State Resources

In National Federation of Independent Business v. Sebelius (NFIB), the Supreme Court decided that the ACA provision requiring states to expand their Medicaid programs to individuals with incomes below 138% of the federal poverty level was constitutional, but the federal government’s enforcement power to require states to implement the expansion is limited. As a result, a number of states have said they may ignore the Medicaid expansion requirement, putting their most vulnerable at risk. NHeLP has drafted a series of resources to help state advocates support full implementation. In addition, advocates from across the country are producing their own fact sheets, reports and other materials supporting Medicaid expansion in their states, provided in the links below. (Unless they are co-branded, NHeLP has not participated in the preparation of these materials and questions should be directed to the state advocates themselves.)

• Ensuring Accessibility for Individuals with Disabilities in the ACA's Marketplaces (May 2013)
• Language Access Checklist For Marketplace Implementation (Mar. 2013)
• Translation Glossaries: The Need for Standardization of ACA-related Terms (Feb. 2013)
• Coverage for Lower-Income Adults: Exchange versus Medicaid (Jan. 2013)
• NHeLP’s Guide for Evaluating Fiscal Analyses of the ACA’s Adult Medicaid Expansion (Jan. 2013)
• Top Five Myths and Facts about the Cost of the ACA’s Adult Medicaid Expansion (Jan. 2013)
• NHeLP and Shriver Center Webinar: Concentrating Resources on Convincing States to Adopt the New Medicaid Eligibility Category (Oct. 2012)
• Fact Sheet: 10 Advocacy Steps To Support A Medicaid Expansion In Your State (Sep. 2012)
• NHeLP Medicaid Expansion Presentation: Make it Happen in Your State (Sep. 2012)
• Health Affairs Blog - Medicaid Expansion: A Closer Look At Vulnerable Populations And State Coverage Opportunities
• Community Catalyst report: Supreme Court Ruling on Medicaid: Challenges and Opportunities for State Advocates (Aug. 2012)
• Medicaid Expansion in Your State: Provider Assessments (Aug. 2012)
• NHeLP’s 50 Reasons Medicaid Expansion is Good for Your State (Aug. 2012)
• Urban Institute: Considerations in Assessing State-Specific Fiscal Effects of the ACA’s Medicaid Expansion (Aug. 2012)
• Urban Institute: The ACA’s Medicaid Expansion: Fiscal Bane or Boon to States Presentation (Aug. 2012)
• NHeLP Q&A: The Supreme Court’s Decision on the ACA’s Medicaid Expansion (#1/2) (Jul. 2012)
• NHeLP Q&A: Disproportionate Share Hospital Payments and the Medicaid Expansion (Jul. 2012)

Reproductive Health Publications

• NHeLP’s 10 Reasons the Medicaid Expansion is Good for Women (Aug. 2012)
• NHeLP’s 10 Reasons the Medicaid Expansion Helps to Address Health Disparities (Aug. 2012)
• NHeLP’s 10 Reasons Medicaid Expansion Benefits Women Living with HIV (Aug. 2012)

