Missouri Becomes 38th State to Expand Medicaid

A group of people watch a sunset over the ocean. They are all healthy thanks to their states' votes to expand Medicaid.

On August 4, Missouri voters approved to expand Medicaid in line with the Affordable Care Act (ACA) guidelines, making Missouri the 38th state to pass Medicaid expansion legislation. Under the ACA, individuals under the age of 65 whose family income falls below 133 percent of the Federal Poverty Line and who would otherwise have access to other Health Insurance Marketplace coverage are eligible for Medicaid services. This expansion occurred at the federal level, but each state has the power to accept or reject the regulation.

As of August 5, 2020, 12 states have not voted to expand Medicaid:

  1. Alabama
  2. Florida
  3. Georgia
  4. Kansas
  5. Mississippi
  6. North Carolina
  7. South Carolina
  8. South Dakota
  9. Tennessee
  10. Texas
  11. Wisconsin (Wisconsin expanded their Medicaid program to 100% of the Federal Poverty Line.)
  12. Wyoming

Expanding Medicaid

If these 12 states each voted to expand Medicaid, the number of uninsured Americans could drop by a total of 3 million. As of 2018, those states that had not expanded their Medicaid programs had an average uninsured rate of over 11 percent, while those that had expanded their Medicaid programs had an average uninsured rate of 6.95 percent. Texas clocked in with the highest uninsured rate of all states at nearly 18 percent.

Studies show that Medicaid expansion improves several aspects of health services, including access to care, affordability of care, and financial security within low-income populations. Those states that have opted not to expand their Medicaid programs often quote the burden of added taxation, yet recently published studies show that the expansion can result in state savings since costs are offset in other areas. In 2020, the federal government covers 90% of the costs of expanding Medicaid.

Since many Americans have lost their jobs and employer health benefits due to the coronavirus emergency, private health plans anticipate a rise in ACA Marketplace and Medicaid enrollment as we head into the 2021 Open Enrollment Period.

What is Medicaid?

As of the April 2020 enrollment deadline, Medicaid covers over 65 million people nationwide. According to medicaid.gov, “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.” Although Medicaid is federally regulated, it is administered by each state’s government. While open enrollment periods vary by state, most are open for a few months each fall-winter.

In 2014, the ACA allowed states to expand their Medicaid services to a broader population. At the start of the expansion, those whose income fell below 138 percent of the Federal Poverty Line qualified for Medicaid benefits. This percentage has since fallen to 133 percent. This allows families, whose income may fluctuate above and below the previously recognized eligibility level, access to affordable coverage and improved insurance continuity.


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