Medicaid Officials Anticipate Sharp Enrollment Declines and Increases in State Spending on Medicaid as Pandemic-Era Policies Continue to Unwind

The 23rd annual survey of state Medicaid directors unearths that states be expecting nationwide Medicaid enrollment will decline via 8.6% in state fiscal yr (FY) 2024 as state Medicaid businesses proceed to unwind pandemic-related steady enrollment protections. After attaining report prime enrollment, those estimates replicate a dramatic year-over-year decline in program enrollment from that prime.

Pushed via expected adjustments in enrollment, general Medicaid spending expansion (federal and state spending blended) is predicted to gradual in FY 2024 to three.4%; on the other hand, the state (non-federal) percentage of Medicaid spending is predicted to extend via 17.2% in FY 2024 basically because of the segment out of enhanced federal Medicaid matching price range (set to run out December 31, 2023.) State spending on Medicaid declined in FY 2020 and FY 2021 because of the pandemic-era enhanced FMAP. Maximum officers indicated that their projections replicate what is believed of their states’ followed budgets, even though estimates of each enrollment and spending are unsure and the results of unwinding are evolving, with vital variation throughout states. Enrollment alternate estimates for FY 2024 replicate new enrollments in addition to protection losses because of unwinding, however in addition they think some “churn” – this is, that some folks shedding protection will re-enroll inside the yr.    

Whilst the unwinding of the continual enrollment provision and enhanced federal fit price had been dominant coverage problems on the finish of FY 2023 and headed into FY 2024, states had been additionally excited by an array of different coverage responses. A companion survey report highlights key insurance policies that state Medicaid methods carried out in FY 2023 or deliberate for FY 2024. Some notable findings come with:

Managing Supplier and Controlled Care Cost Charges

The choice of states imposing fee-for-service supplier price will increase outpaces price restrictions in each FY 2023 and FY 2024. States reported extra price will increase for nursing amenities and residential and community-based services and products (HCBS) suppliers than for different supplier classes, with a number of states reporting considerable will increase – most probably according to ongoing personnel or staffing-related demanding situations. The vast majority of states had been additionally imposing price will increase for behavioral fitness (psychological fitness and substance use dysfunction) suppliers and number one care suppliers. 

Just about two-thirds of states that contract with controlled care plans reported imposing pandemic-related “threat corridors” to regulate usage and controlled care plan price atmosphere uncertainty. Possibility corridors permit states and fitness plans to percentage income or losses if spending falls above or underneath specified thresholds. Maximum states that carried out COVID-19 linked risk-corridors have recouped or be expecting to recoup price range from controlled care plans consequently.

Increasing Advantages 

Psychological fitness and/or substance use dysfunction (SUD) services and products proceed to be essentially the most steadily reported class of receive advantages expansions. States additionally proceed to increase and fortify being pregnant and postpartum services and products, to reinforce maternal and toddler fitness results. States dramatically expanded using telehealth all over the pandemic, and whilst telehealth protection insurance policies have now in large part stabilized, states persevered to record telehealth protection expansions in FY 2023 and FY 2024.

16 states reported fee-for-service protection of weight-loss medicines for the remedy of weight problems for adults as of July 1, 2023. States can make a decision whether or not to hide weight-loss medication underneath Medicaid, resulting in variation in protection insurance policies throughout states. Some states is also re-evaluating their protection of anti-obesity or weight-loss medication because of the emergence of a brand new staff of extremely efficient weight-loss brokers, together with Ozempic, Rybelsus, Wegovy, and Mounjaro.

Addressing Social Determinants of Well being and Well being Disparities

Various states are increasing or bettering Medicaid protection to lend a hand deal with social determinants of fitness or related health-related social wishes (e.g., housing instability, homelessness, vitamin lack of confidence). States also are imposing methods to cut back racial and ethnic fitness disparities, together with thru increasing advantages (e.g., including/bettering being pregnant and postpartum services and products) and including set up care plan monetary incentives tied to decreasing fitness disparities and different plan necessities. 

Those and different survey findings will likely be mentioned as of late, November 14, at midday EST all over a web briefing with KFF and nationwide Medicaid professionals. Register here.

The 2 new experiences launched as of late come with:

Medicaid Enrollment and Spending Growth Amid the Unwinding of the Continuous Enrollment Provision: FY 2023 & 2024

Amid Unwinding of Pandemic Era Policies, Medicaid Programs Continue to Focus on Delivery Systems, Benefits, and Reimbursement Rates: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2023 and 2024

The twenty third annual price range survey of state Medicaid officers was once carried out via KFF and Well being Control Pals (HMA) in collaboration with the Nationwide Affiliation of Medicaid Administrators (NAMD). This yr, 48 states (together with the District of Columbia) spoke back to the survey, even though reaction charges for explicit questions various. States finished the survey in the summertime of 2023. 

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