State Medicaid Expansion

Before the passage of the Affordable Care Act of 2008 (ACA), health care in the U.S. was tenuous at best. Most people get health insurance through their employer. This leaves many people, especially adults with low income, without health insurance coverage. The ACA changed the health insurance landscape for low-income Americans by expanding Medicaid eligibility.

This article overviews the Medicaid expansion and the latest state acceptance or denial information. Because eligibility and expansion status vary by state, always confirm local rules and contact an attorney in your state if you need help navigating enrollment or an appeal.

What Is Medicaid?

Medicaid is a federally funded, state-administered health insurance program for low-income Americans. Eligibility for traditional Medicaid strictly focused on the following factors:

• Income
• Household size
• Disability
• Citizenship

Filling the Coverage Gap

Although millions of the uninsured gained health care coverage with the ACA, millions more fell into a coverage gap. The coverage gap included uninsured persons who technically earned too much for Medicaid coverage but not enough to purchase coverage on the ACA marketplace.

Medicaid expansion was the federal government’s response to this gap. Under the ACA, financial eligibility rose to 133% of the federal poverty level (FPL). This meant that persons with incomes up to 133% of the FPL could qualify for Medicaid.

Initially, the federal government tried to restrict federal Medicaid funding to states that chose to expand it. But in National Federation of Independent Business v. Sebelius (2012), the Supreme Court determined that the federal government couldn’t force states into expanding Medicaid. This led to a series of Medicaid expansion bills, ballot initiatives, and ballot measures designed to get holdout states to expand Medicaid within their borders.

Medicaid Expansion and the COVID-19 Pandemic

In 2021, in response to the COVID-19 public health emergency, the Biden administration sought to expand Medicaid further through incentives under the American Rescue Plan. By the start of the pandemic in 2020, 12 states had not opted to expand Medicaid (“nonexpansion states”). Under the American Rescue Plan, nonexpansion states could receive more than the standard 90% federal funding for Medicaid.

More specifically, these states could receive an additional 5% increase in matching funds if they expanded Medicaid.

Navigating the Medicaid rules, application process, and eligibility requirements in your state can be overwhelming. Find local legal help. 

Not All Low-Income Persons Qualify for Medicaid

It’s important to note that not all low-income persons qualify for Medicaid. The Medicaid expansion specifically covers persons and families with incomes at or below the federal poverty level. Since this number can change from year to year, check with your state or local department of health or human services for more information.

Table of Medicaid Expansion by State

Note: States may expand Medicaid coverage , per ACA guidelines, at any time. While we make every effort to ensure the accuracy of our pages, check with your state department of health or human services or contact a local attorney to confirm expansion.

41 states have opted to expand Medicaid coverage. 10 states have opted out. Find your state in the list below. 

Get Legal Help With Medicaid

If you’re facing difficulty navigating Medicaid, a local attorney specializing in healthcare law can help you. Speak to an experienced attorney near you today for valuable legal guidance and advocacy. You don’t have to navigate Medicaid processes and appeals alone.

FindLaw’s directory of healthcare attorneys can get you started. Enter your legal issue (healthcare or insurance) and then your city or ZIP code for a list of qualified legal professionals near you. Because your state’s Medicaid rules are relevant, your attorney should be licensed in your state. Your search results will also show important details about prospective attorneys, like ratings and whether they offer free case evaluations.