Medicaid Expansion, the Private Option, and Personal Responsibility Requirements: The Use of 1115 Waivers to Implement Expansion

Ever since the Supreme Court effectively ruled in June 2012 that states could choose whether or not to expand Medicaid to nonelderly adults under the ACA, that choice has been one of the most prominent and often one of the most contentious issues for states. This report describes the six states (Arkansas, New Hampshire, Indiana, Iowa, Michigan and Pennsylvania) that requested and received approval from the federal government to experiment with coverage approaches that are modelled on private insurance concepts and not permitted in a standard Medicaid expansion.