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UNITED STATES ROADMAP

ROADMAP POLICIES AND STRATEGIES

EFFECTIVE POLICIES

EFFECTIVE STRATEGIES

Methods and Sources
FAQ
Additional Roadmap Resources
THE POLICY IMPACT CALCULATOR

EXPANDED INCOME ELIGIBILITY FOR HEALTH INSURANCE

States can employ a number of strategies to increase health insurance coverage for their residents, and the most widely studied strategy is the expansion of Medicaid eligibility. Medicaid is a joint federal and state program that provides health insurance to low-income households, covering one in five Americans and 41% of all live births in the United States.1,2

The federal Patient Protection and Affordable Care Act, also known as the ACA, was signed into law in 2010. In addition to providing subsidies to purchase health insurance in the online Marketplace, the ACA expanded Medicaid eligibility for most adults with incomes at or below 138% of the federal poverty level (FPL), to begin in 2014. In 2012, the Supreme Court ruled3 that the federal expansion was unconstitutional, which allowed states to determine their own income guidelines and eligibility criteria.4

For states that have expanded Medicaid, the federal government currently covers 90% of the state’s Medicaid costs for the expansion population.5 States are responsible for paying the remaining 10% using general revenues, alcohol taxes, tobacco taxes, provider taxes, and other dedicated revenues and government contributions.6,7 As an incentive for nonexpansion states to expand Medicaid, the American Rescue Plan Act of 2021 (ARPA) offered an additional 5 percentage point increase to the federal government’s share of a state’s Medicaid costs (the Federal Medical Assistance Percentage, or FMAP). The increase is still available for 2 years after new expansion, on a permanent basis, no matter when the expansion occurs.8,9

Because Medicaid Income Eligibility Varies Widely Across States, Many Individuals Lack Coverage

The populations most affected by a state’s decision to expand Medicaid are previously ineligible childless adults, including childless women of reproductive age,10 and parents whose incomes fall between the pre-ACA income guidelines established in their state and 138% of the FPL. States that have not expanded Medicaid do not cover most childless, nonelderly adults,11 regardless of income level,12 and income eligibility thresholds for parents range from a low of 15% of the FPL in Texas to 105% of the FPL in Tennessee.

In most states, Medicaid income eligibility thresholds are higher for pregnant individuals than other adults. Through options initially included in ARPA and made permanent in the 2023 Consolidated Appropriations Act (CAA), as of October 2024, all states but Arkansas and Wisconsin have moved to extend pregnancy Medicaid coverage from 60 days to 12 months postpartum through state plans, Section 1115 waivers, or enacting legislation.13

When eligibility for pregnancy Medicaid coverage ends, then the person must switch to traditional parent Medicaid or use a subsidy to purchase health coverage on the Marketplace. In nonexpansion states, many of these new parents lose health insurance coverage after the postpartum period because their incomes are too high for traditional Medicaid, but not high enough (100% of the FPL) to receive subsidies on the Marketplace.

Expanding Medicaid Eligibility Allows More People to Access Necessary Care

In nonexpansion states, many parents with low incomes earn too much to qualify for Medicaid, and most childless adults are not eligible regardless of their income. Approximately 2.9 million uninsured adults would become newly eligible for Medicaid if the remaining nonexpansion states expanded the income eligibility for Medicaid to 138% of the FPL.14 Workers with low incomes in these states, including many child care teachers, would be likely recipients of Medicaid coverage.15

Medicaid Expansion Can Help People Initiate Health Care Prior to Conception, a Critical First Step for Healthy Pregnancies and Births

Without expanded Medicaid eligibility, childless adults with low incomes may have limited access to family planning services, preventative care before conception, and prenatal care in the earliest stages of pregnancy. Access to health insurance in these important periods may lead to lower rates of maternal mortality and adverse birth outcomes, including infant mortality, low birthweight, and preterm birth.16

Expanding Medicaid Helps Keep Families Financially Stable

Families who have access to free or low-cost health services through Medicaid are less likely to be severely burdened by medical costs and less likely to incur medical debt, which may reduce families’ medical financial costs and free up resources to spend on other household needs.17,18,19 Further, individuals who previously avoided medical care due to high costs are more likely to access necessary health care, which may lead to improved physical and mental health outcomes.20,21

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on expanded income eligibility for health insurance.

