Medicaid Expansion: What's the Status in Your State?
To date, 10 states have resisted the coverage expansion offered by the Affordable Care Act.
The Affordable Care Act expanded Medicaid coverage to adults making up to 138% of the federal poverty level.
With the unwinding of Medicaid's continuous coverage requirement, up to 15 million Americans could lose their benefits over the next 12 months.
That loss will be most acutely felt in the 10 states that have not expanded Medicaid eligibility, as allowed under the Affordable Care Act. Those states already have higher uninsured rates and more hospital closings, according to a report by the Commonwealth Fund.
Residents will now be at a greater risk of losing their Medicaid coverage and not having affordable alternatives.
Many will fall into a coverage gap, making too much to qualify for Medicaid but not enough to be eligible for ACA marketplace subsidies.
The Urban Institute estimated that if all the holdout states adopted Medicaid expansion, 3.7 million fewer Americans would be uninsured.
For more, find out when Medicare open enrollment ends and learn about Medicare price changes for 2023.
What is Medicaid expansion?
The Affordable Care Act expanded Medicaid coverage to nearly all adults with incomes of up to 138% of the federal poverty level. (In 2023, that's equal to $20,120 for an individual, or $41,400 for a family of four.)
It also increased federal matching funds for states that expanded their coverage.
Originally the expansion was a requirement, but a June 2012 Supreme Court ruling essentially made it optional for states.
To encourage adoption, the American Rescue Act of 2021 gives new expansion states a 5% increase in matching federal funds for two years.
Which states have expanded Medicaid coverage?
As of March 30, 2023, 40 states and Washington, DC, have adopted the Medicaid expansion.
- South Dakota voters approved expanding Medicaid last November but it won't take effect until July 1.
- The North Carolina legislature approved the expansion in March 2023, which will begin at the start of 2024.
Which states have not expanded Medicaid?
Ten states -- Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming -- have not accepted the Medicaid expansion.
In his January State of the State address, Mississippi Gov. Tate Reeves urged legislators to reject expanding the program.
"Don't simply cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine," Reeves said. "Instead, seek innovative free market solutions that disrupt traditional healthcare delivery models, increase competition, and lead to better health outcomes for Mississippians."