Under the Affordable Care Act (ACA), states have the option to expand their Medicaid programs to more low-income individuals, with the feds picking up the cost for the first three years and then gradually decreasing to paying 90 percent of the cost. While I was always hopeful to take this step, I wanted to make sure it was the fiscally responsible thing to do for the state. Our analysis shows that not only can the state afford to expand this program, but upon full implementation of the ACA, it would cost us more to turn it down.