State-by-State

• Arkansas
  • Testimony of Andrew Allison, Ph.D., Director, Division of Medical Services, Arkansas Department of Health Services, Before The Committee on Energy and Commerce Subcommittee on Health (Dec. 13, 2012)
  • Arkansas Advocates for Children and Families - Strengthening Medicaid is a Good Deal for Arkansas
  • Arkansas Dept. of Health Estimated Medicaid-Related Impact of the Affordable Care Act with Medicaid Expansion (July 2012)
  • Arkansas Dept. of Health Initial cost estimates for Medicaid expansion (July 2012)
  • Arkansas Center for Health Improvement - Expanding Health Care Coverage for Arkansans: The Facts
  • Arkansas Surgeon General’s Brief: Importance of Medicaid Expansion through the Patient Protection and Affordable Care Act (Aug. 2012)
  • University of Arkansas - THE ECONOMIC IMPACT OF MEDICAID SPENDING IN ARKANSAS (May 2010)
• Arizona
  • William E. Morris Institute for Justice - Re: Arizona’s Section 1115 Waiver Amendment Request Continuing Coverage for Childless Adults Under the Demonstration (Oct. 2012)
• California
  • Customer Service Principles and Performance Standards for Exchange Call Centers (Mar. 2013)
  • UCLA Center for Health Policy Research - Medi-Cal Expansion under the Affordable Care Act: Significant Increase in Coverage with Minimal Cost to the State (Jan. 2013)
  • Community Health Councils - What the Medicaid Expansion Means for California (webinar) (Oct. 2012)
  • WCLP/NHeLP: The Impact of the Supreme Court ACA Decision on the Medi-Cal Program (Jun. 2012)
• Colorado
  • Office of Gov. John Hickenlooper - Colorado will save more than $280 million as Medicaid Expands (Jan. 2013)
  • Dept. of Health Care Policy and Financing - Expanding Colorado Medicaid: Caseload and Cost Projections (Jan. 2013)
  • Colorado Center for Law and Policy – Expanding Medicaid makes Colorado's workforce and economy healthier (Dec. 2012)
• District of Columbia
  • Medical Care Advisory Committee (MCAC) Behavioral Health Subcommittee: FY 2011 Report and Recommendations (Aug. 2012)
• Florida
  • Florida Legal Services - White Paper: Medicaid Expansion (Feb. 2013)
  • TPM - Rick Scott Under Fire For Inflating Cost Of Health Law's Medicaid Expansion (Jan. 2013)
  • Georgetown Center on Children and Families - Florida's Medicaid Choice: Understanding Implications of Supreme Court Ruling on Affordable Health Care Act (Nov. 2012)
  • Florida Legal Services
  • FLS: Screening for Eligibility for Medicaid Expansion/Interested in Advocacy? (Oct. 2012)
  • FLS: Medicaid Expansion is important for children (Sep. 2012)
  • FLS: Medicaid Expansion Makes Good Sense (Cents) for Florida (Sep. 2012)
  • FLS: Medicaid Expansion is Critical for Florida Communities (Sep. 2012)
  • Social Services Estimating Conference Estimates Related to Federal Affordable Care Act: Title XIX (Medicaid) & Title XXI (CHIP) Programs (Aug. 2012)
  • Florida Center for Fiscal and Economic Policy (Aug. 2012)
• Georgia
  • Atlanta Journal Constitution: Health care reform: Risk of playing the odds (Sep. 2012)

• Idaho
  • Leavitt Partners: Idaho’s Newly Eligible Medicaid Population: Demographic and Health Condition Information (Executive Summary) (Sep. 2012)
  • Leavitt Partners: Idaho’s Newly Eligible Medicaid Population: Demographic and Health Condition Information (Full Report) (Sep. 2012)
  • State Impact: Supporters of Idaho Medicaid Expansion Speak Out, But Costs Remain A Big Question (Aug. 2012)
• Illinois
  • Illinois Health Matters
  • Heartland Alliance: Implementation of the Affordable Care Act and Medicaid Reform in Illinois to Incorporate Permanent Supportive Housing (Sep. 2012)
  • Shriver Center: Illinois Has Committed to Covering Everyone Congress Has Made Eligible for Medicaid (Jul. 2012)
• Indiana

  • Milliman Inc. – Affordable Care Act (ACA) – Medicaid Financial Impact Update (Sep. 2012)

• Iowa
  • Iowa Hospital Association Policy Brief: Support Medicaid Expansion (Sep. 2012)

• Louisiana
  • Louisiana Department of Health and Hospitals - Understanding the Impact of a Medicaid Expansion in Louisiana (March 2013)
  • Testimony by Bruce D. Greenstein Secretary, Louisiana Department of Health and Hospitals before the House Committee on Energy and Commerce, Subcommittee on Health (Dec. 13, 2012)
  • Louisiana Budget Project - Medicaid Expansion: An Opportunity to Invest in Louisiana's Workforce (Oct. 2012)
• Maine
  • Maine Equal Justice Partners - Expanding Medicaid Coverage: An Opportunity Maine Cannot Afford to Pass Up (Oct. 2012)
  • Maine Petition for Review (Sep. 2012)
  • Maine Motion for a Preliminary Injunction (Sep. 2012)
  • First Circuit Order Denying Motion and Request for Preliminary Injunction (Sep. 2012)
  • Maine Letter to HHS Requesting State Plan Amendments (Aug. 2012)
  • Maine Equal Justice Partners Letter to HHS on SPA Request (Aug. 2012)
  • Maine Equal Justice Partners Press Release on SPA (Aug. 2012)
  • Maine Equal Justice Partners/NHeLP: The Impact of the Supreme Court Decision on the MaineCare Program (Jul. 2012)
• Maryland
  • Maryland Dept. of Health and Mental Hygiene: Continuity of Care Issues Between the Maryland Health Benefit Exchange and Maryland Medicaid (Sep. 2012)
  • Health Affairs Blog: Expanding Medicaid: The Smart Decision For Maryland (Aug. 2012)
  • Medicaid Matters Maryland: Medicaid in Maryland (Aug. 2012)
  • The Hilltop Institute: Maryland Health Care Reform Simulation Model: Detailed Analysis and Methodology (July 2012)
  • The Hilltop Institute: The Economic Impact of the ACA (July 2012)
• Michigan
  • Center for Healthcare Research & Transformation - The ACA’s Medicaid Expansion: Michigan Impact State Budgetary Estimates and Other Impacts (Oct. 2012)
  • Center for Healthcare Research & Transformation - The ACA’s Medicaid Expansion: Analyzing the Michigan Impact (Technical Paper) (Oct. 2012)
• Minnesota
  • Urban Institute: The ACA Implementation Monitoring and Tracking/Minnesota (Jul. 2012)

