The specter of Medicaid expansion continues to cast a long shadow in 2015, with many states still fighting political battles that began when the Affordable Care Act was passed. Twenty-eight states plus the District of Columbia have expanded Medicaid to residents earning up to 138 percent of the federal poverty level, and this number will increase in 2015—though only by a few. Many Republican states will continue to balk, and those that do expand will attempt a waiver-based approach, allowing them to structure Medicaid more like private coverage while putting an emphasis on personal responsibility. Expect Alaska and Utah to work out deals in 2015; Idaho and Montana will have tough legislative debates, but will get there this year or next. As for the remaining holdouts, don’t expect expansion this year. However, most, if not all, of the remaining 18 states will likely move toward Medicaid expansion in the next few years.