Briefs & Reports

Implementing the ACA: Medicaid Spending & Enrollment Growth for FYs 2014-2015

Kaiser Commission on Medicaid and the Uninsured

This issue brief was released Oct. 14 by the Kaiser Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 14th annual budget survey of Medicaid officials, “Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015.”

HMA Managing Principals Vern Smith, Eileen Ellis and Kathy Gifford authored this brief with Robin Rudowitz and Laura Snyder from the Kaiser Family Foundation.

Executive Summary

Medicaid spending and enrollment growth are affected by both the economy and policy decisions determining who is covered under the program, the services provided and payments for care. For more than a decade, economic conditions, including two major recessions, were the primary driver of changes in Medicaid spending and enrollment. In FY 2014 and in budgets adopted for FY 2015, enrollment and spending have grown with implementation of the major coverage provisions in the Affordable Care Act (ACA), including the federally financed Medicaid expansion. This report provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015) and an overview of Medicaid financing. Findings are based on interviews and data provided by state Medicaid directors as part of the 14th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) with Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and compare expansion and non-expansion states.