50-State Medicaid Budget Survey Archives
This page provides access to the reports stemming from the 50-state Medicaid budget surveys published annually since 2000 by KFF. It includes the annual surveys as well as shorter mid-year updates that were conducted in select years. The report based on the annual survey is traditionally released each Fall and tracks trends in Medicaid spending and enrollment, as well as Medicaid policy actions around eligibility and enrollment, provider rates, provider taxes/fees, premiums and cost-sharing, benefits and pharmacy, long-term care and delivery system and payment reform.
Data are captured from Medicaid directors and staff through the completion of written surveys as well as structured follow-up telephone interviews. Each survey focuses on spending and enrollment trends as well as policy actions taken for the in the state fiscal year that just ended as well as definitive plans for the coming year. The survey does not attempt to catalog all Medicaid policies. Experience has shown that adopted policies are sometimes delayed or not implemented, for reasons related to legal, fiscal, administrative, systems or political considerations, or due to delays in approval from CMS. Policy changes under consideration are not included in the survey.
The annual survey is conducted by KFF and Health Management Associates. Beginning in 2014, the survey was completed through a partnership with the National Association of Medicaid Directors (NAMD).
2024-2025
Medicaid Enrollment & Spending Growth: FY 2024 & 2025
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2024 and 2025. Findings are based on data provided by state Medicaid directors as part of the 24th annual survey of Medicaid directors in all states and the District of Columbia conducted by KFF and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
As Pandemic-Era Policies End, Medicaid Programs Focus on Enrollee Access and Reducing Health Disparities Amid Future Uncertainties: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2024 and 2025
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country, as states were wrapping up the unwinding of the pandemic-related continuous enrollment provision and focusing on an array of other policy priorities. The findings are drawn from the 24th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report highlights policies in place in state Medicaid programs in FY 2024 and policy changes implemented or planned for FY 2025. Key areas of focus include delivery systems, provider rates and taxes, benefits, and pharmacy.
2023-2024
Medicaid Enrollment & Spending Growth: FY 2023 & 2024
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2023 and 2024. Findings are based on data provided by state Medicaid directors as part of the 23rd annual survey of Medicaid directors in states and the District of Columbia conducted by KFF and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
Amid Unwinding of Pandemic-Era Policies, Medicaid Programs Continue to Focus on Delivery Systems, Benefits, and Reimbursement Rates: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2023 and 2024
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country, as states focused on unwinding of the pandemic-related continuous enrollment provision as well as an array of other policy priorities. The findings are drawn from the 23rd annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report highlights policies in place in state Medicaid programs in FY 2023 and policy changes implemented or planned for FY 2024. Key areas of focus include delivery systems, provider rates and taxes, benefits, pharmacy, and telehealth.
2022-2023
Medicaid Enrollment & Spending Growth: FY 2022 & 2023
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2022 and 2023. Findings are based on data provided by state Medicaid directors as part of the 22nd annual survey of Medicaid directors in states and the District of Columbia conducted by KFF and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
How the Pandemic Continues to Shape Medicaid Priorities: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2022 and 2023
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country, as states are preparing for the unwinding of the COVID-19 federal public health emergency and also are focusing on longstanding issues and new priorities. The findings are drawn from the 22nd annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report highlights policies in place in state Medicaid programs in FY 2022 and policy changes implemented or planned for FY 2023. Key areas of focus include delivery systems, health equity, benefits, telehealth, provider rates and taxes, and pharmacy.
2021-2022
Medicaid Enrollment & Spending Growth: FY 2021 & 2022
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2021 and 2022. Findings are based on data provided by state Medicaid directors as part of the 21st annual survey of Medicaid directors in states and the District of Columbia conducted by KFF and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2021 and 2022
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country, reflecting states’ continued focus on COVID-19 pandemic response as they also look ahead to the unwinding of the public health emergency and other non-emergency priorities. The findings are drawn from the 21st annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report highlights policies in place in state Medicaid programs in FY 2021 and policy changes implemented or planned for FY 2022; it also highlights state experiences with policies adopted in response to the COVID-19 pandemic. Key areas of focus include delivery systems, benefits and telehealth, social determinants of health (also including information on health equity and COVID-19 vaccine uptake), provider rates and taxes, and pharmacy cost containment.
