As states wrap up legislative sessions and make decisions about whether to implement the Medicaid expansion included in the Affordable Care Act (ACA), this new analysis highlights the implications of these decisions for coverage, state finances and providers. As of July 2013, 24 states were moving forward with the Medicaid expansion, 21 states were not moving forward with the expansion and debate was on-going in the remaining 6 states. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave many more uninsured; these states would also forgo billions in federal funds.