Which states have expanded Medicaid? As of , Medicaid has been expanded in 38 states and DC you can click on a state on this map for more information about each state :. Which states have refused to expand Medicaid?
As of , the following states have not yet accepted federal funding to expand Medicaid:. We do not sell insurance products, but this form will connect you with partners of healthinsurance. You may submit your information through this form, or call to speak directly with licensed enrollers who will provide advice specific to your situation. Read about your data and privacy. The mission of healthinsurance. Learn more about us.
The uninsured rate, particularly among low-income residents, is considerably lower in Medicaid expansion states. What is Medicaid expansion? Why are there some states that haven't implemented Medicaid expansion? How is Medicaid expansion funded? What is the Medicaid coverage gap? Based on the assumption of increased coverage and therefore reduced uncompensated care costs under the ACA, the law called for a reduction in federal DSH allotments starting in FFY The cuts have been delayed several times and are currently set to take effect in FFY Unlike in the 50 states and D.
Notwithstanding temporary relief funds, once a territory exhausts its capped federal funds, it no longer receives federal financial support for its Medicaid program during that fiscal year. This places additional pressure on territory resources if Medicaid spending continues beyond the federal cap — making the effective match rate lower than what is set in statute. Over time, Congress has provided increases in federal funds for the territories broadly and in response to specific emergency events.
In addition to increased federal funding, the traditional territory FMAP of 55 percent was increased to 82 percent for Puerto Rico and 89 percent for the other territories through FY Unless Congress acts, there will be a major financing cliff in at the end of FY for the territories. Capitated payments to Medicaid managed care organizations MCOs and for other Medicaid managed care e.
Managed care and health plans 3 accounted for the largest share of Medicaid spending 49 percent with the majority of that share 46 percent representing payments to comprehensive MCOs , 23 percent of Medicaid spending is for fee-for-service acute care, 21 percent for fee-for-service long-term care, 3 percent for DSH, and 3 percent for Medicaid spending for Medicare premiums and cost-sharing on behalf of dual eligible beneficiaries Figure 2. Figure 2: Payments to comprehensive MCOs account for almost half of total national Medicaid spending.
More than half of all Medicaid spending for services is attributable to the elderly and persons with disabilities, who make up one in five Medicaid enrollees Figure 3. Dual eligible beneficiaries — who are enrolled in both Medicare and Medicaid — account for almost 34 percent of all spending. Although only approximately 5. Figure 3: Medicaid spending is mostly for the elderly and people with disabilities. Medicaid enrollment and spending increases during recessions.
Medicaid spending is driven by multiple factors, including the number and mix of enrollees, medical cost inflation, utilization, and state policy choices about benefits, provider payment rates, and other program factors. During economic downturns, enrollment in Medicaid grows, increasing state Medicaid costs at the same time that state tax revenues are declining.
Figure 4 shows peaks in Medicaid spending and enrollment in and due to recessions. Enrollment and spending also increased significantly following implementation of the ACA but have moderated in more recent years. Prior to the coronavirus pandemic which emerged in , slower caseload growth helped to mitigate Medicaid spending growth in recent years ; however, higher costs for prescription drugs, long-term services and supports and behavioral health services, as well as state policy decisions to implement targeted provider rate increases were factors states have recently cited as putting upward pressure on Medicaid spending.
Figure 4: Percent change in Medicaid spending and enrollment, state fiscal years Based on current flexibility in the Medicaid program, there is considerable variation in per enrollee costs across eligibility groups and across states.
Spending for the elderly and individuals with disabilities may be three to four times greater than the spending for adult enrollees and more than six times spending for an average child covered by the program.
In addition, even within a given state and eligibility group, per enrollee costs may vary significantly, particularly for individuals with disabilities. Figure 5: Medicaid spending per full-benefit enrollee in FY varies across states. Medicaid growth per enrollee has been lower than private health spending. Because states share in the financing of Medicaid and states must balance their budgets annually, there is an incentive to constrain Medicaid spending.
States may seek to control costs by restricting payment rates, controlling prescription drug costs, limiting befits and through implementing payment and delivery system reforms. Medicaid per enrollee spending grew slower than Medicare, national health expenditures, and private health insurance for all time periods from to From to , while continuing to grow slower than national health expenditures and private health insurance, Medicaid per enrollee spending grew slightly faster than Medicare Figure 6.
Figure 6: Medicaid spending per-enrollee has increased slower than national health expenditures per capita and private insurance per enrollee. Overall, the expansion group represents 16 percent of overall Medicaid spending and 20 percent of Medicaid enrollment.
For the new adult expansion group, the vast majority of expenditures were paid for with federal funds Figure 7. After receiving a percent federal match rate for the expansion group for CYs , the federal share gradually phased down to 90 percent by January Medicaid accounts for a smaller share of federal spending than Medicare because Medicaid program costs are shared by the federal government and the states.
Federal outlays for FY include large increases for unemployment compensation, primarily as a result of legislation that increased the benefit amount and the duration of the benefit as well as overall increases in claims due to the economic effects of the pandemic.
States that expand their Medicaid coverage will not incur unsustainable costs; rather they will enjoy net fiscal gains due to offsets in savings and increases in revenues. Sources of increased revenues include state sales taxes, insurance taxes, and prescription-drug rebates. States will also incur savings, as the federal government will be paying a much higher share of the cost for populations that were previously ineligible and therefore solely paid for by states.
Coverage for women with breast and cervical cancer, and coverage for some mental health and substance-abuse treatment for previously uninsured poor individuals can now be covered by Medicaid, as opposed to what was previously covered solely by states. The reality is, however, that there is absolutely no precedent for this. Moreover, if a state is committed to expanding Medicaid, there are ways to address this concern. There is both a human and fiscal cost if Medicaid expansion is rejected.
And when it comes to the impact of Medicaid coverage, several studies indicate that Medicaid coverage leads to overall better health and lower mortality rates. According to a study by the state of Oregon, after one year of enrollment in Medicaid , low-income childless adults significantly reduced their financial strain, increased their health care use, and reported having overall better health. Expanded Medicaid coverage also led to decreased rates of delayed care and decreased mortality rates , especially among residents of poorer counties, as indicated by the New England Journal of Medicine.
When a state chooses to forgo expansion, it does not receive the extra funding from the federal government. This is a scenario that Gov. Jan Brewer R of Arizona, an outspoken foe of Obamacare, cites when explaining her surprising support for Medicaid expansion. For the millions of low-income adults and children who would become eligible for care, Medicaid expansion is much more than access to health insurance. Medicaid coverage translates into financial flexibility for families and individuals, allowing limited dollars to be spent on basic needs, including breakfast for the majority of the month or a new pair of shoes for a job interview.
Medicaid expansion means more than health care coverage; it is an expanded opportunity for success and a pathway to the middle class. According to Department of Health and Human Services Secretary Kathleen Sebelius, states may adapt the Medicaid expansion so that is meets their unique needs.
Expansion is an opportunity for innovation, and even allows for the program to be modeled after private plans, as Arkansas has proposed. The Affordable Care Act proposes that the state oversees Medicaid merely as an attempt at proper protection and choices for beneficiaries.
This means that the money that the federal government is giving each state to expand its Medicaid enrollment will go toward helping prospective Medicaid recipients purchase private insurance in the new health insurance exchanges. This is a path that several states are considering but hesitant to adopt.
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