States can opt out of this-
http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap
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NOT MOVING TOWARD EXPANSION
Not participating in Medicaid expansion (16 states)
Alabama: On May 18, 2013, Gov. Robert Bentley (R) reiterated his opposition to expanding Medicaid, saying the state cannot afford it. Despite Democratic lawmakers declaring expansion to be one of their top goals for 2013, they failed to advance such legislation. According to a recent poll conducted by the Joint Center for Political and Economic Studies, two-thirds of state residents support expansion.
Alaska: On Feb. 28, 2013, Gov. Sean Parnell (R) said that based on what he knows about the federal budget, he does not support Medicaid expansion and will not ask the state Legislature for funding or authorization to boost the program's eligibility limits. State Rep. Andy Josephson (D) in March 2013 introduced HCR 8, a resolution to compel the governor to take action on the expansion, but the resolution did not gain traction among Alaska lawmakers.
Georgia : Gov. Nathan Deal (R) on Jan. 16, 2013, confirmed he would not support Medicaid expansion in his state. On March 28, 2013, both the House and Senate adjourned for the 2013 session. A bill to encourage Deal to consider expanding Medicaid died in the House in February 2013. Deal in May 2013 did sign legislation creating the Joint Study Committee on Medicaid Reform, but it only was for "for the purposes of determining an appropriate plan for Medicaid reform" and not specifically expanding the program under the ACA.
Idaho: Gov. Butch Otter (R) on Jan. 7, 2013, in his state-of-the-state address said Idaho would not expand Medicaid. The state House and Senate both adjourned on April 4, 2013.
Kansas: Gov. Sam Brownback (R) punted the decision on expanding Medicaid to state lawmakers, and the state Legislature wrapped up its session for the year on June 2, 2013, without taking action on any expansion proposals.
Louisiana: On Feb. 6, 2013, Gov. Bobby Jindal (R) reiterated his opposition to expanding Medicaid in Louisiana. In an op-ed for the Washington Post, Jindal argued that the expansion would cost his state $1 billion over the first 10 years. The Louisiana Senate in May 2013 rejected an amendment that would permit state voters to decide on Medicaid expansion, effectively ending any possibility for action on the issue before the Legislature recessed for the year.
Maine: On June 17, 2013, Gov. Paul LePage (R) vetoed a bill (LD 1066) that would have expanded the state's Medicaid program. LePage objected to the cost of expansion and also noted that previous hikes to Medicaid eligibility—which he termed "a massive increase in welfare expansion"—have not worked to reduce the number of uninsured in the state. Two days later, on June 19, 2013, House lawmakers failed to gain the two-thirds majority necessary to override the veto.
Mississippi: Republicans in the Legislature in June 2013 blocked plans to expand Medicaid to an additional 300,000 state residents under the ACA.
Montana: Republicans in the statehouse in April 2013 rejected plans to opt into the Medicaid expansion, which could have added another 70,000 state residents to the program.
Nebraska: In May 2013, Republicans in the Legislature filibustered the Medicaid expansion, which is also opposed by Gov. Dave Heineman (R). The expansion could have extended Medicaid coverage to up to 80,000 residents.
North Carolina: Gov. Pat McRory (R) on Feb. 12, 2013, announced that his state would not participate in the Medicaid expansion. McRory also signed legislation—passed in the House and Senate—confirming that the state would not participate.
Pennsylvania: In early July 2013, a Senate-approved bill that would have pushed Gov. Tom Corbett (R) to establish a Medicaid expansion plan by Oct. 1 was dropped in the House after the governor reiterated his opposition—which he wrote about in February—to an expansion and promised to veto the bill.
South Carolina: On March 12, 2013, the state House Republican majority rejected an expansion of Medicaid, opting instead to allocate $80 million in state and federal funding in South Carolina's budget for a hospital incentive payment program. Gov. Nikki Haley (R) announced in July 2012 that she opposes an expansion.
Texas: Gov. Rick Perry (R) and the Republican majority in the state Legislature have unanimously rejected the Medicaid expansion, although Democrats have introduced legislation (HB 3791) that would establish a strategy to expand Medicaid. The bill is still pending in the House.
Wisconsin: Gov. Scott Walker (R) on Feb. 13, 2013, said Wisconsin will not participate in the ACA Medicaid expansion, but will pursue its own strategy to expand health coverage across the state. In addition, the legislature's Joint Finance Committee in June 2013 voted against the expansion.
Wyoming: Gov. Matthew Mead (R) in December 2012 said that he would not support Medicaid expansion in Wyoming. On January 31, 2013, the state Senate struck down a bill that would have expanded Medicaid.
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