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    Map: Where States Stand on Medicaid Expansion Decisions

    *Map updated June 22, 2016

    This map tracks state Medicaid expansion decisions and approaches states are taking for expanding eligibility to 138 percent of the Federal Poverty Level (FPL). This map also includes information on state legislative activity around Medicaid expansion {1}, governors' stances on the issue, and fiscal and demographic analyses from the state or other institutions. For states that are expanding Medicaid, but using an alternative to traditional expansion, the map also contains brief descriptions of these demonstration waivers.

    Like all State Refor(u)m research, this map is a collaborative effort with you, the user. State Refor(u)m captures the health reform comments, documents, and links submitted by health policy thinkers and doers all over the country. And our team periodically supplements, analyzes, and compiles this key content.

    Know of something we should add to this compilation? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment, or email acardwell@nashp.org.

    State

    Color (Key)

    Text Color

    Type of Expansion

    Governor's Stance

    2016 Legislative Activity

    2015 Legislative Activity

    2014 Legislative Activity

    Fiscal and Demographic Analyses

    AL

    #ff9900

    #cccccc

    N/A

    Considering alternative options; see here and here

    In November 2015, a governor-appointed task force, the Alabama Health Care Improvement Task Force, recommended that state policymakers should find a way to provide health coverage to uninsured individuals

    SB 182 expanding Medicaid

    SJR 34 against expansion

    SB 75 supporting expansion

    SB 92 supporting expansion

    HB 270 proposes a state constitional amendment to allow voters to determine participation in expansion

    Fiscal analysis, Alabama Hospital Association, September 2013

    Fiscal analysis, University of Alabama at Birmingham, November 2012

    AK

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    Traditional (See notes under legislative activity)

    Supports

    On 7/16/15, Governor Walker announced plans to expand Medicaid using executive authority; eligible individuals may be able to begin enrolling in September

    In February 2015, the Governor of Alaska and the Department of Health & Social Services released a Medicaid expansion and reform plan, The Healthy Alaska Plan. The plan proposes to expand Medicaid to adults with incomes up to 138% FPL and outlines how Medicaid expansion functions as the catalyst for meaningful reform in the state's existing Medicaid program. The Governor plans to evaluate potential strategies for increasing prevention and shared responsibility, through cost sharing requirements, health savings accounts, incentives for healthy behavior and work assistance benefits.

    HB 219 proposes to implement steps to end expansion if FMAP falls below 90%, if enrollment exceeds projections by 10% or more, if the state does not have proper certification for its Medicaid provider payment system, and if net general fund savings do not meet specified thresholds

    On 8/18/15, the state legislature indicated that it will sue Governor Walker for moving forward on expansion without legislative approval. On 8/31/15 the Alaska Supreme Court ruled that despite the ongoing lawsuit, expansion can move forward. In March 2016, the lawsuit was dismissed. However, on 5/6/16, the House filed an appeal to reinstate the lawsuit.

    There were two special sessions held, but Medicaid expansion was not advanced by legislators and the budget included language restricting the executive branch's authority to expand Medicaid; however some legal analyses indicate that this budget provision is not constitutional

    SB 78 and HB 148 supporting expansion, submitted by request of the Governor; FMAP must be no less than 90%

    Alaska House Finance committee, acting as the subcommittee on the Department of Health and Social Services, removed Medicaid expansion from the department's budget on February 27, 2015.

    HB 18 supporting expansion

    SB 150 supporting expansion; FMAP must comply with ACA

    HB 290 supporting expansion; FMAP must comply with ACA

    Fiscal and demographic analysis, The Menges Group, January 2016

    Fiscal Analysis, Alaska Department of Health and Social Services, February 2015

    Fiscal analysis, Alaska State Legislature, January 2014

    Fiscal analysis, The Lewin Group, April 2013

    Fiscal analysis, The Urban Institute, February 2013

    AZ

    #339966

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    Traditional

    On 8/3/15, Governor Ducey announced the AHCCCS CARE plan, which would require a federal waiver (the state's current Section 1115 waiver expires September 2016). For certain enrollees, the plan includes cost sharing, health savings accounts for premium payments, work search requirements and a lifetime limit on enrollment. The waiver is available here, and further information is available here.

    Supports a version of expansion

    No activity at this time

    Fiscal analysis, Arizona Health Care Cost Containment System, February 2013

    Fiscal analysis, Arizona Health Care Cost Containment System, August, 2012

    Fiscal analysis, Grand Canyon Institute, September 2012

    AR

    #3366ff

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    On 12/29/15, the state submitted a letter outlining plans to submit a waiver amendment in 2016 (see additional notes under Governor's stance)

    Alternative to traditional expansion: Arkansas is expanding Medicaid through an 1115 waiver, the Arkansas Health Care Independence Program, which has been approved by CMS through 12/31/16, with eligibility effective 1/1/14. The waiver allows the state to implement Medicaid expansion through a premium assistance model by using federal Medicaid funds to purchase coverage through qualified health plans (QHPs).

    The plan covers all newly eligible individuals ages 19 to 64, including parents between 17-138% FPL and childless adults between 0-138% FPL (medically frail individuals are exempt). While no premiums are required, there is cost sharing for enrollees between 100-138% FPL that must be consistent with Medicaid and QHP rules.

    For more information, see the state's Arkansas Health Care Independence Program.

    In August 2014, the state provided public notice of its intent to submit a written request to CMS to amend the Health Care Independence 1115 waiver. The proposed amendments include the following: (1) Independence Accounts for individuals with incomes above 50% FPL, (2) cost-sharing for individuals with incomes from 50-100% FPL, and (3) changes to the state's non-emergency medical transportation (NEMT) benefit for individuals participating in the Demonstration. In December 2014, CMS approved the waiver amendment.

