Didn't the Supreme Court weigh in on this?
Yes. The court upheld the Medicaid expansion but limited the federal government's ability to penalize states that choose not to participate.

Will all states that expand Medicaid do it the same way?
No. Many states negotiated "waivers" as a condition of participation. Example: Republican Gov. Rick Scott of Florida announced that he would back expansion just hours after the federal government agreed to allow his state to enroll almost all of its Medicaid people in private managed-care plans.

How many states have decided to expand Medicaid?
So far, governors of 24 states plus the mayor of the District of Columbia have committed to it. But not all of the state legislatures have approved funds for the expansion.

How many states have opted out?
The governors of 14 states have said they oppose the Medicaid expansion, although the debate is still going in several of them.

That leaves 12 states. Do they have a deadline to decide?
No.

Why would a state opt out?
Even with all the help from the federal government, most states will still have to cover the added administrative costs related to the expansion. Some state officials also say they are concerned that the expansion will encourage eligible people who hadn't already enrolled in the program to do so, increasing the ranks of Medicaid recipients to unaffordable levels. Then, beginning in 2017, states will pay an increasing share of the costs (see the last question on the previous page).

What will happen to low-income adults in states that don’t expand Medicaid?
Many could be in a tough spot. One possibility is buying private insurance through an online health insurance "exchange," which all states are required to set up by October under the new health care law. But that option could be unaffordable: There are federal subsidies for this kind of insurance, but ironically the income eligibility requirement is too high for low-income people. (The exchanges were set up on the assumption that all states would expand Medicare coverage for their lowest-income adults.)  So without expanded access to Medicaid, millions of people may fall through the cracks.

To get Medicaid, can someone move from a state that opted out to a state that opted in?
Yes.

Also of Interest

• A sign of Medicaid improvements to come?
• Why is it so hard to fix how Medicare pays doctors?
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