• Mississippi
  • KHN - Q & A with Mississippi Gov. Phil Bryant (Jan. 2013)
  • Mississippi Health Care Access Coalition
  • Center for Mississippi Health Policy - MEDICAID EXPANSION: An Overview of Potential Impacts in Mississippi (Nov. 2012)
  • University Research Center - The Fiscal and Economic Impacts of Medicaid Expansion in Mississippi 2014-2025 (Oct. 2012)
  • Milliman Inc. - Financial Impact Review of the Patient Protection and Affordable Care Act As Amended by H.R. 4782, The Reconciliation Act of 2010 On the Mississippi Medicaid Budget (Oct. 2010)
• Missouri
  • Missouri Hospital Association - 'Hidden Health Care Tax' Costs Missouri Businesses Billions Annually (Mar. 2013)
  • LSEM – The Medicaid Expansion is Good Medicine for Missouri (Jan. 2013)
  • Missouri Hospital Association - Medicaid Expansion Creates Jobs, Grows Missouri's Economy (Nov. 2012)
  • Medicaid Expansion is Critical for Missouri's Communities (Word version – adapt this for your state) (Nov. 2012)
  • Medicaid Expansion Would Help Missouri's Homeless (Word version – adapt this for your state) (Nov. 2012)
  • Medicaid Expansion Is Beneficial for Children (Word version – adapt this for your state) (Nov. 2012)
  • Medicaid Expansion Is Good for Missouri's Veterans (Word version – adapt this for your state) (Nov. 2012)
  • St. Louis Post-Dispatch: Medicaid expansion would benefit Missouri (Sep. 2012)
  • Missouri Nurses Association: Missouri Nurse: The Impact Of The Supreme Court’s Decision On Medicaid Expansion In Missouri: Early Observations (Sep. 2012)
  • Legal Services of Eastern Missouri
  • LSEM Power Point - The Medicaid Expansion and the Affordable Care Act: The Impact of the Supreme Court’s Decision on Medicaid in Missouri (Sep. 2012)
  • NPR - Show-Me Medicaid expansion? Missouri weighs the costs (Aug. 2012)
  • Legal Services of Eastern Missouri: The Impact of the Supreme Court’s Decision on Medicaid Expansion In Missouri: Early Observations (Jul. 2012)
• Montana
  • Montana Budget and Policy Center - Chambers of Commerce on Medicaid Expansion: In Their Own Words
  • Montana Budget and Policy Center - Impacts of Medicaid Expansion by County
  • Montana Budget and Policy Center - Medicaid Expansion: A Good Deal for Montana (Jan. 2013)
  • Montana Budget and Policy Center - Healthy Montanans build a Healthy Economy (Jan. 2013)
  • Montana Budget and Policy Center - Medicaid Expansion: A Good Deal for Indian Country (Oct. 2012)
• Nebraska
  • Nebraska Appleseed – Bridging the Gap
  • Center for Health Policy: Medicaid Expansion in Nebraska under the Affordable Care Act (Aug. 2012)
  • Nebraska Appleseed - A GOOD OPPORTUNITY AND A REAL SOLUTION: Health Care For Low-Income, Working Nebraskans Under The Affordable Care Act (Jul. 2012)
  • Milliman Inc. – Patient Protection and Affordable Care Act  with House Reconciliation Financial Analysis (Aug. 2010)
  • Leighton Ku response to Milliman Analysis (Sept. 2010)
• New Hampshire
  • New Hampshire Medical Care Advisory Committee Letter to Governor (Jan. 2013)
  • Lewin Group - An Evaluation of the Impact of Medicaid Expansion in New Hampshire (Nov. 2012)
  • New Hampshire Fiscal Policy Institute - The ACA's Medicaid Coverage Option: An Affordable Way to Insure Thousands of Granite Staters (Sept. 2012)
• New Jersey
  • Senate Resolution SCR132 - Urges Governor to support expansion of Medicaid program
• New Mexico
  • Health Policy and Research Solutions - New Mexico Medicaid Projections by County for 2014
  • New Mexico Center on Law and Poverty: Medicaid Rocks! Music Video (Nov. 2012)
  • University of New Mexico Bureau of Business and Economic Research: Medicaid expansion fiscal analysis (Oct. 2012)
  • New Mexico Center for Law and Poverty - Issue Brief: The Medicaid Opportunity in New Mexico (Oct. 2012)
  • New Mexico Center for Law and Poverty - Power Point Presentation: Ensuring Affordable Coverage: The Medicaid Expansion &  The Basic Health Program (Oct. 2012)
  • Q&A on Medicaid Expansion in New Mexico (Oct. 2012)
  • ABQ Journal: Medicaid Deal Too Important To Pass Up (Oct. 2012)
  • LFC Hearing Brief: Medicaid Expansion Benefits and Costs (Sep. 2012)
  • LFC Report: Issues for Hearing Medicaid Expansion (Sep. 2012)
  • Advocate Letter to New Mexico Governor Martinez on the ACA’s Medicaid Expansion (Jul. 2012)
• North Carolina
  • Charlotte Observer - Medicaid expansion is vital (Jan. 2013)
  • Legal Services of Southern Piedmont Memorandum to NC Chamber of Commerce (Jan. 2013)
  • NC Dept. of Health and Human Services - Impact of ACA on Medicaid - NC IOM Meeting (Dec. 2012)
  • Online petition - Tell McCrory: Expand Medicaid in NC
  • Legal Services of Southern Piedmont - Medicaid Expansion in North Carolina (Jan. 2013)
  • Health Access Coalition - How Obamacare is helping this small business owner
  • North Carolina Justice Center: Why North Carolina Should Expand Medicaid Under the Affordable Care Act (Jan. 2013)
  • Budget and Tax Center Brief: The Medicaid Expansion: A Transformative and Fiscally Sustainable Policy for North Carolina (Aug. 2012)
  • NC Office of the State Auditor - PERFORMANCE AUDIT DEPARTMENT OF CORRECTION INMATE MEDICAID ELIGIBILITY (Aug. 2010)
• Ohio
  • Ohio Office of Health Transformation - Extend Medicaid Coverage and Automate Enrollment
  • Expanding Medicaid in Ohio – Preliminary Analysis of Likely Effects (Jan. 2013)
  • Ohioans for a Better Future 
    • Ohioans Benefit From Expanded Health Coverage
    • Medicaid Expansion Strengthens Ohio
    • Webinar on How Medicaid Would Affect Ohioans
  • Milliman Report - Patient Protection and Affordable Care Act (ACA) Fiscal Estimates for Ohio Medicaid (June 2011)
  • Milliman Inc. - Patient Protection and Affordable Care Act (ACA) Fiscal Estimates (June 2011)
• Oklahoma
  • Oklahoma Policy Institute - Expanding Medicaid in Oklahoma makes sense
  • Oklahoma Policy Institute Infographic (Nov. 2012)
  • Medicaid and the Affordable Care Act (Aug. 2012)
• Pennsylvania
  • Pennsylvania Health Law Project - News Release: Expanding Medicaid Covers 600,000 Pennsylvanians And Generates Up to $400 Million in State Budget Savings (Jan. 2013)
  • Pennsylvania Health Law Project - Expanding Medicaid in PA: Consider the Savings (Jan. 2013)
  • Gov. Corbett letter to HHS (Dec. 12, 2012)
  • Pennsylvania Health Law Project - Medicaid Expansion: Critical For Pennsylvania's Communities (Nov. 2012)
  • North Carolina Dept. of Health and Human Services – Impact of ACA on Medicaid (Dec. 2012)
  • Letter from PA Dept. of Public Welfare to HHS on ACA implementation (Aug. 2012)
• South Carolina

