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Medicaid

Though the federal government provides some Medicaid funds via matching rates, this welfare program has been taking up a larger and larger share of state budgets in recent years. In fact, Medicaid is the largest category of state spending, accounting for 23.6 percent of state budget expenditures according to the National Association of State Budget Officers.  That percentage is likely to increase over time.

Like other welfare programs, this has a dual effect on state budgets during economic downturns because states face an increasing demand for Medicaid services while their revenues to pay for those services decline. Governors in the states are taking different approaches to deal with this problem. SBS President Bob Williams maintains that the Medicaid system needs to be fixed before it is expanded.

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    • HEADLINES: Pennsylvania

      Pennsylvania budget sees big shortfall

      Pittsburgh Post-Gazette | by Kate Giammarise | December 23, 2013

      Because of rising pension and Medicaid costs, reduced federal Medicaid dollars and a loss of tobacco settlement money, Pennsylvania is facing a $1.2 billion to $1.4 billion budget shortfall.

    • HEADLINES: Virginia

      Medicaid fraud difficult to measure, health secretary says

      Free Lance-Star | by Chelyen Davis | December 20, 2013

      Lawmakers who want to reform Medicaid and oppose its expansion often cite concerns about “waste, fraud and abuse” in the program. But measuring those problems isn’t easy, Secretary of Health William Hazel told the Medicaid Reform and Innovation Commission Tuesday.

    • HEADLINES: Arizona, Florida, Indiana, Montana, Pennsylvania, Virginia, North Carolina , Ohio, Tennessee

      Year-End Review of Medicaid Expansion in the States

      State Budget Solutions | by Joe Luppino-Esposito | December 19, 2013

      A review of state action on Medicaid expansion, and a look at what states are still debating what to do.

    • HEADLINES: Alabama

      Ala. governor says he's not behind pension change

      The News Times | by Phillip Rawls | December 18, 2013

      Gov. Robert Bentley said Tuesday his disagreement with state pension fund Chief David Bronner over expanding the state Medicaid program had nothing to do with new controls being placed on Bronner's investment authority.

    • HEADLINES: Delaware

      Education, Medicaid costs expected to create hole in state budget

      Delaware Online | December 17, 2013

      Gov. Jack Markell, who will present a new budget to the General Assembly next month, will not have a significant boost in new tax revenue to cover mandatory cost increases in health care and education.

    • HEADLINES: Kentucky

      More cuts in next state budget?

      The Louisville Courier-Journal | by Tom Loftus | December 10, 2013

      The basic outlook for the 2014-16 state budget means more spending cuts are on the table as Gov. Steve Beshear and his staff draft the state spending plan that the governor will propose to the General Assembly next month.

    • HEADLINES: Louisiana

      Analysis: Amnesty helps Louisiana balance its budget - for now

      The Shreveport Times | by Melinda DeSlatte | December 9, 2013

      Louisiana lawmakers and Gov. Bobby Jindal's administration shared a collective sigh of relief with the news that their state's tax amnesty program brought in the $200 million they used to help balance this year's budget.

    • HEADLINES: Wyoming

      Wyoming governor says no to Medicaid expansion

      Washington Post | by Reid Wilson | December 4, 2013

      Wyoming Gov. Matt Mead (R) said Friday he doesn’t want his state to accept federal funding to expand Medicaid coverage, due to problems with the rollout of the Affordable Care Act so far.

    • HEADLINES: South Dakota

      South Dakota Gov. Daugaard won't rule out future Medicaid expansion

      Washington Post | by Reid Wilson | December 4, 2013

      South Dakota Gov. Dennis Daugaard (R) doesn’t favor expanding Medicaid coverage to include more low-income residents, but it appears he won’t rule out the possibility of expanding the program in the future.

    • HEADLINES: South Carolina

      First hearing planned on proposed SC Medicaid budget hike

      The State | by Adam Beam | December 3, 2013

      Lawmakers gave the agency an additional $110 million in general fund money for the 2014 budget. The agency is asking for an additional $165 million in the 2015 budget.


