Trends in State Medicaid Programs: Looking Back and Looking Ahead
Section 1: Medicaid Spending and Enrollment Trends
- View Exhibits
- Exhibit 1.1: Economic conditions and policy changes drive growth in Medicaid enrollment and total spending.
- Exhibit 1.2: Total and state Medicaid spending generally grow at similar rates, except when statutory changes impact FMAP.
- Exhibit 1.3: Medicaid enrollment increased sharply in SFYs 2014, 2015 driven by ACA coverage expansions; states projected slower growth in SFY 2016.
- Exhibit 1.4: Expansion states have seen total spending growth far exceed state spending growth due to the federally-financed expansion.
Section 2: Eligibility and Application/Renewals
- View Exhibits
- Exhibit 2.1: Over the course of the past decade, states have made a number of eligibility expansion as well as enrollment simplifications.
- Exhibit 2.2: Over half of states have adopted the Medicaid expansion.
- Exhibit 2.3: Few states have implemented eligibility restrictions or implemented more restrictive enrollment processes due to MOE provisions.
Section 3: Benefits, Pharmacy and Long Term Care
- View Exhibits
- Exhibit 3.1: More states reported restricting benefits during periods of economic downturn.
- Exhibit 3.2: States have always had a focus on pharmacy cost containment.
- Exhibit 3.3: Many of the traditional pharmacy cost containment tools have been in place for a number of years.
- Exhibit 3.4: Over time, changes to the traditional pharmacy cost containment tools have decreased as such programs have matured.
- Exhibit 3.5: Over time, states have continued to expand community-based long-term care options.
- Exhibit 3.6: Most states have expanded community-based long-term care through HCBS expansions (Waivers and SPAs.)
- Exhibit 3.7: States have taken up LTSS options created/expanded under the ACA.
Section 4: Provider Rates and Taxes
- View Exhibits
- Exhibit 4.1: State fiscal conditions have had a direct impact on Medicaid provider rate changes.
- Exhibit 4.2: States are generally more likely to restrict inpatient hospital rates; cuts are more likely to occur during economic downturns.
- Exhibit 4.3: Like other provider types, nursing home rates are affected by economic conditions.
- Exhibit 4.4: Ambulatory care provider rate changes are heavily influenced by changes in economic conditions.
- Exhibit 4.5: While affected by economic trends, MCO rates have been generally bolstered by federal actuarial soundness requirements.
- Exhibit 4.6: The use of provider taxes has increased over time; all but one state (Alaska) has at least one provider tax.
- Exhibit 4.7: In SFY 2015, nearly two-thirds of states have three or more provider taxes or fees in place.
- Exhibit 4.8: Nursing Facility taxes have historically been the most common type of tax though use of hospital and ICF-ID taxes has increased notably.
- Exhibit 4.9: Nearly half of all states have at least 1 provider tax that is over the 5.5% of net patient revenues.
Section 5: Managed Care and Delivery System Reform
- View Exhibits
- Exhibit 5.1: Over three-quarters of states have managed care plans.
- Exhibit 5.2: Over half of Medicaid MCO states have 75 percent or more of their beneficiaries covered under MCO contracts.
- Exhibit 5.3: There is significant variation in the services states cover through Medicaid managed care contracts.
- Exhibit 5.4: States continue to refine and expand quality metrics in MCO contracts.
- Exhibit 5.5: In addition to managed care, states have increased their use of other payment and delivery system reform efforts.
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Exhibit 1.1
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Exhibit 1.2
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Exhibit 1.3
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Exhibit 1.4
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Exhibit 2.1
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Exhibit 2.2
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Exhibit 2.3
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Exhibit 3.1
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Exhibit 3.2
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Exhibit 3.3
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Exhibit 3.4
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Exhibit 3.5
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Exhibit 3.6
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Exhibit 3.7
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Exhibit 4.1
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Exhibit 4.2
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Exhibit 4.3
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Exhibit 4.4
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Exhibit 4.5
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Exhibit 4.6
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Exhibit 4.7
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Exhibit 4.8
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Exhibit 4.9
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Exhibit 5.1
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Exhibit 5.2
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Exhibit 5.3
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Exhibit 5.4
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