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Medicaid budgets mostly on target, but uncertainty looms

A survey of state Medicaid directors found a healthy majority were on budget, thought some states continue to try to restrain spending by the safety-net insurer to address shortfalls.

California sought to require Medicaid copayments, a proposal that died this week (PDF) when federal officials said no. Meanwhile, Washington state health officials have said Medicaid payments would stop for unnecessary emergency room visits. Such dramatic policy proposals underscore the strain on state budgets and Medicaid spending from the slow recovery.Medicaid directors surveyed by the Kaiser Commission on Medicaid and the Uninsured have reported budgets on target or lower than projected for the current fiscal year. (Nearly all states are halfway through their fiscal year.) The average state Medicaid spending growth for the current fiscal year was 2.2%.

The e-mail survey was sent in December and January to the states and the District of Columbia. Twenty-three reported spending on target, and 13 said spending was lower than projected. Fifteen said spending had exceeded budget projections. Roughly half of states (24) have seen enrollment match projections, the survey found. Nineteen have seen enrollment growth fall below projections and eight have seen enrollment surpass expectations.

Medicaid directors began the year uncertain and cautious; half reported the odds for mid-year budget cuts were as likely as not. But so far 10 states reported new Medicaid cuts.

You can follow Melanie Evans on Twitter: @MHmevans.
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