• • Milliman Inc. – Affordable Care Act – Financial  Impact  SFY 2014 Through SFY 2020 (April 2012)
  • The Ruoff Group: Medicaid Expansion: Costs or Savings for South Carolina? (Aug. 2012)
  • AP article: SC Legislature to debate Medicaid expansion (Aug. 2012)
• Tennessee
  • Tennessee Justice Center - Medicaid Expansion in Tennessee Will Produce Additional Revenues That Will More Than Offset the Additional State Costs Through 2020 (Nov. 2012)
  • Medicaid Expansion in Tennessee Will Produce Additional Revenues That Will More Than Offset the Additional State Costs Through 2020 – Word version – (adapt this for your state)
  • Impact of Medicaid Reform on Shelby County (Oct. 2012)
  • Medicaid Expansion Will Improve the Lives of Hundreds of Thousands of Women in Tennessee (Oct. 2012)
  • People With Private Health Insurance Will Face Higher Premiums If Tennessee Does Not Reform Medicaid (Oct. 2012)
  • Medicaid Expansion is a Boon for Tennessee’s Small Businesses
  • Medicaid Expansion: A Lifeline for Tennessee’s Rural Counties
  • Tennessee Justice Center
  • Expanding Medicaid Makes Financial Sense for Tennessee (Aug. 2012)
  • Medicaid Expansion Will Help Close the Health Care Gap for African Americans in Tennessee (Aug. 2012)
  • Medicaid Expansion Would Help Tennessee’s Homeless (Aug. 2012)
  • Medicaid Expansion is Good for Children (Aug. 2012)
  • Medicaid Expansion Would Help Tennessee’s Veterans (Aug. 2012)
  • If Tennessee Does Not Expand Medicaid, It Could Cost Tennessee Businesses (Aug. 2012)
• Texas