2020-2021
Medicaid Enrollment & Spending Growth: FY 2020 & 2021
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2020 and 2021. Findings are based on data provided by state Medicaid directors as part of the 20th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2020 and 2021
Findings from this year’s budget survey policy report primarily focus on Medicaid policy changes planned for FY 2021, particularly those related to the COVID-19 pandemic. The findings are drawn from the 20th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). Key areas of focus include eligibility and enrollment, provider rates and taxes, delivery systems, long-term services and supports, benefits and telehealth, and pharmacy cost containment.
2019-2020
Medicaid Enrollment & Spending Growth: FY 2019 & 2020
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2019 and 2020. Findings are based on interviews and data provided by state Medicaid directors as part of the 19th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings are drawn from the 19th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report highlights certain policies in place in state Medicaid programs in FY 2019 and policy changes implemented or planned for FY 2020. Key areas of focus highlighted in the report include Medicaid initiatives to address social determinants of health, control prescription drug spending, improve birth outcomes and reduce infant mortality, and address the opioid epidemic.
2018-2019
Medicaid Enrollment & Spending Growth: FY 2018 & 2019
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2018 and 2019. Findings are based on interviews and data provided by state Medicaid directors as part of the 18th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019 (which began for most states on July 1, 2018). Key areas covered include changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.
2017-2018
Medicaid Enrollment & Spending Growth: FY 2017 & 2018
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2017 and 2018. Findings are based on interviews and data provided by state Medicaid directors as part of the 17th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.
Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018
This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 17th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2017 and those planned for implementation in FY 2018 based on information provided by the nation’s state Medicaid Directors. Key areas covered include changes in eligibility and enrollment, delivery and payment system reforms, provider payment rates, and covered benefits (including prescription drug policies).
Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2017 and 2018
This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states: Nevada, North Carolina, and West Virginia. These case studies build on findings from the 17th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation and Health Management Associates (HMA).
2016-2017
Medicaid Enrollment & Spending Growth: FY 2016 & 2017
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2016 and 2017. Findings are based on interviews and data provided by state Medicaid directors as part of the 16th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and also look at expansion versus non-expansion states.
Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017
This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 16th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2016 and those planned for implementation in FY 2017 based on information provided by the nation’s state Medicaid Directors. Key areas covered include changes in eligibility and enrollment, delivery and payment system reforms, provider payment rates, and covered benefits (including prescription drug policies).
Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2016 and 2017
This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in four states: Maryland, Montana, New York, and Oklahoma. These case studies build on findings from the 16th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA).
2015-2016
Medicaid Enrollment & Spending Growth: FY 2015 & 2016
This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2015 and 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and also look at expansion versus non-expansion states.
Issue Brief (.pdf)
Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016
This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2015 and those planned for implementation in FY 2016 based on information provided by the nation¹s state Medicaid Directors. Key areas covered include changes in eligibility and enrollment, delivery and payment system reforms, provider payment rates, and covered benefits (including prescription drug policies).
Executive Summary (.pdf)
Report (.pdf)
Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016
This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states: Alaska, California, and Tennessee. These case studies build on findings from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA).
Issue Brief (.pdf)
2014-2015
Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015
This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 14th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2014 and those planned for implementation in FY 2015 based on information provided by the nation’s state Medicaid Directors. Key areas covered include changes in eligibility and enrollment, delivery systems, provider payments and taxes, benefits, pharmacy programs, program integrity and program administration.
Executive Summary (.pdf)
Report (.pdf)
Implementing the ACA: Medicaid Spending & Enrollment Growth for FY 2014 and FY 2015
This report provides an overview of Medicaid financing and Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015.) Findings are based on interviews and data provided by state Medicaid directors as part of the 14th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) survey with Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and also look at expansion versus non-expansion states.
Issue Brief (.pdf)
Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2014 and 2015
This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in four states: Michigan, Utah, Virginia, and West Virginia. These case studies build on findings from the 14th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA.)
Issue Brief (.pdf)
2013-2014
Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014
The report findings are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington.
Executive Summary (.pdf)
Report (.pdf)
2012-2013
Medicaid Today; Preparing for Tomorrow: A Look at State Medicaid Program Spending, Enrollment and Policy Trends Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013
After the worst economic downturn since the Great Depression, state policy makers were finally beginning to see signs of economic recovery at the end of state fiscal year (FY) 2012 and heading into FY 2013. Growth in total Medicaid spending and enrollment slowed substantially in FY 2012 as the economy began to improve. Relatively slow spending and enrollment growth are expected to continue in FY 2013.
