The Kaiser Family Foundation's Commission on Medicaid and the Uninsured recently released its 16th annual 50-state Medicaid Budget Survey. The survey shows that Medicaid enrollment and total Medicaid spending in FY 2016 have slowed substantially from the year prior, and that they will continue to slow going into FY 2017. This is due in part to the enrollment surge caused by the Affordable Care Act's (ACA's) expansion tapering off.
The Kaiser survey also shows an increase in state Medicaid spending growth in FY 2017 tied to the requirement for the 32 Medicaid expansion states (including Washington, DC) to start paying a five percent share of expansion costs beginning January 1, 2017. The federal government paid 100 percent of the expansion costs in 2014-2016. Among expansion states, the median growth in state Medicaid spending is projected to be 5.9 percent in FY 2017 (higher than the national average of 4.4%), up from 1.9 percent in FY 2016 (lower than the national average of 2.9%). For non-expansion states, state Medicaid spending is projected to increase by 4 percent in FY 2017 (just below the national average), compared to 3.9 percent in FY 2016 (above the national average). Total Medicaid spending and enrollment growth in expansion states outpaced growth in non-expansion states in FY 2016 and are projected to do so again in FY 2017. Compared to FY 2015, the differential in these rates across expansion and non-expansion states narrowed in FY 2016 and is projected to narrow further in FY 2017.
Pressure to control Medicaid spending continues as growth in overall state revenues slows, or in some states, revenues decline. A 70 percent drop in oil prices since 2014, for example, has resulted in falling tax revenue in oil-dependent states such as Alaska, North Dakota, and others, causing budget shortfalls with implications for Medicaid programs.
Other key findings of the survey include:
The majority of states are refining their pharmacy programs to control costs.
A majority of states have adopted or are expanding pharmacy strategies to deal with the opioid crisis, including imposing quantity limits, expanding access to naloxone, and implementing new Centers for Disease Control and Prevention criteria for prescribing opioids.
States continue to increase reliance on managed care. At least 75 percent of Medicaid beneficiaries are enrolled in risk-based managed care organizations (MCOs) in 28 of the 39 states (including DC) that contract with MCOs to serve their Medicaid enrollees.
Twenty-nine states are adopting or expanding other delivery system reforms in FY 2016 or FY 2017, such as patient-centered medical homes and Accountable Care Organizations.
In long-term care services and supports, nearly every state reported actions to expand the number of people served in community settings.
These and other findings from the 50-state survey (conducted by analysts at the Foundation and Health Management Associates) were discussed at a public briefing held jointly by Kaiser and the National Association of Medicaid Directors (NAMD). The following new reports are available:
An archived webcast of the briefing, as well as copies of presentation slides and other materials, are available on kff.org.