Medicaid Expansion 2025: Which states are expanding coverage next year and which are not?

Medicaid Expansion 2025: Medicaid expansion continues to evolve across the United States, with 41 states and Washington, D.C., currently offering expanded coverage under the Affordable Care Act (ACA). This expansion allows nearly all low-income adults earning up to 138% of the federal poverty level to qualify for Medicaid.

The expansion has significantly increased healthcare access and affordability in these states, reducing the uninsured rate and improving health outcomes for low-income populations.

However, 10 states, Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming, still have not expanded Medicaid. For 2025, some of these states are reconsidering Medicaid expansion or exploring modified approaches. In states that have expanded Medicaid, the results have included improved access to preventive care, decreased uncompensated care costs for hospitals, and better health outcomes overall.

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The non-expansion states face ongoing debates as they balance budget concerns and health access needs, with increasing attention on the potential health and economic benefits of adopting Medicaid expansion.

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As Senate and House leaders have expressed support for the measure and indicated they may take it up in the next legislative session, expansion talks in Mississippi have heated up.

However, Governor Tate Reeves has opposed this initiative, arguing that Medicaid is a welfare program. It’s unclear if expansion will proceed in 2025 due to the divergent opinions of state leaders.

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With Governor Laura Kelly’s “Cutting Healthcare Costs for All Kansans Act,” which would make Medicaid accessible to more low-income citizens beginning January 1, 2025, Kansas is also looking into expansion. Although there are some exceptions for specific groups, this proposal still has a work requirement. It is still unclear if the Kansas legislature will accept this bill.

Through a Section 1115 waiver, Georgia has recently expanded Medicaid in a limited way, providing coverage to adults who meet certain work requirements and earn up to 100% of the federal poverty level. This represents Georgia’s distinct strategy for increasing healthcare access without completely implementing ACA regulations, and it is distinct from the full ACA Medicaid expansion.

Given that conservative organizations have begun calling for a rollback of the program, Montana may take the unexpected step of considering terminating its Medicaid expansion in 2025. Montana might affect thousands of people if it were to become the first state to stop Medicaid expansion.