How States Are Expanding Medicaid to Low-Income Adults Through Section 1115 Waiver Demonstrations

Following the Supreme Court’s ruling that states could decide for themselves whether to expand eligibility for Medicaid under the Affordable Care Act, a number of states have opted to do so using alternative approaches. Under federal waiver, these states have focused on expanding the use of private health insurance, requiring beneficiaries to pay premiums, and incentivizing them to choose cost-effective care. This new brief examines the variety of Medicaid reforms that Arkansas, Michigan, Iowa, and Pennsylvania are currently testing. By linking broader program reforms to the adult coverage expansion, these states can align Medicaid with local political conditions while extending insurance to more than 1 million adults who would otherwise lack a pathway to coverage. This brief is also accompanied by an interactive map on states’ Medicaid expansions decisions.