Various studies have shown Medicaid expansion can help families access needed care and services, increase household resources, improve healthy and equitable birth outcomes, and improve child health and development. Medicaid expansion also increases rates and the length of Medicaid coverage before and after pregnancy, decreases uninsurance rates, and increases the probability of timely and adequate prenatal care.

Medicaid expansion also bolsters families’ economic security through reduced medical spending and debt. Furthermore, Medicaid expansion has been found to decrease family poverty rates, housing instability, and avoidance of health care due to cost barriers. Additional studies have found positive effects on healthy birth outcomes, such as preterm births, low birthweight, and maternal mortality. Benefits for child health and development include decreased rates of child neglect.

Medicaid Expansion Reduces Racial Disparities in Insurance Coverage, but More Research is Needed to Understand the Full Potential of Medicaid Expansion to Reduce Disparities in Outcomes

Families of color are less likely to have access to affordable health insurance coverage.22 Medicaid expansion decreases uninsurance rates among Hispanic and multiracial women,23 increases Medicaid coverage rates among Hispanic and Black women,24 and increases the receipt of prenatal care among Hispanic women.25 These positive outcomes have a stronger effect size relative to outcomes observed for White women, which may reduce disparities across racial and ethnic groups.

The evidence suggests that Medicaid expansion leads to better birth outcomes, including reductions in maternal mortality rates for some women of color,26,27 but more research is needed to determine whether these results represent reductions in disparities in outcomes. Some studies show that Medicaid expansion reduces disparities in infant mortality rates between Hispanic infants28 and White infants,29 and reduces disparities in the rates of preterm births and very low birthweight among Black infants compared to White infants.30 Despite these positive findings, other studies find no evidence that Medicaid expansion reduces disparities in birth outcomes.31,32,33

Evidence does show, however, that the impact of Medicaid expansion on outcomes related to family financial stability, such as child support receipt, was more beneficial for people with higher educational levels and who identified as White.34 These results are important because they point to possibly exacerbated inequality rather than equity. More research is needed to understand the full potential of Medicaid expansion to reduce disparities beyond access to health insurance.

For more information on what we know and what we still need to learn about Medicaid expansion, see the evidence review on expanded income eligibility for health insurance.

More than 500,000 North Carolinians Now Have Medicaid Coverage
In total, 41 states (including the District of Columbia) have adopted and fully implemented the Medicaid expansion under the ACA. North Carolina enacted Medicaid expansion in March 2023, and coverage became available December 1, 2023, making it the most recent state to expand coverage to individuals with incomes at or below 138% of the FPL.

In the past year, North Carolina was the only state to newly implement expanded Medicaid coverage. In early 2023, the North Carolina legislature enacted Medicaid expansion, which was signed into law by the governor in March 2023. However, implementation of Medicaid expansion was contingent on the passage of the state budget, which was delayed until September 2023. North Carolina Governor Roy Cooper allowed the budget to become law in October 2023 without his signature, paving the way for Medicaid expansion to take effect. Medicaid coverage became available to those eligible on December 1, 2023. As of July 2024, North Carolina reported it had enrolled more than 500,000 in Medicaid expansion during the first 6 months of enrollment.

Among Nonexpansion States, 8 Introduced Legislation to Expand Medicaid

As of October 1, 2024, 10 states have not yet fully implemented the expansion of Medicaid under the ACA. Of these 10 states, eight states considered, but did not pass legislation to adopt the policy this past year. Of the nine nonexpansion states that held regular legislative sessions, Wyoming is the only state that did not introduce legislation to expand Medicaid this year. Texas did not hold a regular legislative session in 2024.

