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Voters in Idaho, Nebraska, and Utah will decide next week whether to expand Medicaid in their respective state, while Montana voters will decide whether to continue Medicaid expansion.

Since the Affordable Care Act (ACA) was enacted in 2010, 33 states and the District of Columbia have chosen to expand their programs for residents earning up to 138 percent of the federal poverty level (FPL). In 2013, Arkansas became the first state to expand Medicaid under an alternative method (utilizing a federal 1115 waiver) and now eight of the 33 expansion states have chosen that path.

Medicaid ballot measure voters are going to the polls as other states continue to grapple with expanding their own programs under the ACA. Earlier this year, Virginia expanded its program after years of resistance from the Republican-controlled General Assembly. Voters in Maine approved a ballot measure to expand Medicaid last year, but the debate continues to make headlines due to Governor Paul LePage (R) delaying the expansion.

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Idaho Proposition 2: Medicaid Expansion Initiative

Idaho Proposition 2 would expand coverage for those earning up to 133 percent of the FPL or below and who are not eligible for other state insurance coverage, which accounts for roughly 62,000 individuals. Despite opposition from most Republican lawmakers, polling shows that a majority of Idahoans seem to support expanding the program.

Montana I-185: Extend Medicaid Expansion and Increase Tobacco Taxes Initiative

Montana voters will be voting to make Medicaid expansion permanent. The state has already expanded its program in recent years, and I-185 would extend expanded eligibility for Medicaid coverage while increasing taxes on tobacco products to fund it. A poll released by Montana State University shows that I-185 is in a dead heat, with 41.4 percent of voters supporting the measure and 40.8 percent of voters opposing it.

Nebraska Initiative 427: Medicaid Expansion Initiative

Nebraska Initiative 427 would expand Medicaid for persons under the age of 65 and with incomes equal to or below 138 percent of the FPL. A Nebraska judge dismissed an effort to block Medicaid expansion from the ballot earlier this year.

Utah Proposition 3: Medicaid Expansion Initiative

Utah Governor Gary Herbert (R) signed a partial Medicaid expansion bill (UT HB 472) back in March that will provide 70,000 Utahns with health coverage as long as they prove that they are working, volunteering, or participating in similar activities. An activist group, Utah Decides Healthcare, collected 147,280 signatures to place a measure on the ballot asking whether Utah should expand Medicaid to 150,000 individuals. The latest poll shows that 59 percent of Utah residents support the Medicaid expansion ballot measure.