    Supports maintaining state's current approach to expansion through 2016; called for creation of legislative task force to examine other options

    In August 2015, Gov. Hutchinson recommended certain changes to the current version of expansion

    In Feb. 2016, the governor began discussions with federal officials to talk about the future of the state's expansion program; HHS indicated a willingness to continue discussions to find compromises related to the governor's goals of incentivizing work, increasing personal responsibility and program integrity, and supporting ESI

    HB 1001 outlining the governor's plan for renewing expansion beyond December 2016, called Arkansas Works, was passed during a special session that began 4/6/16; signed by Governor

    On 4/21/16, the governor signed an appropriation bill to continue funding for the expansion, using a line-item veto to continue the program

    SB 144 proposes to terminate the Health Care Independence Program on 12/31/15

    SB 96 creates a Health Reform Legislative Task Force, as requested by the Governor; passed both chambers

    SB 101 budget bill that provides appropriation for the Arkansas Health Care Independence Program; passed both chambers and signed by the Governor

    SB 111 budget bill provides appropriation for the Arkansas Health Care Independence Program

    HB 1150 budget bill provides appropriation for the Arkansas Health Care Independence Program

    Fiscal analysis, Arkansas Hospital Association, 2014

    Fiscal analysis, Arkansas Department of Human Services, no date

    Fiscal analysis, Arkansas Department of Human Services, no date

    Fiscal analysis, Arkansas Department of Human Services, November 2012

    Fiscal analysis, Arkansas Department of Human Services, November 2012

    Fiscal analysis, RAND Corporation, 2013

    CA

    #339966

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    Traditional

    Supports

    No activity at this time

    Fiscal analysis, Legislative Analyst's Office, February 2013

    Demographic analysis, UCLA Center for Health Policy Research, May 2011

    Fiscal analysis, UCLA Center for Health Policy Research, UC Berkeley Labor Center, January 2013

    CO

    #339966

    #cccccc

    Traditional

    Supports

    No activity at this time

    Demographic analysis, Colorado Health Institute, April 2013

    Fiscal analysis, The Colorado Trust, February 2013

    Fiscal analysis, The Colorado Health Foundation, February 2013

    CT

    #339966

    #cccccc

    Traditional

    Supports

    No activity at this time

    No analysis available

    DC

    #339966

    #cccccc

    Traditional

    Supports

    No activity at this time

    No analysis available

    DE

    #339966

    #cccccc

    Traditional

    Supports

    No activity at this time

    No analysis available

    FL

    #ff9900

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    N/A

    Against

    Florida state lawmakers returned for a special session on June 1; in advance of the session, SB 2A was filed; it is identical to SB 7044, with some exceptions noted here; the special session ended June 19, without passage of expansion

    SB 7044 both expands Medicaid and establishes a state health insurance exchange through the Florida Health Insurance Affordability Exchange Program

    SB 710 supporting expansion; cost sharing and health reimbursement accounts for OOP expenses. FMAP must comply with ACA

    Fiscal and demographic analysis, National Council of La Raza, 2014

    Fiscal analysis, Florida Agency for Health Care Administration, April 2013

    Fiscal analysis, State of Florida, December 2012

    Fiscal analysis, State of Florida, August 2012

    Fiscal analysis, Florida Hospital Association, March 2013

    Fiscal analysis, Health Policy Institute, Georgetown University, November 2012

    GA

    #ff9900

    #cccccc

    N/A

    Against

    SB 368 expanding Medicaid through a premium assistance model to purchase QHP coverage for enrollees; requires premiums; also includes condition that FMAP align with President Obama's proposal to offer three full years of federal match funds to states that newly expand Medicaid

    HB 823 expanding Medicaid

    HB 943 prohibits state or local governments from advocating for Medicaid expansion or from creating a state-run health insurance exchange; signed by Governor

    HB 990 prevents expansion without legislative approval; signed by Governor

    Fiscal analysis, Georgia State University, Healthcare Georgia Foundation, February 2013

    HI

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    Traditional

    Supports

    No activity at this time

    No analysis available

    ID

    #ff9900

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    N/A

    While not an expansion of Medicaid, on 1/7/16, Gov. Otter proposed a program to provide state-funded primary healthcare and preventive services to adults below poverty; the program was not approved by the legislature.

    Considering options; in February 2015, the governor's Workgroup on Medicaid Redesign recommended an alternative approach to Medicaid expansion, the Healthy Idaho Plan, which covers adults 100-138% FPL in QHPs and individuals below 100% FPL in a Medicaid care management model. The plan proposes maximum allowable copayments and employment referral services for all enrollees, and premiums, deductibles and higher copayments for individuals above 100% FPL. The plan also allows for ending the expansion if federal funding changes.

    HCR 63 authorizing the Legislative Council and Dept. of Health and Welfare to apply for an expansion waiver, contingent on legislative approval

    SB 1204 expanding Medicaid

    SB 1205 expanding Medicaid through a premium assistance model; FMAP must comply w/ACA

    No activity at this time

    Fiscal analysis, Milliman, November 2014

    Fiscal analysis, Milliman, August 2014

    Fiscal analysis, Idaho Department of Health and Welfare, September 2012

    Fiscal analysis, Idaho Department of Health and Welfare, November 2012

    Demographic analysis, Idaho Department of Health and Welfare, August 2012

    Demographic analysis, Idaho Department of Health and Welfare, September 2012

    IL

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    Traditional

    Supports

    No activity at this time

    No analysis available

    IN

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    Alternative to traditional expansion: In January 2015, CMS approved Indiana's waiver for the Healthy Indiana Plan 2.0 (HIP 2.0), which expands on the state's existing Healthy Indiana Plan (HIP). HIP 2.0 expands coverage to non-disabled individuals ages 19-64 up to 138% FPL, with coverage beginning 2/1/15. HIP 2.0 permits the state to collect premiums through contributions to Personal Wellness and Responsibility (POWER) accounts. Individual contributions cannot exceed 2% of household income and are also funded with state contributions.

