Which states are expanding medicaid

Under the terms of the Affordable Care Act, the federal government contributes more generous funding to states that offer expanded access to the program to their residents. In Missouri, expansion would have meant an estimated , more people would have become eligible.

Mike Parson in May declined to implement the unfunded program. With Missouri now legally decided, 12 other states, mostly Republican-led, are still expansion holdouts — and seem unlikely to budge, despite the roughly 11 years that have passed since the ACA was passed and 18 months into a global health pandemic. Michener is an associate professor and co-director of the Cornell Center for Health Equity.

Then the program becomes very popular. A raft of studies proves out that Medicaid, and its expansion, is indeed a good investment — not just for health outcomes — but for state economies and budgets as well. But the American Rescue Plan , the massive stimulus legislation passed earlier this year, sweetens the pot even more for holdouts.

A recent report from the Commonwealth Fund analyzed the potential impacts of expansion with the enhanced incentives. One of them is a temporary increase in the portion of Medicaid costs that the federal government pays for each state — but that additional funding is contingent on the states not removing anyone from their Medicaid roles until the end of the COVID emergency period — which is expected to last throughout — unless the person moves out of the state or voluntarily requests that their Medicaid coverage be terminated the Georgetown University Health Policy Institute has a good summary of the Medicaid provisions in the law.

A federal judge has overturned federally-approved Medicaid work requirements in Arkansas , Kentucky , New Hampshire , and Michigan , citing the fact that numerous people would lose coverage under the terms of the work requirements, and the government had done nothing to ameliorate that problem. The Trump administration and some of the affected states appealed the court ruling, and the Supreme Court had planned to hear the case.

But the Biden administration clarified that they would not support an appeal of the court rulings that overturned the work requirements, and the Supreme Court pulled the case from its list of scheduled arguments in In the rest of the states where Medicaid work requirements have been approved, they have either been overturned by a judge, paused by state administrators, or are not yet scheduled to take effect. Governors in Virginia and Maine have also paused or withdrawn the Medicaid work requirements in those states.

Medicaid work requirements in Arizona and Indiana have been postponed or suspended for the time being.

And notably, the bipartisan Medicaid expansion legislation that was considered but not enacted in Kansas in did not include a work requirement it called for a work referral program instead, which would have been less costly for the state to administer and would not have resulted in people losing their coverage. Work requirements that were in effect in early but have since been suspended:. Medicaid expansion states where new governors withdrew pending work requirements:.

Expansion states where work requirements have been approved by CMS but are not yet in effect as of late Lawmakers in Louisiana considered several work requirement bills in , but none were enacted. Lawmakers in Pennsylvania passed Medicaid work requirement legislation in and again in , but Governor Tom Wolf vetoed both bills.

Lawmakers in Alaska considered Medicaid work requirement legislation in , but the measure did not advance to a vote. Several states that have not expanded Medicaid are seeking federal permission to impose Medicaid work requirements, despite the fact that their Medicaid populations are comprised almost entirely of those who are disabled, elderly, or pregnant, as well as children. The Trump Administration has begun granting work requirements in some of these states, although CMS Administrator, Seema Verma clarified in May that these states would have to clearly demonstrate how they plan to avoid situations in which people lose access to Medicaid as a result of the work requirement, and yet also do not have access to premium subsidies in the exchange.

Two non-expansion states have been granted federal approval to implement Medicaid work requirements for their existing Medicaid populations:. Non-expansion states seeking federal permission to impose a Medicaid work requirement:.

None are likely to be approved, given that the Biden administration has noted that work requirements are not in line with the overall mission of Medicaid ensuring access to health care.

Kansas had also requested CMS approval for a work requirement of 20 or 30 hours per week, depending on circumstances. And the bipartisan Medicaid expansion legislation that Kansas lawmakers considered in called for a work referral program instead of a work requirement.

Lawmakers in Missouri also considered legislation that called for an 80 hour per month work requirement, but the bill did not pass in the session. And voters in Missouri approved a ballot measure in that directs the state to expand Medicaid by mid But in November , the Trump administration published an interim final rule to update earlier rulemaking related to the COVID pandemic.

