Medicaid Expansion Update – Idaho, Nebraska, Utah, Maine & Virginia

20 Aug Medicaid Expansion Update – Idaho, Nebraska, Utah, Maine & Virginia

Support for Medicaid expansion is on the rise as states approach general elections this fall. Advocates for expansion have been busy in recent months as they look to expand their programs by way of ballot initiatives. In May we reviewed a number of states considering expansion. Here is an update on their progress:



Nebraska has not been able to expand Medicaid for the last seven years and recent legislative efforts such as the Legislative Resolution 281CA are in gridlock between lawmakers. However, in March, Senator Morfeld supported a petition that would give citizens the opportunity to vote on the issue. Under the Insure the Good Life petition, 84,268 valid signatures were required by July 6th in order to have the issue on November’s ballot. The ballot initiative would expand coverage to 90,000 Nebraskans.

The petition effort surpassed the mandate of 84,268 signatures with 133,000 submitted for review. While this boosted the outlook of expansion supporters, it has been countered by an attempt to block the petition. Two Republican legislators, Senators Lydia Brasch and Mark Christensen, have filed a lawsuit against the effort. The senators are concerned with the negative effects it could have on taxes and also the impact on existing coverage.

The proposal to expand would extend coverage to single adults and couples without minor children that are not eligible for Medicaid currently. In addition, parents and disabled individuals whose income is up to 138% of the poverty level would be covered. Over an 8-year period, it’s estimated that expansion would cost the state $100 million annually.

Meg Mandy, campaign manager for Insure the Good Life, criticized the lawsuit calling it, “a desperate attempt to block the people’s ability to voice their opinion on this issue and ensure affordable health care for 90,000 Nebraskans.” According to Mandy, these are “two politicians who have failed to find solutions for working Nebraskans to access health care.”



Idaho’s ballot initiative, Reclaim Idaho, believes that expansion will save taxpayers money and aims to expand coverage to 62,000 citizens. Supporters of the initiative argue that the 62,000 people are in a coverage gap between Medicaid and insurance on the state exchange. They are either making too much money to qualify for Medicaid or not enough in order to secure insurance on the state exchange.

On July 17th, the effort paid off and Idaho’s Secretary of State, Lawerence Denney, confirmed that the ballot initiative had obtained enough signatures in order to have Medicaid expansion on November’s general election ballot.

The initiative looks to extend coverage for those who are not otherwise eligible for any other coverage under the state plan. If passed, Medicaid eligibility will expand to include people under 65 whose modified adjusted gross income is 133% of the federal poverty level or below.

At the beginning of August, a number of Republicans began to show support for the initiative. Among the supporters was the chairman of the State’s Legislature House Health and Welfare Committee, Fred Wood (R). He announced his endorsement for the initiative and told Times-News, “The Legislature’s been struggling with this problem for years.” The chairman believes that it is the best solution for the uninsured population within the coverage gap.



Medicaid expansion is being pursued by two separate fronts in Utah. While advocacy groups are seeking expansion through a ballot initiative, Governor Herbert has signed a bill requesting for partial expansion from the federal government.

Bill HB472 would expand the state’s Medicaid program under the condition that it would only expand to 100% of the Federal Poverty Level (FPL), rather than the federal mandate of 138%. By 2020, 72,000 residents would be eligible for coverage and the out of pocket expenses would be far less under the bill.

According to The New York Times, CMS is no longer considering Utah’s partial expansion for the time being. However, that may change after the midterm elections.

On the ballot initiative front, Utah Decides secured the required signatures in order to have expansion on the November 6th ballot. If approved by voters, the expansion would extend coverage to 138% of the FPL. That equates to nearly $17,000 a person, or $34,000 for a family of four. It’s estimated by initiative organizers that an additional 150,000 adults would gain eligibility as a result of the expansion.



After nearly 6 years of resistance from Republican legislators, Virginia voted in favor of Medicaid expansion under the ACA on May 30th, 2018. The provision to expand the state’s Medicaid program to over 400,000 Virginia residents was included in the General Assembly’s approved budget. However, it came at a cost. Republicans only approved the expansion under the condition that it would include a 20-hour-a-week work requirement.

As Virginia prepares for Medicaid expansion there may be additional obstacles ahead, delaying and potentially preventing the additional coverage. The main issue is the work requirement mandated by Republicans. Critics consider the restrictions to be a violation of the law because it could potentially block a person from access to healthcare. They argue that many of the people that would be eligible for coverage under expansion would have to choose between working more hours and healthcare.

Regardless of the controversy over work requirements, officials say that Medicaid will expand this coming year regardless of whether or not the requirements are denied or approved.



Last November, MaineCare, Maine’s Medicaid program received support for expansion after 59% of voters voted in favor by way of a ballot initiative. Despite its support, the state’s Governor, Paul LePage opposed the initiative and placed expansion in a legislative deadlock.

Governor LePage is concerned over the financial strain that expansion would place on the state. The governor stated, “this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget.”

Shortly thereafter, Maine Equal Justice Partners filed a lawsuit against DHHS for the failure to act and deny residents coverage. MEJP asserts that the governor is denying newly eligible applicants coverage that is mandated by law.

After review, a Superior Court judge ruled in favor of MEJP; however, the state’s administration is appealing the ruling. Currently, a decision on the matter is pending in Maine’s Supreme Judicial Court.

At the moment, expansion is still in deadlock but that has not stopped citizens from applying for coverage. Additionally, the LePage administration and Maine’s Department of Health and Human Services is immediately rejecting these applications. Regardless of the rejection of applications by the LePage administration, MEJP is instructing people to continue to apply for Medicaid.

Nearly 80,000 low-income citizens would be eligible for Medicaid coverage as a result of the expansion. This number includes parents that were not previously eligible and childless adults.

When questioned about the status of expansion, DHHS has declined to comment due to the pending lawsuit. The state could end up paying nearly $200,000 for a  lawyer to defend the LePage administration.


Despite the Trump administration’s efforts to reform Medicaid on the federal level, a number of states are pursuing Medicaid expansion by implementing ballot initiatives. These efforts are allowing voters to step out in front of their legislatures and voice their support for expansion at the polls this fall.