    HIP 2.0 offers two levels of benefits, HIP Basic or HIP Plus. Individuals in HIP Plus will have access to additional benefits, with the only copayments being for non-emergency use of the emergency room, which is a required copayment for all HIP 2.0 enrollees. All individuals who contribute to POWER accounts will be enrolled in HIP Plus. HIP Basic has more limited benefits and has copayments allowed under existing Medicaid rules.

    For individuals above 100% FPL, contributions to POWER accounts are required as a condition of eligibility. If they stop contributing, after a grace period they will be disenrolled and not permitted to reenroll for six months, unless they meet certain exceptions. Individuals below 100% FPL can participate in either HIP Plus or HIP Basic, but for these individuals, contributions to POWER accounts are not a requirement for coverage. If they are in HIP Plus but then cease to contribute, they will be automatically enrolled in HIP Basic.

    The waiver exempts the state from providing NEMT in the first year and the state can encourage employment through a separate program, but there is no work requirement. The waiver runs through 1/31/18 and offers premium assistance for individuals w/ESI.

    Supports a version of expansion; see the state's page on the HIP 2.0 proposal.

    SB 369 supporting expansion

    HB 1309 supporting expansion

    SB 370 supporting expansion using Premium Assistance model

    Fiscal analysis, Indiana Family and Social Services Administration, September 2012

    Fiscal analysis, Indiana Hospital Association, February 2013

    IA

    #3366ff

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    In July 2015, Iowa released a draft waiver amendment for public comment that proposes to end enrollment of individuals above 100% FPL in the Marketplace Choice Plan due to a lack of plan issuers; these individuals will instead be enrolled in Medicaid managed care plans in 2016

    Alternative to traditional expansion: Iowa is expanding Medicaid through the Iowa Health and Wellness Plan, which required two 1115 waivers, the Iowa Marketplace Choice Plan and the Iowa Wellness Plan. Both waivers were approved by CMS through 12/31/16, with eligibility effective 1/1/14. The Iowa Marketplace Choice Plan allows the state to implement Medicaid expansion through a premium assistance model by using federal Medicaid funds to purchase coverage through qualified health plans (QHPs) for newly eligible individuals ages 19-64 who have incomes 101-138% FPL (medically frail individuals are exempt).

    The Wellness Plan provides Medicaid coverage through a medical home model for individuals ages 19-64 with incomes from 0-100% FPL and medically frail individuals up to 138% FPL.

    Both plans have premiums based on income level beginning in the second year of the demonstration, while cost sharing cannot exceed 5% of the beneficiary's annual income. The premiums can be reduced or waived if certain healthy behavior standards are met. Also, there are copayments for non-emergency use of the emergency room, and non-emergency medical transportation (NEMT) will not be a covered service for individuals under either waiver. Iowa submitted a waiver amendment to request to continue waiving NEMT service for members under the Iowa Health and Wellness plan who are not medically exempt.

    For more information, see the state's Iowa Health and Wellness Plan.

    Supports

    No activity at this time

    Fiscal analysis, Iowa Department of Human Services, Iowa Medicaid Enterprise, December 2011

    KS

    #ff9900

    #cccccc

    N/A

    Against

    SB 371 expanding Medicaid; establishes accounts that enrollees contribute up to 2% of income with disenrollment for nonpayment; also contains a work referral component; expansion ends if FMAP is below 90%

    HB 2319 supporting expansion through an 1115 waiver. The program would be known as KanCare 2.0 and would include cost sharing and healthy behavior incentives.

    HB 2270 supporting expansion; contains language allowing for a work component

    HB 2045 supporting expansion

    HB 2552 prevents expansion without legislative approval

    HB 2434 supporting expansion

    Fiscal analysis, Manatt Health, December 2015

    Fiscal analysis, Kansas Hospital Association, November 2014

    Fiscal analysis, Kansas Center for Economic Growth, April 2014

    Fiscal analysis, Kansas Hospital Association, January 2014

    Fiscal analysis, Kansas Department of Health and Environment, February 2013

    Fiscal analysis, Kansas Department of Health and Environment, February 2013

    Fiscal analysis, Kansas Hospital Association, February 2013

    Fiscal analysis, Kansas Policy Institute, June 2011

    Fiscal analysis, Kansas Health Institute, December 2012

    KY

    #339966

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    Traditional

    Considering alternative options

    On 6/22/16, Gov. Bevin released a Section 1115 waiver proposal to modify the state's Medicaid expansion model

    No activity at this time

    Commonwealth of Kentucky Report on Medicaid Expansion in 2014, Deloitte, February 2015

    Fiscal analysis, Kentucky Voices for Health, October 2012

    LA

    #339966

    #cccccc

    Traditional

    Supports; on 1/12/16, Gov. Edwards issued an executive order to begin the process of expanding Medicaid.

