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Medicaid expansion has continued to shape healthcare access across the U.S., and in 2025, more states may those offering expanded coverage under the Affordable Care Act (ACA). Currently, 41 states and Washington, D.C., have adopted Medicaid expansion, which provides coverage to nearly all adults with incomes up to 138 percent of the federal poverty level.
However, ten states-Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming-still have not expanded their Medicaid programs.
For 2025, some states are actively considering adopting Medicaid expansion, while others are exploring alternative approaches or changes to their existing plans.
States yet to expand their Medicaid programs
In Mississippi, expansion discussions have intensified as leaders in the House and Senate have voiced for the measure, suggesting they might consider it in the legislative session.
This initiative, however, faces opposition from Governor Tate Reeves, who has argued against it, framing Medicaid as a welfare program. The split views among state leaders make it uncertain whether expansion will move forward in 2025.
Kansas is also exploring expansion, with Governor Laura Kelly proposing the "Cutting Healthcare Costs for All Kansans Act," which would make Medicaid available to more low-income residents starting January 1, 2025. This proposal includes a work requirement, though it provides exceptions for certain groups. Whether the Kansas legislature will approve this bill remains to be seen.
Georgia has recently implemented a limited form of Medicaid expansion through a Section 1115 waiver, covering adults with incomes up to 100% of the federal poverty level who meet specific work requirements. This differs from the full ACA Medicaid expansion and reflects Georgia's unique approach to expanding healthcare access without fully adopting ACA guidelines.
In a surprising move, Montana may consider ending its Medicaid expansion in 2025, as conservative groups have started advocating for a rollback of the program. If successful, Montana would become the first state to end its Medicaid expansion, potentially impacting thousands of residents.