Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015

The Kaiser Commission on Medicaid and the Uninsured (KCMU), with the support of the National Association of Medicaid Directors (NAMD) commissioned Health Management Associates (HMA) to survey Medicaid directors in all 50 states and the District of Columbia to identify and track trends in Medicaid spending, enrollment and policy making. This was the fourteenth annual survey, conducted at the beginning of each state fiscal year from FY 2002 through FY 2015. Eight additional surveys have been conducted mid-year during state fiscal years 2002-2004 and 2009-2013, when many states faced budget shortfalls and were forced to consider mid-year Medicaid policy changes. Findings from previous surveys are referenced in this report when they help to highlight trends.The KCMU/HMA Medicaid survey on which this report is based was conducted from June through August 2014. The survey instrument (in the Appendix) was designed to document policy actions states implemented in state FY 2014 and adopted for FY 2015 (which began for most states on July 1, 2014.¹) The Medicaid budget for FY 2014 had been adopted by all states at the time each survey was completed. Each survey is designed to capture information consistent with previous surveys, particularly for spending trends, enrollment, eligibility, provider payment rates, benefits, long-term care and managed care. As with prior years, questions were added to address specific current issues, such as state actions to implement health reform in 2014.Medicaid directors and staff provided data for this report in response to a written survey and a follow-up telephone interview. The survey was sent to each Medicaid director in June 2014. All 50 states and DC completed surveys and participated in telephone interview discussions in June, July and August 2014. The telephone discussions are an integral part of the survey to ensure complete and accurate responses and to record the complexities of state actions.

The focus of the annual survey is on Medicaid policy changes and new initiatives that are implemented, or are adopted and planned for implementation. This survey asked state officials to describe policy changes that occurred in FY 2014 and those adopted for implementation for FY 2015.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.