Mississippi, Alabama, and Kansas Saw Unprecedented Bipartisan Progress to Expand Medicaid

In 2024, three nonexpansion states that had previously seen little progress on expansion changed course and advanced Medicaid expansion with unprecedented momentum. Mississippi legislators, who typically introduce several Medicaid expansion bills each year to no avail, introduced their first bipartisan expansion bill. The bill passed the House, but ultimately died in conference committee in May 2024 when the two legislative chambers could not agree on a compromise.

Alabama legislators introduced a bill which would allow gambling revenue to be used for health care coverage for low-income adults. This marked the first time an expansion of income eligibility for health insurance similar to the Medicaid expansion under the ACA received bipartisan support in the Alabama legislature. Alabama legislators ultimately removed the health coverage proposal from the bill and the bill died when the session ended.

Finally, in Kansas, legislators held the first hearing on Medicaid expansion in 4 years, but the state’s expansion legislation did not pass this session.

Legislative Barriers in Nonexpansion States Stall Progress

Among the 10 states that have not adopted Medicaid expansion, five states have adopted regressive policies to limit the approaches available to implement expansion. Alabama, Georgia, Kansas, and Tennessee all require legislative approval before the state can adopt and implement expansion. In Wisconsin, former Governor Walker signed a law in 2018 that effectively prohibits the Wisconsin governor from expanding Medicaid without some involvement from the state legislature.

10 Expansion States Introduced Legislation to Expand Medicaid Coverage to New Populations, and 2 States Were Successful

Of the 41 expansion states, four states have implemented more generous policies to extend coverage beyond the ACA guidelines, including to most adults with low incomes who were previously ineligible due to immigration status (California, the District of Columbia, Oregon, and Washington). Washington’s expansion was newly implemented beginning July 2024, due to previously enacted legislation, and Colorado’s expansion to children and pregnant individuals who were previously ineligible due to immigration status will be effective in 2025. The District of Columbia also extends coverage to childless adults with incomes at or below 215% of FPL. 

Ten expansion states—Hawaii, Iowa, Kentucky, Minnesota, New Hampshire, New Jersey, New York, Rhode Island, Utah, and Vermont—introduced legislation to expand eligibility for Medicaid coverage to additional income levels and groups of people. Two states—Kentucky and Utah—successfully enacted new policies. Kentucky enacted legislation to develop a Section 1115 waiver to enhance and expand substance use disorder treatment services to Medicaid-eligible incarcerated individuals reentering the community. As of October 2024, the state had not submitted the waiver to CMS. Utah enacted legislation which provides limited Medicaid coverage for incarcerated individuals transitioning out of incarceration, effective May 1, 2024.

Although unsuccessful, Vermont introduced legislation to expand eligibility for the state’s CHIP program, which operates under Medicaid rules in the state, to pregnant individuals earning up to 312% of the FPL, as well as young people up to age 26. Several states also introduced legislation to cover groups of people previously ineligible due to their immigration status (Hawaii, New Hampshire, New Jersey, and New York). Additionally, Hawaii, Iowa, Minnesota, New Jersey, and Rhode Island introduced legislation to provide continuity of care during incarceration and ease enrollment burdens as individuals reenter society. As of October 1, 2024, no other states had enacted legislation to expand eligibility to additional populations, and the New Jersey legislature was still in session.

State Activity on Work Requirements Increased, with Potential to Limit Access to Medicaid Coverage

Eight states, both nonexpansion and expansion, introduced legislation in 2024 to direct their state Medicaid programs to seek approval for Section 1115 waivers for work requirements, and among these states, several bills progressed forward. For example, Mississippi’s Medicaid expansion legislation contained a work requirement, and disagreement between the Senate and House on allowing expansion to go into effect regardless of CMS approval of a Section 1115 work requirement waiver ultimately stalled the bill’s progress forward.

