This brief examines the financial impacts of the Affordable Care Act on (ACA) selected states. The brief concludes that states expanding Medicaid will receive significantly larger inflows of federal dollars than those that do not. Medicaid expansion will bring in large amounts of federal dollars that will offset cuts in the ACA to Medicare provider payment rates and Medicaid and Medicare disproportionate share hospital payments. States that do not expand Medicaid will experience the ACA cuts but will have much smaller inflows of federal revenues. All states will experience some new spending but much can be offset by savings in other parts of state budgets.