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Virginia Gov. Ralph Northam (D) on Thursday signed a budget that includes Medicaid expansion, making Virginia the 33rd state to expand the program under ObamaCare. The signing caps a years-long battle in the state over Medicaid expansion, which Democrats have pushed for but Republicans long resisted. After Democratic gains in the state legislature and Northam’s victory last year, enough Republicans got on board with Medicaid expansion for it to pass the General Assembly. (Sullivan, 6/7)

With his signature, Northam (D) brought a Medicaid battle that raged for four years under his predecessor to an upbeat, bipartisan close. Immediately afterward, he rewarded two senators who had been crucial to the bill’s passage — Democrat Richard L. Saslaw (Fairfax County) and Republican Emmett W. Hanger (Augusta) — with ceremonial pens used to sign the bill. “We showed Virginia and the world that chaos and partisan warfare may dominate Washington, but here in Richmond, we still work together to do the right thing for our people, not our political party,” Northam told hundreds of activists and about 30 legislators at the ceremony. Expansion takes effect Jan. 1. (Vozzella, 6/7)

With the stroke of a pen, Gov. Ralph Northam ended five years of political warfare to expand Virginia’s Medicaid program after just five months in office. Northam then turned to embrace Sen. Emmett Hanger, R-Augusta, one of the few Republicans gathered on the steps on the South Portico of the state Capitol on Thursday afternoon to witness the signing of a two-year, $117 billion budget that will expand health coverage for up to 400,000 uninsured Virginians on Jan. 1. (Martz and Moomaw, 6/7)

The Republican-led Michigan Legislature on Thursday gave final approval to a bill requiring able-bodied adults in the state's Medicaid expansion program to meet work or job-related requirements, sending it to Gov. Rick Snyder for his expected signature. Starting in 2020, adults age 18 to 62 would have to show workforce engagement averaging 80 hours a month — through work, school, job or vocational training, an internship, substance abuse treatment or community service. Michigan would first seek a federal waiver to implement such requirements that have been embraced by President Donald Trump's administration. (Eggert, 6/7)

Iowa cannot deny two transgender women Medicaid coverage for sex reassignment surgery, a state court judge ruled Thursday, declaring a policy denying their care violates the Iowa Constitution and its civil rights law. Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities in eastern Iowa filed the lawsuit last year after their Medicaid provider and the Iowa Department of Human Services denied surgery requests recommended by doctors. (Pitt, 6/7)

A federal law providing 10 more years of funding for the national Children’s Health Insurance Program should help Florida continue to reduce its rate of uninsured kids. But the state’s taxpayers will have to pay millions more for the program starting in 2020. (Ochoa, 6/7)