Nine states that could end Medicaid expansion if Donald Trump cuts funding

The future of Medicaid expansion is on shaky ground in nine states as potential federal funding cuts could trigger automatic rollbacks in health coverage. Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia have established "trigger laws" that would end their Medicaid expansion programs if federal funding falls below specific thresholds. This change could leave millions of low-income adults without health insurance.

The Affordable Care Act (ACA) allowed states to expand Medicaid to cover adults earning up to 138% of the federal poverty level-about $20,783 for a single individual in 2024. This move provided health coverage to millions who previously did not qualify. However, proposed cuts in federal Medicaid under the Trump istration could jeopardize that coverage.

How state "Trigger Laws" could affect Medicaid expansion

"Trigger laws" are designed to automatically end Medicaid expansion if federal contributions decline. Each of the nine states has its own unique criteria for ending the program. For example, Arizona's Medicaid expansion will cease if federal funding drops below 80 percent.

Meanwhile, Montana will end its expansion if federal falls below 90 percent unless state lawmakers allocate additional funding to maintain it.

These state-level protections were put in place to shield state budgets from unanticipated increases in Medicaid costs. While the ACA initially covered 100 percent of Medicaid expansion costs, it later reduced the federal match to 90%, requiring states to cover the remaining 10 percent.

Should federal contributions fall below these thresholds, states would be forced to either cut coverage or identify new funding sources-decisions that would have immediate consequences for enrollees.

If Medicaid expansion is rolled back in these nine states, more than three million low-income adults could lose their health insurance.

Beyond these nine, other states like Iowa, Idaho, and New Mexico have measures that require a review of Medicaid funding but do not automatically end the program. These states would still face significant pressure to either increase state contributions or reduce coverage.