    Medicaid enrollment began 6/1/16; coverage is scheduled to begin 7/1/16

    HCR 51 includes a hospital financing mechanism for Medicaid expansion

    HCR 75 includes a hospital financing mechanism for Medicaid expansion

    SB 10 supporting expansion; effective January 1, 2016

    HB 261 supporting expansion

    HB 759 supporting expansion

    SB 96 to expand Medicaid through a constitutional amendment, with authority for legislature to decide whether to continue expansion if FMAP falls below 90%

    SB 107 to expand Medicaid using premium assistance through the creation of the Louisiana Health Care Independence Program; FMAP must comply with ACA

    HB 290 to expand Medicaid through a constitutional amendment, with authority for legislature to decide whether to continue expansion if FMAP falls below 90%

    Fiscal analysis, Louisiana Department of Health and Hospitals, April 2014

    Fiscal analysis, Louisiana Department of Health and Hospitals, March 2013

    ME

    #ff9900

    #cccccc

    N/A

    Against; considering alternative options

    LD 633 expanding Medicaid through a plan modeled after Insure Tennessee and WY's SHARE program

    Amendment supporting expansion being proposed to LD 1487 which implements managed care in MaineCare; FMAP must comply with ACA and expansion ends on 12/31/16; vetoed by the Governor

    LD 1578 supporting expansion; creates fund to pool any savings, FMAP must comply with ACA, and expansion ends on 12/31/16

    Fiscal analysis, Maine Health Access Foundation, April 2015

    Fiscal analysis, Maine Department of Health & Human Services, January 2014

    Fiscal analysis, Maine Center for Economic Policy, March 2013

    MD

    #339966

    #cccccc

    Traditional

    No statement at this time

    No activity at this time

    Fiscal analysis, The Hilltop Institute, July 2012

    MA

    #339966

    #cccccc

    Traditional

    No statement at this time

    LD 633 expanding Medicaid through a plan modeled after Insure Tennessee and WY's SHARE program

    No activity at this time

    No analysis available

    MI

    #3366ff

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    On 12/17/15, CMS approved the waiver amendment with special conditions; in April 2018, all non-medically frail beneficiaries with incomes above 100% FPL will choose to move to a marketplace option or remain in the Medicaid delivery system. Failing to pay premiums is not a condition of eligibility, and total cost sharing must follow federal Medicaid rules. Individuals in the Medicaid delivery system must engage in certain healthy behaviors that can reduce cost sharing.

    On 9/1/15, as required by state law to prevent expansion from ending in 2016, Michigan submitted a waiver amendment for the Healthy Michigan Plan. The amendment proposed that non-medically frail individuals with incomes above 100% FPL who are enrolled in Medicaid for 48 cumulative months would be required to choose between moving to QHP coverage or to remain in Medicaid and face an increase in cost sharing of up to 7 percent of their income.

    Alternative to traditional expansion: Michigan is expanding Medicaid through an 1115 waiver, the Healthy Michigan program, which has been approved by CMS through 12/31/18 and is effective 4/1/14. The Healthy Michigan program expands Medicaid coverage to individuals ages 19-64 with incomes up to 138% FPL, and beneficiaries will participate in health savings accounts that can be used for required cost sharing payments.

    Total annual cost sharing cannot exceed 5% of the beneficiary's annual income, and cost sharing can be reduced if individuals participate in certain healthy behaviors and preventive care measures. Beneficiaries with incomes above 100% FPL will also make premium contributions, not to exceed 2% of an individual's annual income.

    For more information, see the state's Healthy Michigan Plan.

    Supports

    No activity at this time

    Demographic analysis, Center for Healthcare Research and Transformation, July 2013

    Fiscal analysis, Center for Healthcare Research and Transformation, October 2012

    Fiscal analysis, Center for Healthcare Research and Transformation, October 2012

    MN

    #339966

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    Traditional

    Supports

    No activity at this time

    Fiscal analysis, Minnesota Department of Health, February 2013

    MS

    #ff9900

    #cccccc

    N/A

    Against

    SB 2082 and SB 2060 supporting expansion, ending 12/31/17

    HB 127, HB 223 and HB 316 supporting expansion

    HB 377 supporting expansion and also expanding Medicaid for children up to 200% FPL

    HB 1481 rejecting an amendment to a state budget bill to expand Medicaid

    HB 41 supporting expansion

    HB 1067 supporting expansion

    Fiscal analysis, Milliman, Inc., December 2012

    Fiscal analysis, Mississippi Institutions of Higher Learning, October 2012

    Fiscal analysis, Center for Mississippi Health Policy, November 2012

    MO

    #ff9900

    #cccccc

    N/A

    Supports

    In March 2015, Governor Nixon revised his thoughts on a proposed Medicaid expansion plan. In the governor's plan, all adult Medicaid recipients would be referred to a career center, those who refuse to work would face higher premiums and copays and could lose coverage, and beneficiaries would be charged for improper use of the emergency room. The plan would also include incentives to quit smoking.

    In April 2014, the governor announced Missouri Health Works proposal which directs federal Medicaid dollars to small businesses to subsidize part of the cost of health insurance for employees that are paid less than 138% FPL

    HB 2201, HB 2457 and SB 961 expanding Medicaid; expansion would end if FMAP is below 90%; bills also direct research on potential savings and components of alternative expansion models

    SB 419 to expand Medicaid under a block grant through the creation of the "Healthcare Transformation Trust Fund."

    HB 825 supporting expansion

    SB 287 supporting expansion but only for veterans and their families

    SB 524 supporting expansion

    HB 1901 supporting expansion through a Premium Assistance model with maximum cost sharing and premiums of 1% of income for all enrollees and a workforce requirement for most individuals. Adults under 100% FPL would be covered through Medicaid managed care plans.

