Backers of Medicaid expansion in a number of red states see hope from voter initiatives in Idaho, Utah and Nebraska and are mulling whether they too can override opposition from their Republican leaders.

Voters in those three states last week cast their ballots to broaden access the federal health program to a greater spade of low-income individuals. The exception was Montana, which voted down a bid to continuing its Medicaid expansion program (though there is a chance the state legislature will vote to continue funding for the program).

Still, the victories are inspiring expansion backers from Missouri, Mississippi and Oklahoma that have found themselves boxed out by Republican lawmakers unwilling to extend health coverage to more low-socioeconomic status residents. It comes as polls show public support for the program.

"Folks here have seen the success of ballot initiatives in other states and would certainly consider beginning the process to putting this on the ballot in 2020 if the legislature doesn't act," David Blatt, executive director of the Oklahoma Policy Institute, told Healthcare Dive.

Many would prefer the legislature act first on Medicaid expansion, he said, noting there is a new governor and a large contingent of freshman lawmakers. But Oklahoma's new governor, Republican Kevin Stitt, does not support expanding the program.

As stakeholders in other states eye a ballot initiative, they're also concerned about the cost.

"For a state like Mississippi, there's not a whole lot of resources to do it," Roy Mitchell, executive director of Mississippi Health Advocacy Program, told Healthcare Dive.

On his to-do list is contacting major funders including The Fairness Project, an organization that has helped back other Medicaid ballot initiatives.

When asked about whether the Fairness Project would look to invest in other ballot measures, Colin Diersing of the group said it's "fair to say we're taking a hard look at whether there are resources and support to run effective campaigns in all states with ballot initiative processes but no Medicaid expansion," but that's it's too early to single out any particular states publicly.

Discussion are ongoing in Missouri as well.

"We’ve spent the last six years advocating for expansion and we are open to exploring all the available options," Bridget McCandless, president and CEO of the Health Care Foundation of Greater Kansas City, told Healthcare Dive.