Even the states that have committed to expanding their Medicaid programs under the Affordable Care Act want additional guidance from the government, a new federal report finds.

States have questions around the new methodology for determining eligibility, updating information technology systems, accessing data through the Federal Data Services Hub, and putting in updates to online enrollment bases, according to a Government Accountability Office investigation. The six states profiled in the GAO report were Colorado, Georgia, Iowa, Minnesota, New York and Virginia.

The Supreme Court’s ruling on the ACA made it optional for states to participate in the law’s massive expansion of Medicaid which pays for the majority of long-term care.