STATE DIRECTORY
Medicaid directors and HIV prevalence data for all 40 expansion states plus D.C. “HCH” stands for Health Care for the Homeless: those columns show insurance data for patients served by Health Care for the Homeless programs in each state.
Did my state expand Medicaid? ↓
Jump to state exemption forms, code lists & templates ↓
DID MY STATE EXPAND MEDICAID?
40 states plus D.C. expanded Medicaid. 10 did not. This decides whether a state has an "expansion group," the adults who face work requirements and renewals every 6 months. Open the list and click your state for what it means there.
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YES Expanded Medicaid
NO Did not expand
Alabama NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
Alaska YES
Expanded in 2015. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Arizona YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Arizona accepts self-attestation for medical frailty. See its exemption form in the directory below.
Arkansas YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Uses a 3-month look-back at application for the work requirement.
California YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• State materials cite March 2027, when most enrollees hit the new rules at renewal.
Colorado YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Connecticut YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Delaware YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
District of Columbia YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Florida NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
Georgia NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
• Georgia covers some adults up to 100% of poverty through Georgia Pathways, which already has its own work requirement. These adults are also subject to the federal work requirement rules.
Hawaii YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Idaho YES
Expanded in 2020. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Uses a 3-month look-back at application. A 2026 bill to repeal expansion died in committee.
Illinois YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Has a state exemption form. See the directory below.
Indiana YES
Expanded in 2015. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Uses a 3-month look-back and checks compliance every 3 months, not just at renewal. Has a medical frailty code list.
Iowa YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
Kansas NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
Kentucky YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Passed a law charging adults in the expansion group higher copays than H.R. 1 requires.
Louisiana YES
Expanded in 2016. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Gives applicants only one chance to submit citizenship or immigration documents.
Maine YES
Expanded in 2019. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
Maryland YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Passed the Protecting People with Disabilities Act to help people with intellectual or developmental disabilities avoid losing coverage over paperwork.
Massachusetts YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Michigan YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Minnesota YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Mississippi NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
Missouri YES
Expanded in 2021. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
Montana YES
Expanded in 2016. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
Nebraska YES
Expanded in 2020. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
• Has a state exemption form and a medical frailty code list. See the directory below.
Nevada YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
New Hampshire YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Bans self-attestation for medical frailty. Checks compliance every 3 months with a 3-month look-back at renewal. Has a state exemption form.
New Jersey YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
New Mexico YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
New York YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
North Carolina YES
Expanded in 2023. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
• Bans self-attestation for medical frailty and uses a 3-month look-back. Requires the highest allowed copays for both expansion and traditional Medicaid. Has an exemption form and code list.
North Dakota YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Ohio YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
Oklahoma YES
Expanded in 2021. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
• A 2026 proposal to put expansion repeal on the ballot was not passed.
Oregon YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Pennsylvania YES
Expanded in 2015. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Rhode Island YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
South Carolina NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
South Dakota YES
Expanded in 2023. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
• Has a state exemption form. See the directory below.
Tennessee NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
Texas NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
Utah YES
Expanded in 2020. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Voters approved expansion through a ballot measure.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
Vermont YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Virginia YES
Expanded in 2019. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a "trigger law" that would end or rethink expansion if federal funding for it drops. H.R. 1 did not cut that funding, so these laws have not been set off.
Washington YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
• Has a state exemption form and a medical frailty code list. See the directory below.
West Virginia YES
Expanded in 2014. Adults 19–64 who qualified on income face work requirements (from Jan 1, 2027) and renewals every 6 months. People who qualify through a disability, SSI, pregnancy, or as parents or older adults do not.
Wisconsin NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
• Wisconsin covers adults up to 100% of poverty through BadgerCare. These adults are subject to the federal work requirements, even though Wisconsin did not formally expand.
Wyoming NO
Did not expand. Most adults without children can’t get Medicaid on income alone, so there is no expansion group. Changes for everyone on Medicaid still apply: address checks, narrower immigrant eligibility, and 2-month retroactive coverage.
• Passed a law banning self-attestation for Medicaid eligibility, and gives applicants only one chance to submit citizenship or immigration documents.
