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Executive Summary
  1. Kaiser Family Foundation, State Health Facts. Total Medicaid MCO Spending, FY 2017. https://www.kff.org/other/state-indicator/total-medicaid-mco-spending/.

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Issue Brief
  1. Federal Register, November 28, 2018 (Vol 83, No. 229), pp 61159, available at: https://www.govinfo.gov/content/pkg/FR-2018-11-28/pdf/2018-25944.pdf.

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  2. Kaiser Family Foundation, State Health Facts. Federal and State Share of Medicaid Spending, FY 2017. http://kff.org/medicaid/state-indicator/federalstate-share-of-spending/.

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  3. Samantha Artiga, Elizabeth Hinton, Robin Rudowitz, and MaryBeth Musumeci, Current Flexibility in Medicaid: An Overview of Federal Standards and State Options, (Washington, DC: Kaiser Family Foundation, January 31, 2017), https://www.kff.org/medicaid/issue-brief/current-flexibility-in-medicaid-an-overview-of-federal-standards-and-state-options/.

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  4. Kaiser Family Foundation, State Health Facts. Medicaid Spending Per Full-Benefit Enrollee, FY 2014. https://www.kff.org/medicaid/state-indicator/medicaid-spending-per-full-benefit-enrollee/.

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  5. To assist states with these investments and system upgrades, federal regulations provided for an increase in the administrative match rate - 90 percent federal funding for necessary investments in information technology, along with 75 percent federal match for operating expenses. The 90 percent match rate for initial eligibility-related IT investments was initially set to expire at the end of 2015, but CMS recently released a proposal to extend the higher federal match rate permanently. Centers for Medicare & Medicaid Services (CMS). Notice of Proposed Rulemaking: Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10.) (Washington, DC: Federal Register,) April 16, 2015. https://www.federalregister.gov/articles/2015/04/16/2015-08754/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010#h-9.

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  6. Urban Institute estimates based on data from CMS (Form 64), FY 2017.

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  7. To qualify as a DSH hospital a hospital must meet two minimum qualifying criteria. The first criterion is that the hospital has at least two obstetricians who have staff privileges at the hospital and who have agreed to provide obstetric services to Medicaid patients (except when the hospital predominantly serves children under 18 years or the hospital does not offer obstetric services to the general public). The second criterion is that the hospital has a Medicaid inpatient utilization rate (MIUR) of at least 1 percent. A hospital is deemed as a DSH if the hospital’s MIUR is at least one standard deviation above the mean MIUR in the state, or if the hospital’s low-income utilization rate exceeds 25 percent.

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  8. Kaiser Family Foundation, State Health Facts. Distribution of Medicaid Spending by Service, FY 2017. http://kff.org/medicaid/state-indicator/distribution-of-medicaid-spending-by-service/.

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  9. Kaiser Family Foundation, State Health Facts. Total Medicaid Spending, FY 2017. https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/.

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  10. Managed care and health plans includes payments to Managed Care Organizations (MCOs), prepaid health plans (PHPs), and other health plans, as well as primary care case management (PCCM) fees.

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  11. Urban Institute estimates based on data from CMS (Form 64), as of August 2018.

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  12. Kaiser Family Foundation, State Health Facts. Dual Eligibles’ Share of Medicaid Spending. https://www.kff.org/medicaid/state-indicator/duals-share-of-medicaid-spending/.

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  13. Kaiser Family Foundation estimates based on data from FY 2013 MSIS and CMS-64.

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  14. Robin Rudowitz, Elizabeth Hinton, and Larisa Antonisse, Medicaid Enrollment & Spending Growth: FY 2018 & 2019 (Washington, DC: Kaiser Family Foundation, October 25, 2018), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2018-2019/.

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  15. Kaiser Family Foundation, State Health Facts. Medicaid Spending Per Full-Benefit Enrollee, FY 2014. https://www.kff.org/medicaid/state-indicator/medicaid-spending-per-full-benefit-enrollee/.

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  16. Ibid.

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  17. Medicaid spending per enrollee includes long-term care spending, while Medicare and private health insurance generally cover and pay for very limited long-term care. Previous analysis has suggested that Medicaid acute care per enrollee spending has typically increased more quickly than long-term care per enrollee spending. Without recent administrative data, we cannot analyze the current effects of long-term care being included in Medicaid per enrollee spending growth, but it is possible that inclusion of such spending has contributed to overall low Medicaid growth in recent years.

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  18. In some states that had expanded coverage to adults prior to the ACA, the new adult group includes some adults that were previously eligible through these pre-ACA expansions. These adults may be matched at a rate lower than the 100% rate for 2014-2016.

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  19. Kaiser Family Foundation based on Congressional Budget Office, Budget and Economic Outlook Fiscal Years 2019-2029, January 2019.

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  20. Congressional Budget Office, The Budget and Economic Outlook: 2019 to 2029 (Washington, D.C.: Congress of the United States, January 2019), https://www.cbo.gov/system/files?file=2019-01/54918-Outlook.pdf.

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  21. Kaiser Family Foundation, State Health Facts. Medicaid Expenditures as a Percent of Total State Expenditures by Fund, SFY 2017. https://www.kff.org/medicaid/state-indicator/medicaid-expenditures-as-a-percent-of-total-state-expenditures-by-fund/.

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  22. Kaiser Family Foundation, State Health Facts. Distribution of State Expenditures (Percent). https://www.kff.org/other/state-indicator/distribution-of-state-spending/.

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  23. Kaiser Family Foundation estimates based on the National Association of State Budget Officers (NASBO) 2018 State Expenditure Report: Fiscal Years 2016-2018 (data for Actual FY 2017).

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  24. Kaiser Family Foundation survey of Medicaid officials in 50 states and DC conducted by HMA, October 2018.

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  25. Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, D.C.: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/.

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