Where each state stands on ACA's Medicaid expansion

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Text last updated on Jan. 7, 2013, at 1 p.m. ET.

The Supreme Court's ruling on the Affordable Care Act (ACA) allowed states to opt out of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.

Based on lawmakers' statements, press releases, and media coverage, the Daily Briefing and American Health Line editorial teams have rounded up where each state currently stands on the expansion.

We will continue to update this map and list as more information becomes available. Send us news, tips, and feedback by commenting below or emailing dailybriefing@advisory.com.

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 * indicates a state's participation in the multistate lawsuit against ACA

NOT PARTICIPATING (9 states)

• Alabama*: Gov. Robert Bentley (R) on Nov. 13 announced that Alabama will not participate in the Medicaid expansion "because we simply cannot afford it" (Gadsden Times, 11/13; Lyman, Montgomery Advertiser, 11/13).
• Georgia*: Gov. Nathan Deal (R) in an Atlanta Journal-Constitution/Politico/11 Alive interview on Aug. 28 said, "No, I do not have any intentions of expanding Medicaid," adding, "I think that is something our state cannot afford." When asked about the insurance exchanges, Deal said "we do have a time frame for making the decision on that I think, especially on the exchanges," adding that "we have just a few days after the election in order to make a final determination on that" (Wingfield, "Kyle Wingfield," Atlanta Journal-Constitution, 8/28).
• Louisiana*: Gov. Bobby Jindal (R) in an NBC "Meet the Press" interview on July 1 said, "Every governor's got two critical decisions to make. One is do we set up these exchanges? And, secondly, do we expand Medicaid? And, no, in Louisiana, we're not doing either one of those things." However, state Sen. Karen Carter Peterson (D) and other Democratic leaders after the Nov. 6 election urged Jindal to reconsider his opposition or the state will not be forced to accept a "one-size-fits-all" plan, CBC News "Money Watch" reports (Barrow, New Orleans Times-Picayune, 7/2; "Money Watch," CBS News, 11/9).
• Maine*: Gov. Paul LePage (R) on Nov. 16 said that Maine will not participate in the Medicaid expansion. He called the expansion and the state-based insurance exchanges a "degradation of our nation’s premier health care system" (Mistler, Kennebec Journal, 11/16).
• Mississippi*: Gov. Phil Bryant (R) on Nov. 7 said Mississippi will not participate in the Medicaid expansion, reiterating previous statements that he had made about the ACA provision (Pender/Hall, Jackson Clarion-Ledger, 11/7).
• South Carolina*: Gov. Nikki Haley (R) on July 1 announced via Facebook that South Carolina "will NOT expand Medicaid, or participate in any health exchanges." The state Legislature is expected to make a decision on the Medicaid expansion during the 2013 session (Gov. Haley Facebook page, 7/1; Holleman, Columbia State, 11/9).
• South Dakota: Gov. Dennis Daugaard (R) in his annual budget address on Dec. 4 said he does not plan to participate in the Medicaid expansion. "I really think it would be premature to expand this year," he said, adding that he hoped for more flexibility for the state program (Montgomery, Sioux Falls Argus Leader, 12/4).
• Oklahoma: Gov. Mary Fallin (R) on Nov. 19 said Oklahoma will not participate in the Medicaid expansion. "Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid," she said in a statement. She noted that the program would cost the state as much as $475 million over the next eight years (Greene, Tulsa World, 11/19).
• Texas*: Gov. Rick Perry (R) in a statement on July 9 said, "If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under ObamaCare." Perry also sent a letter to HHS Secretary Kathleen Sebelius on July 9 asserting this position. The Dallas Morning News reported that on Nov. 8, Perry reiterated his opposition to the expansion, saying, "Nothing changes from our perspective" (Office of Gov. Perry release, 7/9; Gov. Perry letter, 7/9; Garrett, Dallas Morning News, 11/11).

