Under health care reform, all 50 states are required to set up a health insurance marketplace and to choose whether or not to expand their Medicaid programs.
Get the facts for your state’s Health Insurance Marketplace at the U.S. Department of Health and Human Services website.
You can also find updates on your state’s Medicaid program, which provides health coverage to millions of lower-income individuals and families.

Health Care in Your State

A lot of people are trying to understand what the states’ role is in the new health care insurance law. The states have two primary roles: choosing whether to set up state health insurance marketplaces, and choosing whether or not to expand Medicaid eligibility.

Keep in mind that from your perspective as a consumer, there will be no difference whether your state marketplace is state-run, federally run, or cooperatively run. You can still apply for and choose the coverage that best works for you.

Health Insurance Marketplaces in the States

In order to provide competitive coverage to over 41 million Americans who currently don’t have insurance, ObamaCare gives states three options for setting up health insurance marketplaces. These marketplaces were required to be ready for consumers to use by October 1, 2013.

Under the first option, a state may choose to set up its own insurance marketplace. In this case, the state can decide which insurers can participate and negotiate benefits and prices. In addition, these states received additional federal funds to operate their marketplace.

A second option for the states is to partner with the government in creating their health insurance marketplace. Any insurance carrier meeting the minimum federal and state health coverage requirements can participate in the marketplace when the state and the federal government work together.

The third option for the states is to not create or participate in creating a health marketplace at all. States that choose this option will instead have the U.S. Department of Health and Human Services choose the insurers. Some states have chosen not to participate due to a lack of staff or funds; others are not participating as a form of protest against ObamaCare.

Expanding Medicaid Eligibility in the States

Originally, ObamaCare required states to expand Medicaid coverage to all Americans with family incomes at or below 133% of the federal poverty line. In 2013, this equates to an income of $31,322 for a family of four. The federal government would pay for the majority of the cost of expansion. States who did not comply would risk losing federal support for existing Medicaid programs.

In a ruling issued June 28, 2012, the Supreme Court held that withholding existing federal Medicaid funding as a penalty for not expanding the program was unconstitutional. The result is that the states can decide either to expand or not, with no penalty in existing funding. However, the additional expansion assistance would not apply to states that did not choose to expand their programs. In addition, states that choose to expand are subject to all of the rules for the expansion, including ObamaCare rules surrounding the types of coverage Medicaid plans must offer.

How is Your State Affected?

Since the health insurance situation varies by state, it’s important to know the status of the state health insurance marketplace where you live. The U.S. Department of Health and Human Services has a very helpful website which will allow you to see the effects of health reform in your state. In addition, the federal government has provided information on which states are expanding Medicaid and what you can do if your state isn’t. For additional information regarding The Affordable Care Act and your state please explore our state pages:

Whatever the political situation is in your state, you can still use the state health care marketplace if you don’t have other health insurance coverage. The marketplace will still function the same for consumers regardless of the choice the state makes. Links to the marketplace in every state are available here.