A total of 25 states including the District of Columbia are planning to move forward with Medicaid expansion beginning next year, which will provide health coverage for all adults earning up to $15,896 for an individual in 2013. Twenty-six states have rejected expanding Medicaid, though several, such as Ohio, Tennessee and Pennsylvania have discussed alternatives ways of expanding coverage to low-income residents. Among states planning to expand Medicaid, enrollment is projected to grow by 11.8%, compared with 5.3% in states not moving forward with expansion.
The study projected that total Medicaid spending growth across all states will average 10.3% in 2014, compared with 3.8% in 2013. In states expanding coverage, total spending is expected to increase on average by 13%, compared with 6.8% in non-expansion states. In the ACA expansion states, however, the federal government will pay 100% of the costs through 2016, reducing its portion to no less than 90% afterward.
The states' share of Medicaid spending is expected to increase by 5.1% across all states in 2014, due largely to increased participation by those currently eligible for the program, according to the report. The rate of spending growth was lower, however, in the expansion states, at 4.4%, compared with 6.1% in the states rejecting the expansion. That difference is due to federal contribution for the expansion population.
Nine states saw declines in Medicaid enrollment in 2013, with the average rate of enrollment growth across all 50 states falling to 2.5%, the lowest rate of growth since 2008. For 2014, Louisiana, Maine and Wisconsin were the only states to project decreased Medicaid enrollment, according to the study. All three states have enacted eligibility restrictions with the intent of reducing the number of people who can qualify to receive benefits.
In Maine, Republican Gov. Paul LePage, a longtime critic of ACA, vetoed a bill in June to expand Medicaid on the premise that the federal government could not be relied upon to carry out its promise to cover the costs. The veto came after a decision in March to reduce the income threshold for parents receiving Medicaid coverage from 200% of the federal poverty level to 133%.
In Wisconsin, Republican Gov. Scott Walker, along with the GOP-led legislature, rejected an ACA-related Medicaid expansion and instead changed income eligibility requirements from 200% of the poverty level to 100%. That disqualified an estimated 92,000 residents. Wisconsin officials anticipate that most of the people losing coverage will receive federally subsidized coverage through the state health insurance exchange.
In Louisiana, Republican Gov. Bobby Jindal has refused to expand Medicaid, turning down an estimated $16 billion in federal funding over the 10 years despite the fact the state has one of the highest percentages of people living in poverty in the country (20%) and a high rate of chronic health conditions. It is estimated as many as 345,000 Louisiana residents with incomes under 100% of poverty will fall into the gap of not qualifying for Medicaid or federally subsidized private coverage through the state insurance exchange.