    HB 1608 supporting expansion

    HB 1239 supporting expansion

    Fiscal analysis, Missouri Governor's Office, April 2014

    Fiscal Analysis, Families USA, April 2014

    Fiscal analysis, Missouri Department of Economic Development, March 2014

    Fiscal analysis, University of Missouri School of Medicine and Dobson DaVanzo & Associates LLC, November 2012

    Fiscal analysis, Missouri Budget Project, Saint Louis University School of Law, Washington University, January 2013

    Fiscal analysis, Missouri Budget Project, February 2013

    MT

    #3366ff

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    Alternative to traditional expansion: On April 29, 2015, Governor Bullock signed SB 405, the Montana Health and Economic Livelihood Partnership Act (HELP Act), which expands the state's Medicaid program through an 1115 Waiver. The HELP Act requires enrollees to pay the maximum copayment amounts allowed under federal law, and excludes copayments on preventive services, generic drugs, immunizations, and other medically necessary healthcare screenings. Additionally, enrollees are required to pay premiums of 2% of their monthly income. Enrollees above 100% FPL who fail to pay premiums within 90 days of notification of the overdue payment, may be disenrolled in coverage unless they meet specific criteria such as participation in a workforce program or following a healthy behavior plan. The HELP Act also authorizes and appropriates funds to implement a new voluntary workforce development program for enrollees.

    In July 2015, Montana's Department of Public Health and Human Services (DPHHS) posted a draft waiver application for public comment.

    On 9/15/15, the state submitted an application to CMS for a new section 1115 waiver demonstration to implement the HELP program; the waiver was approved on 11/2/15. Eligibility will be effective 1/1/16; most enrollees will receive services provided through a third party administrator.

    Further information is available at DPHHS' page on the HELP Act.

    Supports; a Medicaid expansion proposal, the Healthy Montana Plan, is included in the proposed 2017 biennium budget; plan is modeled after state's CHIP program and would contract with an insurer to provide healthcare through a private provider network at negotiated rates

    SB 405 supporting expansion through the Montana Health and Economic Livelihood Partnership Act (HELP Act); signed by the governor on 4/29

    HB 455 supporting expansion only for parents up to 100% FPL and some veterans

    HB 249 supporting expansion and aligned with Governor's expansion proposal; not passed by legislature

    HB 256 requiring legislative approval for Medicaid expansion

    No activity at this time

    Fiscal analysis, University of Montana, January 2013

    Fiscal analysis, Montana Department of Public Health and Human Services, December 2012

    NE

    #ff9900

    #cccccc

    N/A

    Against

    LB 1032 supporting expansion through a premium assistance model w/premiums of 2% for individuals above 50% FPL (medically frail individuals exempt)

    LB 472 supporting expansion; premium assistance for individuals with incomes between 100-133% FPL

    LR 601 to study the impact of Medicaid expansion

    LB 887 supporting expansion; premium assistance for individuals with incomes between 100-133% FPL

    Fiscal analysis, Milliman, Inc., January 2014

    Fiscal analysis, Milliman, Inc., January 2013

    Fiscal analysis, University of Nebraska Medical Center's Center for Health Policy, August 2012

    NV

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    Traditional

    Supports

    No activity at this time

    No analysis available

    NH

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    See 2016 Legislative Activity section for recent activity

    Alternative to traditional expansion: New Hampshire passed legislation (SB 413) approving Medicaid expansion, signed into law on March 27, 2014. Under the proposal, the state sought a federal waiver for a premium assistance model of coverage, the Health Protection Program, which was approved in March 2015. Prior to this federal approval, eligible individuals were enrolled on July 1, 2014, with coverage beginning on August 15, 2014 in New Hampshire's Medicaid managed care program. With waiver approval, the state will transition these individuals in 2016 to the Health Protection Program. Also, some individuals who are eligible for an existing program to subsidize employer-based coverage, the Health Insurance Premium Payment program, will receive coverage through that program. The Health Protection Program also includes a work referral component, and expires on December 31, 2018.

    On May 30, 2014, the New Hampshire Department of Health and Human Services submitted a waiver to CMS to support reform of the state's Medicaid program and overall delivery system; the waiver for the Health Protection Program was submitted in November 2014; this premium assistance waiver was approved on 3/4/15.

    Supports

    Although the federal waiver for the Health Protection Program is approved through 12/31/18, the program will sunset on 12/31/16 without legislative approval.

    HB 1696 continues expansion, and proposes to add work requirements and enrollee premiums; also proposes for the state's share to be paid for by an insurance premium tax and the Medicaid enhancement tax, as well as the enrollee premiums; on 4/5/16 the bill was signed by the Governor, with a clause to continue expansion even if federal officials do not approve the work requirements

    HB 1690 extends the Health Protection Program in its current form

    SB 531 extends the Health Protection Program in its current form; also proposes for the state's share to be paid for by an insurance premium tax and the Medicaid enhancement tax

    SB 7 gives the existing Joint Health Care Reform Oversight committee the power to oversee Medicaid expansion

    SB 413 to expand coverage using a premium assistance model, with a severability clause after three years, when FMAP falls below 100%

    HB 544 supporting expansion; passed in the House; uses premium assistance model

    Fiscal analysis, Report of the Commission to Study Expansion of Medicaid Eligibility, October 2013

    Fiscal analysis, The Lewin Group, November 2012

    Fiscal analysis, The Lewin Group, January 2013

    NJ

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    Traditional

    Supports

    No activity at this time

    No analysis available

    NM

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    Traditional

    Supports

    No activity at this time

    Fiscal analysis, University of New Mexico Bureau of Business and Economic Research, October 2012

    NY

    #339966

    #cccccc

    Traditional

    Supports

    No activity at this time

    No analysis available

    NC

    #ff9900

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    N/A

    Against; considering alternative options

    HB 1073 expanding Medicaid

    HB 330 and SB 365 supporting expansion

    No activity at this time

    Fiscal analysis, Wake Forest University, January 2016

    Fiscal analysis, The George Washington University, December 2014

    Fiscal analysis, North Carolina Institute of Medicine, January 2013

    ND

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    Traditional

    Supports

    No activity at this time

    No analysis available

    OH

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    Traditional

    Supports

    In April 2016 the governor's administration submitted a draft waiver for public comment to require non-disabled Medicaid enrollees to pay premiums; the state is aiming to submit the waiver to federal officials in June 2016; a summary of the waiver is available here

