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Medicaid: Still the Forgotten Issue in Health Reform. Robert B. Helms Resident Scholar American Enterprise Institute. AEI on the Hill January 25, 2012. Unchecked entitlement growth. Total Estimated Cost in 2084. 46.0% of GDP. Net Interest. 9.7%. % GDP. Medicaid & Exchanges . 10.4%.

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medicaid still the forgotten issue in health reform

Medicaid: Still the Forgotten Issue in Health Reform

Robert B. Helms

Resident Scholar

American Enterprise Institute

AEI on the Hill

January 25, 2012

unchecked entitlement growth
Unchecked entitlement growth

Total Estimated

Cost in 2084

46.0%

of GDP

Net Interest

9.7%

% GDP

Medicaid & Exchanges

10.4%

26.4%

of GDP

Medicare

6.3%

Social Security

Source: CBO Long Term Budget Outlook, 2010

medicaid the second largest entitlement program
Medicaid – the second largest entitlement program
  • Medicaid Expenditures $383.5 B in FY 2010
    • Federal $260.0 Billion
    • States $123.5 Billion
  • Projected to reach $840.4 B by 2019
  • 91% of new Medicaid expenditures to be paid by Federal government
  • Medicaid covered about 62 million in FY 2009
  • ACA projected to increase enrollment by 34% to 84.3 million by 2019 (CMS estimates are low compared to others)
  • CBO projects Federal outlays of $4.08 T 2012-21

Sources: CMS Form 64; Office of the Actuary; CBO

medicaid state matching rates fy 2012
Medicaid State Matching Rates, FY 2012

14 States with 50% FMAPs – and their FMAP without the 50% minimum*:

Connecticut 14.2%

Massachusetts 26.5%

New Jersey 26.7%

Maryland 33.5%

New York 34.5%

Wyoming 40.6%

Alaska 45.1%

Virginia 45.2%

New Hampshire 46.8%

Washington 48.2%

California 48.6%

Colorado 48.8%

Minnesota 49.0%

Illinois 49.7%

10 States with highest FMAPs

Mississippi 74.2%

West Virginia 72.6%

Kentucky 71.2%

Utah 71.0%

Arkansas 70.7%

South Carolina 70.2%

Idaho 70.2%

District of Columbia 70.0% (set by law, not by formula)

New Mexico 69.4%

Alabama 68.6%

Arizona 67.3%

Source: Federal Register, 75-217, 69083

*Vic Miller calculations, FY 2013

nine states get half the federal medicaid money billions 2010
Nine States Get Half the FederalMedicaid Money, Billions, 2010

*States with ~50% matching rate

Total Federal Medicaid expenditures were $260 Billion in FY 2010

federal medicaid funds are flowing to the richer states
Federal Medicaid Funds are Flowing to the Richer States

Federal Medicaid Spending per Poor Person*, 2010

*States are ordered by per capita income. “Poor persons” are individuals below 125% of the Federal Poverty Line.

aca matching rates for the newly eligible
ACA Matching Rates for the Newly Eligible
  • In 2014, states required to provide coverage for individuals with incomes up to 133% FPL
  • Adds an estimated 16 to 21 million new enrollees
  • 2014 – 2016 FMAP = 100%
  • 2017 = 95%
  • 2018 = 94%
  • 2019 = 93%
  • 2020+ = 90% What will this cost?
additional spending in the five richest and poorest states 2014 2019
Additional Spending in the Five Richest and Poorest States, 2014-2019

Additional Federal Spending ($millions)

Additional State Spending ($millions)

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