Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and Utah have approved Section 1115 waivers to operate their Medicaid expansion programs in ways not otherwise allowed under federal law. In some states, these included previously-approved Section 1115 work requirements that have since been withdrawn by CMS under the Biden Administration.
Previously, Governor Mike Parson announced that the state would not implement expansion because the ballot measure did not include a revenue source. In May 2021, individuals who would be eligible for expansion coverage filed a lawsuit against the state. However, in July 2021, the Missouri Supreme Court ruled that the initiated amendment is valid under the state constitution and that the legislature’s budget appropriation authorizes the state to fund expansion coverage.
Previously, Democratic Governor Roy Cooper proposed Medicaid expansion in his state budget proposals for both State Fiscal Years (SFY) 2020-2021 and 2022-2023;however, the Republican-controlled legislature did not include expansion in either final budget. In Governor Cooper signed the SFY 2022-2023 budget that again omitted expansion, although the budget bill did establish a legislative committee to study Medicaid expansion and potentially propose legislation. In 2019, Governor Cooper vetoed the SFY 2020-2021 budget due to omission of Medicaid expansion and the 2019 legislative session resulted in a budget impasse.
A legislatively referred constitutional amendment validated for the June 2022 ballot would have directly challenge the Medicaid expansion ballot initiatives by increasing the voter approval threshold from 50% to 60% for any petitions that would require more than $10 million in state appropriations; however, it was defeated by voters.