The NCSL Blog


By Emily Blanford

Medicaid, which accounts for a significant portion of state expenditures and also the largest source of federal revenue for states, continues to be a high priority for state policymakers.

Medicaid with stethescopeMedicaid is a “counter cyclical” program―when the economy contracts, Medicaid spending and enrollment grows. Prior to the coronavirus pandemic, enrollment in Medicaid nationally was declining, but is now on the rise due to the pandemic and the resulting record unemployment.

This blog post highlights Medicaid 2020 legislative actions across the country from coronavirus to cost controls―trends we expect to continue into 2021 sessions.

Due to the pandemic, many 2020 legislative sessions were suspended or delayed and most of the policy activity for Medicaid occurred in the executive branch. To respond to the increased demand in the program, all 50 states, the District of Columbia and three territories received approvals for 1135 waivers to waive certain requirements during this public health emergency. States used these waivers in many ways, including increasing access to services through expanding access to telehealth, allowing flexible provider settings, modifying provider qualifications and streamlining enrollment into the program.

Once legislative sessions kicked back into gear, some states legislatively extended the executive actions for the duration of the emergency, and some states adopted COVID-19 flexibilities permanently—namely, telehealth policies.

For example, Colorado enacted a bill allowing for coverage of Medicaid telehealth services at several different provider locations to be paid at the same rate as in-person visits. New Hampshire enacted a similar bill with reimbursement parity for telehealth services that applies to both Medicaid and private insurers. The Colorado bill also expanded the type of services provided via telehealth including physical therapy, hospice and home health. Virginia also enacted legislation to provide for telehealth coverage at certain provider sites but does not require reimbursement to equal in-person visits.

Another trend in 2020 Medicaid legislation: extension of postpartum coverage. Efforts to reduce maternal and infant mortality, particularly recommendations from maternal mortality review committees, are leading states to consider expanding postpartum coverage to one full year from the current 60-day requirement.

In October 2020, the District of Columbia enacted a bill for one year of postpartum coverage and Illinois submitted its proposal for coverage for federal approval. Virginia and Washington enacted legislation to provide one year of postpartum coverage—however, these initiatives were vetoed or implementation paused due to budget concerns. Washington has already reintroduced a bill similar to the vetoed bill and this topic will likely still be an area of focus for many states in their upcoming sessions.

While states took action in 2020 that lead to increased Medicaid spending in some areas to respond to the pandemic, states are still faced with the need to control spending due to potentially reduced state revenues. For example, Florida’s governor vetoed a planned increase to reimbursement rates for services provided to people with disabilities, while Rhode Island implemented a temporary 10% across-the-board rate increase.

Controlling Medicaid spending in light of dwindling revenues while balancing the need for increased demands due to the COVID-19 pandemic are likely to generate much discussion in 2021 state legislative sessions.

Emily Blanford is a program principal in NCSL’s Health Program.

Email Emily

This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $853,466 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.

Actions: E-mail | Permalink |

Subscribe to the NCSL Blog

Click on the RSS feed at left to add the NCSL Blog to your favorite RSS reader. 

About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.