Voter-backed Medicaid expansion hit snags in 4 states. Where are they now?

Voters in several states approved Medicaid expansion in ballot measures in the 2018 election.

But whether politicians in those states actually decide to embrace them is another story.

Voters in Idaho, Utah, Nebraska and Maine approved ballot measures to expand Medicaid after leaders in all three red states shunned the option to do so under the Affordable Care Act in 2014.

But the response has been mixed, as some state leaders have stalled or sought loopholes to actually implementing expansion plans. Here’s more on where they stand: 


Republicans in Idaho’s state legislature are discussing nearly a dozen waiver options to restrict the expanded Medicaid program, including work requirements, copays and lifetime limits, the Idaho Statesman reported

RELATED: The 4 biggest Medicaid controversies in 2018 

Expansion won big in the state last year, where voters approved the policy by a 61-39 margin. Reclaim Idaho, a group that led the charge on Medicaid expansion in the state, estimates that an additional 62,000 Idahoans will be eligible for coverage once the program is expanded. 

The state’s Department of Health and Welfare projects that expansion would cost Idaho $10.4 million when it launches in 2020 and a cumulative $105 million. 

RELATED: CMS blocks Idaho’s plan to bypass ACA rules; Dems call Medicaid lifetime caps ‘unspeakably cruel’ 

But the debate on different “sideboards” to the expanded program could delay the Jan. 1 start date, according to the Statesman. State officials are expected to send an amended version of their Medicaid plan to the Centers for Medicare & Medicaid Services in the coming weeks, but Republicans want to hear back about the different waiver options before moving forward with the expansion. 

Each waiver the legislators decide to submit must be sent to CMS separately, according to the article. 

“That doesn’t mean they all have to be approved,” state Rep. John Vander Woude said. “It just means we want an answer. Don’t leave us hanging.” 


Legislators in the Beehive State are looking to push through a scaled-back version of the Medicaid expansion plan that was approved by voters in November, The Salt Lake Tribune reported

About 53% of voters approved the expansion in the state, which would cover an additional 150,000 residents. Utah will receive $800 million from the federal government to cover the program and will fund their share with a 0.15% sales tax increase. 

State senators delayed a vote on a slimmed-down version of Medicaid expansion on Friday to rewrite a bill that was too costly for some Republicans to support, according to the Tribune. Under the alternative plan, the expanded Medicaid program would cover people earning up to 100% of the poverty level, with the rest of an eligible expansion population—people making up to 138% of the poverty level—up for subsidies on the Affordable Care Act exchanges. 

RELATED: Utah may become the next state to seek Medicaid work requirements 

The bill would also add $30 million in funding on top of the $90 million earned by boosting the sales tax to fund an expansion “bridge” beginning on April 1 until CMS approves additional funding, according to the article. 

“We are looking for a win-win consensus and making sure we follow the will of the people, but do it in a fiscally prudent way,” Utah Gov. Gary Herbert said, CNN reported


Plenty of questions remain on how Nebraska’s expansion—passed by voters last year—could take shape, according to a report from NET, the state’s public radio station. 

A major holdup is a lack of information on who will sign up for Medicaid once the program grows, according to the article. For example, at present, 72% of Nebraskans on Medicaid are pregnant women, children and new mothers, but it’s unclear if the new Medicaid enrollees would follow that trend, thus leading to a snag in determining appropriate benefits. 

Legislative attempts to expand Medicaid in Nebraska failed six times, but it was approved by 53% of voters last year. A report from the University of Nebraska found the state to be a prime candidate for expansion, as greater access to Medicaid could meet the needs of a significant rural population. 

RELATED: 45% of the uninsured population is out of the ACA’s reach, KFF finds 

In addition, fewer than half (about 42%) of the state’s employers offer insurance coverage, the university found. 

Because of the stalled discussion on the appropriate benefits, Nebraska’s expansion rollout could take longer than planned, according to the article, though the governor’s budget anticipates a Jan. 1, 2020, launch. 

“At this juncture, I would tell you it’s certainly not going to be this year, and in all likelihood, it’s going to be somewhere further into 2020,” Matthew Van Patton, the state’s director of Medicaid, told NET. 


Maine’s young expanded Medicaid program has already enrolled more than 3,200 people, according to the latest figures from the state’s Department of Health and Human Services. 

Maine voters approved Medicaid expansion in 2017, but the road to implementing the program was decidedly bumpy. Former Gov. Paul LePage, who opposed expansion, said he would not allow it to move forward until legislators found the money to cover the state’s additional costs. 

However, in June, a Maine Superior Court judge ruled that LePage must move ahead with expansion. Despite the court’s order, LePage dragged his feet on expansion until he left office. 

Newly instated Gov. Janet Mills and her administration have worked to expedite the delayed expansion since she took office and are planning a much larger marketing blitz in the coming days, which should boost enrollment significantly, according to the Bangor Daily News.