Sources: KFF, Status of State Action on the Medicaid Expansion Decision (as of October 2026); Georgetown CCF, 2026 state legislative sessions (July 2026). Rules change; verify with your state Medicaid agency.
STATE
MEDICAID DIRECTOR
STATE WEBSITE
EST. PLWH (2023)
RATE / 100K
HCH UNINSURED
HCH MEDICAID
Alaska
Emily Ricci
805
132.5
14%
43%
Arkansas
Janet Mann
6,493
252.3
33%
48%
Hawaii
Meredith Nichols
2,402
196.6
15%
70%
Massachusetts
Ryan Schwarz
21,766
358.8
11%
66%
New Hampshire
Henry Lipman
1,400
113.9
17%
50%
Oregon
Emma Sandoe
7,703
210.6
12%
71%
Virginia
Steve Ford
25,355
343.1
27%
53%
Director names and titles: National Association of Medicaid Directors (as of directory publication). PLWH estimates and rates: CDC NCHHSTP AtlasPlus, 2023, via KFF State Health Facts. HCH (Health Care for the Homeless) uninsured/Medicaid rates: National Health Care for the Homeless Council, "Health Insurance at HCH Programs, 2023" (patients served by Health Care for the Homeless programs in each state). Director names change; verify before outreach.
STATE EXEMPTION FORMS & TEMPLATES
Some states have published forms clients or their providers can use to claim an exemption from Medicaid work requirements, most often for medical frailty or substance use treatment. Case managers can use these to prepare clients before renewal. Self-attestation is generally allowed through 2027 (but not in Arkansas, Idaho, Indiana, New Hampshire, North Carolina, or Ohio, which have barred it for medical frailty); starting in 2028, clients can self-attest to medical frailty only once per enrollment period, after which a provider form or medical records will be needed.
ARIZONA
Self-attestation
AHCCCS now accepts self-attestation for the medical frailty exemption, so clients can state on their own that they are medically frail. Check the AHCCCS page for how to submit it.
COLORADO
Self-attestation
No stand-alone exemption form yet. HCPF checks its own data first; if it can’t confirm an exemption, a work requirements form comes with the renewal packet about 60 days ahead. A draft of the paper version (Worksheet J) has yes/no boxes for each exemption, including medical frailty and mental health or SUD treatment, signed by the client only. In 2027, clients can self-attest with no provider signature, and can respond through PEAK, the Health First Colorado app, mail, or drop-off.
ILLINOIS
Announced
A “Manage My Work Requirement” form is coming. Clients will be able to submit it by mail, fax, or at a local Family and Community Resource Center, or report online through ABE in late 2026.
KENTUCKY
Official form
Two forms for the state’s Medicaid Work or Community Engagement (MACE) rules. MACE-200 documents a medical condition exemption, including medical frailty, mental health, or substance use disorder; for 2027 only, clients can fill it out and sign it themselves with no provider signature. MACE-300 requests a short-term hardship exception, such as a hospital stay or travel for medical care.
LOUISIANA
Official form
Community Engagement Requirements Verification Form (issued Sept. 25, 2026), sent in renewal packets. Clients can check an exemption and sign the caregiver (Section E) or medically frail (Section F) page themselves for 2027 renewals; a provider may need to complete it starting in 2028. Return it online, by email, fax, mail, or in person.
MICHIGAN
Draft · Comment by Nov 23
No separate form. In 2027, clients can self-attest to medical frailty on their application, renewal, or in MI Bridges, with no documentation needed; the state also flags people automatically from 12 months of claims. The draft Healthy Michigan Plan policy (Project 2636) is open for comment through November 23, 2026.
MONTANA
Official form
Form HCS 495 lets each adult (19–64) in a Medicaid Expansion household claim an exclusion, including medical frailty, caregiving, SUD treatment, pregnancy, or tribal membership. New applicants can self-declare frailty; at renewal, enrollees the state can’t verify from claims need a provider to sign the attestation page. Submit online at apply.mt.gov, by mail, fax, or at a local OPA office.
NEBRASKA
Official form
Individual Declaration Form (MLTC-118). Clients claiming medical frailty describe their health condition; those claiming the SUD treatment exemption name their treatment facility. Requirements have been in effect since May 1, 2026.
