Medicaid Spending, Enrollment and Policy Trends: A View from the States

Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020 at a Forum with the National Association of Medicaid Directors

As the presidential debate focuses on national plans like Medicare-for-all, state-level political and health policy debates continue to play out in Medicaid, which is largely administered by states that have considerable flexibility to design their programs.  In recent years, more states have adopted Medicaid expansion under the Affordable Care Act, some have sought added flexibility to implement work requirements through waivers, and many are using Medicaid as a key tool in the fight against opioids.

At 9:30 a.m. ET on Friday, Oct. 18, KFF released its 19th annual 50-state Medicaid budget survey for state fiscal years 2019 and 2020. KFF and the National Association of Medicaid Directors (NAMD) held a joint briefing to discuss trends in enrollment and spending and highlight key Medicaid policy developments that states implemented in FY 2019 or plan to implement in the current fiscal year. The survey provides new information and data that address a range of Medicaid issues, including:

  • What are national estimates for Medicaid spending and enrollment growth for state fiscal years 2019 and 2020?
  • What Medicaid waivers are states pursuing that have implications for eligibility?
  • What initiatives are state Medicaid programs implementing to help address the opioid epidemic?
  • What strategies are states using to expand community based long-term care?
  • What are new developments related to delivery system and payment reforms, including how states are addressing social determinants of health?

In conjunction with the briefing, KFF released two reports based on the survey. The first, Medicaid Enrollment & Spending Growth: FY 2019 and 2020, is an analysis of national trends in state Medicaid enrollment and spending. The second, A View From the States: Key Medicaid Policy Changes: Results from a 50-State Survey for State Fiscal Years 2019 and 2020, completed in partnership with NAMD, presents detailed state-specific information on Medicaid policies and programs.

Robin Rudowitz, a Vice President at KFF, moderated the briefing. Survey findings were presented by co-authors Elizabeth Hinton, a Senior Policy Analyst for KFF’s Program on Medicaid and the Uninsured, and Kathy Gifford, a Principal at Health Management Associates, which helped conduct the survey.

Offering perspective were Medicaid directors from three states:

  • Cindy Beane, Commissioner, State of West Virginia, Department of Health and Human Resources
  • MaryAnne Lindeblad, Medicaid Director, State of Washington, Health Care Authority
  • Gabe Roberts, Director of TennCare, Deputy Commissioner, State of Tennessee, Department of Finance and Administration


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