Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?

Appendix: Table Notes and Sources

Table 1: State Characteristics

Expansion Status, as of January 1, 2017
Source: Kaiser Family Foundation’s State health Facts, Status of State Action on the Medicaid Expansion Decision, as of January 1, 2017.

Share of Medicaid Spending, by Enrollment Group, FFY 2014
Source: Kaiser Family Foundation estimates based on analysis of data from the FFY 2014 Medicaid Statistical Information System (MSIS) and CMS-64 reports. Because FY 2014 data was missing some or all quarters for some states, we adjusted the data using secondary data to represent a full fiscal year of enrollment.

Total Number of Residents, 2015
Note: Population numbers are rounded to the nearest 100.
Source: Kaiser Family Foundation estimates based on the Census Bureau’s March 2016 Current Population Survey (CPS: Annual Social and Economic Supplement).

Table 2: ACA Expansion

Expansion Enrollees, Number and as a Share of Total Medicaid Enrollees, January-March 2016
Note: Louisiana expanded Medicaid on July 1, 2016 and thus has no expansion enrollment in January-March 2016. Data is not available for North Dakota.
Source: Kaiser Family Foundation analysis of Medicaid spending and enrollment data collected from the Centers for Medicare and Medicaid Services (CMS) Medicaid Budget and Expenditure System (MBES).

Federal Expansion Funding, Amount and as a Share of all Federal Medicaid Spending, FFY 2015
Note: Alaska expanded on September 1, 2015 and thus reported expansion data for one month in FFY 2015. Louisiana (7/1/2016) and Montana (1/1/2016) expanded after FFY 2015.
Source: CMS, Medicaid Budget and Expenditure System (MBES) Expenditure Reports, December 2016.

Percentage Point Change in Uninsured Rate for Nonelderly, 2013-2015
Source: Kaiser Family Foundation estimates based on the Census Bureau’s March 2014 and March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements).

Nonelderly Uninsured Rate, 2015
Source: Kaiser Family Foundation estimates based on the Census Bureau’s March 2014, March 2015, and March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements).

Number of Adults in the Medicaid Coverage Gap, 2016
Note: Wisconsin covers adults up to 100% FPL in Medicaid under a waiver but did not adopt the ACA expansion. No data is available for Maine.
Source: Kaiser Family Foundation analysis based on 2016 Medicaid eligibility levels and 2016 Current Population Survey.

Table 3: Medicaid Policy

Eligibility Income Levels for Parents, as a Percent of the Federal Poverty Level, as of January 1, 2017
Notes: Eligibility levels are based on the FPL for a family of three, which is $20,420.
Sources: Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey, Kaiser Family Foundation, January 2017. Based on a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, 2017.

Scope of Medicaid Adult Dental Benefits, as of February 2016
Source: Center for Health Care Strategies, Inc. (CHCS), Medicaid Adult Dental Benefits: An Overview, (Hamilton, NJ: CHCS, May 2017), https://www.chcs.org/resource/medicaid-adult-dental-benefits-overview/.

Medicaid Physician Fee Index, 2014
Note: Tennessee does not have a Medicaid fee-for-service program and so data is not applicable.
Source: Stephen Zuckerman, Laura Skopec, and Kristen McCormack, “Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015?,” Urban Institute, December 2014.

Shared of Medicaid Population in a Managed Care Organization (MCO), as of July 1, 2016
Source: Vernon K. Smith, Kathleen Gifford, Eileen Ellis, and Barbara Edwards, Health Management Associates; and Robin Rudowitz, Elizabeth Hinton, Larisa Antonisse and Allison Valentine, Kaiser Commission on Medicaid and the Uninsured. Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017, Kaiser Family Foundation, October 2016.

Percent of Long-Term Care Spending for Home and Community Based Services (HCBS), FY 2015
Note: Data do not include expenditures for managed care programs in California and North Carolina. Percent HCBS is not calculated for these states because a significant portion of data are missing.
Source: Truven, Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2015, April 14, 2017

Table 4: Demographics

Percent of the population below 100% FPL, 2015
Note: The U.S. Census Bureau’s poverty threshold for a family with two adults and one child was $19,078 in 2015.
Source: Kaiser Family Foundation estimates based on the Census Bureau’s March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements).