• • Texas Impact - Extending Medicaid to Low-Income Adults...What's in it for Your Community?
  • Texas Tribune - Interactive: Which Health Care Costs Could be Offset by a Medicaid Expansion? (Jan. 2013)
  • Texas Impact and Methodist Healthcare Ministries of South Texas, Inc. - Expanding Medicaid in Texas: Smart, Affordable and Fair (Jan. 2013)
  • Texas Well and Healthy Coalition - The Medicaid Opportunity: Health Care for Low-Income Texans (Nov. 2012)
  • Texas Well and Healthy Coalition - 3 Great Tools on Medicaid Expansion and Texas
  • Center for Public Policy Priorities - Data on impact of Texas Medicaid expansion by county
  • The Perryman Group - Only One Rational Choice - Texas Should Participate in Medicaid Expansion Under the Affordable Care Act (Oct. 2012)
• Utah
  • SL Tribune -  Expand Medicaid - Counties need the mental health aid (Jan. 2013)
• Virginia
  • The Commonwealth Institute – Medicaid Expansion Pays for Itself (Jan. 2013)
  • Virginia Hospital and Healthcare Association - The Economic Impact of the Medicaid Expansion on Virginia’s Economy (Dec. 2012)
  • Weldon Cooper Center for Public Service – Virginia Medicaid Now and Under Health Reform (Sep. 2010)
  • Virginia Poverty Law Center
  • VPLC: The ACA Medicaid Expansion in Virginia (July 2012)
  • Urban Institute: The ACA Implementation Monitoring and Tracking/Virginia (Aug. 2012)
  • Virginia Commonwealth Institute: Saving Money, Saving lives (Aug. 2012)
  • The Commonwealth Institute: Making the Right Choice on Medicaid: Refusing Expansion Would Be a Costly Mistake for Virginia (Jul. 2012)
• Washington State
  • Washington State Health Care Authority - Medicaid Expansion 2014
  • Washington State Budget and Policy Center - Infographic: Four Reasons Why Medicaid Expansion is a Good Idea
  • Healthy Washington Coalition - Secure the full Medicaid Expansion to 138% of the federal poverty level (Oct. 2012)
  • Expanding Medicaid in Washington State: An Overview of Key Policy Decisions (Oct. 2012)
  • Urban Institute: The ACA Medicaid Expansion in Washington (May 2012)
• West Virginia
  • West Virginians for Affordable Health Care
  • West Virginia Center on Budget & Policy - Expanding Medicaid: A Winning Proposition for West Virginia (Oct. 2012)
• Wisconsin
  • Statement of Dennis G. Smith Secretary, Wisconsin Department of Health Services, Subcommittee on Health, House Committee on Energy and Commerce (Dec. 13, 2012)
• Wyoming
  • Consumer Advocates: Project Healthcare: a shared project of several Wyoming advocacy organizations concerned with monitoring the impact of health reform on Wyoming consumers
  • Wyoming Eagle Tribune: Mead still wary of Medicaid expansion (Aug. 2012)