Medicaid expansion will continue to boom

Although the open enrollment period for the first year of the Affordable Care Act (ACA) ended months ago, enrollment in the Medicaid program is expected to record large increases again in the coming months.

Medicaid enrollments will likely rise 13.2 percent in the coming year, according to a survey of state Medicaid directors by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured.

States that expanded Medicaid under the ACA should see an average enrollment increase of 18 percent, while states that have declined to expand Medicaid will still see their rolls increase 5.2 percent. That's up considerably from a year ago, when enrollments in those states rose 12.2 percent and 2.8 percent.

"Whether a state elected to expand or not, Medicaid programs across the nation are being transformed with new enrollment procedures and outreach efforts combined with increased emphasis on delivery systems reforms," Diane Rowland, executive director of the Kaiser commission, said in a statement.

Spending on Medicaid programs is also expected to rise significantly.  The survey suggests spending will increase 18.3 percent in states that have embraced Medicaid expansion and 6.5 percent in non-expansion states. The states' share of the spending increases will likely be much smaller than that.

The projections should be welcome news for hospitals, which have seen the greater flow of Medicaid money substantially reduce their uncompensated care burden. The U.S. Department of Health and Human Services recently reported that uncompensated care costs are projected to drop by nearly $6 billion a year, mostly as a result of Medicaid expansion, with the lion's share of the savings going to pro-expansion states. By contrast, hospitals in non-expansion states have been hit harder by cuts in disproportionate share hospital payments.

Meanwhile, many states say they plan to introduce significant reforms to their Medicaid programs in order to streamline their enrollment processes and cut the costs of delivering care. Twenty-three states say they intend to expand Medicaid managed care programs, and 40 states say they will introduce other initiatives.

To learn more:
- check out the Kaiser report
- read the Kaiser announcement