By Melissa Hansen

A recent Kaiser Family Foundation report based on a recent survey of Medicaid directors in all 50 states and the District of Columbia provides an overview of Medicaid spending and enrollment growth for fiscal years 2014 and 2015.

The largest enrollment and spending growth are expected in the 27 states and the District of Columbia implementing the Medicaid expansion—an 18 percent increase in enrollment and an 18.3 percent increase in total Medicaid spending in FY 2015, on average.

This growth is mostly driven by the boost in enrollment of adults who are newly eligible under the Affordable Care Act’s Medicaid expansion. Care for this population is financed 100 percent with federal money. With the additional federal dollars, state spending in expansion states is projected to increase at a slower rate of 4.4 percent in FY 2015.

States not implementing the Medicaid expansion report lower enrollment growth compared to expansion states with total and state spending growing at similar rates.

For FY 2015, enrollment growth is projected to average 5.2 percent across nonexpansion states as these states (like expansion states) experience increased participation among individuals eligible under pre-Affordable Care Act rules—often referred to as the woodwork effect.  

Enrollment is not the only area to see change in 2015. The survey found that a little less than half of all states Medicaid directors reported that their states are increasing benefits for Medicaid beneficiaries in fiscal year 2015.

Among the states adding benefits, the most common new benefits include dental coverage and mental health care/substance misuse services.

Melissa Hansen is a program principal in NCSL's health program.

Email Melissa