“Since January 1, 2014, states have had the option to extend Medicaid coverage to most non-elderly, nonpregnant adults with income up to 133% of FPL. Twenty-four states and the District of Columbia implemented the ACA Medicaid expansion at that time. Since then, the following seven states have implemented the expansion: Michigan (April 1, 2014), New Hampshire (July 1, 2014), Pennsylvania (January 1, 2015), Indiana (February 1, 2015), Alaska (September 1, 2015), Montana (January 1, 2016), and Louisiana (July 1, 2016). (See Figure 1.)

“Virginia is expected to begin coverage of the ACA Medicaid expansion on January 1, 2019. Maine adopted the expansion through a ballot initiative in November 2017, and Maine’s current governor has refused to implement the expansion. However, the governor-elect has stated publicly that she will implement the expansion.

“The results of the November 2018 election could have implications for the ACA Medicaid expansion. In Idaho, Nebraska, and Utah, voters approved ballot initiatives to implement the expansion. Also, new governors and changes in the composition of state legislatures could change states’ decisions regarding the expansion. Some non-expansion states might decide to adopt the expansion, and some expansion states could decide to end that coverage.”

Source: U.S. Congressional Research Service. In Focus: Overview of the ACA Medicaid Expansion (IF10399; Dec. 3, 2018). https://crsreports.congress.gov/product/pdf/IF/IF10399