinding the Kentucky HEALTH waiver that had been set aside by the court in March 2019. The waiver had included a number of provisions including a work requirement, monthly premiums up to 4% of income, and coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances. Kentucky’s expansion program was originally implemented and continues to operate under SPA authority.
Maine Maine implemented expansion on January 10, 2019. Maine adopted the Medicaid expansion through a ballot initiative in November 2017. After former Governor LePage delayed implementation of the expansion for months, new Governor Mills signed an executive order on her first day in office (January 3, 2019) directing the Maine Department of Health and Human Services to begin expansion implementation and provide coverage to those eligible retroactive to July 2018. CMS approved the state’s plan retroactive to July 2, 2018 on April 3, 2019.
Montana On April 18, 2019, the Montana Legislature passed a bill (which was signed by Governor Bullock on May 9, 2019) to continue the state’s expansion program with significant changes until 2025. This action came after Montana voters voted down a measure on the November 2018 ballot that would have extended the Medicaid expansion beyond the June 30, 2019 sunset date and raised taxes on tobacco products to finance the expansion. The approved bill directs the state to seek federal waiver authority to make several changes to the existing expansion program, including adding a work requirement as a condition of eligibility and increasing the premiums required of many beneficiaries. Per the legislation, the state submitted a Section 1115 waiver proposal with these changes to CMS on August 30, 2019 and the request is pending.
Nebraska Enrollment in Medicaid coverage under expansion in Nebraska began on August 1, 2020, and coverage for these enrollees began on October 1, 2020. Nebraska voters had approved a Medicaid expansion ballot measure in November 2018 and the state submitted a state plan amendment (SPA) for the expansion on April 1, 2019. The SPA delayed Medicaid expansion implementation until October 1, 2020 to allow time for the state to seek a Section 1115 waiver to implement expansion with program elements that differ from what is allowed under federal law, including a tiered benefit structure that requires beneficiaries to meet work and healthy behavior requirements to access certain benefits. CMS approved this waiver on October 20, 2020, with implementation of some waiver elements to begin on April 1, 2021 and others (including the work requirement) to follow one year later.
Utah Medicaid coverage under expansion began on January 1, 2020. Following a successful Medicaid expansion ballot measure in November 2018, the state legislature took steps to roll back the full expansion by directing the state to submit a series of Section 1115 waivers. On December 23, 2019, CMS approved certain provisions in the state’s “Fallback Plan” waiver request to amend its Primary Care Network Waiver to expand Medicaid eligibility to 138% FPL, effective January 1, 2020; the approval also included work requirements for the newly expanded adult Medicaid population.
Virginia The Virginia General Assembly approved Medicaid expansion as part of its FY 2019-2020 budget on May 30, 2018; Governor Northam signed the budget into law on June 7, 2018. Expansion coverage became effective under state plan amendment (SPA) authority on January 1, 2019 after enrollment began on November 1, 2018.
STATES THAT HAVE ADOPTED BUT NOT YET IMPLEMENTED EXPANSION
Missouri Missouri voters approved a ballot measure on August 4, 2020 which adds Medicaid expansion to the state’s constitution. The amendment requires the state to submit all SPAs necessary to implement expansion to CMS no later than March 1, 2021 and for expansion coverage to begin July 1, 2021. Language in the amendment prohibits the imposition of any additional burdens or restrictions on eligibility or enrollment for the expansion population.
Oklahoma Oklahoma voters approved a ballot measure on June 30, 2020 which adds Medicaid expansion to the state’s Constitution. The amendment requires the Oklahoma Health Care Authority to submit a state plan amendment (SPA) and other necessary documents to CMS within 90 days of the ballot measure’s approval, and for expansion coverage to begin no later than July 1, 2021. Language in the approved measure prohibits the imposition of any additional burdens or restrictions on eligibility or enrollment for the expansion population. In line with the amendment, the Oklahoma Health Care Authority submitted a SPA to expand Medicaid on September 8, 2020.
