Status of State Medicaid Expansion Decisions: Interactive Map

States Abstract of Exercise United States Protection below the Medicaid enlargement turned efficient January 1, 2014 in all states which have adopted the Medicaid enlargement aside from the next: Michigan (4/1/2014), New Hampshire (8/15/2014), Pennsylvania (1/1/2015), Indiana (2/1/2015), Alaska (9/1/2015), Montana (1/1/2016), Louisiana (7/1/2016), Virginia (1/1/2019), Maine (1/10/2019 with protection retroactive to 7/2/2018), Idaho (1/1/2020), Utah (1/1/2020), Nebraska (10/1/2020), Oklahoma (7/1/2021), and Missouri (Processing functions starting 10/1/2021 with protection retroactive to 7/1/2021).

Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, New Hampshire, New Mexico, Ohio, and Utah have accredited Part 1115 waivers to function their Medicaid enlargement packages in methods not in any other case allowed below federal legislation. A few of these Part 1115 waivers embody work necessities, which the Biden Administration has just lately begun the method of withdrawing.

STATES THAT HAVE ADOPTED AND IMPLEMENTED EXPANSION Arkansas In April 2021, Governor Asa Hutchinson signed a invoice handed by the Arkansas Legislature that will exchange the state’s present Medicaid enlargement program, Arkansas Works, with the Arkansas Well being and Alternative for Me (HOME) program, contingent on federal approval. Arkansas Residence would permit enlargement enrollees who adjust to work necessities and month-to-month premiums to enroll in personal market plans whereas enrollees who choose out of those necessities would obtain conventional fee-for-service Medicaid protection. Arkansas Works is about to run out on the finish of 2021 and has confronted authorized challenges. Idaho Enrollment in Medicaid protection below enlargement started on November 1, 2019, and protection for these enrollees started on January 1, 2020. Following a profitable enlargement poll measure in November 2018, in 2019 Governor Brad Little signed a invoice handed by the legislature that directed the Idaho Division of Well being and Welfare to hunt waivers for a number of modifications to the enlargement program and specified that if the waivers weren’t accredited by January 1, 2020, then all people as much as 138% FPL can be enrolled in Medicaid. The state submitted 4 waivers at path from this laws; nevertheless, just one has been accredited up to now. Kentucky On December 16, 2019, newly elected Democratic Governor Andy Beshear signed an government order rescinding the Kentucky HEALTH waiver that had been put aside by the courtroom in March 2019. The waiver had included numerous provisions together with a piece requirement, month-to-month premiums as much as 4% of earnings, and protection lockouts for failure to well timed renew eligibility or well timed report a change in circumstances. Kentucky’s enlargement program was initially carried out and continues to function below state plan modification (SPA) authority. Maine Maine carried out enlargement on January 10, 2019. Maine adopted the Medicaid enlargement via a poll initiative in November 2017. After former Governor LePage delayed implementation of the enlargement for months, new Governor Mills signed an government order on her first day in workplace (January 3, 2019) directing the Maine Division of Well being and Human Companies to start enlargement implementation and supply protection to these eligible retroactive to July 2018. CMS accredited the state’s plan retroactive to July 2, 2018 on April 3, 2019. Missouri Missouri started implementing enlargement by accepting functions on August 10, 2021, although the state won’t start processing functions till October 1, 2021. Protection can be out there retroactive to July 1, 2021, per a state supreme courtroom order. Missouri voters accredited a poll measure on August 4, 2020, that added Medicaid enlargement to the state’s structure. After Governor Mike Parson introduced that the state wouldn’t implement enlargement as a result of the poll measure didn’t embody a income supply, people who could be eligible for enlargement protection filed a lawsuit towards the state. In the end, the Missouri Supreme Courtroom dominated that the initiated modification is legitimate below the state structure and that the legislature’s funds appropriation authorizes the state to fund enlargement protection. Montana On April 18, 2019, the Montana Legislature handed a invoice (which was signed by Governor Bullock on Might 9, 2019) to proceed the state’s enlargement program with important modifications