Medicaid Enrollment and Expenditures by Federal Core Requirements and State Options

To receive federal Medicaid matching funds, states that participate in Medicaid must meet federal requirements, which include covering specified “federal core” enrollee groups and mandatory health benefits. States also may choose to cover additional “state expansion” enrollees and optional benefits with federal Medicaid matching funds.

The federal core eligibility standards have expanded incrementally over time, mostly for children and pregnant women, as the Medicaid program separated from welfare. Moreover, many states have taken up options to extend coverage to expansion groups, primarily for children and individuals in need of nursing home care. In addition, all states offer at least some optional benefits, but there is significant variation across states in the scope of their benefit packages. Using 2007 data, this analysis examines the proportion of Medicaid enrollment and spending attributable to state expansion enrollees versus federal core enrollees and presents estimates of spending on mandatory versus optional health benefits across all enrollee types.

Issue Brief (.pdf)