In Idaho and South Dakota, two states that bypassed legislatures and expanded Medicaid through ballot initiatives (in 2018 and 2022, respectively), legislators proposed bills to restrict expansion and add work requirements. Legislators in Idaho introduced legislation to effectively repeal the state’s Medicaid expansion by October 2025 if restrictions, including a work requirement, were not approved by CMS. Although this bill died in committee, legislators passed a resolution requesting that the Department of Health and Welfare develop and apply for a waiver to impose a work requirement on the Medicaid expansion population, similar to current and previously implemented requirements in Georgia and Arkansas, respectively.

In South Dakota, legislators passed a resolution to add a referendum to the November 2024 general election ballot by which voters will decide whether to impose a work requirement on Medicaid enrollees.

Previously, under the Trump administration, 13 states received CMS approval to add work requirements to their Medicaid programs by submitting Section 1115 waivers (Arizona, Arkansas, Georgia, Indiana, Kentucky, Maine, Michigan, Nebraska, New Hampshire, Ohio, South Carolina, Utah, and Wisconsin). Until 2023, of those states, only Arkansas had ever implemented penalties for failure to comply with work reporting requirements. Arkansas’ work requirement was overturned by a federal judge in April of 2019; and in September 2021, following the Biden administration’s recission of waivers that included work requirements, Arkansas submitted a Section 1115 waiver request to CMS to seek approval of its new Medicaid program, which removed the work requirement.

In 2023, following litigation, Georgia became the only state with an active work reporting requirement in Medicaid. The state’s partial Medicaid expansion program, Pathways to Coverage, only covers individuals with incomes up to 100% of the FPL and requires enrollees to work 80 hours each month, provide documentation to maintain their Medicaid coverage, and does not allow any exceptions for caregiving responsibilities. Because of these requirements, far fewer individuals than are eligible based on income alone enrolled during the first year of the program. As of July 2024, Pathways to Coverage had enrolled approximately 4,300 individuals, which is only 2.5% of the 175,000 uninsured individuals who may be eligible for the program based on income alone.35

Because CMS’s position on work requirements may change under a new administration, policies that make it more difficult to maintain Medicaid coverage may be approved in the future. In the last year, states have initiated or resurrected attempts to impose work requirements, but under the Biden Administration, CMS has not approved these state requests.

For more information on the state policy levers to help maximize the effectiveness of policies that improve access to perinatal health insurance, including Medicaid expansion, see our State Policy Lever Checklists.

States Rapidly Adopted Policies to Extend Pregnancy Medicaid Coverage to 12 Months After New Opportunities Became Available

Before passage of the American Rescue Plan Act (ARPA), Medicaid coverage for pregnant individuals typically only lasted through 60 days postpartum. Following the temporary state option included in ARPA, states could extend pregnancy Medicaid coverage to 12 months postpartum through state plan amendments (in addition to previously available options). The option for states to extend via state plan amendments through ARPA went into effect on April 1, 2022. The 2023 Consolidated Appropriations Act made this temporary option permanently available to states. If states provide postpartum coverage through the Children’s Health Insurance Program (CHIP), the state option would need to include coverage through CHIP as well.

Since the ARPA option to extend postpartum coverage via state plan amendment became effective, nearly all states have implemented the policy and extended pregnancy Medicaid coverage to 12 months postpartum. As of October 1, 2024, 47 states, both expansion and nonexpansion states, have fully implemented 12-month postpartum coverage. In 2024, Idaho and Iowa both enacted legislation that directs the states to seek CMS approval for 12-month postpartum extension. As of October 1, 2024, neither state had submitted a state plan amendment. 

Only two states – Arkansas and Wisconsin – have not taken action to extend Medicaid postpartum coverage to 12 months. Wisconsin proposed extending postpartum coverage for a period of 90 days, but has not received CMS approval for this extension. In 2024, legislators in Arkansas took no action to extend postpartum coverage.

States’ rapid action to extend Medicaid coverage through 12 months postpartum opens new possibilities for caring for parents during the postpartum period. This policy may improve stability of and access to health care coverage and better allow new parents to address health issues that appear following birth, but outside of the 60 days previously covered with pregnancy Medicaid.