The new rules take effect immediately, but public comments were being accepted through January 4. The November guidance is called an interim final rule with request for comments, or IFC. In the IFC, the administration implemented a new approach, designed to give states more flexibility but also panned by critics as allowing states to reduce Medicaid benefits in the midst of a global health crisis.

Under the IFC, states are still required to keep Medicaid beneficiaries enrolled in coverage unless they voluntarily disenroll or move out of state. Most types of Medicaid coverage are considered minimum essential coverage, but there are a few exceptions.

Under the IFC, a person whose Medicaid eligibility circumstances change eg, due to age, or length of time since a baby was born, etc. But if their original Medicaid coverage was considered minimum essential coverage, they could only be moved to a category that also provides minimum essential coverage.

And if their original category was not minimum essential coverage but did provide access to zero-cost COVID testing and treatment, they could only be moved to another category that also provides that benefit.

The IFC does not change anything about the first requirement for the enhanced federal Medicaid funding, which is that a state cannot make its Medicaid eligibility standards any more restrictive than they were at the start of So as noted above, Medicaid work requirements would still prevent a state from receiving the additional federal funding. Revising the IFC is among the various health care actions that the Biden administration could take, but they have not done so as of June But thus far, CMS has not approved this provision for any states.

The agency also rejected a similar proposal from Utah in , and from Georgia in Massachusetts has a similar request that is pending CMS approval , although Massachusetts has already expanded Medicaid. And no states have received approval for an asset test for Medicaid.

Maine proposed an asset test as part of an waiver proposal, but that portion of the waiver was not approved. Several states have received approval , however, to impose premiums on certain Medicaid populations, restrict retroactive eligibility, and require more eligibility redeterminations.

Some other states followed suit to varying degrees over the coming years, but have since transitioned back to a more traditional approach Medicaid fee-for-service or Medicaid managed care. Arkansas is the only state that still uses the private option approach. New Hampshire enacted legislation in that directed the state to abandon the private approach to Medicaid expansion that was being used in the state at the time buying policies in the exchange for people eligible for expanded Medicaid and switch to a Medicaid managed care program instead.

The state submitted a waiver amendment proposal to CMS in August , and the transition took effect in Jaime S. King is the Bion M. Concentration on Law and Health Sciences. She is the Co-Founder and Executive Editor of The Source on Healthcare Price and Competition, a multi-disciplinary web-based resource about healthcare price and competition. Professor King has testified before Congressional committees on health insurance mergers and price transparency and currently sits on the Board of the American Society of Law, Medicine, and Ethics.

She holds a Ph. Carissa Dougherty, LCSW, has over 18 years experience providing direct clinical practice, program management, and policy work. Dougherty previously managed an array of permanent and transitional supportive housing programs for persons with mental health and substance use issues. She has co-chaired the local homeless Continuum of Care and provided Mental Health First Aid training to hundreds of homeless service and housing providers.

She leads a team of program specialists and policy analysts responsible for stakeholder engagement, system coordination, and policy initiatives. Prior to this role, she served as a Senior Advisor with a focus on coordinating services to address the housing needs for persons with IDD and behavioral health disabilities, exploring the sustainable financing options for health and housing initiatives, and promoting policies and programs that support such endeavors.

Improving Health through Housing. With over 30 years of healthcare experience, Ms. She manages all aspects of affirmative enforcement by the office, including multi-district cases involving antitrust and government program fraud, consumer protection, the opioid epidemic, the Affordable Care Act, immigration, the environment, privacy and data security, as well as cases pending locally.

She handled a broad variety of cases on behalf of the United States, its agencies and employees. She also spent over a decade in law firm practice focusing on business and financial litigation. His team provides support to the Oklahoma Health Care Authority state Medicaid agency in managing the pharmacy benefits for our state Medicaid members.

Jackson, the President of the Maine Senate. Craig practiced law at a firm in Portland, Maine, for two years prior to joining the Maine Legislature in Stacey received her B.

As Program Director, Ms. Through this initiative, Ms. Bresaw and her team work to empower employers to challenge stigma and provide supportive work environments for people in recovery and those impacted by substance use disorders. At Granite United Way, Ms. Bresaw oversees public health strategies and initiatives and works to align these efforts with existing collaborations, partnerships, and Community Health Improvement Plans. In addition, Ms. Born and raised in NH, Ms. Bresaw received her Master of Social Work Degree in from the University of New Hampshire, with a concentration in community and administrative practice.

