State Budget Cuts: Preserving the Health Care Safety-Net

State Budget Cuts: Preserving the Health Care Safety-Net

As a result of the recession, Medicaid enrollment has increased to cover millions of additional people experiencing unemployment and subsequently a loss of affordable health insurance. As of January 2011, Medicaid covered nearly 60 million low-income people. Policymakers, under pressure to balance state budgets, face the difficult task of reducing Medicaid spending while aiming to preserve their state’s health care safety-net.

Examples of state efforts include the following:

  • The Maryland General Assembly created the Community Health Resources Commission to provide specific assistance to safety-net providers and examine issues and potential challenges they may experience in implementing certain Affordable Care Act provisions. The commission will report its findings to the legislature during the 2012 session.
  • Ohio lawmakers passed legislation to allow federally qualified health centers to participate in presumptive eligibility within Medicaid. This means health centers may bypass administrative hurdles for patients who are eligible but not currently enrolled in Medicaid.
  • Utah legislators passed a bill that requires the Department of Health to apply for federal grants to help simplify the enrollment and renewal process for Medicaid, the Utah Premium Partnership, and the Primary Care Network Demonstration Project.
  • Oregon has submitted waivers to the Centers for Medicare and Medicaid Services (CMS) to save an estimated $240 million in FY 2012 through the creation of Coordinated Care Organizations to manage physical, oral and mental health services, improve quality and reduce costs. If CMS grants Oregon the requested waivers, and if the plan receives legislative approval next February, the Coordinated Care Organizations will move forward.

Sources: Kaiser Commission on Medicaid and the Uninsured “Key Questions About Medicaid and its Role in State/Federal Budgets and Health Reform” Kaiser Family Foundation. (Washington D.C.: January 2011).

 United States map of Percent Change in Total Medicaid Enrollment June 2009 to June 2010
















Source: Kaiser Family Foundation, Medicaid Enrollment: June 2010 Data Snapshot Washington, D.C.: KFF, 2011), 2.


United States map of Percent Increase in Total Medicaid Spending from FY 2009 to FY 2010
















* Note: Annual Medicaid growth rate includes both state and federal funds.
Source: The National Governors Association and the National Association of State Budget Officers, The Fiscal Survey of the States (Washington, D.C.: NGA and NASBO, 2011), 51-64.

This publication was made possible by Grant Number U30CS0016 from the Bureau of Primary Health Care, Health Resources and Services Administration. Its contents do not necessarily represent the official views of the Bureau of Primary Health Care, the Health Resources and Services Administration or the U.S. Department of Health and Human Services.