    The FY2016-FY2017 budget bill HB 64 proposes the Healthy Ohio program, which would require certain Medicaid recipients to contribute to state-run health savings accounts to cover care costs; on 6/30/15 Governor Kasich signed the budget bill with this plan included; will require federal approval

    No activity at this time

    Fiscal analysis, Ohio Department of Medicaid, August 2015

    Fiscal analysis, Ohio Department of Job and Family Services, June 2011

    Fiscal analysis, Governor's Office of Health Transformation, February 2013

    Fiscal analysis, Health Policy Institute of Ohio and The Ohio State University, August 2013

    Fiscal analysis, Health Policy Institute of Ohio, The Ohio State University, The Urban Institute, and REMI, February 2013

    Fiscal analysis, The Ohio Medicaid Expansion Study, March 2013

    OK

    #ff9900

    #cccccc

    N/A

    Against

    In April 2016, the state's Health Care Authority released a proposal to extend the state's premium assistance program, Insure Oklahoma, to ACA Medicaid expansion eligible individuals; plan would require state and federal approval

    SB 1372 expanding Medicaid

    No activity at this time

    Fiscal analysis, Leavitt Partners, June 2013

    Fiscal analysis, Leavitt Partners, May 2013

    OR

    #339966

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    Traditional

    Supports

    No activity at this time

    Fiscal analysis, State Health Access Data Assistance Center, February 2013

    PA

    #339966

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    Traditional

    On 7/27/15, Governor Wolf announced that the state had completed the transition of individuals from the prior administration's Healthy PA plan to Health Choices, the state's expanded traditional Medicaid program.

    For more information, see the state's page on the HealthChoices PA program.

    Supports

    HB 1492 would make Medicaid coverage available while state awaits approval on Healthy PA waiver

    Fiscal analysis, Department of Public Welfare, May 2013

    Fiscal analysis, RAND Corporation, 2013

    Fiscal analysis, Families USA and Pennsylvania Health Access Network, February 2013

    Fiscal analysis, Pennsylvania Health Law Project, January 2013

    Demographic analysis, Pennsylvania Health Law Project and Pennsylvania Office of Rural Health, January 2013

    RI

    #339966

    #cccccc

    Traditional

    Supports

    No activity at this time

    No analysis available

    SC

    #ff9900

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    N/A

    Against

    No activity at this time

    Fiscal analysis, Milliman, Inc., July 2012

    SD

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    N/A

    Considering alternative options; on 9/29/15, Gov. Daugaard met with Sec. Burwell to discuss expansion plan options; in October 2015 a coalition of state and tribal officials and health representatives met to discuss the possibility of expansion. In his 12/8/15 budget address, the governor expressed support for expanding Medicaid, contingent on costs being covered by the general fund budget.

    The state is seeking greater federal reimbursement for Medicaid services provided through Indian Health Services, which would increase funding in the state budget to cover expansion costs. In February 2016, HHS updated guidance that expanded the circumstances when full federal funding is available for services provided to Medicaid-eligible American Indians and Alaska Natives through Indian Health Services. Despite this policy update, Gov. Daugaard indicated he will not ask legislators to consider expansion this session due to time constraints, though he said the issue could be revisited in the future.

    On 6/22/16, the governor indicated that he would not call a special legislative session to consider expansion.

    SB 147 supporting expansion; FMAP must comply with ACA

    HB 1210 supporting expansion; FMAP must comply with ACA

    Fiscal analysis, Medicaid Opportunities and Challenges Task Force Final Report, September 2013

    TN

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    N/A

    Supports a version of expansion; in December 2014, Gov. Haslam proposed an expansion plan, the Insure Tennessee Plan, which would have provided coverage to individuals ages 21 to 64 with incomes up to 138% FPL. The proposed plan was to be a two-year pilot program requiring approval from both the state legislature and federal officials, but in February 2015, the legislature voted against Insure Tennessee. Individuals would have chosen to participate in either the Volunteer Plan or the Healthy Incentives Plan.

    The Volunteer Plan would have provided individuals with vouchers to cover premiums and OOP costs in an individual's ESI plan. The voucher program would have provided a fixed contribution amount; individuals would have had to pay any other costs.

    Individuals that would have chosen the Healthy Incentives Plan would have received coverage through a component of the TennCare program. They would have participated in Healthy Incentives for Tennessee (HIT) accounts, and would have received contributions into their HIT accounts by participation in healthy behaviors. Account funds would have paid for cost sharing expenses. Individuals with income above 100% FPL would have had to pay both premiums and copayments, and all enrollees would have had pharmacy copayments.

    In addition to the federal match, state hospitals would have covered the state's portion after the FMAP decreased below 100%.

    In April, Republican lawmakers announced plans to put together a task force to study ways to improve Medicaid

    HB 2545 to place a question about Medicaid expansion on the November ballot

    SJR 103 seeks to expand Medicaid through a block grant

    SJR 93 supporting expansion through a proposal based on Governor Haslam’s Insure Tennessee plan. Three new elements include a lockout provision for enrollees failing to pay premiums, delaying implementation of the program until the U.S. Supreme Court rules on King vs. Burwell, and receiving written confirmation from CMS that TN can opt out if state tax money is ever required for the program. The bill was defeated in the Senate Commerce Committee in April 2015, less than a week after it was initially passed by the Senate Health and Welfare Committee.

