Medicaid Enrollment & Spending Growth: FY 2015 & 2016
Executive Summary
Two expansion states (Arkansas and Pennsylvania) did not respond to this question. Of the remaining 27 states that had implemented the Medicaid expansion at the time of the survey, 20 reported the average per-member per-month costs had come in either below or on target with initial projections.
Alaska and Montana plan to implement the Medicaid expansion in FY 2016; they are therefore counted as not implementing the Medicaid expansion in FY 2015.
Historical state Medicaid spending refers to all non-federal spending, which may include local funds and provider taxes and fees as well as state general fund dollars. State spending for FYs 2014-2016 collected as part of this survey reflect state spending, largely state general fund dollars.
National Association of State Budget Officers, Fiscal Survey of States (Washington, DC: National Association of State Budget Officers, Spring 2015), http://www.nasbo.org/publications-data/fiscal-survey-of-the-states.
Issue Brief
Historical state Medicaid spending refers to all non-federal spending, which may include local funds and provider taxes and fees as well as state general fund dollars. State spending for FYs 2014-2016 collected as part of this survey reflect state spending, largely state general fund dollars.
National Association of State Budget Officers, Fiscal Survey of States (Washington, DC: National Association of State Budget Officers, Spring 2015), http://www.nasbo.org/publications-data/fiscal-survey-of-the-states.
Two expansion states (Arkansas and Pennsylvania) did not respond to this question. Of the remaining expansion states, responses were less clear. Some noted higher than expected costs in reference to an earlier period not covered in this survey. Others indicated that they could not disaggregate expansion increases from other MCO increases. Only a few indicated that costs on a pmpm basis were higher than they had originally projected.
The state adopted the Medicaid expansion through legislation that requires federal waiver approval.
Stan Dorn, Norton Francis, Laura Snyder and Robin Rudowitz, The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2015), https://www.kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/.
Sherry Glied and Stephanie Ma, How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion (New York City, NY: The Commonwealth Fund, December 2013), http://www.commonwealthfund.org/Publications/Issue-Briefs/2013/Dec/Federal-Funds-Medicaid-Expansion.aspx.
Stan Dorn, Norton Francis, Laura Snyder and Robin Rudowitz, The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2015), https://www.kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/.
State Health Care Spending Project, Managing Prison Health Care Spending (Washington DC: Pew Charitable Trusts and John D. and Catherine T. MacArthur Foundation, October 2013), http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2014/PCTCorrectionsHealthcareBrief050814pdf.pdf.
Ibid.
Methodology
National Association of State Budget Officers, Fiscal Survey of States (Washington, DC: National Association of State Budget Officers, Spring 2015), http://www.nasbo.org/publications-data/fiscal-survey-of-the-states.
The Kaiser Family Foundation State Health Facts. Data Source: Centers for Medicare and Medicaid Services, Medicaid & CHIP Monthly Application, Eligibility Determinations, and Enrollment Reports. (Washington, DC: Centers for Medicare and Medicaid Services, August 2014), http://www.medicaid.gov/medicaid-chip-program-information/program-information/medicaid-and-chip-enrollment-data/medicaid-and-chip-application-eligibility-determination-and-enrollment-data.html.
Laura Snyder, Robin Rudowitz, Eileen Ellis and Dennis Roberts, Medicaid Enrollment: June 2013 Data Snapshot (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 29, 2014), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-june-2013-data-snapshot/.
Appendix
The Kaiser Family Foundation State Health Facts. Data Source: 79 Fed. Reg. 71426 – 71428 (Dec. 2, 2014) accessed September 29, 2015, https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/.
Kaiser Commission on Medicaid and the Uninsured estimates based on the data reported in:
National Association of State Budget Officers, State Expenditure Report – Examining Fiscal 2012-2014 State Spending (Washington, DC: National Association of State Budget Officers, November 2014), http://www.nasbo.org/publications-data/state-expenditure-report/state-expenditure-report-fiscal-2012-2014-data.
To be eligible for ARRA funds, states could not restrict eligibility or tighten enrollment procedures in Medicaid or CHIP.
Vic Miller, Impact of the Medicaid Fiscal Relief Provisions in the American Recovery and Reinvestment Act (ARRA) (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2011), https://www.kff.org/medicaid/issue-brief/impact-of-the-medicaid-fiscal-relief-provisions/.
Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, “(Seas) Unemployment Rate (Series ID: LNS14000000)” accessed October 2, 2015, http://data.bls.gov/timeseries/LNS14000000.
Bureau of Labor Statistics, Employment, Hours, and Earnings from the Current Employment Statistics Survey, “Total Private Employment (Series ID: CES0500000001) December 2007 through September 2015”accessed October 2, 2015, http://data.bls.gov/cgi-bin/dsrv.
Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, “A-12. Unemployed persons by duration of unemployment, seasonally adjusted” accessed October 2, 2015, http://www.bls.gov/web/empsit/cpseea12.htm.
Bureau of Economic Analysis, “Broad Growth Across States in 2014 – Advance 2014 and Revised 1997-2013 Statistics of GDP by State” (Washington, D.C.: US Department of Commerce, June 10, 2015), http://www.bea.gov/newsreleases/regional/gdp_state/gsp_newsrelease.htm.
US Census Bureau, Quarterly Summary of State & Local Tax Revenue, “Table 3: Latest State Tax Collections by State” accessed September 29, 2015, http://www.census.gov/govs/qtax/.
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