A Mid-Year State Medicaid Budget Update for FY 2013

This report, based on structured discussions with a cross-section of Medicaid directors in late October 2012 and survey questions emailed to all 50 states and DC in January 2013, builds on findings from Kaiser’s most recent comprehensive Annual Survey of Medicaid Directors.

Mid-way through FY 2013, more than 3 out of 4 states reported Medicaid spending and enrollment growth at or below original projections.

• A total of 40 states reported that the most recent enrollment growth trend for FY 2013 was about the same or lower than that which was projected at the beginning of FY 2013.
• Consistent with trends in enrollment growth, a total of 39 states reported that their spending trend for FY 2013 was about the same or lower than was projected at the beginning of the fiscal year.
• Only 3 states reported mid-year Medicaid cuts and 4 states reported mid-year policy improvements or program expansions.

Focus group discussions with Medicaid directors show that states are moving ahead on a number of fronts to implement delivery system and payment reforms and develop initiatives to coordinate care for beneficiaries with high health needs.  For example, Oregon is moving ahead with Coordinated Care Organizations to better serve Medicaid enrollees and reduce costs and other states are developing similar models.  Other key reforms include working across payers to improve delivery of care and reduce costs, implementing new payment reforms, developing initiatives for dual eligible beneficiaries, expanding community based long-term care, integrating physical and behavior health services.  The Medicaid director discussion took place in October prior to the elections.  However, states were actively engaged in planning related to major provisions in the ACA.  At the same time, the major concern expressed by states related to how Medicaid might be affected by the discussions at the federal level on how to reduce the deficit and address the fiscal cliff. 

Report (.pdf)