KFF Examines How the ACA Medicaid Expansion Now Accounts for Significant Medicaid Enrollment and Spending in Both Blue and Red States
A new KFF analysis lays out key facts about the Affordable Care Act’s (ACA) Medicaid expansion, illustrating that both red and blue states could be affected by any potential efforts to scale back federal financing for the expansion or repeal it altogether.
The ACA’s Medicaid expansion has been adopted by 41 states including the District of Columbia, split nearly evenly between states that voted for President-elect Trump (21 states) in the most recent election, and those that voted for Vice President Harris (20 states).
As of March 2024, over 21 million people were enrolled through the Medicaid expansion representing nearly a quarter of enrollment across all states and about three in ten Medicaid enrollees in expansion states.
Under the law, the federal government picks up 90% of the costs of covering the expansion population. In FY 2023, total spending on the expansion group was $178.2 billion (including $158.3 billion in federal funds). That represented 20% of the $863.9 billion in total (state + federal) Medicaid spending across all states, and 26% of the $686.9 billion in total Medicaid spending in just the expansion states and D.C.
Nearly 4.3 million expansion enrollees live in the 12 states with some type of trigger law that would end expansion coverage or require review of expansion coverage to mitigate increases in state costs if federal funding for the expansion is reduced.
