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Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017

The Kaiser Commission on Medicaid and the Uninsured (KCMU) commissioned Health Management Associates (HMA) to survey Medicaid directors in all 50 states and the District of Columbia to identify and track trends in Medicaid spending, enrollment, and policy making. This is the 16th annual survey, each conducted at the beginning of the state fiscal year from FY 2002 through FY 2017. Additionally, eight mid-fiscal year surveys were conducted during state fiscal years 2002-2004 and 2009-2013, when a large share of states were considering mid-year Medicaid policy changes due to state budget and revenue shortfalls. Findings from previous surveys are referenced in this report when they help to highlight current trends. Archived copies of past reports are available on the following page.

The KCMU/HMA Medicaid survey on which this report is based was conducted from June through August 2016. The survey instrument (in the Appendix) was designed to document policy actions states implemented in FY 2016 and adopted for FY 2017 (which began for most states on July 1, 2016).1 Each survey is designed to capture information consistent with previous surveys, particularly for eligibility, provider payment rates, benefits, long-term care, and managed care. Each year, questions are added to address current issues, such as state actions to address the opioid epidemic.

Medicaid directors and staff provided data for this report in response to a written survey and a follow-up telephone interview. The survey was sent to each Medicaid director in June 2016. All 50 states and DC completed surveys and participated in telephone interview discussions in July and August 2016. The telephone discussions are an integral part of the survey to ensure complete and accurate responses and to record the complexities of state actions. FY 2017 information was incomplete for Illinois as the budget for FY 2017 had not been adopted at the time the survey and telephone discussions were completed.

The survey does not attempt to catalog all Medicaid policies in place for each state. The focus is on changes in Medicaid policy and new initiatives that are implemented in FY 2016 and those adopted and planned for implementation in FY 2017. Experience has shown that adopted policies are sometimes delayed or not implemented, for reasons related to legal, fiscal, administrative, systems or political considerations, or due to delays in approval from CMS. Policy changes under consideration without a definite decision to implement are not included in the survey. The District of Columbia is counted as a state for the purposes of this report; the counts of state policies or policy actions that are interspersed throughout this report include survey responses from the 51 “states” (including DC).

Administrative Challenges, Priorities, and Conclusion Appendix

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