Association for Public Policy Analysis & Management

Since the implementation of the Affordable Care Act (ACA) in 2014, the federal government has paid 100% of the costs of state Medicaid expansions. Beginning in 2017, expansion states begin sharing in the costs of expansion, ultimately paying 10% of total Medicaid expansion costs in 2020 and beyond. As states prepare to take on their share of expansion costs, the ability to estimate state general fund dollars “saved” through Medicaid expansion, generate revenue increases, and identify opportunities to maximize federal matching dollars is critical to sustainability of Medicaid coverage expansions. We will discuss our ongoing work under the Robert Wood Johnson Foundation (RWJF) State Network project to provide technical assistance to states in assessing the impact of and sustaining Medicaid expansion. Further, we will discuss the role of the State Network in collecting and curating factual information regarding expansion and its impact nationally to support states in their efforts to adopt and sustain Medicaid expansion.

 We will review examples of direct assistance to states as well Manatt Health’s topic brief for the State Network on the economics of Medicaid expansion: States Expanding Medicaid See Significant Budget Savings and Revenue Gains[1].  The topic brief provides evidence from eleven states and the District of Columbia gathered through interviews and state generated data on the positive fiscal impact of Medicaid expansion.  This information demonstrates that states continue to realize budget savings and revenue gains as a result of expanding Medicaid.  Savings and increased revenue in expansion states fall into three major categories: 

• State savings from accessing enhanced federal matching funds,

• State savings from replacing general funds with Medicaid funds, and

• Revenue gains through assessments or fees on providers and/or health plans.

 We will also discuss the broader benefits of Medicaid expansion, beyond state budget benefits, including deep reductions in uninsurance and related decreases in hospital uncompensated care costs, reduced recidivism for justice involved populations, and health sector job growth.  Finally, we will review opportunities to maximize federal matching dollars as part of a Medicaid expansion sustainability strategy.