Voters in traditionally more conservative Idaho, Utah and Nebraska voted Tuesday to adopt Medicaid expansion provisions through ballot measures. Montana voters decided against an initiative that proposed a tax hike on tobacco products to continue funding the Medicaid expansion programs already active in the state.

In Idaho voters approved Proposition 2 that proposed expanding Medicaid eligibility to individuals under 65 years of age whose income is 133 percent of the federal poverty level or less and are not eligible under other coverage options under the state plan, bringing the effective coverage to individuals at or under 138 percent of the poverty level. This provision is in line with sections 1902(a)(10)(A)(i)(VIII) and 1902(e)(14) of the Social Security Act. The proposition passed with 61.63 percent voting in favor.

In Utah voters approved Proposition 3 by 54.08 percent, with approximately 75 percent of precincts reporting, which similarly expands Medicaid eligibility for persons under the age of 65 with incomes at or under 138 percent of the federal poverty level. The provision also increased the sales tax by 0.15 percent to finance the state’s share of the costs of expansion.

Nebraska Initiative 427 was approved by 53.2 percent with 98 percent of precincts reporting. The Nebraska initiative also provided for the expansion of Medicaid coverage to individuals under 65 earning at or below 138 percent of the federal poverty level.

Montana Initiative 185 did not pass with 53.6 percent of voters (91 percent reporting) against the initiative. The initiative proposed raising the tax on tobacco products to continue to fund the Medicaid expansion that Montana already instituted. With the no vote on the initiative, the Medicaid expansion is set to expire on June 30, 2019.