LEANING TOWARD NOT PARTICIPATING (5 states)

• Iowa*: Gov. Terry Branstad (R) on July 2 said that he expects to opt out of the expansion. Reiterating the position in an Aug. 22 interview, Branstad spokesperson Tim Albrecht said the governor remains opposed to the expansion. Branstad likely will instead pursue state-based efforts to make health insurance coverage more affordable, Albrecht said (Totland, Washington Times, 7/2; Wiser, Waterloo Cedar Falls Courier, 7/3; AP/Omaha World-Herald, 8/22).
• Nebraska*: Gov. Dave Heineman (R) in a statement on his website on June 28 said, "As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased. If some state senators want to increase taxes or cut education funding, I will oppose them." Heineman on July 11 sent a letter to state lawmakers saying the state could not afford the expansion, but he stopped short of saying that the state will not participate in the expansion, according to Reuters (Office of Gov. Heineman release, 6/28; Wisniewski, Reuters, 7/11).
• New Jersey: Gov. Chris Christie (R)—in an interview on Fox News' "Fox and Friends" in July—said, "Medicaid is pretty well expanded in our state already because of the legacy of previous Democratic governors" and noted that he is leaning toward not raising the program's eligibility limit any further. In April 2011, New Jersey opted to expand Medicaid eligibility ahead of 2014 to nearly 70,000 childless adults through a Section 1115 waiver allowed under the ACA. The Examiner on Nov. 12 reported that New Jersey likely would opt out of the expansion (Defalco, AP/Philadelphia Inquirer, 4/15/2011; "Fox News Insider," Fox News, 7/3; Livio/Friedman, Newark Star-Ledger, 7/3; Reilly, The Examiner, 11/12).
• Virginia: Gov. Bob McDonnell (R) on Nov. 8 said he opposes expanding Medicaid, noting that he does not "believe the federal government can possibly deliver its commitment to fully fund the program, and I don't want to be part of contributing trillions of dollars to the national debt." However, McDonnell said Virginia could change course at a later date (AP/Modern Healthcare, 11/8).
• Wyoming*: Gov. Matt Mead (R) on Nov. 30 recommended that Wyoming not participate in the Medicaid expansion, but added that his position could change in the future and urged "everyone to keep an open mind on this." The state legislature will make the final decision on whether to expand the program, the AP/Jackson Hole Daily reports (Brown, Wyoming Tribune Eagle, 12/1; Graham, AP/Jackson Hole Daily, 12/1).

LEANING TOWARD PARTICIPATING (4 states)

• Kentucky: Gov. Steve Beshear (D) when asked about the expansion in July said, "If there is a way that we can afford that will get more coverage for more Kentuckians, I'm for it." However, state lawmakers are putting pressure on Beshear to reject the expansion (Office of Gov. Beshear release, 6/28; AP/Evansville Courier & Press, 6/28; AP/Evansville Courier & Press, 7/17; Autry, WYU, 7/5; Cross, Louisville Courier-Journal, 6/29).
• New Hampshire: Outgoing Gov. John Lynch (D) in a statement on his website on June 28 said the state has "been preparing to implement the Affordable Care Act and will continue doing so in a way that best fits New Hampshire." In the November 2012 election, Democrat Maggie Hassan defeated Republican Ovide Lamontagne in the state's gubernatorial race. In an email to Politico, Marc Goldberg—a spokesperson for Hassan—said, "Gov.-elect Hassan believes New Hampshire should accept the more than $1 billion in available funding to help working families afford health insurance" (Lynch statement, 6/28; Cheney/Smith, Politico, 11/12).
• New York: Gov. Andrew Cuomo (D) in a statement on his website on June 28 said he was "pleased the Supreme Court upheld the [ACA]" and looks forward "to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers." On July 26, Danielle Holahan—project director for New York's health insurance exchange planning—said the state "largely meet[s] the federal required Medicaid levels already." Although Cuomo's office has not officially announced a decision, the Associated Press reported on Nov. 13 that New York will expand Medicaid (Office Gov. Cuomo release, 6/28; Grant, North Country Public Radio, 7/27; Delli Santi/Mulvihill, AP/San Francisco Chronicle, 11/13).
• Oregon: Gov. John Kitzhaber (D) said on June 28 that he is confident that the Oregon Legislature will approve a state Medicaid decision. In an interview with the Oregonian just hours after the Supreme Court issued its ruling on the ACA, Kitzhaber said, "We'll make a decision on whether or not to expand the Medicaid program really based on, I think, the resources we have available in the general fund for that purpose going forward" (Budnick, Oregonian, 6/28).

