Filling the need for trusted information on national health issues…

Key Healthcare Proposals in Governors’ Proposed Budgets for SFY 2019 from a Preliminary Look at 32 States

The table below presents key healthcare proposals from governors’ proposed state budget documents for state fiscal year (SFY) 2019, state-of-the-state speeches, news reports, and other budget-related documents, based on a review of these materials by the Kaiser Family Foundation and Health Management Associates. Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider, however, the level of detail presented in governors’ proposed budget documents varies significantly and in most cases does not capture all of the activity in a given state. As of the time of this publication, the table includes information from 32 governors’ proposed budgets and will be updated periodically as additional budgets are released and reviewed. The table captures proposals that fall into six categories:

A look at key health care provisions in governors’ proposed state budgets for SFY 2019, including #Medicaid spending cuts, enhancements and #workrequirements, as well as #opioid/behavioral health proposals & more.

  • Medicaid spending cuts
  • Medicaid enhancements
  • Medicaid work requirements
  • Other major Medicaid proposals
  • Opioid/behavioral health proposals (both within and outside of Medicaid)
  • Other major non-Medicaid healthcare proposals

Figure 1: Key Healthcare Proposals in Governors’ Proposed Budgets for SFY 2019 from a Preliminary Look at 32 States

The final two columns of the table note whether state-of-the-state speeches and budget proposals have been released and/or reviewed and included in this table. Based on the review of budget documents and other materials released and reviewed to date, it is clear that addressing the opioid and substance use disorder crisis is a high priority for governors across the country. As of the date of this publication, 27 governors have proposals to address opioid use disorder and other behavioral health challenges either within or outside of Medicaid. Another emerging theme from the proposals reviewed to date is that despite some budget challenges, governors are proposing more Medicaid enhancements (17 governors) compared to Medicaid spending cuts (9 governors) (Figure 1).

Many states have Medicaid waivers under development at the state level or pending at the Centers for Medicare and Medicaid Services; that information may or may not be captured in governors’ state budget proposals and this table (for more comprehensive information on approved and pending Section 1115 Medicaid waivers, see the KFF Section 1115 Waiver Tracker).

Governors’ Proposed Budgets for SFY 2019 — Key Healthcare Proposals as of February 14, 2018

NOTES: Table includes information from addresses to the legislature by the new governors in Kansas and Virginia rather than information from the State of the State addresses from previous Governors Brownback and McAuliffe. Virginia row includes information from Governor McAuliffe’s proposed budget given Governor Northam’s statement that the McAuliffe budget will “guide the work of [his] administration and the General Assembly in the coming legislative session.” *At the direction of the Ohio legislature, Governor Kasich’s administration is preparing to request permission from CMS to add a work requirement for the state’s Medicaid expansion population.

N/A: As of the date of publication, the state’s governor has not released a proposed budget or made a state-of-the-state speech, or the proposals/speeches have not yet been reviewed.
SUD: Substance use disorder.
LTSS: Long-term services and supports.
HCBS: Home and community-based services.
FMAP: Federal medical assistance percentage.
MCO: Medicaid managed care organization.
UPL: Upper payment limit.
PDMP: Prescription drug monitoring program.

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270 | Email Alerts: | |

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.