Medicaid Expansion Under the ACA: How States Analyze the Fiscal and Economic Trade-Offs

Within the next few months, state leaders must make a decision about whether or not to expand Medicaid to residents who earn 138 percent of the federal poverty level. Among the things to consider are:

  • The legal and policy context under which states must decide whether or not to expand Medicaid;
  • The status of decision-making about Medicaid expansion; and
  • How states are analyzing the fiscal effects of Medicaid expansion.

Key Finding

  • In each state where relatively comprehensive analyses of costs and fiscal gains were conducted, the net result showed that, on balance, Medicaid expansion would yield state fiscal advantages.

The report is based on interviews with key decision-makers in 10 states: Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. The report is part of the Robert Wood Johnson Foundation’s ACA Monitoring - Implementation and Tracking series.

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