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Toolkit: Medicaid Expansion

Lobbying for Medicaid Expansion with Your Governor and State Legislators

If you live in a state that has not expanded Medicaid, NETWORK invites you to take action to expand Medicaid in your state. As most of you know, Medicaid is a joint federal-state program that finances health care for certain categories of low-income individuals, including seniors, kids and disabled persons. We have put together a comprehensive toolkit that provides more information about the Medicaid Expansion and tools for lobbying your governor. We also have an interactive map that shows where each state stands, ways to get involved, and more!


On June 28, 2012 the Supreme Court upheld the constitutionality of the Affordable Care Act but it also held that expanding Medicaid in 2014 is not mandatory. As of this ruling, it is a choice that states can opt into or out of. This can be devastating for those living in lower socioeconomic circumstances who counted upon this coverage for their families.

Nevertheless, the Court ruled that the expansion itself is constitutional, and the Gospel declares that it is the right and just thing to do. Tragically, since the Supreme Court decision, some governors have announced that they will not expand Medicaid in their state. Others remain quiet because they fear political consequences in this election year.

The reality is that, if a state doesn’t expand Medicaid in 2014, there will be no valid health insurance option for many low-income people who earn between 100 and 133% of the national poverty level. (About $22,000 - $29,000 for a family of four). Under the expansion, these people would have had coverage.

What to do

As Martin Luther King admonished from the Birmingham jail in 1963, “We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people.” Politicians and the ones with the most money are vocal about their factually insufficient reasons for refusing to expand Medicaid. We must push back.

Advocates are needed to lay the groundwork to make sure that their state expands Medicaid. We are asking people who are concerned for those who live on the margins to follow up the "nuns on the bus" campaign by commiting to the following actions:

1. Learn the messaging related to Medicaid Expansion and bring others along.

Generate support for the expansion by working with interfaith coalitions. Teach others at work, home and church how expanding Medicaid improves everyone’s future. Attend church groups such as the Social Justice group, JustFaith, women’s or men’s groups and speak about the need to provide care for all our brothers and sisters. Explain how expanding Medicaid will achieve that goal. Discuss with your friends and acquaintances that if one of us suffers, we all hurt. For example, large numbers of people who are uninsured will mean that uncompensated care costs in your state will remain high. Hospitals and doctors will continue to make up for those costs with higher charges for those who have insurance. That results in higher insurance premiums for ALL employers and everyone else who purchases insurance. Expanding Medicaid can keep health care costs lower for everyone in your state.

„„2. Meet with your Governor and/or decision makers

  • Choose a wise “ask” or “request”, depending upon Governor’s known ideology and proximity to election.
  • Encourage your Governor/state to study the impact of coverage.

In states where your Governor is unlikely to commit to expansion before the election, do not push for an answer. He/she may end up publicizing a negative response and it will be harder for him/her to go back on that after the election. Instead, visit the Governor and other decision makers to build relationship and your “ask” for the first visit may be for a study of impact. There should be little resistance to this “ask” and it will build a relationship in case the climate changes a bit after the election.

Ask your Governor or legislators in your state to perform a thoughtful and thorough financial and moral analysis of the impact of expanding Medicaid. Ask them to include an assessment of indirect costs and benefits of expansion that would affect state residents. Encourage your state to get input from multiple stakeholders during this process, and volunteer to be part of any working group formed. Savings from uncompensated care costs, decreased state death rate, and job creation due to a healthy work force, productivity and increase spending in state should be a part of that study.

Leave behind a one page request and explanation of the type of impact study you would like to see. See for information related to impact studies of Medicaid Expansion.

  • Lobby for Medicaid expansion

After the election, some Governors may be more willing to consider the expansion. Make an appointment and lobby for the expansion.

For more information related to expansion, refer to

3. If commitment to expand is obtained, lobby federal legislators for continued federal funding.

4. Publicize your actions - get media atttention

  • Write letters to the editor about Medicaid expansion.
  • Write blogs, use Facebook and Twitter to advertise your lobby efforts.
  • Work with media outlets and find personal stories.

Part of generating broad support includes working with media. Papers and other news outlets are more likely to cover the issue if you have a personal story of someone who could be helped by expanding Medicaid. Start gathering personal stories now.

Contact NETWORK at for help.

Or let us know about your plans for a Nuns on the Bus Medicaid Expansion campaign by using this form:  NOTB form for Medicaid Expansion


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