While many of the states that have chosen to expand their Medicaid programs under the terms of the Affordable Care Act did so by embracing those terms, others are viewing Medicaid expansion as an opportunity to pursue wholesale changes in how they serve their low-income residents.

Arkansas and Iowa have already received federal waivers to expand their Medicaid programs – exemptions from selected aspects of existing Medicaid law.  Under these waivers, the states operate demonstration programs to test the effectiveness of their variations on ordinary Medicaid practices.

In addition to Arkansas’s and Iowa’s successful waiver applications, Pennsylvania, Virginia, New Hampshire, Indiana, and possibly a few other states are expected to seek federal waivers in 2014.

Many states remain opposed to expanding their Medicaid programs under any conditions.  The National Association of Urban Hospitals (NAUH) supports Medicaid expansion everywhere.

Learn more about Medicaid waivers, how states pursue them, the challenges states face in pursuing them, and the kinds of innovations they can make possible in this Stateline report.