For the first time in a decade, states are reporting roughly flat enrollment in Medicaid, according to a new national survey released Thursday, a product of the stronger economy and tightened eligibility requirements.
The 50-state survey from the Kaiser Family Foundation also found that Medicaid costs are rising, despite flat enrollment, in part because of higher prescription drug costs.
Enrollment was down by an average 0.6 percent in states’ fiscal 2018. The decline marked the first time in a decade that states aren’t reporting overall growth in Medicaid enrollment, Kaiser said.
For instance, for the 2017 state fiscal year, Medicaid enrollment grew by 2.8 percent. The majority of state fiscal years end on June 30, with all fiscal years having ended by Sept. 31.
“States largely attribute the enrollment slowdown to a strengthening economy, resulting in fewer new low-income people qualifying for Medicaid,” Kaiser said in a release. “Some states also cited new efforts and systems to verify enrollees’ continued eligibility for the program as a factor.”
But while enrollment is roughly flat, spending for Medicaid continues to go up. Medicaid is a state and federal partnership, through which the federal government matches funding from the states.
The average combined federal and state Medicaid spending grew by 4.2 percent in fiscal 2018, after a similar increase in 2017.
One of the reasons for the spending growth is that states enrolled more seniors and people with disabilities than children and adults, who are “relatively inexpensive to cover,” Kaiser said.
Also, states are paying higher prices for prescription drugs, especially high-cost specialty drugs that treat cancer and HIV.
There was also increased spending on substance-use treatment, mental health services and long-term care for seniors and the disabled, Kaiser added.
Going into the 2019 fiscal year, a potential major factor in enrollment is the pursuit by several states to install work requirements for certain beneficiaries.
So far four states — Arkansas, Kentucky, Indiana, and New Hampshire — have received federal approval to install work requirements for “able-bodied” adults on Medicaid.
Arkansas is the only state to have implemented a work requirement program, which calls on affected beneficiaries to complete 20 hours a week of either work, job training, education, or volunteering. The state has said that more than 4,000 people have been removed from the Medicaid rolls for not meeting the requirements.
