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Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016

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 15th annual survey, each conducted at the beginning of the state fiscal year from FY 2002 through FY 2016. 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 2015. The survey instrument (in the Appendix) was designed to document policy actions states implemented in FY 2015 and adopted for FY 2016 (which began for most states on July 1, 2015.1) 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 rising costs for specialty prescription drugs.

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 2015. All 50 states and DC completed surveys and participated in telephone interview discussions in July and August 2015. The telephone discussions are an integral part of the survey to ensure complete and accurate responses and to record the complexities of state actions. At the time the survey and telephone discussion was completed, the Medicaid budget for FY 2016 had not been adopted in Illinois and Pennsylvania. For Pennsylvania, FY 2016 responses were generally based on the Executive Recommended Budget. FY 2016 information was incomplete for Illinois.

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 2015 and those adopted and planned for implementation in FY 2016. 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.

Priorities for FY 2016 and Beyond Reported by Medicaid Directors 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.