Unemployment Rate, as of April 2017
Source: Bureau of Labor Statistics (BLS), Regional and State Employment and Unemployment (Monthly), Table 1, Civilian labor force and unemployment by state and selected area, seasonally adjusted, April 2017; and BLS Employment Situation News Release, State Employment and Unemployment Summary – April 2017, May 19, 2017.

Projected Change in persons 85+, from 2015 to 2030
Source: U.S. Census Bureau, Population Division, Interim State Population Projections, 2005, compiled by the US Administration on Aging.

Percent of Nonelderly Population in Rural Areas, 2015
Source: Kaiser Family Foundation analysis based on the 2015 American Community Survey 1-Year Estimates.

Percent of Total Population that is Non-White, 2015
Note: Non-White includes Black, Hispanic, Asians, NHOPIs, American Indians and persons of two or more races.
Sources: Kaiser Family Foundation estimates based on the Census Bureau’s March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements).

Table 5: Health Status

Overall State Health Ranking, 2016
Note: The Overall Health Status Score is compiled by the United Health Foundation and is a weighted standard deviation relative to the US value. It is based on a series of measures related to health behavior, community and environment, policy, clinical care, and health outcomes. For a complete list of measures and methodology, see http://assets.americashealthrankings.org/app/uploads/ahr16-complete-v2.pdf. The District of Columbia is not ranked.
Source: United Health Foundation, America’s Health Rankings: 2016 Annual Report; May 25, 2016.

Percentage of Non-Institutionalized Population Who Reported a Disability, 2015
Source: Erickson, W., Lee, C., von Schrader, S. (2017). Disability Statistics from the 2014 American Community Survey (ACS). Ithaca, NY: Cornell University Employment and Disability Institute (EDI). Retrieved June 7, 2017 from www.disabilitystatistics.org.

Percent of Adults Reporting Poor Mental Health, 2015
Source: Kaiser Family Foundation analysis of the Centers for Disease Control and Prevention (CDC)’s Behavioral Risk Factor Surveillance System (BRFSS) 2013-2015 Survey Results.

Age-Adjusted Opioid Overdose Deaths Rates, per 100,000
Source: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on March 2, 2017.

New HIV Diagnoses, Among Adults and Adolescents, per 100,000 Population, 2015
Source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) AtlasPlus accessed February 2017.

Table 6: Taxes

Personal Income Per Capita, 2014
Source: Bureau of Economic Analysis, state personal income accounts, 2014.

Total Taxable Resources Per Capita, 2014
Source: U.S. Department of Treasury, Total Taxable Resources, accessed April 2017.

Tax Collections as a Percent of Personal Income
Source: KFF analysis of Bureau of Economic Analysis, state personal income accounts, 2015; and U.S. Census Bureau, 2014 State & Local Government Finance, 2014.

Total State and Local Spending per Capita, 2014
Source: U.S. Census Bureau, 2014 State & Local Government Finance, 2014.

Federal Medical Assistance Percentage (FMAP) for Medicaid, 2018
Source: Federal Register, November 15, 2016 (Vol 81, No. 220), pp 80078-80080.

Table 7: Costs and Access

Health Care Expenditures per Capita, 2009
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. National Health Expenditure Data: Health Expenditures by State of Residence, December 2011. U.S. Population by State, 1991-2009 obtained from the U.S. Bureau of the Census, February, 2011.

Average Family Premium per Enrolled Employee for Employer-Based Health Insurance, 2015
Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. Medical Expenditure Panel Survey (MEPS) -Insurance Component, 2013-2015, Tables II.D.1, II.D.2, II.D.3 available at: Medical Expenditure Panel Survey (MEPS).

Share of Adults Reporting not Seeing a Doctor Due to Cost, 2015
Source: Kaiser Family Foundation analysis of the Center for Disease Control and Prevention (CDC)’s Behavioral Risk Factor Surveillance System (BRFSS) 2013-2015 Survey Results.

Share of Population in Health Profession Shortage Area for Primary Care, as of December 2016
Sources: Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of December 31, 2016 and U.S. Census Bureau, State Population Totals Datasets: 2010-2016.

Physicians Accepting new Medicaid Patients, 2013
Source: Hing et al., “Acceptance of new Patients with Public and Private Insurance b Office-based Physicians: United States, 2013,” NCHS Data Brief, No. 195, March 2015, CDC, USDHHS.