With the policy change, many state officials hope to use extended coverage as one tool to address the maternal health crisis, providing resources to boost maternal mental health, and more. To maximize potential beneficial impacts, states need to identify how systems of care can work together to provide support during this longer coverage period – including identifying which providers are responsible for ongoing support of new parents in the first year postpartum.

For more information on each state’s progress on expanding Medicaid, find our individual state summaries under Additional Resources below (and here).

In Nonexpansion States, Most Childless Adults and Many Low-Income Parents Are Not Eligible for Medicaid Coverage

In nonexpansion states, most childless adults are not eligible for coverage through Medicaid. Two exceptions are Georgia and Wisconsin, which provide coverage to adults with incomes at or below 100% of the FPL, or $15,060; although Georgia’s program has a work requirement, which substantially limits eligibility.

In contrast, in all expansion states, childless adults with incomes at or below 138% of the FPL ($20,783, annual income) are eligible for Medicaid, and the District of Columbia is even more generous, granting coverage to childless adults with incomes at or below 215% of the FPL ($32,379). The income level to qualify for Medicaid coverage in 2024 is based on the federal poverty level for the 48 contiguous states and the District of Columbia. Hawaii and Alaska have slightly higher federal poverty levels.

For parents with low incomes in nonexpansion states, income eligibility varies from a low of 15% of the FPL for a family of three in Texas ($3,873 annual income) to 105% of the FPL in Tennessee ($27,111).

In contrast, in expansion states, parents with incomes at or below 138% of the FPL for a family of three are eligible, with New York (143% of the FPL or $36,923), Connecticut (160% of the FPL or $41,312), and the District of Columbia (221% of the FPL or $57,062) setting more generous income guidelines for parents.

In Most States, Regardless of Expansion Status, Income Eligibility Guidelines Are Typically Higher for Pregnant Individuals

Medicaid coverage for pregnant individuals is typically set at a higher income eligibility threshold than for childless adults or parents, regardless of the expansion status of the state. However, the income eligibility thresholds vary considerably across states.

In 26 states, the income eligibility threshold for pregnant individuals is at least 200% of the FPL, and in three of these states (the District of Columbia, Iowa, and Wisconsin), the threshold is higher than 300% of the FPL. Iowa has the most generous threshold for pregnant individuals at 380% of the FPL.

In three states (Idaho, Louisiana, and South Dakota) the income eligibility threshold for pregnant individuals is only 138% of the FPL, which is the same as the threshold for parents in these states.

Lack of Health Insurance Prevents Women of Childbearing Age from Accessing Health Care That Can Lead to Healthier Perinatal Outcomes and Stronger Financial Security

Access to health insurance allows women of childbearing age to seek affordable medical care prior to becoming pregnant and to begin prenatal care earlier once they become pregnant. Each of these behaviors is linked to healthier birth outcomes. In each state, the percentage of women of childbearing age with low incomes (defined as incomes at or below 138% of the FPL) who lack health insurance indicates the proportion of women in that state who could be served by expanding eligibility and access to Medicaid.

Currently, more than two out of five income-eligible women lack health insurance in Texas (41.4%), which has the highest uninsurance rate in the country, and the lowest Medicaid eligibility threshold of 15% of the FPL; however, only 3.0% of income-eligible women lack health insurance in the District of Columbia, a state that has the most generous income eligibility threshold (215% of the FPL) and has the lowest uninsurance rate in the country. On average, across states, approximately one in five (19.2%) income-eligible women lacks health insurance.

Unwinding of Continuous Coverage Provisions Presents New State Challenges

The pandemic ushered in a new era of policies designed to protect families’ access to health care coverage. With the Families First Coronavirus Response Act in March of 2020, Congress prohibited states from disenrolling individuals from Medicaid during the public health emergency (PHE). For more than 3 years, this continuous coverage provision allowed millions of people to maintain Medicaid coverage without interruptions. The 2023 Consolidated Appropriations Act (CAA) delinked the Medicaid continuous coverage requirement from the PHE, which ended the continuous coverage on March 31, 2023. Beginning April 1, 2023, for the first time in 3 years, states could disenroll individuals who were no longer eligible because of their income.

