Gov. Jan Brewer on Monday signed the largest expansion of Arizona’s Medicaid program since its inception a generation ago, ending a fierce five-month legislative battle that drove a wedge through the Republican Party.

Gov. Jan Brewer has signed into law an $8.6 billion budget for next fiscal year that includes increases for certain education, public-safety and health programs but also puts $450 million into a "rainy-day fund."

A state consultant says most of the 58,000 people who would qualify for Medicaid under the expansion would either remain insured under private coverage or be able to buy subsidized insurance through a health exchange established by the federal law if the program isn't expanded.

Gov. Rick Snyder signed a 2013-14 state budget that doesn't address two of his major priorities - expanded Medicaid coverage and raising more than $1 billion in extra revenues for repair and maintenance of state roads and bridges.

Gov. Jan Brewer's proposal was met with derision from conservatives who argued that it was a massive expansion of government, would drive the federal government deeper into debt and that the government promises of paying for the expansion would turn out to be false.

The House is poised to approve a $28.3 billion spending plan for 2013-14. It would increase funding for basic education by $100 million, provide money to hire 300 state troopers and boost overall spending by 2.1 percent.

The Republican-led Legislature adjourned in April without passing a Medicaid budget because members couldn't agree on expansion. And if they don't come up with a solution, the program goes out of existence on July 1.

The Kasich administration is in the position of dickering with lawmakers over what shape the program could take while dickering with the federal government on what it would find acceptable.

While it's not unusual for the Legislature to delay some decisions and amend the budget later, the unresolved issues on roads and Medicaid are so enormous - amounting to $2.5 billion in new spending - that it can be considered a stretch to say the budget is finished.

Michigan lawmakers finished sending Gov. Rick Snyder a $48.7 billion state budget, notable not just for what's in it but also for what didn't make the cut - his proposed $2.5 billion in new spending for road repairs and health insurance for low-income adults.

In the wake of a 2012 Supreme Court ruling, states face complex decisions con cerning whether to expand Medicaid coverage as specified in the Affordable Care Act (ACA). With the federal government no longer able to coerce expansion, states must base their decisions on subjective value judgments that will vary from state to state, incorporating each state's unique budgetary circumstances, the needs of its uninsured population, and the incentives established by interactions between the ACA's provisions. A first important consideration is that states face substantial near-term Medicaid cost increases irrespective of coverage expansion decisions.

Alternative views on the problem the United States is facing: financing retirement consumption as its population ages.

The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, made significant changes to the way eligibility for the Medicaid program will be determined and who the program will cover. State governments will play a key role in implementing many aspects of this reform, which must be in place by the beginning of 2014. States will need to address the financial implications of implementing this Medicaid expansion and accompanying enrollment systems.

State finances are not transparent and often include hidden liabilities as well as rapidly growing responsibilities which are difficult to control.  While state revenues are gradually recovering from the drastic decline of the Great Recession, they are not growing sufficiently to keep pace with the spending required by Medicaid costs, pensions, and other responsibilities and obligations.  This has resulted in persistent and growing structural deficits in many states which threaten their fiscal sustainability.

An examination of Medicaid spending by state over a decade.  In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average.

The sixth-annual Tennessee Pork Report is chock-full yet again, of waste, fraud, abuse, and mismanagement of taxpayer money by state and local government officials. Despite a changing political landscape in Tennessee, wasteful government spending has not disappeared.

This study examines the potential increase in Medicaid costs from ObamaCare for the State of Texas-one of several states that have challenged the validity of the individual health insurance mandate in court. This study constructs Texas' Medicaid spending projections under ObamaCare to reveal the implied increase in that state's Medicaid spending commitments from the new health care law.

The biggest problem with the Medicaid expansion in the Senate health bill is not the "Cornhusker Kickback," but that it leverages an already flawed formula to determine federal payments to state Medicaid programs

This report outlines Medicaid's current problems, explains how Medicaid is financed, describes and quantifies
the impact of the Patient Protection and Affordable Care Act (PPACA) on state programs, and then offers
policy options for moving forward.

Three Things to Fix Health Care Now:

#1: Reject the Health Insurance Exchange
#2: Don't Expand Medicaid
#3: Offer an Alternative

Supporters of Obamacare claim that expanding Medicaid will entail little to no cost to state governments, since the federal government will fund the vast majority of the additional costs. Indeed, some analyses project states achieving savings from adopting the expansion. However, state lawmakers should be wary of accepting such analyses at face value.

Block-granting Medicaid is the best way to deliver better, cost-effective care to the most vulnerable Americans.

Any serious attempt at state budget reform in North Carolina must include an examination of its Medicaid program. Costs have been soaring, and past cost-containment efforts have proven both insufficient and detrimental to enrollees' access to care. Moreover, Medicaid enrollees are merely passive participants in the program with little or no choices, and at the mercy of the whims of politicians.

The Health Care Compact is an interstate compact - which is really just "an agreement between two or more states that is consented to by Congress" - that would return the authority and the responsibility to regulate health care back to the member states.

Replacing MinnesotaCare with a state subsidy for individually owned private health plans is one of the key parts of the effort to redesign how the state provides health care to the poor. This can save $100 million on childless adults and up to $600 million if everyone is included.

In light of Oregon facing a budget crisis, the Taxpayer Foundation has issued a master list of budget balancing ideas that do not require raising taxes. These ideas have been collected from Oregon lawmakers, think tank groups, taxpayer organizations, unions, policy analysts, Democrats, Republicans and even ideas utilized in states across the nation.

despite constraints that are both political and self-imposed, we believe that it is quite possible to reduce unnecessary and wasteful spending throughout the New Mexico budget. In order to provide a guide for policymakers, the Rio Grande Foundation has compiled a list of specific budget reduction ideas.

Establish limited priorities for Oklahoma’s state government. Once limited priorities are set, everything else should be considered according to these priorities. The state currently has hundreds of agencies, boards, and commissions; it’s no wonder there is chronic overspending and regular “revenue shortfalls.”

Replacing the current federal financing structure of Medicaid with fixed allotments to the states would help save both state and federal budgets. Without this policy change, states will dig further budgetary holes and the federal government will face an increased likelihood of a debt crisis.  If states received a non-fungible Medicaid block grant from the federal government rather than fungible matching funds, each state would have the incentive to reign in Medicaid spending.  If states were freed from the myriad federal mandates (such as the “maintenance of effort” clause of the Patient Protection and Affordable Care Act) they would gain the ability to run Medicaid efficiently.