Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2017 and FY 2018

Medicaid has long-played an important role in the U.S. healthcare system, accounting for one in every six dollars of all U.S. health care spending while providing health and long-term services and supports coverage to millions of low-income Americans.1 Medicaid also plays an important role in states budgets as both an expenditure item and the largest source of federal revenue for states.

KFF #Medicaid budget survey takes a deeper look at programs in #Nevada, #NorthCarolina and #WestVirginia.

This year’s survey was conducted as Congress debated proposals to repeal major portions of the Affordable Care Act (ACA), including the ACA’s Marketplace and Medicaid coverage expansions, as well as other proposals to fundamentally restructure Medicaid’s financing structure. States adopted budgets for FY 2018 facing uncertainty about the outcome of the federal legislative debate, some volatility in state revenues and while trying move forward with an array of initiatives to advance Medicaid payment and delivery system reforms and to address emerging public health issues like the opioid epidemic. These policy priorities are playing out in the context of broader state budgets and an economy that varies across states, with some states experiencing steady economic growth and others facing declines in state revenues.

This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states:

These case studies build on findings from the 17th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Additional research on budget activity, economic conditions, and other relevant health policy activity was collected to supplement survey responses.


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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.