Medicaid Expansion: A State by State Report Card

Article from KFF, The independent source for health policy research, polling, and news

Medicaid expansion has had a transformative impact on addiction and behavioral health treatment by increasing access to care, improving coverage and benefits, reducing unmet treatment needs, increasing treatment utilization, enhancing financial sustainability for providers, and promoting integration of care. These changes have helped to address longstanding disparities in access to treatment services and have improved outcomes for individuals with mental health and substance use disorders across the United States.

KFF has detailed 41 states that have adopted Medicaid expansion, along with 10 that have not and each state's current status.

Sample Status Reports from KFF

  1. Kentucky:  On December 16, 2019, newly elected Democratic Governor Andy Beshear signed an executive order rescinding the Kentucky HEALTH waiver that had been set aside by the court in March 2019. The waiver had included a number of provisions including a work requirement, monthly premiums up to 4% of income, and coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances. Kentucky's expansion program was originally implemented and continues to operate under state plan amendment (SPA) authority.
  2. Oklahoma: Enrollment in Medicaid coverage under expansion in Oklahoma began on June 1, 2021, with coverage for these enrollees beginning on July 1, 2021. Oklahoma voters approved a ballot measure on June 30, 2020 which added Medicaid expansion to the state's Constitution. Language in the approved measure prohibits the imposition of any additional burdens or restrictions on eligibility or enrollment for the expansion population.
  3. Virginia: The Virginia General Assembly approved Medicaid expansion as part of its FY 2019-2020 budget on May 30, 2018; Governor Northam signed the budget into law on June 7, 2018. Expansion coverage became effective under state plan amendment (SPA) authority on January 1, 2019 after enrollment began on November 1, 2018.
  4. Florida: An initiative to put Medicaid expansion on the 2020 ballot was delayed by its organizing committee.
  5. Georgia: On July 1, 2023, Georgia began implementation of the state's Section 1115 Pathways to Coverage waiver. The waiver, which is not a full Medicaid expansion under the ACA and does not qualify for enhanced matching funds, was initially approved in October 2020 and gives Georgia authority to extend Medicaid coverage to 100% FPL for parents and childless adults. Initial and continued enrollment is conditioned on compliance with the work and premium requirements. In December 2021, CMS under the Biden Administration withdrew Georgia's Section 1115 approval for work and premium requirements in the state's Pathways to Coverage waiver. However, in August 2022, a Federal District Court judge issued a decision vacating CMS's rescission of Georgia's waiver provisions, thus reinstating these provisions.

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