    In January 2015, Governor Haslam called for a special legislative session beginning on February 2, 2015 to consider the Insure Tennessee Plan. On February 4, 2015, the Tennessee Senate Health and Welfare Committee voted against Insure Tennessee.

    SB 885/HB 1018 proposes to repeal the existing requirement that the legislature must approve expansion

    SJR 105 allows the governor to take all necessary action to expand Medicaid

    SJR 94 allows the governor to take certain actions related to Insure Tennessee

    HB 937/SB 804 against expansion, with amendment added requiring legislative approval of expansion

    HB 1723/SB 1975 supporting expansion if FMAP remains at 100%

    Fiscal analysis, A Healthy TN, March 2013

    TX

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    N/A

    Against; in November 2014 the Texas Institute of Health Care Quality and Efficiency recommended that the state health commissioner should be authorized to negotiate with the federal government to expand health coverage

    HB 116 supporting expansion

    In August 2014, legislators held a Senate Health and Human Services Committee hearing to identify market-based alternatives to Medicaid expansion

    Fiscal Analysis, Code Red Task Force on Access to Health Care in Texas, January 2015

    Demographic analysis, National Council of La Raza, August 2014

    Fiscal analysis, Billy Hamilton Consulting/Methodist Healthcare Ministries, January 2013

    UT

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    N/A (See notes under legislative activity)

    In December 2015, the governor's office indicated that the governor does not plan to propose another Medicaid expansion plan and next steps will be dependent on the legislature's action

    Supports a version of expansion through the Healthy Utah plan

    In December 2014 Governor Herbert released further details about the Healthy Utah Plan. The plan, which still needs state legislative and federal approval, expands Medicaid for adults ages 19-64 with incomes up to 138% FPL primarily through a premium assistance model. For most enrollees the plan uses federal Medicaid funds to purchase qualified health plan (QHP) coverage through Avenue H, the state's health insurance marketplace for small businesses. Medically frail individuals have the choice to enroll in Healthy Utah or receive traditional Medicaid benefits. Eligible adults with access to employer-sponsored insurance will enroll in those plans with Medicaid providing premium assistance, cost sharing and wrap-around coverage.

    The plan proposes premiums for individuals with income above 100% FPL and has copayments for certain services for all enrollees. In the second and third year the plan would provide incentives for participants to complete certain healthy behaviors. Certain unemployed individuals will be enrolled in an integrated work program, which will include job search and training services, and currently the state is exploring options to maximize program participation. The plan would terminate if federal funding drops below the ACA's enhanced Medicaid match rate.

    HB 437 does not implement the ACA's expansion but provides Medicaid coverage to approximately 16,000 adults who are homeless, in parole or substance abuse programs, or receiving treatment for mental health issues, as well as some low-income parents; signed by Governor

    The plan requires federal approval; further information available here.

    HB 302 expands Medicaid through a premium assistance model, with cost sharing requirements; would require federal waiver

    SB 77 expands Medicaid; FMAP must comply w/ACA

    HCR 12 resolution passed stating governor, lieutenant governor, and legislative leaders will find a compromise to the Healthy Utah Plan by July 31, 2015.

    On July 17, 2015, state officials indicated that they have agreed on a conceptual framework for expansion; in mid-October, the Utah Access Plus proposal was rejected by legislators.

    HB 446 expands Medicaid to 100% FPL; some individuals would receive traditional Medicaid benefits and some would receive benefits through state's primary care network

    SB 164 supporting expansion through the Healthy Utah Plan

    HB 307 supporting expansion only if the maximum federal match is provided

    SB 153 supporting expansion to individuals up to 100% FPL and to medically frail individuals only

    SB 83 supporting expansion; FMAP must comply w/ACA

    HB 401 instructs the Health Reform Task Force to evaluate the proposals for coverage of the optional Medicaid population- signed by the Governor

    SB 272 supporting expansion; FMAP must comply with ACA

    SB 251 uses federal funding for premium assistance for individuals under 100% FPL

    HB 141 proposes using state funding to cover individuals under 100% FPL- signed by the Governor

    Fiscal analysis, Notalys, June 2015

    Demographic analysis, University of Utah, 2014

    Fiscal analysis, Utah Department of Health, September 2013

    Demographic analysis, Utah Department of Health, August 2013

    Fiscal analysis, Utah Department of Health Medicaid Expansion Options Community Workgroup, September 2013

    Fiscal analysis, Utah Department of Health Medicaid Expansion Options Community Workgroup, September 2013

    Fiscal analysis, Public Consulting Group, June 2013

    Fiscal analysis, Utah Health Policy Project, December 2012

    VT

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    Traditional

    Supports

    No activity at this time

    No analysis available

    VA

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    N/A

    Supports

    In December 2015, Gov. McAuliffe released a budget proposal that calls for Medicaid expansion.

    Legislature held a special session in September 2014 and did not pass Medicaid expansion

    HB 797 includes a provision to expand Medicaid

    In June 2014, the budget passed without Medicaid expansion included

    SB 5003 budget bill to expand Medicaid using premium assistance model proposed in special session of the General Assembly

    Amendment in budget bill SB 30 to expand Medicaid using premium assistance model

    Fiscal analysis, The Commonwealth Institute, January 2013

    Fiscal analysis, The Commonwealth Institute, August 2012

    Fiscal analysis, The Commonwealth Institute, December 2012

    WA

    #339966

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    Traditional

    Supports

    No activity at this time

    Fiscal analysis, The Urban Institute, May 2012

    WV

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    Traditional

    Supports

    No activity at this time

    Fiscal analysis, Governor's Office, May 2013

    Fiscal analysis, CCRC Actuaries, April 2013

    WI

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    N/A {2}

    Against

    No activity at this time

    Fiscal analysis, Wisconsin Legislative Fiscal Bureau, February 2015

    Fiscal analysis, Wisconsin Legislative Fiscal Bureau, August 2014

    Fiscal analysis, Legislative Fiscal Bureau, February 2013

    Fiscal analysis, Legislative Fiscal Bureau, May 2013

    WY

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    N/A

    Supports a version of expansion

    In December 2015, Gov. Mead released a two-year budget request that includes Medicaid expansion; in January 2016, the Joint Appropriations Committee voted to remove expansion from the budget.