Prior to the expiration of continuous coverage, experts estimated that approximately 15 million individuals risked losing Medicaid and CHIP coverage in this process.36 As of August 23, 2024, KFF estimated more than 25 million Medicaid enrollees had lost coverage in the unwinding process to date, with wide variation in the termination rates across states, from 57% in Montana to 12% in North Carolina. Across the states with data available, 69% of individuals were disenrolled for procedural reasons, including more than 4 million children who are likely still eligible for coverage.37, 38

To mitigate coverage losses among individuals who remain eligible but whose coverage is at risk due to procedural reasons, states can complete renewals more slowly (as allowable by the federal government) and adopt policies to expand income eligibility for Medicaid to additional populations (e.g., expanding coverage to adults with incomes up to 138% of the FPL, extending postpartum Medicaid coverage from 60 days to 12 months, and adopting 12-month continuous eligibility for all children in Medicaid and CHIP, a policy the CAA required for all states effective January 1, 2024). In 2024, Colorado enacted legislation to extend previous efforts to limit the number of people disenrolled from Medicaid following these policy changes.

States Have Taken Steps to Provide Continuity of Coverage for Children

The 2023 CAA required all states to provide 12-month continuous coverage for children in an effort to provide stability and help children maintain eligibility for health insurance. As states work to implement this requirement, several states have sought CMS approval for more generous, multi-year continuous eligibility for children covered under Medicaid.

As of October 2024, New Mexico, Oregon, and Washington have begun implementing continuous coverage for children birth to age 6. Additionally, California, Colorado, the District of Columbia, Hawaii, Illinois, Minnesota, New York, North Carolina, Ohio, and Pennsylvania are developing policies to provide multi-year eligibility for various lengths of time. In 2024, legislators in Connecticut, Iowa, and Rhode Island all introduced bills to provide multi-year continuous coverage for children, but none of the bills passed this legislative session.

Click here to view the compiled 2024 Roadmap expanded income eligibility for health insurance progress summaries for all 50 states and the District of Columbia.

