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The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States

Appendix C: Washington State Budget Impacts of the Medicaid Expansion

The figures included below were provided by Washington State budget officials and reflect estimates used when the state enacted its FY 2013-2015 state budget. These figures were derived from an alternative budget scenario that estimates the state costs in the absence of the Medicaid expansion maintained by state officials. States often do not maintain alternative budget scenarios of what would have happened had the state not implemented a specific policy over time; Washington state officials noted that they do not plan to continue this process going forward.

Washington State Budget Effects of Medicaid Expansion, SFYs 2014 and 2015
Budget Areas SFY 2014 SFY 2015
Increased Enrollment among those previously eligible but not enrolled* $22.8 million $59.9 million
State Administrative Costs* $4.0 million $3.5 million
State Administrative Savings* -$0.3 million -$1.6 million
Savings within Medicaid from pre-ACA eligibility transitions:
1115 Waiver Transition -$34.0 million -$69.1 million
Medically Needy Spend-Down Adults -$11.5 million -$35.0 million
Breast and Cervical Cancer Program -$0.7 million -$3.6 million
Family Planning -$0.5 million -$1.0 million
Presumptive SSI*** -$38.1 million -$109.8 million
Savings outside of Medicaid:
Mental Health and Substance Abuse -$13.4 million -$51.2 million
Inpatient Care for Prisoners -$0.7 million -$1.4 million
Public Health Services -$2.6 million -$5.8 million
Other health care programs for vulnerable populations** -$4.0 million -$9.7 million
Increased Revenues:
Premium tax revenue * $33.9 million
Fiscal Benefit (Net Savings and New Revenues): $79.0 million $258.7 million
Total State General Fund Spending in SFY 2013 $15.5 billion $15.5 billion
Fiscal Benefit from Medicaid Expansion as a Share of Total State General Fund Spending in SFY 2013 0.5% 1.7%
NOTES: *The cost and savings figures included here reflect the total impact of the ACA and are not isolated to the Medicaid expansion.**This included savings for programs related to long term care, developmental disability and labor and industries programs outside of Medicaid. ***Washington State also noted savings from the transition of adults who were previously eligible for their presumptive SSI category. This is an optional Medicaid eligibility category that provides Medicaid coverage while adults await a disability determination for SSI coverage. It is unclear how many states offer Medicaid coverage for such individuals. While expenses for those that qualified under this pre-ACA eligibility pathway were not reimbursed at the 100 percent federal match rate, the state did receive a higher matching rate for these individuals (equivalent to the early adopter matching rates.)
SOURCE: Based on estimates from the state’s Forecast Model as well as from the 2013-2015 budget as originally enacted by the legislature in Washington State and discussions with Washington state budget officials. Figures may differ from more recent updates to budget analyses. The calculations of savings compared to SFY General Fund Spending are those of the authors based on savings figures provided by state officials compared to the state general fund spending across all budget categories for SFY 2013 as reported by the National Association of State Budget Officers in their State Expenditure Report: Examining Fiscal 2012-2014.
Appendix B: Optional Medicaid Eligibility Pathways Appendix D: Estimates from Separate Report Commissioned by Kentucky

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