Affordable Care Act Medicaid Expansion

4/3/2019

Medicaid—a federal/state partnership with shared authority and financing—is a health insurance program for low-income individuals, children, their parents, the elderly and people with disabilities.

Medicaid pays for health care for more than 74.5 million people nationally. Although participation is optional, all 50 states participate in the Medicaid program.

However, eligibility for Medicaid benefits varies widely among the states - all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guidelines, the details are outlined here.

What’s Next for Medicaid expansion? States are considering the costs and benefits of expansion, and whether or not to pursue expansion through innovative Section 1115 waivers. Recent changes may affect enhanced federal financing for expansion populations, conditions for eligibility, and enrollment and renewal procedures.

Status of expansion categories on the map below are updated as of April 2019.

Click on a state to see health insurance coverage for the total state population by coverage category.

State Decisions on ACA-Related Medicaid Expansion

Total Health Coverage by State Health insurance coverage for the total state population by coverage category AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PR MP GU AS VI

Legend:

Currently not expanded

Expansion approved by ballot initiative, not yet implemented

Currently implementing expansion through a CMS Section 1115 Waiver

Currently expanded

Click on state to see health insurance coverage for the total state population by coverage category.

These 2016 data are available from the Kaiser Family Foundation’s State Health Facts.

 
Health Insurance Coverage Nationally
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
19% 14% 2% 49% 7% 7%
ALABAMA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
21% 16% 3% 47% 5% 9%
ALASKA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
20% 10% 8% 46% 3% 14%
ARIZONA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
21% 15% 3% 44% 5% 12%
ARKANSAS
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
21% 17% 2% 44% 9% 8%
CALIFORNIA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
25% 11% 1% 46% 8% 8%
COLORADO
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
16% 13% 3% 52% 7% 10%
CONNECTICUT
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
20% 14% N/A 54% 6% 6%
DELAWARE
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
22% 16% 2% 47% 4% 9%
DISTRICT OF COLUMBIA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
24% 11% N/A 51% 7% 5%
FLORIDA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
16% 18% 3% 42% 10% 12%
GEORGIA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
17% 12% 4% 49% 7% 12%
HAWAII
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
15% 15% 6% 55% 3% 5%
IDAHO
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
17% 14% 2% 48% 10% 9%
ILLINOIS
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
18% 14% 1% 51% 8% 7%
INDIANA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
20% 14% 1% 52% 6% 7%
IOWA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
18% 15% 1% 54% 6% 5%
KANSAS
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
14% 13% N/A 53% 9% 8%
KENTUCKY
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange Uninsured
21% 16% N/A 44% 10% 6%
LOUISIANA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
25% 14% N/A 42% 6% 11%
MAINE
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
21% 16% 1% 49% 5% 7%
MARYLAND
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
16% 14% 3% 54% 7% 6%
MASSACHUSETTS
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
22% 12% 1% 54% 6% 6%
MICHIGAN
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
22% 15% 1% 51% 5% 6%
MINNESOTA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
14% 15% N/A 55% 8% 6%
MISSISSIPPI
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
24% 14% 3% 42% 5% 12%
MISSOURI
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
15% 17% 1% 51% 8% 8%
MONTANA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
22% 18% 3% 43% 7% 7%
Note: Medicaid expansion sunsets in June 30, 2019
NEBRASKA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
13% 15% 2% 55% 7% 7%
NEVADA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
18% 15% 4% 50% 5% 9%
NEW HAMPSHIRE
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
13% 16% 2% 58% 6% 7%
NEW JERSEY
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
17% 14% N/A 55% 6% 8%
NEW MEXICO
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
31% 14% 2% 36% 5% 11%
NEW YORK
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
24% 13% 1% 50% 7% 6%
NORTH CAROLINA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
18% 15% 3% 45% 9% 11%
NORTH DAKOTA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
12% 13% 4% 55% 8% 8%
OHIO
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
22% 15% 1% 51% 5% 6%
OKLAHOMA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
18% 16% 3% 48% 5% 11%
OREGON
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
24% 16% 1% 46% 7% 5%
PENNSYLVANIA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
19% 16% 1% 53% 6% 5%
RHODE ISLAND
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
20% 15% N/A 51% 8% 5%
SOUTH CAROLINA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
19% 16% 4% 46% 7% 9%
SOUTH DAKOTA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
15% 17% 2% 49% 10% 8%
TENNESSEE
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
20% 15% N/A 46% 6% 11%
TEXAS
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
16% 11% 2% 49% 6% 15%
UTAH
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
10% 10% N/A 60% 7% 12%
VERMONT
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
20% 16% 2% 47% 9% 5%
VIRGINIA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
12% 14% 5% 55% 5% 10%
WASHINGTON
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
22% 13% 2% 49% 7% 7%
WEST VIRGINIA
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
26% 18% 1% 43% 4% 7%
WISCONSIN
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
16% 14% 2% 56% 5% 7%
WYOMING
Public Insurance Private Insurance Uninsured
Medicaid Medicare Military & Veteran Employer Marketplace Exchange  
13% 14% 3% 55% 7% 10%

The roll-over feature on the map above provides information on the overall health insurance coverage of each state's population, for comparison, including 2016 data on the percent of the population enrolled in public insurance (Medicaid, Medicare and the military), private insurance (employer based plans and subsidized market plans from the state and federal exchanges), as well as the percent of the state population without health insurance.

A number of states are currently implementing or planning to implement Medicaid expansion through an approved Section 1115 Waiver. For more information on Medicaid waivers click here.

Additional NCSL Resources

Other Recent Medicaid Expansion Resources