She has worked in the field of public health and substance use disorders since In her current role, Ms. Bresaw provides ongoing technical assistance and support to key sectors to ensure the use of best practice approaches in public health and prevention.

Bresaw has significant experience in the development of strategic plans, logic models, evaluation plans, and work plans designed to impact crucial public health issues in our communities. Sarah Finne, DMD, MPH brings over 30 years of experience from both private practice dentistry and public health supervision of a large school-based dental program in New Hampshire to her work in Dental Medicaid. The Office is legislatively mandated as the state coordinating body for suicide prevention, intervention and postvention efforts.

The Office sets statewide priorities and works with state agencies and community organizations to develop and implement effective strategies, including a community grant program, means restriction education initiatives, the Zero Suicide initiative, education and awareness programs, emergency department and hospital outreach and education, the Colorado-National Collaborative, federal grant-funded initiatives, Mental Health First Aid, and a school grant program.

Brummett practiced family and appellate law in both Colorado Springs and the Denver Metro area. At CHIR she directs research on health insurance reform issues.

Her areas of focus include state and federal regulation of private health insurance plans and markets and evolving insurance market rules. Prior to joining the Georgetown faculty, Ms. From to , Ms. Corlette worked as a professional staff member of the U.

After leaving the Hill, Ms. Corlette is a member of the D. Bar and received her J. She lives in Alexandria, Virginia with her husband and two daughters. How to Slice the Pie? Market Segmentation. Richard N. He works to expand publicly funded health coverage; protect patient autonomy, especially in reproductive and end-of-life care; and support safety-net health care providers. She also comes with prior experience replicating effective youth development interventions and evaluating and improving child welfare and educational programs.

Prior to starting at CMS in , Mr. She began her work in the health insurance arena in law school with research on the impact of discriminatory health insurance benefit design on marginalized populations. In the four years that Ms. Duhamel has been with OSI, her work has focused on regulatory and legislative policy development, including the Surprise Billing Protection Act, legislation to align New Mexico law with the Affordable Care Act, protections against unscrupulous purveyors of short term and limited benefits plans, and guarantees for network adequacy and prompt and transparent benefit utilization review.

Her interests include treating whole families with a special focus on preventative health care, group visits, and medication-assisted treatment for opioid use disorder. Michael White has worked in the field of substance use disorder for over 9 years with an additional 3 years working with children and families. Michael specializes in substance use disorder program development between community agencies and judicial systems and has developed, implemented, and supported the integration of Medication Assisted Treatment into county and state correctional facilities located in Alaska, Arizona, Montana, North Dakota, Wisconsin, and Texas.

At Community Medical Services Michael supervises a team that closely works with Superior Court Drug Court Programs along with coordinating care to and from county and state correctional facilities. His experience also includes working within family courts, Department of Child Safety, and obtaining resources for pregnant women with substance use disorders by collaborating with community partners.

Michael is a national presenter in the areas of Collective Impact as an effective tool for the continuum of care, pregnancy and opioid dependence, along with Opioid treatment within Criminal Justice systems. For more than twenty years, Meredith has worked on behalf of children and their families, spending much of her career working to address the complex needs of children with mental health challenges who become involved with various other child-serving systems, including substance use, juvenile justice and child welfare.

Megan worked on Capitol Hill for 13 years for both Rep. Matt is a person in recovery from a substance use disorder who has spent his career helping those with substance use disorders initiate and sustain recovery. He brings together key individuals and groups that have the talents and resources needed to develop, foster, fund and implement new, integrated community services at the local level.

Mark has served as an Ombudsman for Long-Term Care learning firsthand the complex reality our most vulnerable adults live with each day. Before that role, he served with the US military in various leadership positions with responsibility for small and large-scale, multi-faceted teams and complex financial situations. Grant Foundation. She has published over papers, editorials, intervention training manuals, and several book chapters, focused on improving health care for diverse racial and ethnic populations.

In October , she was elected as a member of the National Academy of Medicine in acknowledgement of her scientific contributions to her field. Leann is the director of the Equity and Inclusion Division for the Oregon Health Authority, joining the agency in Leann has 25 years of leadership experience developing equity, diversity and inclusion programs.

