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Medicaid Expansion on State Ballots

As of June 1, 14 states have not expanded their Medicaid programs under the Affordable Care Act, but program expansion is on the ballot in several states as part of the 2020 election cycle.

For example, after securing enough signatures for ballot inclusion, Missouri voters will decide whether to expand Medicaid on the August 4 primary ballot. The ballot initiative originally was planned for the November general election, but Gov. Mike Parson (R) recently announced the timing change to “prepare and account for the outcome in our state budget.”

Likewise, in January, Oklahoma approved a petition to put Medicaid expansion on the ballot, and Gov. Kevin Stitt (R) decided to put the question to voters in the June 30 primary. The governor recently vetoed a Senate bill that would pay for expansion with an increased hospital fee, and the state Health Care Authority recently withdrew a state plan amendment to expand Medicaid.

However, the topic of expansion will remain unaddressed in several states this year. Plans to include expansion on the 2020 ballot in Florida now have been pushed to 2022. In South Dakota, a Medicaid expansion ballot initiative was submitted in May 2019 but failed to advance.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Abigail Painchaud is a policy associate at America's Essential Hospitals.

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