PARTICIPATING (16 states and the District of Columbia)

• Arkansas: Gov. Mike Beebe (D) on Sept. 11 said he planned to participate in the Medicaid expansion, the Associated Press reports. According to the AP, Beebe agreed to participate in the expansion after officials assured him the state could opt out later if it faces a financial crunch. Beebe said, "I'm for it. I think it's good for our people because it's helping folks that don't have insurance now that are working their tails off. They're not sitting on a couch somewhere asking for something" (Brantley, Arkansas Times, 9/11).
• California: Gov. Jerry Brown (D) in a statement on June 28 said the Supreme Court’s ruling “removes the last roadblock to fulfilling President Obama’s historic plan to bring health care to millions of uninsured citizens.” California got a head start on expanding its Medicaid program in November 2010 with its “Bridge to Reform” program, which aimed to bring at least two million uninsured Californians into Medicaid (Office of Gov. Brown release, 6/28; DeBord, “KPCC News,” KPCC, 6/28).
• Colorado*: Gov. John Hickenlooper (D) on Jan. 3 announced that his state will participate in the expansion. In a news release, his office said the move would extend Medicaid coverage to about 160,000 low-income residents and save Colorado an estimated $280 million over 10 years without affecting the state's general fund (Stokols, KDVR, 1/3; Wyatt, AP/Denver Post, 1/3).
• Connecticut: Gov. Dannel Malloy (D) was among the first governors to sign up for the Medicaid expansion after the ACA was enacted in March 2010. Soon after the Supreme Court ruling on June 28, Malloy said “it’s great … [and a] very important decision for the people of Connecticut. 500,000 people would have lost coverage if Republicans had their way” (Davis, WTNH, 6/28).
• Delaware: Gov. Jack Markell (D) in a statement on June 28 said, "The Supreme Court's ruling enables Delaware to continue to implement provisions of the Patient Protection and Affordable Care Act to provide access to health care benefits for Delawareans." He added, "On the Medicaid front, Delaware already voluntarily expanded the state's Medicaid coverage program in 1996 to cover many Delawareans not previously covered" (Office of Gov. Markell release, 6/28).
• District of Columbia: D.C. Mayor Vincent Gray (D) in a statement on June 28 said, "The District is not at risk of losing any Medicaid funding as a result of this ruling, because District officials have already begun implementation of the ACA's Medicaid-expansion provisions and will continue to implement the expansion" (Executive Office of the Mayor release, 6/28).
• Hawaii: Gov. Neil Abercrombie (D) in a statement on June 28 welcomed the Supreme Court's ruling and said the ACA "is our ally" in the effort to "support a health care system that ensures high quality, safety and sustainable costs." Pat McManaman, director of the state Department of Human Services, said Hawaii's Medicaid eligibility requirements in July would fall in line with the law' guidelines, meaning an additional 24,000 people will be eligible for the program by 2014 (Office of Gov. Abercrombie release, 6/28; Garcia, AP/CBS News, 6/29).
• Illinois: Gov. Pat Quinn (D) on June 28 praised the court's decision and said he "will continue to work with President Obama to help working families get the healthcare coverage they need," including expanding Medicaid (Office of the Governor release, 6/28; Thomason, Rock River Times, 7/3; Ehley, Fiscal Times, 8/20).
• Maryland: Gov. Martin O'Malley (D) in a statement on June 28 said the Supreme Court's decision "gives considerable momentum to our health care reform efforts here in Maryland," adding that the state will move forward to implement the overhaul (Office of the Governor release, 6/28).
• Massachusetts: Gov. Deval Patrick (D) in late June said Massachusetts is "an early expansion state as you know and we're expecting further resources from the federal government to sustain the experiment here in Massachusetts." Patrick called the ruling "good news for us" (Walker, YNN, 6/28).
• Minnesota: Gov. Mark Dayton (D) said in a statement on June 28 said, "Today's ruling will be met with relief by the Minnesotans whose lives have already been improved by this law." Dayton in 2011 used federal money to expand Medicaid early to 84,000 adults with annual incomes below $8,400 (Lohn, AP/San Francisco Chronicle, 6/28).
• Missouri: Gov. Jay Nixon (D) on Nov. 29 announced that Missouri will participate in the Medicaid expansion. Nixon said he will include the expansion in the state budget proposal he submits to lawmakers. "We're not going to let politics get in the way of doing the best thing for our state," he said (Crisp, "Political Fix," St. Louis Post-Dispatch, 11/29).
• Montana: Gov.-elect Steve Bullock (D) -- who takes office on Jan. 7 -- on Jan. 4 announced several changes to outgoing Gov. Brian Schweitzer's (D) two-year budget recommendations, but retained the proposal to expand Medicaid. During a news conference, Bullock said the Medicaid expansion is part of his "Access Health Montana" plan to increase health care coverage for more Montana families. (Johnson, Billings Gazette, 1/5; Johnson, Montana Standard, 1/5).
• Nevada*: Gov. Brian Sandoval (R) on Dec. 11 announced that the state will participate in the Medicaid expansion. "Though I have never liked the Affordable Care Act because of the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care, the law has been upheld by the Supreme Court," Sandoval said in a statement, adding, "As such, I am forced to accept it as today’s reality and I have decided to expand Nevada’s Medicaid coverage" (Damon, Las Vegas Sun, 12/11).
• Rhode Island: Gov. Lincoln Chaffee (I) in a statement on his website on June 28 said, "I have fully committed to ensuring Rhode Island is a national leader in implementing health reform whatever the Supreme Court decision, and this just reinforces that commitment." According to Steven Costantino, the state's secretary of health and human services, "The expansion is easy to do and makes sense." Moreover, on July 12, USA Today reported that Chaffee planned to participate in the expansion (Chaffee statement, 6/28; Wolf, USA Today, 7/12; Radnofsky et al., Wall Street Journal, 7/2).
• Vermont: Gov. Peter Shumlin (D) on June 28 said Vermont's Medicaid program already meets the requirements under the health reform law's Medicaid expansion (Steimle, WCAX, 7/1).
• Washington*: In an email responding to a query by American Health Line, Karina Shagren—a deputy communications director in Gov. Chris Gregoire's (D) administration—in early July said "the governor supports the Medicaid expansion—and Washington will move forward." U.S. Rep. Jay Inslee (D)—who supports the expansion—was elected governor on Nov. 6 (Shagren email, 7/5; Washington Secretary of State website, 11/12).