He has 13 years of healthcare experience ranging from systems management to program integrity and mostly focusing on data analysis in various forms. Recently he has been involved in several large payment reform efforts including, implementation of the Enhanced Ambulatory Patient Grouper methodology for outpatient hospitals and developing a per member per month payment model for FQHCs. Prior to joining the staff of Children and Family Futures, Mr.

Katherine L. Gudiksen, Ph. Her work focuses on policies to address rising healthcare costs with an emphasis on state-level interventions to promote competition. While at The Source, she developed the pharmaceutical page to track and analyze state legislation to address rising drug prices. She also holds an A. This has streamlined and simplified the program for both members and providers, freed up resources for an extensive array of care delivery and value-based payment interventions, and enabled the program to reduce both per member, per month costs and overall spend.

Kate is a graduate of Oberlin College with a B. Her background is in community-based services for older adults, and she is the author of Connecticut Elder Law, a treatise that is republished each year. Both State agencies are responsible for promoting the transparency of health care costs and quality in the State of Maine. MQF is responsible for improving health care quality in the state. Prior to her current role, Ms. She earned her B. Julia works with ADHS leadership and management on a variety of public health functions as related to oral health and has been in her current position for ten years.

She was responsible for developing the first comprehensive state oral health plan for Arizona. She has over 20 years of experience in various public health settings providing needs assessment, policy development and quality assurance at local, state and national levels. In this position Mr. Allen is responsible for developing agency-wide goals, objectives and strategies to eliminate health disparities and promote health equity for all Ohio residents.

Additionally, Mr. Allen works in partnership with national public health organizations, state cabinet-level agencies and a variety of public health programs to target services to disenfranchised groups, measure program performance and assess outcomes. Allen has served in various public health capacities. Allen has implemented statewide social marketing activities to respond to chronic diseases; developed enterprise-wide program evaluation systems; and pioneered the use of market research analytic tools with GIS mapping capability to respond to health inequities.

Cardenas has played a critical role in the shaping of important health coverage legislation in Maryland including the Maryland Easy Enrollment Health Insurance Program. Cardenas also manages agency relationships with state and federal legislators and regulatory industries; oversees the implementation and administration of the State Reinsurance Program; and provides end-to-end management and oversight of carrier relationships ranging from consumer enrollment to experience.

He has been with the Maryland Health Benefits Exchange since in a variety of roles before assuming his current position in As Assistant Secretary, Jodi supports the development of health and behavioral health policy in the Commonwealth.

Jason Rachel, Ph. In this role, he is responsible for providing executive leadership in the management and implementation of both current and new integrated care programs. Rachel directs and oversees all operations, policies, contract compliance and quality monitoring activities within the division to provide high quality, person-centered coordinated care services.

An attorney with extensive experience as a litigator, researcher and advocate, Ms. New Recipes to Control Rx Pricing. She served as legal counsel to the Washington State House of Representatives for twenty years, working on a broad range of health, behavioral health, long term care, human services and criminal justice issues. Jim provides executive consulting services to technology-enabled companies in the pharmacy services and SaaS space.

Heidi has over 20 years of experience working with individuals and families in private practice, group homes, long-term and home health care settings. Thomas in St. After serving one term as a Representative in the Maine House, Heather ran for the State Senate and is currently serving her first term, representing part of Portland and Westbrook, Maine. A former public school teacher and attorney, Heather now owns and runs Rising Tide Brewing Company with her husband, Nathan, in Portland.

Heather and her husband live in Portland with their teenage son. In her role as Section Supervisor, she coordinates the Hawaii Stop Flu at School Program, a school-located influenza vaccination program that conducts annual clinics in over participating schools, statewide.

Gary Cohen has been a pioneer in the environmental health movement for thirty years. He was also instrumental in bringing together the NGOs and hospital systems that formed the Healthier Hospitals Initiative. All three were created to transform the health care sector to be environmentally sustainable and serve as anchor institutions to support environmental health in their communities. He has helped build coalitions and networks globally to address the environmental health impacts related to toxic chemical exposure and climate change.