till 2025. This motion got here after Montana voters voted down a measure on the November 2018 poll that will have prolonged the Medicaid enlargement past the June 30, 2019 sundown date and raised taxes on tobacco merchandise to finance the enlargement. The accredited invoice directs the state to hunt federal waiver authority to make a number of modifications to the present enlargement program, together with including a piece requirement as a situation of eligibility and rising the premiums required of many beneficiaries. Per the laws, the state submitted a Part 1115 waiver proposal with these modifications to CMS on August 30, 2019 and the request is pending. Nebraska Enrollment in Medicaid protection below enlargement in Nebraska started on August 1, 2020, and protection for these enrollees started on October 1, 2020. Nebraska voters had accredited a Medicaid enlargement poll measure in November 2018, and the state delayed implementation to permit time to hunt a Part 1115 waiver to implement enlargement with program parts that differ from what’s allowed below federal legislation, together with a tiered profit construction that requires beneficiaries to fulfill work and wholesome habits necessities to entry sure advantages. Whereas CMS accredited this waiver on October 20, 2020, on August 17, 2021, the state requested to withdraw its accredited waiver, which CMS subsequently accredited on September 2. The state introduced that it plans to supply all enlargement adults full advantages beginning October 1, 2021. Oklahoma Enrollment in Medicaid protection below enlargement in Oklahoma started on June 1, 2021, with protection for these enrollees starting on July 1, 2021. Oklahoma voters accredited a poll measure on June 30, 2020 which added Medicaid enlargement to the state’s Structure. Language within the accredited measure prohibits the imposition of any extra burdens or restrictions on eligibility or enrollment for the enlargement inhabitants. Utah Medicaid protection below enlargement started on January 1, 2020. Following a profitable Medicaid enlargement poll measure in November 2018, the state legislature took steps to roll again the total enlargement by directing the state to submit a collection of Part 1115 waivers. On December 23, 2019, CMS accredited sure provisions within the state’s “Fallback Plan” waiver request to amend its Major Care Community Waiver to develop Medicaid eligibility to 138% FPL, efficient January 1, 2020; the approval additionally included work necessities for the newly expanded grownup Medicaid inhabitants. In February 2021, the Biden Administration started to withdraw waivers with work requirement provisions Virginia The Virginia Common Meeting accredited Medicaid enlargement as a part of its FY 2019-2020 funds on Might 30, 2018; Governor Northam signed the funds into legislation on June 7, 2018. Enlargement protection turned efficient below state plan modification (SPA) authority on January 1, 2019 after enrollment started on November 1, 2018. STATES THAT HAVE NOT ADOPTED EXPANSION Florida An initiative to place Medicaid enlargement on the 2020 poll was delayed by its organizing committee to the 2022 poll. Georgia On October 15, 2020, CMS accredited an 1115 waiver known as Georgia Pathways to Protection which extends Medicaid protection to 100% FPL for folks and childless adults with preliminary and continued enrollment conditioned on compliance with work and premium necessities and different eligibility and profit restrictions on the common state match charge. Though protection below this eligibility extension was set to start on July 1st, 2021, the state introduced a delay in waiver implementation till at the very least the tip of calendar 12 months 2021, following the Biden Administration’s steps to withdraw waivers with work requirement provisions. Kansas Democratic Governor Laura Kelly included Medicaid enlargement in her proposed funds for State Fiscal 12 months (SFY) 2022; nevertheless, the Republican-controlled legislature didn’t embody enlargement in its remaining funds. Individually, in February 2021 Governor Kelly had proposed Medicaid enlargement laws much like a bipartisan Medicaid enlargement invoice launched in January 2020 with premiums and a piece referral program, funded with income from medical marijuana gross sales and taxes relatively than with a reinsurance program and hospital surcharge as proposed within the 2020 invoice. On Might 26, the 2021 legislative session adjourned with none extra motion on Kelly’s invoice. Mississippi Though Mississippi’s