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    Tracking Medicaid Expansion Decisions

    At State Refor(u)m, we are continuing to track state Medicaid expansion decisions and activities. This chart includes direct links to statements from the governor or executive branch, activity in the state legislature, and fiscal and demographic analyses from the state or other institution.

    Like all State Refor(u)m research, this chart 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.

    Do you know of state activity or analyses that we should add to this compilation? Eager to update a fact we've included? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment below, or email the author with your suggestion. She can be reached at ksheedy@nashp.org.

    *Chart updated May 9, 2013

     

    Visit this new version of the chart for additional information such as details about key elements of Medicaid expansion bills that have been introduced in state legislatures and where states stand on expansion decisions.

    StatePercentage of Poor Adults Who are Uninsured1History of Subsidized Coverage2Governor or Executive Branch ActivityActivity in the LegislatureFiscal and Demographic Analysis3
     Adults ages 19-64 under 100% FPL who do not have health insurance coverageStates that have provided coverage financed through Medicaid above the federal minimum at some point in time to adults without children. States that have provided coverage financed through Medicaid above the federal minimum at some point in time to both employed and unemployed parents. Announcement regarding the state’s Medicaid expansion decision from a governor in the state’s budget, state of the state address, other official statement or news article.

    State bills related to Medicaid expansion moving forward in the legislature.  May also include city or county legislative materials.

    Conducted directly by a government agency or contracted out by the state to another institution.
    Conducted by organizations and institutions independent of the state.
      Childless Adults Parents  State GovernmentOther
    AL44%  
    Governor against expansion

    Proposed bill (SB 259) to expand Medicaid

     F
    AK44% XGovernor against expansionHouse resolution (HCR 8) to expand MedicaidFF
    AZ40%XXGovernor supports expansionProposed bill to expand MedicaidFF, FF
    AR50%X Governor supports expansionProposed bills (SB 1020, HB 1143) to expand Medicaid eligibility through the exchangeF,FF, FF
    CA47%XXGovernor supports expansionProposed bill (AB 1X-1) to expand Medicaid eligibilityFF, F
    CO45%XXGovernor supports expansionProposed Senate bill (SB-12-200) to expand Medicaid DFF
    CT31%XXGovernor supports expansion   
    DE30%XXGovernor supports expansion   
    DC26%XXMayor supports expansion   
    FL54%  Governor supports expansionProposed bill (SPB 7038) to create an alternative to Medicaid expansion FFFFFF
    GA52%  Governor against expansion

    Senate proposed resolution to expand Medicaid

    Senate passed HR 107, to create a committee to study Medicaid reform

     F
    HI25%XX Proposed bills (HCR147SCR 153SR 112to support Medicaid expansion  
    ID54%X Governor against expansion F , FD, D 
    IL45% XGovernor supports expansionHouse and Senate filed a bill (HB 106 and SB 26) to expand Medicaid  
    IN37%X Governor against expansionSenate approved SB551 to block grant Medicaid programFF
    IA
    37%X Governor against expansion

    Proposed bill (House File 232) to expand Medicaid through the Healthy Iowa Plan

    Senate passed SF 291 to expand Medicaid

    F 
    KS
    43%  Governor undecided on expansion

    Proposed House Concurrent Resolution No. 5013 against Medicaid expansion

    Proposed House bill (HB 2032) to support Medicaid expansion

    FFFFF
    KY41%  Governor supports expansion   
    LA51%  Governor against expansion F 
    ME24%XXGovernor undecided on expansion  F
    MD38%XXGovernor supports expansionTwo Administration bills proposed to expand Medicaid: SB 274 and HB 228F 
    MA
    12%XXGovernor supports expansion   
    MI
    37%XXGovernor supports expansion  F, F
    MN33%XXGovernor supports expansionGovernor signed a bill (HF9) to expand MedicaidF 
    MS48%  Governor against expansion FF, F
    MO42%X Governor supports expansion

    Proposed House bill (HB 627) to expand Medicaid

    Senate bill proposed to reduce Medicaid eligibility levels

     FF, F, F
    MT52% XGovernor supports expansion

    Proposed bill (HB590) to expand Medicaid eligibility level

    Proposed House bill (HB458) to implement Medicaid expansion

    FF 
    NE38% XGovernor against expansionProposed bill to expand Medicaid (LB 577)FF
    NV55% XGovernor supports expansion   
    NH39% XGovernor supports expansionProposed bill (HB 271) to prevent Medicaid expansionF, F 
    NJ46%XXGovernor supports expansion

    Proposed bill (SB 2644) to include Medicaid expansion

    Senate Concurrent Resolution No. 132 proposed to expand Medicaid

      
    NM49%XXGovernor supports expansion   
    NY31%XX    
    NC47%  Governor against expansionProposed Senate bill (SB4) against Medicaid expansion  
    ND42% XGovernor supports expansion

    Governor proposed bill to expand Medicaid

    House passed bill (HB 1362) to allow the Department of Human Services to accept funding for expansion 

      
    OH39% XGovernor supports expansion F, FF, F
    OK48%XXGovernor against expansionProposed bill (SB 777) to mandate Medicaid expansion  
    OR41%XX   F
    PA31%  Governor against expansion FFFF, D
    RI38% XGovernor supports expansion   
    SC49% XGovernor against expansionHouse voted to reject Medicaid expansionF 
    SD45% XGovernor against expansion   
    TN37% XGovernor against expansionProposed bill (HB 82) to prevent Medicaid expansion F
    TX58%  Governor against expansion

    Proposed bill (SB 3791) to create an alternative way to Medicaid expansion

    Senate Joint Resolution (SJR) 8 proposing a constitutional amendment to require Texas to expand Medicaid

