The Medicaid expansion map is changing, with five states poised to expand the program in the next few months. On November 6th, voters in three states approved ballot measures accepting the Affordable Care Act’s Medicaid expansion, joining two other states with recently approved expansion plans. This means more low-income adults will have access to occupational therapy services. Here’s a quick snapshot of where Medicaid expansion stands today.
Thirty-six states and Washington, DC have expanded Medicaid under the Affordable Care Act (this number includes the states that have adopted but not yet implemented the expansion). Fourteen have not. The health care reform law required states to expand Medicaid to people up to 138% of the federal poverty level, but a 2012 Supreme Court decision made expansion optional.
In four states where lawmakers declined to expand Medicaid, advocates of expansion have put the question to voters and won. In the 2018 elections, citizens of Idaho, Nebraska, and Utah approved Medicaid expansions that are set to be implemented in the spring of 2019. Maine’s voter-approved Medicaid expansion, blocked by the governor since a ballot measure passed in 2017, will be implemented soon – either by the current governor under a court’s order, or by the incoming governor, who supports expanding the program.
On November 1st, Virginia began enrolling people in coverage that will take effect on January 1, 2019. The state legislature approved a Medicaid expansion package with a work requirement in March, but the coverage expansion will take effect before implementation of the work requirement starts.
Voters in Montana, in contrast, rejected a tobacco tax that would have funded the state’s 10% share of Medicaid expansion costs, leaving doubts about whether Medicaid expansion will continue there. Their expansion will sunset on June 30, 2019 if lawmakers don’t settle on another way to pay for it.
In Kansas and Wisconsin, pro-expansion governors will replace expansion opponents in January, making them the most likely candidates to be the 37th and 38th expansion states, although the legislatures might not go along. In Alaska, a state that expanded Medicaid in 2015, the new governor might move to roll back the expansion.
For an overview of state Medicaid expansion decisions and other resources, check out the Kaiser Family Foundation’s interactive map.
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