Secretary of State accredited a 2022 Medicaid enlargement poll initiative for circulation in April 2021, on Might 19 the organizing committee suspended its marketing campaign following a Mississippi Supreme Courtroom determination ruling that the state’s whole poll initiative course of is inoperable resulting from procedural errors relating to poll initiative language within the state’s structure. Whereas Medicaid enlargement was a key challenge within the 2019 Mississippi gubernatorial election, present Republican Governor Tate Reeves opposes enlargement, making it unlikely that the state will take up enlargement via laws. North Carolina On March 24, 2021, Democratic Governor Roy Cooper included Medicaid enlargement in his biennial state funds proposal for State Fiscal Years (SFY) 2022-2023. The funds assumes that the estimated $1.3 billion for the state’s share of enlargement could be greater than offset with federal {dollars} below the inducement within the American Rescue Plan. In 2019, Governor Cooper vetoed the SFY 2020-2021 funds handed by the Republican-controlled legislature resulting from omission of Medicaid enlargement, and the 2019 legislative session resulted in a funds deadlock. In August 2020, Governor Cooper as soon as once more included Medicaid enlargement in his proposal for coronavirus-related changes to the FY 2020-2021 funds, however the legislature has not included enlargement in any of its coronavirus aid payments. South Carolina On December 12, 2019, CMS accredited two separate 1115 waivers for South Carolina which might lengthen Medicaid protection from 67% to 100% FPL for its dad or mum/caretaker relative teams and a brand new focused grownup group with preliminary and continued enrollment conditioned on compliance with work necessities on the common match charge. In February 2021, the Biden Administration started to withdraw waivers with work requirement provisions. South Dakota In November 2020, South Dakota’s Secretary of State accredited two 2022 Medicaid enlargement poll initiative petitions for circulation, each filed by the organizing committee Dakotans for Well being. One is a constitutional modification and the opposite is an initiated state statute (the constitutional modification requires roughly double the variety of signatures). Individually, the organizing committee South Dakotans Resolve Healthcare filed two related petitions for the 2022 poll in February 2021, together with an initiated constitutional modification subsequently accredited for circulation on March 25, 2021. Advocates have till November 2021 to collect the signatures. Wisconsin After the Wisconsin Legislature’s Joint Finance Committee voted to take away Medicaid enlargement funding from Democratic Governor Tony Evers’ State Fiscal Years (SFY) 2022-2023 funds proposal, Governor Evers signed an government order to carry a particular session for Medicaid enlargement laws on Might 25, 2021, proposing to make use of the extra federal funds the state might obtain below the inducement within the American Rescue Plan Act for different state improvement tasks. Nevertheless, on Might 25, the Republican-controlled legislature adjourned the particular session with out additional motion, and the legislature handed a SFY 2022-2023 funds with out Medicaid enlargement funding on June 30. The governor had included Medicaid enlargement in his earlier funds proposal for FY 2020-2021, however the Republican-controlled legislature didn’t embody it within the remaining funds. Wisconsin covers adults as much as 100% FPL in Medicaid however didn’t undertake the ACA enlargement. Wyoming A Medicaid enlargement invoice that handed the Wyoming Home for the primary time subsequently failed a vote within the Senate Labor, Well being, and Social Service Committee in March 2021. Nevertheless, on Might 11, 2021, the legislature’s Joint Income Committee voted to sponsor this invoice throughout a future session. The invoice would develop Medicaid contingent on the state persevering with to obtain a 90% federal match help proportion (FMAP) for the enlargement inhabitants and at the very least 55% for the normal Medicaid inhabitants (a 5 proportion level enhance from the normal match charge of fifty%, which is an incentive included within the American Rescue Plan Act for adopting enlargement). Previous to the brand new ARPA incentive, the Wyoming legislature had rejected a number of Medicaid enlargement payments throughout the 2020 and different earlier legislative classes.

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