West Virginia will expand Medicaid as called for by the federal health care overhaul.
Gov. Earl Ray Tomblin said Thursday the plan would extend coverage to about 91,500 low-income residents.
Tomblin was one of just two Democratic governors who had yet to choose whether to expand Medicaid. He leaves Kentucky Gov. Steve Beshear as the party's last holdout.
President Barack Obama is deeply unpopular in West Virginia, and the state's Republican Party attacked Tomblin over his expected decision even before he announced it.
The decision follows a financial analysis that found more than $5 billion in promised federal funds will cover nearly all of the resulting costs over the next decade. But the report also calculates that West Virginia's share during that time will increase by $375 million.