Funder: Robert Wood Johnson Foundation

April 2014 | Fact Sheet


Of the states implementing or pursuing Medicaid expansions, four states—Arkansas, Iowa, Michigan, and Pennsylvania—have bypassed the Affordable Care Act’s (ACA) conventional expansion pathway and are pursuing alternative models. These states are using authority granted by 1115 waivers from the Centers for Medicare & Medicaid Services to run demonstrations testing new coverage approaches. The expansion demonstrations allow states to use federal funds to cover previously uninsured populations while potentially mitigating the political consequences associated with enlarging an existing Medicaid program.

This fact sheet highlights four common themes from these alternative models, including reliance on the private insurance market, emphasis on healthy behaviors, exemptions from Medicaid rules, and limits or contingencies.