By Tara Mancini
Earlier this week, the Kaiser Commission on Medicaid and the Uninsured released their 13th annual Medicaid budget survey. The survey found that the average growth in total Medicaid spending and enrollment remained relatively low. However, spending and enrollment will increase across the board in FY 2014 as a result of the welcome mat effect created by the full implementation of the ACA (see KFF’s table below).
In FY 2013, enrollment growth was 2.5%, lower than anytime since the beginning of the recession, but it is expected to rise in FY 2014 for all states, regardless of the decision to expand Medicaid. Of course, enrollment is expected to increase more on average in the 24 states and DC that are expanding Medicaid (almost 12 %) compared to the 26 states that are not expanding (5.3%). Three outlier states, Louisiana, Maine, and Wisconsin actually expect to see decreases in enrollment in 2014. This is due, unfortunately, to their decision to not expand Medicaid, in addition to other eligibility cuts.
In FY 2013 average growth in total Medicaid spending was not quite as low as enrollment growth. Still, the 3.8% increase is considered modest in the context of historical spending, and one that matched the original legislative appropriations.
As we move into the first year with expanded Medicaid coverage options, total Medicaid spending growth is projected to average 10.3% across all states in FY 2014. Although states moving forward with the expansion are expected to have higher total spending than states that have not yet decided to do so (13% v. 6.8%), the former expect lower state Medicaid spending than non-expansion states (4.4% v. 6.1%). This is because most of the 25 states moving ahead with the expansion expect to realize net savings from other state funded services, such as mental health and uncompensated care.
Also of interest, is the survey’s reporting on eligibility, enrollment, and benefit changes. Outside of the changes that are required by the ACA, 45 states are making positive changes to eligibility and enrollment, more than in any of the previous three years. Twenty-one states will be able to expand or reinstate benefits in the areas of Home and Community Based Services, behavioral health, and dental health. Still, 13 states will implement eligibility restrictions and 11 states will cut or restrict similar benefits. For more details on the measures taken in your state, take a look at the appendices.
