Image Point Fr // Shutterstock The 2010 Affordable Care Act offered states an opportunity to expand eligibility for Medicaid, a health care program paid for jointly by the federal and state governments that covers care for low-income children, adults, people who are pregnant or have a disability, and older adults. The expansion extended Medicaid coverage to all low-income adults earning up to 138% of the federal poverty level–for individuals, that’s roughly $20,120 in 2023. To cover the costs, the federal government would pay for 90% of the program, and states would have to pay the remaining 10%. The result was a significant increase in the number of people covered by Medicaid. Before the expansion, 56.5 million people were enrolled in Medicaid and the closely associated Children’s Health Insurance Program. By May 2023, those programs enrolled 93.8 million people, according to the Kaiser Family Foundation. That’s 1 in 5 people (and 4 in 10 children) in the United States. Under the original law, states that chose not to expand their eligibility criteria would risk not receiving any federal funding for any of their Medicaid programs. But in 2012, the Supreme Court overturned that penalty for not expanding eligibility, and made it fully optional for states. While 40 states and Washington D.C. have adopted expansion, 10 have not. Most states that haven’t expanded have less health care coverage than the national average. Foothold Technology used data from the Kaiser Family Foundation to look closer at each of the 10 states that haven’t expanded Medicaid to learn about their ongoing health care challenges. Data points on Medicaid and Children’s Health Insurance Program enrollment are also included. The difference in enrollment from before the Affordable Care Act compared to May 2023 is calculated based on total enrollment per 100 residents in the state. Where Medicaid expansion hasn’t been adopted Foothold Technology At the beginning of 2014, 24 states and Washington D.C. expanded their coverage immediately. Since then, another 16 states have followed suit. In March 2023, North Carolina became the most recent state to enact Medicaid expansion legislation, but implementation may not come until 2024. In the remaining states, the Kaiser Family Foundation estimates that 1.9 million people who earn too much to receive government subsidies to buy private health insurance would be covered by Medicaid if it were expanded. States that haven’t adopted expansion cite economic factors and federal governmental overreach as reasons why they won’t. But Kaiser reviews of studies on Medicaid expansion have found people in states that did expand eligibility have better health, which is good for the states’ health care providers and overall economies. Alabama
10 states haven't expanded Medicaid–here are the health care challenges they face