NEW HAMPSHIRE
2019 model
Exemption Request Form (BFA 330) from the state’s earlier Granite Advantage waiver, with a section for a licensed medical professional to certify. Useful as a model; not the current federal version.
NORTH CAROLINA
Draft · Comment by Nov 5
Draft DSS-8209, Medical Report: Work Requirement Exclusions and Exemptions, covering SNAP and Medicaid. Providers must have an established relationship with the client. The policy, provider attestation form, and medically frail code list are open for public comment through November 5, 2026.
OHIO
Document list
No exemption form. Ohio’s partner packet lists the proof clients bring to their county JFS office for each exemption: for medical frailty, a doctor’s statement or disability award letter; for drug or alcohol treatment, a statement from a doctor or the program. The state will also flag frail members from claims.
SOUTH DAKOTA
Screening tool
Accepts a Medical Frailty Screening Tool, a written provider statement, or medical records to document medical frailty or SUD treatment. A completed attestation form counts for community service hours. The state’s advisory committee deck outlines a physician attestation.
WASHINGTON
In application
No separate form. The application will include a medical screener where clients attest, under penalty of perjury, that they are medically frail. The state checks the attestation against its medically frail code set.
MEDICAL FRAILTY CODE LISTS
Some states have published the ICD-10 diagnosis codes they use to identify people who are medically frail. If a qualifying code appears in a client’s recent claims, the state may exempt them automatically, with no paperwork. It’s worth making sure clients’ HIV, behavioral health, and substance use diagnoses are coded in their recent care.
GEORGIA
List posted
Two ICD-10 lists for Pathways members, effective January 2027. Attachment A conditions count as medically frail on their own; Attachment B conditions may qualify with other diagnoses or documentation. Only HIV that has led to cancer (code B21) is on Attachment A. Other HIV diagnoses are reviewed case by case, so clients with HIV may need to ask for a review.
INDIANA
Full list posted
About 4,300 Tier 1 ICD-10 codes, grouped by chapter, each with a description and condition. Only the listed codes qualify, not every code in a chapter. Tier 2 uses claims evidence (treatments, medications, services); Tier 3 is individual review by state clinical staff.
MICHIGAN
Draft · Comment by Nov 23
Draft list, effective January 2027, in two categories. Category 1 diagnoses, including B20 (HIV disease), qualify on their own; Category 2 diagnoses also need a hospital stay or at least two moderate-to-high intensity outpatient visits. A stay of 30+ days in a hospital, nursing home, or hospice, or enrollment in PACE or certain waivers, also counts.
NEBRASKA
Process only
About 90 days before renewal, the state reviews 12 months of claims for qualifying diagnosis and procedure codes. Its code index is not posted publicly; the provider update explains the process.
NORTH CAROLINA
Draft · Comment by Nov 5
Diagnosis and service code list (Excel) in two tiers. Tier 1 codes found in claims or health records exempt a client with no extra paperwork; Tier 2 codes also need the DSS-8209 provider form, signed by the client. Final version expected late November or early December 2026.
OHIO
List posted
Ohio Medicaid’s ICD-10 list of diagnoses it treats as a serious or complex medical condition, dated October 29, 2025. Each code uses a one-year claims lookback. The list includes B20 (HIV disease) along with many cancer codes.
WASHINGTON
List posted
Uses a diagnosis list developed by the Harvard School of Public Health, plus added behavioral health and long-term care codes. A diagnosis counts when paired with care that shows severity, such as a hospital stay. Certain Z codes also count, including Z59.3 and several Z74 codes on dependence on care providers.
Federal framework: CMS’s September 2026 guidance gives states an optional three-tier approach, in which Tier 1 diagnosis codes alone can confirm medical frailty. CMS guidance deck →
TEMPLATES FOR ADVOCATES & PROVIDERS
Civilla: Human-Centered Application Templates
A toolkit of application and exemption question templates for states implementing H.R. 1. Useful when giving input to your state Medicaid agency.
ACP: How Physicians Can Prepare
Practical steps for clinics handling exemption paperwork, such as setting appointments and turnaround times for form completion.
Last checked November 4, 2026. Other states are still finalizing forms ahead of the January 1, 2027 start date; check the state website links in the directory above for updates.
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