Medicaid Expansion Enrollment and Spending Leading up to the COVID-19 Pandemic

Issue Brief
  1. The match rate for the expansion group in FY 2019 was 93%; however, the data analyzed in this brief show that the federal government contributed about 90.5% of expansion spending in that year. This discrepancy is because the ACA initially provided the enhanced match rate only for beneficiaries made newly eligible for Medicaid under the law (these beneficiaries composed 89% of the expansion group in FY 2019). The ACA also provided additional federal funding for not newly eligible expansion enrollees, with match rates for this population increasing to 90% in CY 2020 and onward (the same year that the match rate for newly eligible expansion enrollees decreased to 90%). (For more details, see Understanding How States Access the ACA Enhanced Medicaid Match Rates.) Accounting corrections in the MBES data (where states corrected for over or under charging the federal government for Medicaid in prior years) may also contribute to the discrepancy in the federal share.

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