  1. KFF. (n.d.) State Health Facts: Births Financed by Medicaid, 2022.  https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/
  2. Rudowitz, R., Burns, A., Hinton, E., & Mohamed, M. (2023, June 30). 10 things to know about Medicaid. KFF. https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid/
  3. National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al. (US Supreme Court, 2012). US 11-393. https://www.law.cornell.edu/supct/pdf/11-393.pdf
  4. Perkins, J. (2012, July). Fact sheet: The Supreme Court’s ACA decision and its implications for Medicaid. National Health Law Program. https://healthlaw.org/resource/fact-sheet-the-supreme-courts-aca-decision-its-implications-for-medicaid/
  5. Rudowitz, R., Corallo, B., & Garfield, R. (2021, March 17). New incentive for states to adopt the ACA Medicaid expansion: Implications for state spending. KFF. https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to-adopt-the-aca-medicaid-expansion-implications-for-state-spending/
  6. Park, E. (2021, March 18). Medicaid learning lab. Session 2: Medicaid and CHIP financing. Georgetown University Health Policy Institute: CCF. https://ccf.georgetown.edu/2021/02/05/medicaid-learning-lab/
  7. Hayes, S.L., Coleman, A., Collins, S.R. & Nuzum, R. (2019). The fiscal case for Medicaid expansion. The Commonwealth Fund. https://www.commonwealthfund.org/blog/2019/fiscal-case-medicaid-expansion
  8. Park, E. (2021, March 18). Medicaid learning lab. Session 2: Medicaid and CHIP financing. Georgetown University Health Policy Institute: CCF. https://ccf.georgetown.edu/2021/02/05/medicaid-learning-lab/
  9. Park, E., & Corlette, S. (2021, March). American Rescue Plan Act: Health care provisions explained. Georgetown University Health Policy Institute: CCF. https://ccf.georgetown.edu/wp-content/uploads/2021/03/American-Rescue-Plan-signed-fix-2.pdf
  10. Reproductive age is defined as ages 15 to 44; state Medicaid expansion covers adults ages 19 to 64.
  11. Georgia and Wisconsin are two exceptions, which both provide coverage for adults with incomes at or below 100 percent of the FPL.
  12. To see the range of Medicaid eligibility requirements during the perinatal period, see the evidence review on expanded income eligibility for health insurance.
  13. KFF. (2024, August 26). Medicaid postpartum coverage extension tracker. https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/
  14. Drake, P., Tolbert, J., Rudowitz, R., & Damico, A. (2024, February 26). How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/
  15. McLean, C., Austin, L.J.E., Whitebook, M., & Olson, K.L. (2021). Early Childhood Workforce Index – 2020. Berkeley, CA: Center for the Study of Child Care Employment, University of California, Berkeley. from https://cscce.berkeley.edu/workforce-index-2020/report-pdf/
  16. Park, E., & Corlette, S. (2021, March). American Rescue Plan Act: Health care provisions explained. Georgetown University Health Policy Institute: CCF. https://ccf.georgetown.edu/wp-content/uploads/2021/03/American-Rescue-Plan-signed-fix-2.pdf
  17. Giled, S., Chakraborty, O., & Russo, T. (2017, August). How Medicaid expansion affected out-of-pocket health care spending for low-income families. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2017/aug/how-medicaid-expansion-affected-out-pocket-health-care-spending
  18. Kuroki, M. (2020). The effect of health insurance coverage on personal bankruptcy: Evidence from the Medicaid expansion. Review of Economics of the Household, 00, 1-23. doi:10.1007/s11150-020-09492-0
  19. 19. Callison, K., Walker, B., Stoecker, C., Self, J., & Diana, M.L. (2021). Medicaid expansion reduced uncompensated care costs at Louisiana hospitals; May be a model for other states. Health Affairs, 40(3), 529–535. doi: 10.1377/hlthaff.2020.01677
  20. 20. Wen, H., Druss, B.G., Cummings, J.R. (2015). Effect of Medicaid expansions on health insurance coverage and access to care among low-income adults with behavioral health conditions. Health Services Research,50(6), 1787–1809
  21. Winkelman, T.N.A & Chang, V.W. (2018). Medicaid expansion, mental health, and access to care among childless adults with and without chronic conditions. Journal of General Internal Medicine, 33(3), 376–383.
  22. Garfield, R., Orgera, K., & Damico, A. (2021, January 21). The coverage gap: Uninsured poor adults in states that do not expand Medicaid. KFF. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/
  23. Johnston, E.M., McMorrow S, Thomas, T.W., & Kenney, G.M. (2020). ACA Medicaid expansion and insurance coverage among new mothers living in poverty. Pediatrics, 145(5), e20193178. DOI: https://doi.org/10.1542/peds.2019-3178 [Expanded Income Eligibility for Health Insurance Evidence Review Study DD]
