The federal government initially pays the entire cost of the expansion, dropping to 90 percent after the first few years. That means states that don't participate in the expansion will be paying for benefits their residents can't receive.
The Medicaid expansion is central to the coverage expansion in the Affordable Care Act — it was initially supposed to cover about half of the newly insured people, before the Supreme Court gave states the ability to opt out.
Beshear's office said the Medicaid expansion will help improve the state's overall health. It ranks 44th in overall health, according to the governor's office, and ranks 50th in smoking rates and cancer deaths.
“I, for one, am tired of being at the bottom,” Beshear said. “Giving every Kentuckian access to affordable health care coverage will help us tackle these abysmal health outcomes. Our poor health has contributed to us being a poor state. Improved health will help improve our education levels and job opportunities.”