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State Medicaid Spending Growing Slower in Expansion States Than Others

October 27, 2014 at 2:43 PM

States that have expanded Medicaid as part of health reform expect their share of Medicaid spending to grow more slowly this year than states that have not expanded, a new Kaiser Family Foundation report finds.  That’s yet more evidence that states are headed down divergent paths based on whether they have taken up the expansion.

The 28 states (including Washington, D.C.) that have expanded Medicaid or will expand it this fiscal year (2015) expect their Medicaid spending to grow by 4.4 percent this year, compared to 6.8 percent among non-expansion states, Kaiser’s annual survey finds (see graph).

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What’s more, state Medicaid spending growth will actually slow in expansion states this year, down from 6.6 percent last year.  Meanwhile, non-expansion states expect a modest uptick in state spending growth from last year.

While benefiting from slower spending growth, expansion states are making substantial progress in reducing the ranks of the uninsured.  The uninsured rate among non-elderly adults has fallen by 38 percent in expansion states but only by 9 percent in non-expansion states, an Urban Institute survey found.  The fact that the federal government picks up the entire cost of newly eligible individuals under the expansion allows states to expand coverage while limiting their costs.

While the Kaiser report examined only state Medicaid budgets, it notes that expansion states also expect a more far-reaching positive impact on their overall finances:

States expanding Medicaid also typically cited net state budget savings beyond Medicaid.  States reported that expanded coverage through Medicaid could allow for reductions in state spending for services such as mental health, correctional health, state-funded programs for the uninsured and uncompensated care.