  24. Johnston, E.M., McMorrow S, Thomas, T.W., & Kenney, G.M. (2020). ACA Medicaid expansion and insurance coverage among new mothers living in poverty. Pediatrics, 145(5), e20193178. DOI: https://doi.org/10.1542/peds.2019-3178 [Expanded Income Eligibility for Health Insurance Evidence Review Study DD]
  25. Harvey, S. M., Oakley, L.P., Gibbs, S.E., Mahakalanda, S., Luck, J., & Yoon, J. (2021). Impact of Medicaid expansion in Oregon on access to prenatal care. Preventive Medicine, 143, 106360. https://doi.org/10.1016/j.ypmed.2020.106360. Received 17 July 2020; Received in revised form 30 October 2020; [Expanded Income Eligibility for Health Insurance Evidence Review Study EE] 
  26. Wiggins, A., Karaye, I. M., & Horney, J. A. (2020). Medicaid expansion and infant mortality, revisited: A difference-in-differences analysis. Health Services Research, 55(3), 393-398. https://doi.org/10.1111/1475-6773.13286 [Expanded Income Eligibility for Health Insurance Evidence Review Study V] 
  27. Eliason, E. L. (2020). Adoption of Medicaid expansion is associated with lower maternal mortality. Women’s Health Issues, 30(3), 147-152. https://doi.org/10.1016/j.whi.2020.01.005 [Expanded Income Eligibility for Health Insurance Evidence Review Study J] 
  28. Wiggins, A., Karaye, I. M., & Horney, J. A. (2020). Medicaid expansion and infant mortality, revisited: A difference-in-differences analysis. Health Services Research, 55(3), 393-398. 6). https://doi.org/10.1111/1475-6773.13286
  29. Cook, A., & Stype, A. (2021). Medicaid expansion and infant mortality: the (questionable) impact of the Affordable Care Act. Journal of Epidemiology and Community Health, 75, 10-15. http://dx.doi.org.ezproxy.lib.utexas.edu/10.1136/jech-2019-213666 [Expanded Income Eligibility for Health Insurance Evidence Review Study GG] 
  30. Brown, C. C., Moore, J. E., Felix, H. C., Stewart, M. K., Bird, T. M., Lowery, C. L., & Tilford, J. M. (2019). Association of state Medicaid expansion status with low birth weight and preterm birth. JAMA, 321(16), 1598–1609. https://doi.org/10.1001/jama.2019.3678 [Expanded Income Eligibility for Health Insurance Evidence Review Study A] 
  31. Boudreaux, M. H., Dagher, R. K., & Lorch, S. A. (2018). The association of health reform and infant health: Evidence from Massachusetts. Health Services Research, 53(4), 2406–2425. https://doi.org/10.1111/1475-6773.12779 [Expanded Income Eligibility for Health Insurance Evidence Review Study W] 
  32. Cook, A., & Stype, A. (2021). Medicaid expansion and infant mortality: the (questionable) impact of the Affordable Care Act. Journal of Epidemiology and Community Health, 75, 10-15. http://dx.doi.org.ezproxy.lib.utexas.edu/10.1136/jech-2019-213666 [Expanded Income Eligibility for Health Insurance Evidence Review Study GG] 
  33. Eliason, E. L. (2020). Adoption of Medicaid expansion is associated with lower maternal mortality. Women’s Health Issues, 30(3), 147-152. https://doi.org/10.1016/j.whi.2020.01.005 [Expanded Income Eligibility for Health Insurance Evidence Review Study J] 
  34. Bullinger, L.R. (2020). Child support and the Affordable Care Act’s Medicaid expansions. Journal of Policy Analysis and Management, 40(1), 42-77. doi:10.1002/pam.22238 [Expanded Income Eligibility for Health Insurance Evidence Review Study JJ] 
  35. Chan, L. (2024). One-year anniversary of Georgia’s Pathways to Coverage Program highlights need for reform. Georgia Budget & Policy Institute. https://gbpi.org/one-year-anniversary-of-georgias-pathways-to-coverage-program-highlights-need-for-reform/
  36. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.  (2022, August 19). Unwinding the Medicaid continuous enrollment provision: Projected enrollment effects and policy approaches (Issue Brief HP-2022-20) August 19, 2022. Available at https://aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf
  37. KFF (2024, August 26). Medicaid enrollment and unwinding tracker. https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/
  38. Alker, J., Osorio, A., Brooks, T., & Park, E. (2024). Child Medicaid disenrollment data shows wide variation in state performance as continuous coverage pandemic protections lifted. https://ccf.georgetown.edu/2024/05/02/child-medicaid-disenrollment-data-shows-wide-variation-in-state-performance-as-continuous-coverage-pandemic-protections-lifted/
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Peabody College of Education & Human Development

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