The survey, conducted by the Government Accountability Office, examined how Colorado, Georgia, Iowa, Minnesota, New York, and Virginia would meet requirements by the deadline of Jan. 1. 

The health-care law that passed two years ago requires an expansion of Medicaid eligibility to non-elderly people with incomes below 133 percent of the poverty line, according to the report. States also are required to offer a “simplified and streamlined” eligibility process.

State budget directors’ are concerned about how they will pay to add more people, update information technology to fit with Medicaid’s standards, and enroll now-eligible individuals. 

Medicaid is funded both by federal and state governments. State budget directors fear their budgets can’t afford the expansion, according to the report. 

The report also showed that states are looking for more guidance, possibly through regulation, on how to implement changes.