Although the federal government has agreed to fund 100 percent of state Medicaid expansions spurred by reform until 2019, thus increasing some states' federal funding, states point out that they'll still need to come up with the money to fund technology and staff enhancements to manage the soaring numbers on their Medicaid rolls.
When it comes to Medicaid, states are mostly concerned with administering the new system, Raymond Scheppach, executive director of the National Governors Association, told Reuters. Relying on weak databases due to a lack of upgrades during the recession, states will be forced to improve and add systems just to track the enrollees eligible for the 100 percent reimbursement. States will also have to manage bloated payrolls at a time when they are furloughing and laying off workers.
In addition, states have precious little time to figure out how they will implement insurance exchanges by 2014, as the law dictates, and note that these issues will weigh heavily on this fall's election season.
Nonetheless, a study released by the Kaiser Family Foundation indicates that, because of the federal subsidies, states budgets may not suffer as much as some have predicted. For example, California will have the most new enrollees, at least 2.01 million people through 2019, but will have to pay only 1.5 percent more for Medicaid, while federal spending there on the program will rise at least 23 percent.
Texas will follow, with at least 1.8 million new enrollees, with a 39 percent jump in federal funds because the program is currently so much smaller than it will become. According to the study's conservative estimates, six states will have between 500,000 and 1 million new people enroll in Medicaid through 2019, Reuters reports.
"The reality of the fiscal situation today at the state level is going to be the lens through which any state is going to assess the future," Kaiser Executive Vice President Diane Rowland said. But, she added, "if you want to make assumptions like 100 percent of people signing up, that doesn't bear out any experience we've had."