Executive Summary (.pdf)
Report (.pdf)
2011-2012
Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012
The 11th annual 50-State Medicaid budget survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured finds that Medicaid officials in virtually every state are enacting a variety of cost cutting measures as states’ spending for Medicaid is projected to increase 28.7 percent in fiscal year 2012 to make up for the loss of federal stimulus money.
Executive Summary (.pdf)
Report (.pdf)
2010-2011
Hoping for Economic Recovery, Preparing for Health Reform: A Look at Medicaid Spending, Coverage and Policy Trends — Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2010 and 2011
This annual 50-state survey finds that number of states experienced rapid growth in their Medicaid enrollment and spending last year and expect additional growth, though at a slower pace, in fiscal year 2011.
Executive Summary (.pdf)
Report (.pdf)
2009-2010
The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession
This annual 50-state survey finds that number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs despite increased financial help from the federal government through the American Recovery and Reinvestment Act (ARRA).
Executive Summary (.pdf)
Report (.pdf)
2008-2009
Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn, Results from a 50-State Medicaid Budget Survey for State Fiscal Year 2008 and 2009
As states finalized Medicaid policy decisions for fiscal year 2009, they faced a dramatically different situation than the prior year. At the start of state fiscal year 2008, the economy was generally strong and many states were restoring cuts from the last economic downturn and moving forward with Medicaid improvements and expansions to cover more low-income uninsured individuals. A year later, over half of all states faced significant budget shortfalls and slower than anticipated state revenue growth. For some states, plans to expand Medicaid were put on hold as states struggled to allocate funding and balance their budgets. Despite the budget crunch, few states took significant actions to cut Medicaid. During the last economic downturn from 2001 to 2004, most of the major Medicaid restrictions came later in the downturn cycle, not at the very beginning.
Report (.pdf)
2007-2008
As Tough Times Wane, States Act to Improve Medicaid Coverage and Quality: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008
The annual 50-state survey of state officials on Medicaid and state budget actions reports enrollment in Medicaid declined for the first time in nearly a decade. The 0.5 percent enrollment decline in fiscal year 2007 was driven primarily by two factors. States reported that the new citizenship documentation requirements were causing significant delays in processing applications, affecting mostly individuals already eligible for the program. State officials also cited the good economy and lower unemployment for reducing enrollment. Faced with an improving economy, 42 states expect to expand coverage to the uninsured in the next year.
Executive Summary (.pdf)
Report (.pdf)
2006-2007
Low Medicaid Spending Growth Amid Rebounding State Revenues: Results From a 50-State Medicaid Budget Survey State Fiscal Years 2006 and 2007
The 50-state annual survey about budget conditions and Medicaid cost containment actions in FY2006-07 finds an improved economy combined with the implementation of the new Medicare prescription drug benefit has contributed to the lowest rate of Medicaid spending growth in a decade and the fourth consecutive year in which Medicaid spending growth has slowed.
Report (.pdf)
Executive Summary (.pdf)
2005-2006
Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006
The 50-state annual survey of about budget conditions and Medicaid cost containment actions in FY2005-06 shows that all states implemented and planned more Medicaid cost-containment actions, but are also implementing expansions as the gap between Medicaid spending growth and state tax revenue narrowed.
Report (.pdf)
Executive Summary (.pdf)
2004-2005
The Continuing Medicaid Budget Challenge: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2004 and 2005
The 50-state annual survey of about budget conditions and Medicaid cost containment actions in FY2004-05 shows that all states plan more Medicaid cost-containment actions in FY2005.
Report (.pdf)
2003-2004
States Respond to Fiscal Pressure: State Medicaid Spending Growth and Cost Containment
The third annual survey of the 50 states and the District of Columbia reveals that all 50 states and DC implemented Medicaid cost control strategies in FY2003 and they all planned additional action for FY2004 as they cope with fiscal crisis.
Report (.pdf)
2002-2003
Medicaid Spending Growth: Results from a 2002 Survey
The report presents the findings of a 50 state survey of Medicaid directors, identifying state Medicaid spending trends and how states are responding to them for FY 2003 budgets.
Report (.pdf)
2000-2002
Medicaid Budgets Under Stress: Survey Findings for State Fiscal Year 2000, 2001, and 2002
A new survey of states detailing current Medicaid spending, the factors contributing to the growth, and what states are doing to curb the growth.
Report (.pdf)