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    • POLICY BRIEF: Oklahoma

      Medicaid expansion is the price to shift the balance of federalism

      State Budget Solutions | by Joe Luppino-Esposito | September 25, 2013

      The debate over Medicaid expansion is as much about federalism and the issue of state control as it is about money-because these are ultimately one in the same.

    • POLICY BRIEF: Virginia

      Medicaid Expansion: The Wrong Prescription for Virginia

      State Budget Solutions | by Joe Luppino-Esposito, Bob Williams | August 16, 2013

      Virginia's Medicaid commission is considering expansion, and this report explains some of the current problems with Medicaid coverage, anticipated problems with accepting Medicaid expansion and discuss alternatives and reforms that will better serve Virginians.

    • RESEARCH

      The Affordable Care Action's Optional Medicaid Expansion: Considerations Facing State Governments

      The Mercatus Center | by Charles Blahous | March 5, 2013

      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.

    • RESEARCH

      On Financing Retirement with an Aging Population

      The National Bureau of Economic Research | by Ellen McGrattan & Edward Prescott | February 4, 2013

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

    • RESEARCH

      States' Implementation of the Patient Protection and Affordable Care Act

      U.S. Government Accountability Office | August 1, 2012

      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.

    • RESEARCH

      State Budget Crisis Task Force Report

      State Budget Crisis Task Force | by Richard Ravitch and Paul Volcker | July 17, 2012

      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.

    • RESEARCH

      Health Spending by State of Residence, 1991 - 2009

      Centers for Medicare and Medicaid Services | by Gigi Cuckler | December 12, 2011

      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.

    • RESEARCH: Tennessee

      2011 Tennessee Pork Report

      The Tennessee Center for Policy Rsearch and Citizens Against Government Waste | by Justin Owen, Christopher Butler, & Ryan Turbeville | December 2, 2011

      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.

    • RESEARCH: Texas

      Final Notice: Medicaid Crisis

      Texas Public Policy Foundation | by Jagadeesh Gokhale | February 28, 2011

      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.

    • RESEARCH

      The Rich Get Richer

      The Pacific Research Institute | by John Graham | February 28, 2011

      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


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    • SOLUTIONS: Florida

      Three Things You Can Do to Fix Health Care Now

      Foundation for Government Accountability | by Christie Herrera | December 6, 2012

      Three Things to Fix Health Care Now:

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

    • SOLUTIONS

      State Lawmaker’s Guide to Evaluating Medicaid Expansion Projections

      The Heritage Foundation | by Edmund F. Haislmaier and Drew Gonshorowski | October 17, 2012

      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.

    • SOLUTIONS

      Medicaid Is Broken—Let the States Fix It

      The Wall Street Journal | by Paul Howard and Russell Sykes | October 15, 2012

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

    • SOLUTIONS: North Carolina , Florida

      Medicaid Reform

      Civitas Institute | by Brian Balfour | September 12, 2012

      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.

    • SOLUTIONS

      Health Care Compact is real way to reform health care system

      by Keli Carender, Shonda Werry | March 26, 2012

      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.

    • SOLUTIONS: Minnesota

      The very serious reasons for replacing MinnesotaCare with subsidies for private health insurance

      Center of the American Experiement | by Peter J. Nelson | November 29, 2011

      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.

    • SOLUTIONS: Oregon

      Budget solution report offers 100 ideas

      The Taxpayer Foundation of Oregon | November 3, 2011

      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.

    • SOLUTIONS: New Mexico

      Resolving New Mexico’s $450 million Deficit (without raising taxes or cutting K-12 education and Medicaid)

      The Rio Grande Foundation | by Paul J. Gessing and Kevin Rollins | October 31, 2011

      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.

    • SOLUTIONS: Oklahoma, Indiana

      Ten Budget Reforms for 2012

      Oklahoma Council of Public Affairs | by Jonathan Small | August 4, 2011

      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.”

    • SOLUTIONS: Nebraska

      Medicaid The Need for Medicaid Reform Grows Larger After Obamacare

      The Platte Institute | by Brian Blasé and C.L. Gray, M.D. | August 1, 2011

      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.


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