     FF
    UT40%XXGovernor undecided on expansionProposed bill (HB 153) to expand Medicaid F
    VT24%XX    
    VA44% XGovernor against expansion

    General Assembly passed a budget bill (HB 1500) with amendments providing for Medicaid expansion under certain conditions

    Proposed resolution in the city of Charlottesville, VA to expand Medicaid

    FF, F, F
    WA42%XXGovernor supports expansionProposed bill (SB 5894to expand Medicaid  
    WV36%  Governor supports expansion F, F 
    WI35%XXGovernor against expansionProposed bill (SB 38) to expand MedicaidF 
    WY49% XGovernor undecided on expansion

    Proposed bill to change Medicaid eligibility levels for pregnant women and children to comply with the ACA but prevent further expansion of Medicaid 

    Proposed bill to expand Medicaid

    F, FF 

    Notes:

    1 Based on Statehealthfacts.org, Health Insurance Coverage of Adults 19-64 Living in Poverty (under 100% FPL), states (2010-2011), U.S. (2011). Accessed December 2012.

    2Based on Statehealthfacts.org, Medicaid Income Eligibility Limits for Adults as a Percent of Federal Poverty Level, July 2012. Accessed December 2012.

    3The letter "F" in a column indicates a Fiscal Analysis and the letter "D" in a column indicates a Demographic Analysis.

    Chart produced by: Kaitlin Sheedy and Sonya Schwartz, National Academy for State Health Policy

    Contributions by Shuchita Madan, Medicaid Health Plans of America

     

     

     

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    Comments

    In Illinois, our Governor supports Medicaid expansion: http://www.chicagobusiness.com/article/20121226/NEWS03/121229918/illinoi...

    So far, Georgia's Governor has elected not to expand: https://gov.georgia.gov/press-releases/2013-01-17/deal-focus-foundations...

    Senate Democrats have authored a resolution on expansion, but it will most certainly not go forward: http://www.legis.ga.gov/Legislation/20132014/128217.pdf

    It might also be helpful to identify Red and Blue states in the tracking list (Governor as well as House/Senate)

    Kaitlin, Arkansas has had several financial analyses, two of which I have posted here. One was conducted by our state Medicaid Director and the other was an independent analysis commissioned by my organization, the Arkansas Center for Health Improvement, and coducted by RAND. Great work on the compilation shown here!

    Two new Medicaid Expansion Bills were introduced in our new legislative session (HB 6253 was the bill in our last session -- and there wasn't time for a vote on the House floor before session ended). The two bills are: SB 26/HB 106. Fact sheet here: http://illinoishealthmatters.org/wp-content/uploads/2013/01/ACAFactSheet...

    North Carolina is considering Senate Bill 4 (SB4) that rejects both Medicaid expansion and state-based exchange: http://www.ncga.state.nc.us/gascripts/BillLookUp/BillLookUp.pl?Session=2...

    With a little more than a week remaining in our legislative session, the House and Senate have taken two approaches to considering Medicaid expansion. With the Governor indicating he will accept no expansion of Medicaid without significant reforms to the program, the House requires federal approval to reform CURRENT benefits, services, and cost-sharing for all current Medicaid recipients and approval of our Dual Demonstration initiative before the Commonwealth will consider Medicaid expansion, which will need to be approved by the 2014 General Assembly. The Senate triggers Medicaid expansion upon federal approval of commercial-like benefits, services, and cost-sharing for the EXPANSION population. My question to other states is this: once the final decision is made to expand Medicaid (assuming your state decides to do so), how long does it take to begin providing health care to the expansion population? We are being advised that it will take one year to negotiate rates to health plans, set up networks, finalize benefits, etc. Any counsel from other states would be appreciated.

    I have attached links to the House and Senate approaches below.

    House amendment
    http://leg2.state.va.us/WebData/13amend.nsf/bdaf73bc8841c0778525688b005f...

    Senate amendment
    http://lis.virginia.gov/cgi-bin/legp604.exe?131+amd+SB800AS

    In response to how long it can take once a decision is made is very state dependent - does your state already have managed care contracts for Medicaid that can be amended to add a new population and new rates? Does your current MCO rate methodology and current data allow for a relatively quick analysis for rates? Do the networks under your current Medicaid contracts have enough capacity to add the new population? Do you need new regulatory authority once you have legislative authority or is your legislative authority sufficient? What IT infrastructure, policy and procedures, etc do you and your MCOs need - if you currently have them adding a new population is less significant? Who is doing your enrollment and consumer education - do they have capacity and training to add a new population? Remember all won't enroll at one time but there will be an initial "bump" potentially? How electronic are you already? Is FFS an option until all the MCO activity is in place? If you have nothing, and you need to do a procurement of contracts with MCOs, set rates, determine capacity for service delivery, add IT infrastructure, it could take a long time and that depends on the priorities of the state to adequately resource the effort with staff,etc?

    Rhode Island has proposed expansion in Article 19 of the FY 2014 budget (2013 H-5127). Here is the link to the bill text: http://webserver.rilin.state.ri.us/BillText13/HouseText13/Article-019.htm

    In response to Virginia's question about preparation time for states that decide to expand, some MHPA members believe that in a state that already has a presence of managed care, only a contract amendment would be necessary because networks are already in place, and rates have been set.

    A bill was introduced in the New Jersey Senate on March 11, 2013 to amend the New Jersey Medical Assistance and Health Services Act to include the Medicaid expansion. http://www.njleg.state.nj.us/2012/Bills/S3000/2644_I1.HTM

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