    In November 2014, Governor Mead and the state's Department of Health released a Medicaid expansion plan, the Strategy for Health, Access, Responsibility, and Employment (SHARE) plan to expand Medicaid to adults with incomes up to 138% FPL. The plan, which still needs approval by the state legislature and federal officials, imposes co-payments for certain services on all enrollees, while individuals with incomes above 100% FPL would pay premiums ranging from $20 to $50 per month. Enrollees who complete certain healthy behaviors could reduce premiums in the following year. Program participants would be enrolled in a work assistance benefit at the time of application, including job search and training services, but the use of these services would not be a condition of eligibility. The expansion program would terminate if federal funding drops below the 90% match for these new adults.

    SF 066 supporting expansion (official version of draft December 2014 bill)

    SF 129 supporting expansion; aligns with Governor's SHARE plan; on February 6, 2015, the Wyoming Senate voted against the bill

    In December 2014 the Joint Labor, Health and Social Services Interim Committee endorsed a draft Medicaid expansion bill that differs from the plan proposed by the state's Department of Health, and includes a proposal for individuals to contribute to personal health and wellness accounts.

    Amendment in budget bill allowing the Governor and other executive branch departments to negotiate with the federal government about a Medicaid expansion waiver

    SF 118 supporting expansion through a Premium Assistance model with premiums not exceeding 2% of annual income for individuals with at or below 100% FPL; FMAP must comply with ACA and non disabled individuals will enroll in health savings accounts

    SF 88 supporting expansion using premium assistance

    HB 84 supporting expansion with limited benefits

    Fiscal analysis, Wyoming Department of Health, August 2013

    Fiscal analysis, Wyoming Department of Health, November 2012

    Fiscal analysis, Wyoming Department of Health, September 2012

    Fiscal analysis, Milliman, Inc., September 2012

    #FFFFFF

    #FFFFFF

    Key: 

    states are not expanding Medicaid
    states (count includes the District of Columbia) are expanding Medicaid
    states are expanding Medicaid, but using an alternative to traditional expansion

    {1} This map provides a record of legislation introduced, but does not track the exact status of bills moving in state legislatures. Map is updated when bills pass chambers and/or are signed by the Governor.

    {2} CMS approved WI's proposal to modify existing Medicaid eligibility; under the waiver, all childless adults ages 19-64 with income up to 100% FPL will be covered through BadgerCare Plus beginning 4/1/14.

     

    Map produced by Anita Cardwell and Kaitlin Sheedy

    Related categories: 

    Topics: 

    Click on a state to view the status of Medicaid expansion, including:

    Type of Expansion

    Traditional: State is implementing Medicaid expansion as outlined in the ACA

    Alternative to traditional expansion: State is using a demonstration waiver to expand Medicaid

    N/A: State is not expanding Medicaid at this time

    Governor's Stance on Expansion

    Indicates whether the current Governor is against or supportive of Medicaid expansion

    Legislative Activity

    View bills introduced in 2016, 2015 and 2014 related to expansion.

    Fiscal and Demographic Analyses

    Includes state-specific analyses related to Medicaid expansion, conducted directly by a government agency, contracted out by the state to another institution, or conducted by organizations or institutions independent of the state.

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    Comments

    Hi Anita, this was really informative. I am trying to get some information around IES, basically which state has planned to integrate the eligibility systems etc. Can you please guide me on any such resource.

    Hello,
    Is it possible to receive a copy of the map and legend? Thank you, the information is very helpful.

    Hi Anita,
    I really like your Map and this would be helpful to include in a presentation on the ACA I am presenting. Is there anyway, I would be allow to use your mAP? Thanks!

    Anita - Great info & insights! Thanks for sharing.

    Is there any connection between Medicaid Expansion and the Medicaid Waiver Payments (Disability of Care) described in IRS Notice 2014-7?

    Texas Congressman have filed a proposal to expand Medicaid. See here:

    http://www.capitol.state.tx.us/BillLookup/Text.aspx?LegSess=84R&Bill=HB116

    You can remove footnote number 2 below your map (the one about Indiana) since it no longer applies. CMS did approve HIP 2.0 and it is now in place in Indiana.

    Robert Smith posses a very important question: Medicaid Waivers are at risk of being lost by non-expanding states like Texas and Florida. Texas stands to loose in excess of $3.5 Billion dollars in Medicaid waivers. It is hard to tell how many consumers these funds serve, but a quick analysis of marketplace coverage suggests 700,000 individuals can be insured in the healthcare Marketplace with those same funds (benchmark Silver, HMO, $0 Deductible; $1.5K Max OOP). Meanwhile Texas just filed an amicus brief in support of Florida's surprising turn around against medicaid expansion and the risk of loosing Medicaid waivers.

    WHAT STATES OTHER THAN NEW MEXICO, PAYS FOR SUBSTANCE ABUSE TREATMENT? ALSO, TRANSPORTATION TO ALL MEDICAL APPOINTMENTS, ARE COVERED BY MEDICAID.
    THANK YOU FOR YOUR TIME,

    Hello Anita, Thanks for sharing this information. It helps in overall analysis. I am working on a business case and was wondering if there is a way to find out the Magi and Non-Magi Medicaid population for the states. Are you aware of any such reference where I can find this data ?

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