Which specific states had not expanded Medicaid as of December 2025, and when did each state last change its status?

1. The holdouts identified — who they are and how consistent the count is

Major research and government outlets converge on a count of ten non‑expansion states as of late 2025: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming, a list repeated in policy analyses and briefing pages ^{[1] [3] [2]}, and KFF’s mapping tools and CMS enrollment reports show 41 expansion states versus 10 non‑expansion states through late 2025 ^{[3] [2]}.

2. Changes and momentum — what reporting flags as recent shifts

Reporting makes clear the political pressure on holdouts intensified through 2024–2025, producing piecemeal moves in some places: North Carolina completed an expansion deal in December (reported as the “latest” expansion) and Georgia enacted a partial expansion prior to 2024, indicating that state trajectories are not static and that business and hospital interests have pushed some Republican legislatures toward change ^{[4] [5] [6]}.

3. The limits of public reporting on exact “last change” dates

The available sources reliably identify which states remained non‑expansion in late 2025 ^{[2] [1]} but do not provide a clean, vetted date for the last statutory or executive action that altered expansion status in each of those ten states; KFF and CMS maintain status maps and implementation trackers that are updated continuously but do not consolidate “last legal change” dates for every holdout in the excerpts provided ^{[3] [2]}. Therefore, a state‑by‑state list with precise last‑change timestamps cannot be compiled from the supplied reporting without consulting each state’s legislative records or the full KFF state pages beyond the snippets provided.

4. What “last changed” would typically mean and where to look next

Context matters: for many holdouts the meaningful “last change” is effectively the state’s ongoing refusal to adopt the ACA expansion since the 2012 Supreme Court decision made expansion optional — a status that has persisted except where legislatures passed expansion bills or governors signed them ^[7]. For precise dates, authoritative sources would include state statutory enactment dates, governor executive orders, and KFF’s full state narrative pages or CMS implementation notices; the supplied materials point to those sources but do not include the granular date stamps for each of the ten states ^{[3] [2]}.

5. Politics, incentives, and the hidden agendas shaping reporting

Coverage from outlets like NPR and policy shops such as KFF and AJMC frames holdouts as mostly Southern and Republican-controlled and emphasizes fiscal and political calculations — hospitals and business groups pushing for expansion, GOP resistance centered on long‑term costs and work‑requirement experiments ^{[4] [7] [6]}. Readers should note the implicit agendas: advocacy and policy groups stress health and coverage gaps, while state political actors emphasize budget risk and ideological opposition; source selection therefore tilts narratives toward either coverage gains or fiscal concerns depending on the outlet ^{[7] [1]}.

6. Bottom line for researchers and reporters

Reliable consensus confirms ten non‑expansion states through December 2025 ^{[2] [1]}, but the exact “last change” date for each state is not available in the provided reporting; obtaining those dates requires consulting each state’s legislative records or the detailed KFF/CMS state pages referenced in the excerpts ^{[3] [2]}. Any definitive timeline should cite the specific state law or executive action for every listed state to avoid overgeneralization.