It’s true of most states that Medicaid enrollment has
slowed and state revenues are steadily increasing. Yet, as governor’s prepared their budgets for fiscal year
2013, enough uncertainty lingered that when budgeting for Medicaid, there
continued to be a focus on cost containment.
Key findings from the Kaiser Commission on Medicaid and
the Uninsured’s (Kaiser) “Governors’ Budgets for FY 2013 – What is Proposed for
Medicaid?” reveals that 30 states are still anticipating budget
shortfalls. Governors’ proposals
for closing those gaps mostly include spending reductions, while those states
that are experiencing fiscal improvements are now looking to make investments
in health care, which along with areas like education, had previously been the
target of tightened purse strings.
For the report, Kaiser examined budgets from the 42
states that prepare them on an annual cycle. Noted Medicaid policy changes
include provider payments, which 13 states are looking to enhance, while 11
plan to implement reductions. Six
states are proposing eligibility and enrollment enhancements, while the same
number plan to cut back in those areas.
Five states are planning enhancements to benefits, while a dozen are
seeking curtailments.
Additionally, three states are seeking to decrease cost-sharing for
beneficiaries, while nine states are pursuing increases for beneficiaries. These changes are limited, as stability
protections built into the ACA restrict changes that states can make to
eligibility and Medicaid rules limit cost-sharing and limitations on benefits.
Three areas where states are targeting investments in
Medicaid include: management, program integrity efforts, and information
technology. States hope to foster
better management of beneficiaries with complex health needs through increased
funding for community based long-term care. States hope to strengthen program integrity through new data
mining activities. Investments in
health information technology are important for reinforcing program integrity,
but it is also an integral component of preparing states for health care
reform.
Until the Supreme Court rules on the ACA in June, the law
will continue to be tinged with unpredictability. However, many states are taking advantage of federal funding
to upgrade their eligibility and enrollment systems. In fact, seven states
incorporated funding for systems upgrades into their FY 2013 budgets.
As of the report’s printing, just 10 states had passed
their FY 2013 budgets. Maine
approved a number of cuts limiting adult access to Medicaid, although some of
the governor’s more severe suggestions were defeated. In contrast, legislators
in Alabama and Iowa adopted more restrictive legislation than was originally
proposed by the governor. In most states, FY 2013 budgets go into effect on
July 1, 2012.