Medicaid Expansion Resource Center

Get the latest data and facts on Medicaid Expansion’s impact on state budgets, the economy, uncompensated care costs and more.

Resource Topics

Medicaid Expansion Impact on State Budgets

Medicaid Expansion Impact on the Economy

Medicaid Expansion Financial Benefits for the Low-Income Population

Medicaid Expansion Impact on Providers, Patients, and Uncompensated Care Costs

Medicaid Expansion Impact on Rural Hospitals

Medicaid Expansion Impact on Access, Patients, and Public Health

Medicaid Expansion Impact on Behavioral Health and the Criminal Justice System

Other General Medicaid Expansion and Marketplace Resources

Medicaid Expansion Impact on State Budgets

Resources include data on how Medicaid expansion has impacted state spending, including state budget and revenue changes and savings.

  • The Cost to States of Not Expanding Medicaid. Urban Institute. (August 2016).
    • This report analyzes 19 states that have not expanded Medicaid, finding that from 2017 to 2026, expansion in these states would increase nominal state costs by less than $60 billion while increasing federal funding by more than $400 billion.
  • States Expanding Medicaid See Significant Budget Savings and Revenue Gains. Deborah Bachrach, Patricia Boozang, Avi Herring, and Dori Glanz Reyneri. (March 2016).
    • This brief examines data regarding Medicaid expansion in 11 states, confirming that states continue to realize savings and revenue gains as a result of expanding Medicaid.
  • The Governor’s FY 2017 Budget: Budget Summary. New Jersey Office of Management and Budget. (February 2016).
    • This budget summary includes an overview of New Jersey’s Medicaid expansion program and the number of uninsured who are now covered as a result of expansion.
  • SFY 2015 Annual Report: Health Care for Ohioans. The Ohio Department of Medicaid. (August 2015).
    • This annual report provides 2015 highlights from the Ohio Department of Medicaid.
  • Medicaid Per Enrollee Spending: Variation Across States. Katherine Young, Robin Rudowitz, Saman Rouhani, and Rachel Garfield. (January 2015).
    • This brief examines variation in Medicaid spending per enrollee across eligibility groups, across states, and over time, and discusses implications for program policy and financing.

Medicaid Expansion Impact on the Economy

Resources demonstrate the impact Medicaid expansion has had on state economies, job creation, and state savings.

  • Employment Effects of the ACA Medicaid Expansions. Pauline Leung, Alexandre Mas. National Bureau of Economic Research. (August 2016).
    • This paper examines whether the expansions in Medicaid reduced “employment lock” among childless adults who were previously ineligible for public coverage, finding no significant impact on employment.
  • Medicaid Work Requirement Would Limit Health Care Access Without Significantly Boosting Employment. Hannah Katch. Center on Budget and Policy Priorities. (July 2016).
    • This report finds that experiences with work requirements in other income support programs have not yielded additional employment, while income eligibility increases in Medicaid have shown increased employment.
  • Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado: FY 2015-16 through FY 2034-35. Charles Brown, Steven B. Fisher, PhD, Phyllis Resnick, PhD. Colorado Health Foundation. (June 2016).
    • Finds that expansion of Medicaid in Colorado created 31,074 new jobs and added $3.8 billion to economic activity.
  • Economic and Fiscal Impacts of the Medicaid Expansion in New Mexico. Lee A. Reynis, PhD. (February 2016).
    • This report updates a previous analysis on the likely impacts of Medicaid expansion in New Mexico.
  • Medicaid Expansion Did Not Result In Significant Employment Changes Or Job Reductions In 2014. Angshuman Gooptu, Asako S. Moriya, Kosali I. Simon, and Benjamin D. Sommers. Health Affairs. (January 2016).
    • This report analyzed labor-market participation among adults with incomes below 138 percent of the federal poverty level, comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups, for the pre-ACA period (2005–13) and the first fifteen months of Medicaid expansion, finding no significant changes in employment and little impact on labor-market outcomes.
  • Lots of Jobs and More to Come. Debra Miller. (November 2015).
    • This article examines job growth in the health care sector and the impact of the ACA.
  • Economic Impact of the Medicaid Expansion. Office of the Assistant Secretary for Planning and Evaluation. (March 2015).
    • This fact sheet shows that expanding Medicaid will benefit states both directly and indirectly by generating additional federal revenue, increasing jobs and earnings, increasing Gross State Product (GSP), increasing state and local revenues, and reducing uncompensated care and hospital costs.
  • KY’s Medicaid Expansion: 40,000 Jobs, $30 B Economic Impact. Commonwealth of Kentucky Office of the Governor. (February 2015).
    • This press release highlights findings from a study reviewing Kentucky’s first full year of Medicaid expansion, including the findings that expansion generated widely positive results for the state’s economy, local governments, medical providers, and Medicaid recipients.

Medicaid Expansion Financial Benefits for the Low-Income Population

Resources highlight the financial and economic impact on the low-income, Medicaid-eligible population, most of whom are part of working families and are caring for children.

