As the Supreme Court decision to cut financial subsidies for the health insurance of millions of Americans looms, many states are still grappling with the question of whether to expand Medicaid in the traditional way outlined by the Affordable Care Act (ACA).

And this month, two states, Florida and New Hampshire, considered their answers.

Federal officials on Friday approved a New Hampshire plan to use federal Medicaid dollars toward the private insurance premiums of low-income residents. The plan, hardly an expansion of Medicaid so much as of private insurance, makes New Hampshire the sixth state to get federal approval to implement an alternative to the public insurance program.

Under the ACA, opposed and undermined by Republican state lawmakers for years, states can decide whether or not to expand Medicaid eligibility to people earning up to 138 percent of the federal poverty level. States can also create an alternative to the expansion outlined by the ACA, though they first must be granted a “waiver” by the federal government.

Only 28 states plus Washington, D.C. have opted to expand Medicaid. Of those, six states, including Indiana, Iowa, Michigan, and now New Hampshire, have received federal waivers to launch alternative expansions, as legislators in favor of health-care reform struck compromises with those who have fought the expansion of health care for their constituents.

“While the waivers are each unique,” say researchers for the Kaiser Family Foundation, “they include some common provisions such as implementing the Medicaid expansion through a premium assistance model, charging premiums, eliminating certain required benefits (most notably non-emergency medical transportation), and using healthy behavior incentives.”

The New Hampshire plan will also include a mandatory work referral program, meant to connect low-income people, assumed to be out of work, with job opportunities.

“Because of our bipartisan health care expansion plan, more than 36,000 hard-working Granite Staters now have peace of mind and financial security that comes with quality, affordable health insurance,” Democratic New Hampshire Gov. Maggie Hassan said in a statement. “The premium assistance waiver will allow these people to choose among private insurance plans offered on the health insurance marketplace.”

Meanwhile, a Florida state senate committee on Tuesday unanimously approved a bill that would accept federal money for its own alternative to Medicaid expansion. SB 7044, introduced and passed by the Committee on Health Policy, would expand private insurance coverage to certain adults making between 100 and 138 percent of the federal poverty level.

Those adults, who must have children to qualify, would receive federal money to help cover the cost of private insurance premiums. Floridians must also have a job or be in school to meet the program’s eligibility criteria.

The bill would insure nearly one million Floridians, according to state estimates.

“The Florida Senate proved again today that they are willing to do what’s right for Florida by backing an affordable, private health care coverage options for low-income Floridians,” said A Healthy Florida Works, the coalition behind the bill, in a statement. “We thank the Senators in the Healthy POlicy Committee for unanimously passing SB 7044.”

The bill’s approval by the senate panel on Tuesday comes as the state faces a potential $1 billion budget hole as early as this summer.

The federal government funds the Low-Income Pool, a program that reimburses Florida hospitals for treating uninsured patients. That funding agreement ends in June, and the federal government has said it may not continue to give money to a program delivering care to people who would be insured by Medicaid, if the program were expanded in the state.

State senators have reignited talks to expand Medicaid as a way to appease the federal government, and ensure that hospitals won’t face deep cuts if the Pool program funding ends.

“The passage of this bill is a responsible, realistic act,” Senate Majority Leader Bill Galvano, a Republican, told the Palm Beach Post.

Still, expansion remains divisive among House Republicans, who successfully opposed expansion in previous legislative sessions. Those Republicans contend that they are against receiving federal money tied to the ACA, and say they worry the Obama Administration will not follow through on its payment process.

Those concerns have so far proven unfounded.

Republican state Sen. Don Gaetz, a former senate president, told the Palm Beach Post he believes it is “intellectual dishonesty” to accept federal money for one health program while rejecting the same for another.

Florida Republican Gov. Rick Scott, a former hospital executive whose company paid more than $600 million in fines for defrauding Medicare, recently came out in support of Medicaid expansion after years-long opposition.

If Florida expands Medicaid, it would be the second-largest state to do so, after California.