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

Alabama

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 Considering Expansion
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 Opted Out
Montana Expanded
Nebraska Considering Expansion
Nevada Expanded
New Hampshire Expanded
New Jersey Expanded
New Mexico Expanded
New York Expanded
North Carolina Opted Out
North Dakota Expanded
Ohio Expanded
Oklahoma Opted Out
Oregon Expanded
Pennsylvania Expanded
Rhode Island Expanded
South Carolina Opted Out
South Dakota Opted Out
Tennessee Opted Out
Texas Opted Out
Utah Considering Expansion
Vermont Expanded
Virginia Expanded
Washington Expanded
West Virginia Expanded
Wisconsin Opted Out
Wyoming 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.

Related Resources

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.

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