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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 Findlaw article overviews the Medicaid expansion and the latest state acceptance or denial information.

State Medicaid Expansion

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 persons whose incomes were up to 133% of the FPL could qualify for Medicaid.

Initially, the federal government tried to restrict federal funding for Medicaid to states that chose to expand Medicaid. 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.

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, you should check with your state or local department of health or human services for more information.

State Medicaid Expansion

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


Opted Out
Alaska Expanded
Arizona Expanded
Arkansas Expanded
California Expanded
Colorado Expanded
Connecticut Expanded
Delaware Expanded
District of Columbia Expanded
Florida Opted Out
Georgia Opted Out
Hawaii Expanded
Idaho Expanded
Illinois Expanded
Indiana Expanded
Iowa Expanded
Kansas Opted Out
Kentucky Expanded
Louisiana Expanded
Maine Expanded
Maryland Expanded
Massachusetts Expanded
Michigan Expanded
Minnesota Expanded
Mississippi Opted Out
Missouri Expanded
Montana Expanded
Nebraska Expanded
Nevada Expanded
New Hampshire Expanded
New Jersey Expanded
New Mexico Expanded
New York Expanded
North Carolina Expanded
North Dakota Expanded
Ohio Expanded
Oklahoma Expanded
Oregon Expanded
Pennsylvania Expanded
Rhode Island Expanded
South Carolina Opted out
South Dakota Expanded
Tennessee Opted Out
Texas Opted Out
Utah Expanded
Vermont Expanded
Virginia Expanded
Washington Expanded
West Virginia Expanded
Wisconsin Opted Out
Wyoming Opted Out

Get Legal Help

If you're facing difficulty navigating Medicaid, a government services attorney specializing in health care can help you. Speak to an experienced government services attorney near you today.

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