UNDECIDED/NO COMMENT (16 states)

• Alaska*: Gov. Sean Parnell (R) on Aug. 8 said he is guarded on the expansion "because our history with the federal government right now is they cut what they promise to fund." Parnell said he wants to thoroughly understand the costs to the state before making a decision (Bohrer, AP/San Francisco Chronicle, 8/8).
• Arizona*: Gov. Jan Brewer (R) will not say until January whether the state will participate in the Medicaid expansion, Brewer administration officials said on Aug. 2. Brewer in a statement following the Supreme Court ruling repeated her call for the entire law to be repealed but did not directly address the expansion (AP/Arizona Central, 8/2; Brewer statement, 6/28).
• Florida*: Florida’s position on the Medicaid expansion became unclear after Gov. Rick Scott (R) in an Associated Press interview on Nov. 13 expressed a willingness to reconsider the Affordable Care Act and its provisions. Scott sent a letter to HHS Secretary Kathleen Sebelius on Nov. 16 requesting a meeting to "find a common ground" (Kam, The Palm Beach Post, 11/16; AP/Florida Today, 11/14).
• Idaho*: Gov. C.L. Otter (R) in July appointed a 15-member group to determine whether Idaho should expand Medicaid coverage, and the panel on Nov. 9 unanimously recommended that the state expand its Medicaid program to cover working, low-income individuals in order to "do something right" and save money. Otter will make the final decision, along with state lawmakers, who must approve any changes to the state's Medicaid plan (AP/Idaho Press-Tribune, 8/3; Miller, AP/San Francisco Chronicle, 11/9; Russell, Spokesman-Review, 11/10).
• Indiana*: Gov. Mitch Daniels (R) in a statement on June 29 said, "Any decision to expand Medicaid in 2014 is entirely the province of the next General Assembly and governor." U.S. Rep. Mike Pence (R) was elected governor on Nov. 6. In a position statement earlier this year, Pence noted that the Medicaid expansion would double "down on an already broken and unaffordable Medicaid system." Addressing the Affordable Care Act as a whole, he wrote, "I believe the State of Indiana should take no part in this deeply flawed healthcare bureaucracy" (Office of Gov. Daniels release, 6/29; Pence letter).
• Kansas*: Gov. Sam Brownback (R), who has been a vocal opponent of the Affordable Care Act, has not stated whether to opt in or out of the Medicaid expansion, the Associated Press reported on Nov. 9 (AP/NECN, 11/9).
• Michigan*: Gov. Rick Snyder (R) on Aug. 3 told the Associated Press that he had not decided whether to participate in the Medicaid expansion. He said he is weighing many factors in his decision, but said he thought the state could save money if it decides to participate (Barks Hoffman, AP/WSBT, 8/3).
• Ohio*: Gov. John Kasich (R) in a statement on June 28 said his administration is "very concerned that a sudden, dramatic increase in Medicaid spending could threaten Ohio's ability to pursue needed reforms in other areas." On July 2, Kasich said he had not made a decision on whether the state would participate in the expansion and he would not set a "deadline" to do so. The Cleveland Plain Dealer on July 2 reported that the decision could be pushed back until next year (Office of Gov. Kasich release, 6/28; Tribble, Cleveland Plain Dealer, 7/2).
• New Mexico: Gov. Susana Martinez (R) remains undecided on whether to expand Medicaid in the state. In September, Martinez sent a letter to HHS asking for clarity on how the expansion would be implemented. She told KRQE News on Sept. 18, "We need to know how to do this correctly because there aren't a lot of instructions on how this is done if we are going to expand" the Medicaid program (Goldsmith, KRQE News, 9/18).
