Utah residents are going to vote on Medicaid expansion in November, after organizers got enough signatures to put the item on the ballot.

The advocacy group, Utah Decides Healthcare, submitted more than 165,000 signatures on Monday to put a “clean” Medicaid expansion on the November ballot — about 50,000 more signatures than required. The news came less than a month after Gov. Gary Herbert (R) approved legislation requesting federal approval for a conservative Medicaid expansion, or a partial expansion with work requirements.

Utah is among 18 states that did not expand Medicaid under the Affordable Care Act (ACA), leaving more than 100,0000 people in a “coverage gap.” This group of people is uninsured because they make too much to qualify for Medicaid, but they don’t make enough for subsidized private health plans either.

Utah isn’t the only state trying to expand Medicaid. Health advocates in Idaho and Nebraska are trying to expand Medicaid eligibility by ballot box. And Virginia lawmakers are currently negotiating Medicaid expansion through the legislature — but it won’t be without concessions for Democrats and progressives. A plan approved on Friday in a House subcommittee requires “able-bodied” applicants to participate in work, training, or educational programs or they’ll be disqualified from coverage. The measure goes to a full House vote on Tuesday before it’s sent to the Senate, where the fight’s more contentious, according to the Washington Post.

The Utah ballot initiative would add more than 150,000 people to the Medicaid rolls — no concessions required.

“Look at Maine — I think you are going to see the same thing in Utah,” Utah Decides Healthcare‘s RyLee Curtis recently told ThinkProgress. “You are going to see the political will of the people.” A recent poll found two-thirds of Utah voters support expansion.


Maine was the first state to expand Medicaid by ballot last year, but its fate is somewhat uncertain as it has met much resistance from Republican Gov. Paul LePage.

Meanwhile in Utah, the fate of Medicaid expansion is also uncertain. Last month, the state submitted a plan to the Trump administration that only expands health care to 60,000 people. The plan would only expand Medicaid to people making up to 100 percent of the federal poverty level, rather than 138 percent as federal law requires. It’s unclear whether the Trump administration will approve the measure and allow Utah to still receive federal funding, as it didn’t immediately approve Arkansas’s request.