Although Medicaid expansion is now eight years old, a dozen states still haven’t adopted it. How likely are the holdouts to change course in 2022?
More likely than it might seem. State leaders are looking for ways to shore up budgets, support struggling hospitals, and rebuild public trust as the pandemic wanes. They know expansion is popular with voters of all party affiliations, saves money, and prevents rural hospital closures.
Also read: New Wave of Medicaid Expansion? Maybe!
The holdouts — Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming — have more reason than ever to ink expansion into law this year.
Here’s which ones actually might:
- North Carolina
After fighting Expansion for years, state Senate Republicans finally appear to be on board. They’re expected to introduce legislation shortly that would expand Medicaid to about 600,000 North Carolinians, more than doubling the number of state residents currently enrolled.
Democratic Gov. Roy Cooper, who tried in state budget negotiations to sway legislative Republicans on Expansion, is likely to sign the bill.
- South Dakota
This November, South Dakotans will vote on a constitutional amendment to expand Medicaid. But thanks to a referred amendment on the June ballot, it — and any other ballot question involving $10 million or more in taxation or spending — may require 60% approval.
If the expansion amendment passes, 42,500 new South Dakotans may qualify for Medicaid coverage.
Legislators joined pro-expansion Wyomingites at a rally in February in support of House Bill 20, which would expand Medicaid to 24,000 additional residents.
Although the legislation passed Wyoming’s House in 2021, it was defeated in the Senate. Two-thirds of Wyoming residents support expansion
Kansas Gov. Laura Kelly announced on February 9 legislation to fulfill her 2018 campaign promise to expand Medicaid. If it becomes law, 150,000 additional Kansans would be able to enroll for coverage beginning January 1, 2023.
Although nearly 8 in 10 Kansans favor expansion, the proposal is likely to face pushback in Kansas’s Republican-controlled House and Senate.
For full expansion, Georgians may need to be patient. However, low-income mothers will be eligible for a year of Medicaid coverage, based on a bill passed by the Georgia State Senate, which Gov. Brian Kemp just signed into law.
Bonus: The Biden Administration
Although Medicaid is state-administered, a recent move by the Biden administration is expected to boost adoption in some expansion states this year.
Program waivers give states flexibility to customize their Medicaid programs. The Biden administration reversed waivers granted by the Trump administration allowing limited collection of premiums from Medicaid recipients. In its announcement, the Biden White House pointed to data suggesting these waivers have reduced sign-ups and re-enrollments.
Don’t expect expansion to go nationwide in 2022. But in these states — and perhaps even a few surprises — watch for the winds to blow in its favor.