Ten states have 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 seven Medicaid expansion updates from this year:
1. Twelve Democratic senators signed a letter March 19 indicating a heightened focus on health insurance reform. One tenet of their plan is to increase health insurance access for lower-income Americans. The lawmakers said their efforts will specifically include those who rely on private insurance in states without expanded Medicaid.
2. Medicaid work requirements are on the horizon for expansion states in 2027, with managed care plans already projecting large membership losses. 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. Montana, an expansion state, is working to become an “early adopter” of work requirements ahead of the federal deadline, with the state preparing to launch community engagement rules July 1.
3. 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.
4. 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.
5. 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.
6. Idaho Gov. Brad Little said he is not in favor of pulling back a voter-approved Medicaid expansion program. In December, a panel of state lawmakers had suggested repealing the expansion.
7. As of 2026, states no longer get a temporary two-year, 5-percentage-point federal medical assistance percentage increase for expanding Medicaid.
This story was updated March 19, 2026.
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