• North Carolina: Outgoing Gov. Beverly Perdue (D) on Aug. 14 was evaluating "what's in the best interest of North Carolina families and North Carolina taxpayers," spokesperson Chris Mackey told the Associated Press. In the November 2012 election, Republican Pat McCrory defeated Democrat Walter Dalton in the state's gubernatorial race. After the election, a spokesperson for McCrory told Politico that the governor-elect will work to "fully understand the long-term implications of Medicaid expansion" before making a decision and he would consult with advisers, experts and other governors about how to move forward (Robertson, AP/WWAY, 8/14; Cheney/Smith, Politico, 11/12).
• North Dakota*: Gov. Jack Dalrymple (R) in a statement on June 28 reiterated that the ACA "is wrong for North Dakota." On July 5, a spokesperson for Dalrymple said the governor had not decided whether to opt in or out of the Medicaid expansion. In the state's gubernatorial race in November 2012, Dalrymple was re-elected (Office of Gov. Dalrymple release, 6/28; Galewitz, "Capsules," Kaiser Health News, 7/5; Galewitz, "Capsules," Kaiser Health News, 11/7).
• Pennsylvania*: Gov. Tom Corbett (R) during a press conference on Aug. 3 said the cost of expanding Medicaid would be "exceptionally high," but he did not indicate his position on the expansion. Meanwhile, Majority Whip Rep. Stan Saylor (R) in early August said he planned to introduce a bill that would block the expansion, while Minority Caucus Chair Rep. Dan Frankel (D) has sponsored legislation that would enable the expansion. The Examiner on Nov. 12 reported that Pennsylvania likely would opt out of the expansion (Daniels, PA Independent, 8/3; Daniels, PA Independent, 8/8; Reilly, The Examiner, 11/12).
• Tennessee: Gov. Bill Haslam (R) has not decided whether Tennessee will participate in the Medicaid expansion. However, two lawmakers—Sen. Brian Kelsey (R) and Rep. Jeremy Durham (R)—already have committed to introducing legislation that would block expansion, and the state's new Republican supermajority in the General Assembly means such a bill could pass (Bohs, "Bohs Column," The Jackson Sun, 11/9).
• Utah*: In an email responding to a query by American Health Line, Nate McDonald—public information officer for Gov. Gary Herbert (R), who won re-election in the state's gubernatorial race in November 2012—said "[n]o official decision" has been made on the Medicaid expansion (McDonald email, 11/9).
• West Virginia: Gov. Earl Ray Tomblin (D) in a statement on his website on June 28 said, "We know what the law is but as I've said before, I will continue to do what is best for West Virginia … We're going to review the Supreme Court's ruling, and work with our federal delegation on how we move forward." In the state's gubernatorial race in November 2012, Tomblin was re-elected (Office of Gov. Tomblin release, 6/28; AP/Marietta Times, 11/7).
• Wisconsin*: Gov. Scott Walker (R) in a statement on his website on June 28 said, "We are not going to spend time, effort, and resources on implementation until after the November elections." On Nov. 13, the Associated Press reported that Walker has "declined to expand Medicaid coverage as allowed under the law." However, there has been no official announcement from Walker's office (Office of Gov. Walker release, 6/28; Bauer, AP/San Francisco Chronicle, 11/13).