STATES THAT HAVE NOT ADOPTED EXPANSION
Florida An initiative to put Medicaid expansion on the 2020 ballot was delayed by its organizing committee to the 2022 ballot.
Georgia On October 15, 2020, CMS approved an 1115 waiver called Georgia Pathways to Coverage which extends Medicaid coverage to 100% FPL for parents and childless adults with initial and continued enrollment conditioned on compliance with work and premium requirements and other eligibility and benefit restrictions at the regular state match rate. Although coverage under this eligibility extension is set to begin on July 1st, 2021, the Biden Administration has recently begun to withdraw waivers with work requirement provisions.
Kansas On February 1, 2021, Democratic Governor Laura Kelly announced a Medicaid expansion bill and included it in her FY 2022 budget proposal, with the stated goal of implementing a Medicaid expansion plan by January 2022. This bill is similar to a bipartisan Medicaid expansion bill Governor Kelly and Republican Senate Majority leader Jim Denning introduced on January 9, 2020 with premiums and a work referral program. Governor Kelly’s new proposal also includes medical marijuana legalization and would fund expansion with revenue from medical marijuana sales and taxes, rather than with a reinsurance program and hospital surcharge as proposed in the 2020 bill. Despite receiving bipartisan support, the 2020 expansion bill failed after Republican Senate President Susan Wagle stalled its progress in an attempt to force passage of a separate anti-abortion bill.
Mississippi Medicaid expansion was a key issue in the 2019 Mississippi gubernatorial election, dividing candidates in both the August 27 Republican primary and in the November 5 general election. Republican Lieutenant Governor Tate Reeves, who adamantly opposes expansion, ultimately won both races, making it unlikely that the state will take up expansion in the next four years.
North Carolina In 2019, Democratic Governor Roy Cooper included Medicaid expansion in his state budget proposal for State Fiscal Years 2020-2021 and subsequently vetoed the state budget passed by the Republican-controlled legislature when it did not include expansion. Senate Republicans were unsuccessful in securing the necessary votes for a veto override before the legislative session adjourned on October 31, 2019 without a new budget. After passage of multiple adjustment bills to the current operating budget in April 2020, Senate Republicans announced they would no longer attempt to override the budget veto due to the ongoing pandemic. Governor Cooper once again included Medicaid expansion in his FY 2021 budget proposal, and the legislature may consider this issue ahead of passing a new biennial budget in the 2021 legislative session.
South Carolina On December 12, 2019, CMS approved two separate 1115 waivers for South Carolina which would extend Medicaid coverage from 67% to 100% FPL for its parent/caretaker relative groups and a new targeted adult group with initial and continued enrollment conditioned on compliance with work requirements at the regular match rate. Recently, the Biden Administration has begun to withdraw waivers with work requirement provisions.
South Dakota In November 2020, South Dakota’s Secretary of State approved two 2022 Medicaid expansion ballot initiative petitions for circulation, both filed by the organizing committee Dakotans for Health. One is an initiated constitutional amendment (which requires 33,921 signatures to get on the 2022 ballot) and the other is an initiated state statute (which requires 16,961 signatures). Advocates have until November 2021 to gather the signatures.
Wisconsin On February 16, 2021, Governor Tony Evers included Medicaid expansion in his FY 2021-2023 budget proposal. The governor included Medicaid expansion in his previous budget proposal, but the Republican- controlled legislature did not include it in the final budget. Wisconsin covers adults up to 100% FPL in Medicaid but did not adopt the ACA expansion.
Wyoming During the 2020 legislative session, the Wyoming House rejected multiple Medicaid expansion bills. In June 2020, the legislature’s Joint Revenue Committee held a special session to discuss Medicaid expansion in light of the COVID-19 crisis and recommended a reconsideration of expansion during the 2021 legislative session.

Medicaid Expansion Resources

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