Factors That May Affect State Decisions about the Medicaid Expansion

A key question after the Supreme Court’s ACA decision for states is whether they will choose to expand Medicaid to people at or below 133 percent of the federal poverty level. Without the “stick” of having funds from the existing Medicaid program taken away, most states are still weighing their options and have not made a final decision. This chart captures some of the key factors states may be weighing as they consider the Medicaid expansion.

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State	Provides Medicaid or other state health coverage for low-income childless adults1	Covers optional pregnant women above 133% FPL2	Applied for or been awarded funding for development of ACA-compliant Medicaid eligibility systems3	Governor’s statement supportive of health reform implementation post-SCOTUS4	No projected shortfall in FY ’13 state budget5	Total
DE	X	X	X	X	X	5
AZ	X	X	X		X	4
CA	X	X	X	X		4
DC	X	X	X	X		4
HI	X	X	X	X		4
IA	X	X	X		X	4
IN	X	X	X		X	4
MA	X	X	X	X		4
MD	X	X	X	X		4
MN	X	X	X	X		4
NM	X	X	X		X	4
NY	X	X	X	X		4
OK	X	X	X		X	4
OR	X	X	X	X		4
RI		X	X	X	X	4
TN		X	X		X	3
VT	X	X	X	X		4
WA	X	X	X	X		4
AK		X	X		X	3
AR	X	X			X	3
CT	X	X		X		3
ID	X		X		X	3
IL		X	X	X		3
KS		X	X		X	3
KY		X	X	X		3
MI	X	X			X	3
MT		X	X		X	3
NC		X	X	X		3
NH		X	X	X		3
NJ	X	X	X			3
SC		X	X		X	3
WI	X	X	X			3
CO	X		X	X		3
FL		X	X			2
GA		X	X			2
LA		X	X			2
ME	X	X				2
MO	X	X	X			3
ND			X		X	2
NE		X	X			2
OH		X	X			2
PA		X	X			2
SD			X		X	2
TX		X	X			2
UT	X				X	2
WV		X			X	2
WY			X		X	2
AL			X			1
MS		X				1
NV			X			1
VA			X			1

Sources
¹Based on Statehealthfacts.org, Medicaid Income Eligibility Limits for Adults as a Percent of Federal Poverty Level, July 2012 (accessed July 17, 2012).
²Based on Statehealthfacts.org, Income Eligibility Limits for Pregnant Women as a Percent of Federal Poverty Level (FPL), January 2012 (accessed July 10, 2012).
³Manatt Health Solutions, 49 States and DC Have Applied for Funding and Moved Forward to Implement the ACA, June 2012.
⁴State Refor(u)m, Governors Respond to SCOTUS Decision Infographic, June 2012.
⁵Center on Budget and Policy Priorities, States Continue to Feel Recession’s Impact, June 2012.

Produced by Katie Sheedy, National Academy for State Health Policy