Cohen is a member of the International Advisory Board of the Sambhavna Clinic in Bhopal, India, which has been working for over 25 years to heal people affected by the Bhopal gas tragedy and to fight for environmental cleanup in Bhopal. Erica Guimaraes is a program coordinator in the Office of Community Health Workers at the Massachusetts Department of Public Health, where she assists in promoting best practices for CHW integration into health care and public health teams.

Stout directs the Suicide Prevention Resource Center SPRC project at EDC, leading a team that provides resources and capacity building services to state and local leaders, health and behavioral health agencies and organizations, federal suicide prevention grantees, and national stakeholders involved in suicide prevention efforts across the country. She has worked in the suicide prevention field for 12 years, with a focus on building state and tribal suicide prevention workforce and infrastructure capacity for strategic, comprehensive, evidence-informed suicide prevention programs.

Stout serves as a subject matter expert on substance abuse and suicide prevention collaboration, strategic planning, accessing and using surveillance data for program planning and evaluation, and knowledge translation and dissemination. She has presented widely at national and local conferences, as well as participating in federal and other national advisory groups, including a current national effort to develop recommendations for state suicide prevention infrastructure.

Stout holds a Masters of Science in Health Communication, and has worked with state and local audiences to build capacity in strategic and effective messaging and campaigns for behavior change. Doug has worked in the mental health and substance use disorder field for over 24 years in various capacities as a direct service provider and administrator. He has worked in both urban and rural settings and previously oversaw County services implementing evidence-based service delivery models; expanding prevention, treatment and recovery support services in rural Utah including work with tribal government.

Doug is passionate about prevention and early intervention and integrating prevention efforts into systems to produce lasting outcomes to reduce risk and increase the well-being of individuals, families, and communities. Within that role, her focus is on person-centered strategy and innovation.

A Little More Help Please? Improving Assisted Living. Chan School of Public Health. After voters legalized medical marijuana in Oklahoma through ballot initiative, David was the lead Senate staffer on the bicameral Medical Marijuana Working Group, which held public meetings with experts from the marijuana industry, state agencies, law enforcement, the medical field, the Oklahoma business community and NCSL throughout the summer of to study how best to implement the new medical marijuana program.

David drafted the resulting Oklahoma Medical Marijuana and Patient Protection Act, which created a regulatory framework for the program, as well as various other pieces of legislation relating to medical marijuana. David serves as the Deputy Commissioner of Insurance in Las Vegas, and oversees the consumer services and enforcement sections of the Division.

David also has spent many years as an assistant attorney general, in Vermont and American Samoa, and started his law career in private practice in Florida, where he was board certified in appellate practice, mostly working on behalf of insurance companies.

As the programs undergo transformation to even better fit the needs of state and its residents, he is committed to the fundamental goal of improving the health and well-being of all residents. Richard believes the right way to achieve success is to work closely with stakeholders in all aspects of Medicaid. Richard joined DHHS after leading The Arc of North Carolina, an advocacy and service organization for people with intellectual and developmental disabilities, as its Executive Director for 24 years.

She provides support to families, advocates and service providers on family driven care, systems advocacy, and family empowerment. Daphnne provides training and technical assistance to family-run and provider agencies in preparation for the transformation to Medicaid Managed Care.

Daphnne has a B. In his role, Tsai is responsible for ensuring a robust and sustainable MassHealth program that best meets the needs of members. That includes developing new policies, payment models, and operational processes that improve the way health care is delivered to 1. He has significant experience on the design and implementation of innovative, state-wide health care payment systems for Medicaid, Medicare, and Commercial populations, and has worked closely with multiple state Medicaid programs, private payers, and health services companies.

He received a Bachelor of Arts in applied mathematics and economics from Harvard University. Assistant Secretary Tsai lives with his wife and son in Cambridge. Which Way is the Wind Blowing? MCOs at a Crossroads. Prior to OHCS, he worked in a homeless shelter as a housing case manager, for elected officials, and in various levels of government working in different capacities at the nexus of health and housing.

Born and raised in Alaska, Mr. Lasley has 25 years of business management and organizational leadership experience with a passion for elders and promoting public health.

Kirk Robins has worked to develop, progress, and implement state-level policy to address prescription drug affordability, and continues to collaborate with other state initiatives to improve legislative approaches to this issue.

