Ten states have still not expanded Medicaid under the ACA. If those states were to move toward expansion, 2.3 million people would secure health insurance coverage.
While Medicaid expansion has long been a possibility, there is still some room for upheaval in 2026, from pushes for expansion to unexpected drawbacks.
Here are six Medicaid expansion updates from this year:
1. Kansas Gov. Laura Kelly seemed to back off her push for Medicaid expansion in the state, avoiding mentions of it in her latest budget proposal and State of the State address.
2. Medicaid work requirements are on the horizon for expansion states, beginning in 2027. For example, Alameda Alliance for Health, a county-organized Medicaid managed care plan in California, is bracing for up to a 45% membership loss over the next three years amid federal cuts and work requirements.
3. A Florida Medicaid expansion campaign — Florida Decides Healthcare — is back, now pivoting to focus on the 2028 ballot. The organization said a state law interfered with previous signature-collection efforts.
4. A study published Jan. 27 in JAMA Network Open found states that expanded Medicaid saw a 4.8% reduction in risk for breast cancer mortality.
5. Gov. Brad Little said he is not in favor of pulling back Idaho’s voter-approved Medicaid expansion program. In December, a panel of state lawmakers had suggested repealing the expansion.
6. As of 2026, states no longer get a temporary two-year, 5-percentage-point federal medical assistance percentage increase for expanding Medicaid.
