State Medicaid Expansion
In an effort to ensure health insurance coverage for all U.S. residents, the Affordable Care Act (ACA) included a provision that would significantly expand Medicaid eligibility in all states. This expansion would cover people whose income was higher than the poverty level but still too low to actually afford coverage on the private market. Those states that failed to expand coverage under this provision faced the prospect of losing all Medicaid funds from the federal government.
Although 100 percent of the expansion costs would be paid for by the federal government (90 percent federal coverage after 2020), many states rejected the plan as federal overreach and sued for their right to opt out. In 2012, the U.S. Supreme Court agreed and effectively gave state governors the right to abstain from Medicaid expansion without being subject to sanctions.
The following is an explanation of state Medicaid expansion, including a state-by-state list showing whether states have expanded Medicaid coverage, are considering expansion, or have opted out.
State Medicaid Expansion: What it Means for You
Medicaid, the federally mandated (but state-administered) health care program for low-income Americans, has certain eligibility requirements for all U.S. residents, such as income, household size, disability, and other factors. But in states that have expanded Medicare in compliance with the ACA's original provision, more residents may be eligible.
Specifically, individuals in households with an income level that's below 138 percent of the federal poverty level qualify for Medicaid in states that have expanded coverage.
These rates are subject to change, but the federal poverty level for a family of four in 2018 was $25,100 (138 percent of that rate is $34,638). Income is calculated as modified adjusted gross income (MAGI), which includes adjusted gross income plus untaxed foreign income, Social Security benefits, and tax-exempt interest (if applicable).
State Medicaid Expansion: Who's In and Who's Out
|District of Columbia||Expanded|
|North Carolina||Opted Out|
|South Carolina||Opted Out|
|South Dakota||Opted Out|
Note: States may choose to expand Medicare coverage, per ACA guidelines, at any time. While we make every effort to ensure the accuracy of our pages, recent changes may not be reflected in the preceding table.
- Medicaid Coverage of Spouse's Nursing Home Expenses
- Medicare Overview
- Medicaid State Plan Amendments (Medicaid.gov)
- State Overviews (Medicaid.gov)
- Children's Health Insurance Program (Medicaid.gov)
Have Medicaid Questions? A Local Attorney Can Help
State and federal laws are fairly clear with regard to eligibility for Medicare, with or without state Medicaid expansion. But every situation is different and you may need a legal expert to sort out the details. Don't take chances; get the help you need from an experienced, local health care attorney today.