Thirty-three states and Washington, DC, have expanded access
to Medicaid under the Affordable Care Act. In most states, expansion took place
through legislative action, but after November, three states may expand access
through the polls. Medicaid
expansion referendums are on ballots in Idaho, Nebraska and Utah,
and a similar initiative to extend expansion beyond a scheduled sunset is on
the ballot in Montana. Experts see the referendums as significant, as all four
states are traditionally conservative and opposition to Medicaid expansion is
most likely to occur. The referendums are polling in favor of the expansions
in all four states.
In Utah, the expansion vote will compete against a partial
expansion proposal that was passed by the legislature and signed by
Governor Gary Herbert in March. The legislative plan would expand access to
individuals who earn up to 100% of the federal poverty level, instead of 133%
as prescribed by the Affordable Care Act. The partial expansion would also implement
a work requirement for enrollees and would require approval of a waiver by the
Centers for Medicare & Medicaid Services (CMS). CMS is not expected to make
a determination on the partial expansion waiver until after
the November midterm elections.
A similar referendum passed in Maine last November, but
implementation has not occurred, as the state’s governor, Paul LePage, has
refused to implement the program. Implementation in that state may soon begin,
however, as Governor LePage was ordered by
the Maine Supreme Judicial Court to submit plans for expansion to the federal
government.