Medicaid Expansion Impact on Providers, Patients, and Uncompensated Care Costs

Resources show the effect Medicaid expansion has had on reducing uncompensated care costs, and what this has meant for hospitals, physicians, and patients.

Medicaid Expansion Impact on Rural Hospitals

Resources demonstrate the impact Medicaid expansion has had on rural hospitals across the country.

  • Medicaid Expansion Affects Rural And Urban Hospitals Differently. Brystana G. Kaufman, Kristin L. Reiter, George H. Pink, and George M. Holmes. Health Affairs. (September 2016).
    • This preliminary analysis of the early effects of Medicaid expansion suggests that its financial impacts may be different for hospitals in urban and rural locations; increases in revenue were greater in rural hospitals than urban hospitals in Medicaid expansion states, and decreases in uncompensated care costs were greater in urban areas than rural areas.
  • Lack of Medicaid expansion hurts rural hospitals. Irene North. (August 2015).
    • This article outlines the impact of nonexpansion on rural hospitals in Nebraska.
  • Vulnerability to Value: Rural Relevance under Healthcare Reform. iVantage Health Analytics. (April 2015).
    • This study examines and reveals that rural hospitals have achieved a significant level of comparative performance, including demonstrated: quality, patient satisfaction and operational efficiency, for the type of care most relevant to rural communities.

Medicaid Expansion Impact on Access, Patients, and Public Health

Resources show changes in access to primary and preventive care, continuity of coverage, and the impact on patient health and costs as a result of Medicaid expansion.

Medicaid Expansion Impact on Behavioral Health and the Criminal Justice System

Resources demonstrate the impact Medicaid expansion has had on improving access to care for the justice-involved population and people with behavioral health needs.

Other General Medicaid Expansion and Marketplace Resources

These resources provide an overview of questions around, and results and provisions of, Medicaid expansion and the Marketplace.

  • The Effect of Medicaid Expansion on Marketplace Premiums. Aditi P. Sen and Thomas DeLeire. ASPE Issue Brief. (September 2016).
    • This brief looks at how Medicaid expansion helped lower premiums for Marketplace enrollees, finding Marketplace premiums are about seven percent lower in expansion states, controlling for differences across states.
  • Effects of Medicaid Expansion under the ACA. Kaiser Family Foundation. (June 2016).
    • This brief summarizes findings from 61 studies of the impact of state Medicaid expansions under the ACA, including peer-reviewed studies as well as free-standing reports, government reports, and white papers published by research and policy organizations between January 2014 and May 2016, using data from 2014 or later.
  • Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act. Molly Frean, Jonathan Gruber, and Benjamin D. Sommers. National Bureau of Economic Research. (April 2016).
    • This report provides an assessment of the effects of ACA provisions on coverage including subsidies, the individual mandate, and Medicaid expansion, noting that two-thirds of newly enrolled Medicaid beneficiaries are due to the woodwork effect and that there is no evidence that Medicaid crowds out private insurance coverage.
  • ACAView: Tracking the Impact of Health Reform. Josh Gray, Anna Zink, and Tony Dreyfus. (March 2016).
    • This report looks at how the experience of patients in three categories has changed since the coverage expansion of the ACA came into effect: those with Medicaid coverage, with commercial coverage, and without insurance. It also explores how the economics of primary care practice have changed since coverage expansion.
  • Study of the Impact of the ACA Implementation in Kentucky – Quarterly Snapshot (July-September 2015). State Health Access Data Assistance Center (SHADAC). (January 2016).
    • This is the third Quarterly Snapshot produced under the Study of the Impact of the ACA Implementation in Kentucky.
  • The ACA and Medicaid Expansion Waivers. Robin Rudowitz and MaryBeth Musumeci. (November 2015).
    • This brief provides an overview of the role of Section 1115 waivers in expanding coverage since the enactment of the ACA and highlights key themes in these waivers as well as highlights provisions that CMS has turned down.
  • The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid—An Update. Rachel Garfield and Anthony Damico. (October 2015).
    • This brief presents estimates of the number of people in non-expansion states who could have been reached by Medicaid but instead fall into the coverage gap, describes who they are, and discusses the implications of them being left out of ACA coverage expansions.
  • The Medicaid Experience In Michigan. Marianne Udow-Phillips, Kersten Burns Lausch, Erin Shigekawa, Richard Hirth, and John Ayanian. (August 2015).
    • This blog looks at Medicaid expansion in Michigan one year after implementation.
  • Frequently Asked Questions About Medicaid. Edwin Park, Matt Broaddus, Hannah Katch, and Jesse Cross-Call. (June 2015).
    • This report addresses common questions and debates surrounding Medicaid and Medicaid expansion.
  • Demonstrations and Waivers. Medicaid.gov (2015).
    • This state by state list includes all current and concluded state programs authorized under Section 1115 demonstration and waiver authorities.