In this role, she promotes public health and prevention activities, as well as provides guidance and oversight on a variety of cross-Departmental issues. She has been active and has served in leadership roles in many local, state, and national pediatric, public health and preventive medicine organizations. Beth Waldman is a Senior Consultant at Bailit Health with national expertise in health care policy, program development and implementation, specializing in Medicaid and CHIP programs and coverage for the uninsured.

Prior to joining Bailit Health, Beth worked for 12 plus years within the Massachusetts Medicaid program and served as the Massachusetts Medicaid Director from — Beth Kuhn is Chief Engagement Officer at the Kentucky Cabinet of Health and Family Services, leading policy and operational efforts to better integrate workforce, health and human service programs. She was until recently Commissioner of the Kentucky Department of Workforce Investment, collaborating with many partners in a system of Kentucky Career Centers providing employment, vocational rehabilitation, veterans, and other workforce services to employer and individual customers.

Prior to her appointment as Commissioner in December of , Beth served as Sector Strategies Director, assisting with the design and implementation of industry sector-based approaches to workforce and economic development. Beth has over 30 years of experience creating and implementing innovative workforce programs.

The Maryland Health Care Commission is an independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access to health care and health care coverage in Maryland. This Center has analytic and operational responsibilities for health care practitioner initiatives in the state including development of an All Payer Data Base and the Patient Centered Medical Home Program.

Steffen serves as a spokesperson for the Commission at state and national levels on state health care expenditures, physician work force, physician uncompensated care, and information security. Before joining the MHCC, he served as a budget analyst in the Health, Housing, and Income Security Division of the Congressional Budget Office, among activities he worked on the modeling that produced the estimates of reforms that ultimately led to the Medicare Prospective Payment System.

He is a former Peace Corps volunteer to Nepal. As a California native, Amir earned his B. W from Columbia University. Alfred has served in various staff and management capacities in private industry, county and state government serving vulnerable populations since Alfred has worked for the Division of Quality Assurance since While in DQA, Alfred has been instrumental in establishing collaborative statewide working relationships with counties, care management organizations, advocates and industry representatives to help improve the quality of care in assisted-living settings.

Knudson has over 25 years of experience implementing and directing public health programs, leading health services and health policy research projects, and evaluating program effectiveness. Her research and policy project findings have informed state, Tribal, and Federal health policy. A lifelong Oklahoman, Ashley has dedicated herself to the people of Oklahoma. Ashley is active in her political party at the state level, recently served as the Speaker of the House of Oklahoma Intercollegiate Legislature, and volunteers with a nationally accredited animal rescue, Tornado Alley Bulldog Rescue.

When she is not saving dogs, Ashley enjoys fishing, reading, and cooking although not at the same time. Where States Stand on Medicaid Expansion. Updated Oct. Sign Up for Our Weekly Newsletter.

This form needs Javascript to display, which your browser doesn't support. Sign up here instead. This field is for validation purposes and should be left unchanged. Washington, DC Office: 20th St. Contact Us Phone: Develop sustainable cross-agency financing. Under the waiver, five independent pilot programs are currently being implemented. The state is exploring use of i Medicaid authority to implement the remaining approved pilot programs, including a tenancy support project to support individuals at risk of institutionalization and homelessness.

Compiled information from a state-operated facility to inform interventions for super-utilizer groups in Chicago. CSH provided education and TA with a particular focus on supporting individuals living with developmental disabilities.

This population remains a priority for the Illinois team. Facilitated five rounds of funding for supportive housing developments of 25 units or less through the Permanent Supportive Housing Development Program, with approximately units approved per round. The Request for Applications has been released, and IHDA is encouraging applicants to develop larger and more creative housing projects.

Next Steps Continue review of health and hospital projects for potential state system data matching and housing initiative opportunities. Continue work on pre-tenancy and tenant supports for Illinois residents. Subscribe to our Palliative Care e-newsletter. Fuse Brown. Victoria Veltri. Trisha Schell-Guy. Schell-Guy resides in Glenmont, New York with her husband, two children and several pets.

Michael MacKenzie. Jordan Kiszla. Jessica Altman. Christopher Smith. Oliver Droppers. Ben Money. Barbara Paulson. Steve Pearson. Michelle Mello. Trish Riley. Pam MacEwan. Todd Landry.