We surveyed all 50 states for how 2019 budgets are expected to impact Medicaid.
Check out our findings below.
Have questions or want more information about how Medicaid will be affected in your state? Contact us at https://www.stotlerhayes.com/contact-us/#
Alabama: (FY begins Oct. 1)
- All general funds requested by Medicaid Commissioner in 2019 budget were appropriated by Governor with some carryover from prior year.
https://www.al.com/news/index.ssf/2018/01/alabama_medicaid_agency_delive.html
http://budget.alabama.gov/wp-content/uploads/sites/9/2018/01/BudDoc20192.pdf
Arizona:
- No substantive changes to Medicaid appropriations from prior year.
https://www.azleg.gov/jlbc/19AR/FY2019AppropRpt.pdf
Arkansas:
- As a result of 10% reduction in Medicaid rolls, Governor has requested $47 million less than expected in state general funds for fiscal 2019.
- Governor Asa Hutchinson proposed increasing state spending for FY 2019 that begins July 1 by nearly $173 million. Most of that increase goes toward Medicaid. Hutchinson said the funding increase is lower than what was originally proposed for the program last year.
http://ualrpublicradio.org/post/arkansas-governor-proposes-56-billion-budget-coming-year
California: Governor just signed FY 2018-2019 budget on June 27th.
- The revised budget proposal continues the Administration’s commitment to using the Proposition 56 tobacco tax funding to provide supplemental payments for Medi-Cal providers. However, because claims for physician payments for the designated CPT codes were lower than expected, expenditures in the current fiscal year were also lower than expected. The total dollar amount allocated for physician payments remains unchanged from the January budget at $1.3 billion, and any funds unspent in 2017-18 and 2018-19 will rollover for expenditure in 2019-20.
- The budget does not include money to increase subsidies for Californians who get health insurance through the state’s Affordable Care Act exchange or expand Medi-Cal coverage to undocumented adults.
https://www.cmanet.org/news/detail/?article=gov-browns-may-budget-maintains-tobacco-tax
Colorado:
- FY 2019 budget: No one had proposed any major health care initiative that required tax money, so health programs mostly maintained the status quo. The Department of Health Care Policy and Financing (HCPF), which runs Medicaid, will get a modest 2.5 percent increase, bringing its total budget to $10.1 billion and keeping it the state’s largest agency.
https://www.coloradohealthinstitute.org/research/legislation-review-2018
Delaware:
- No significant changes to Medicaid from prior year. Proposed $2 million for prescription assistance for seniors
Florida:
- HB 5001: Lawmakers passed an $88.7 billion budget for the 2018-2019 fiscal year.
- $130 million increase in Medicaid funding for nursing homes.
http://www.tbo.com/florida-politics/buzz/2018/06/25/these-laws-take-effect-next-week-in-florida/
Georgia:
- Amendments to 2018 budget (in January): $11.6 million to cover additional costs for the portion of Medicaid that supports seniors and people with physical or intellectual disabilities. Meanwhile, the budget includes a reduction of $5.6 million in state funds for the low-income portion of Medicaid. https://gbpi.org/2018/overview-georgias-2019-fiscal-year-budget/
- For the first time, Georgia lawmakers in 2018 held a committee hearing to consider abill for a clean expansion of Medicaid income eligibility, although it did not make it to a floor vote. Medicaid expansion will put an insurance card in the pockets of hundreds of thousands of Georgians. https://gbpi.org/2018/gbpi-2017-2018-milestones-highlights/
- FY2019 budget: 240.9 million for Medicaid programs. https://gov.georgia.gov/press-releases/2018-05-02/deal-signs-fy-2019-budget
Idaho:
- 2019 budget includes $2.44 billion for the Department of Health and Welfare’s Medicaid Division on Wednesday. That’s an increase in total funding of $160.3 million, or 7 percent over the current year. State general fund support is up $52.2 million, or 9.8 percent, to $584.1 million.
Illinois:
- FY 2019 budget includes provision to provide Medicaid preventative dental services.
- FY 2019 budget also includes $443 million for the Healthcare Provider Relief Fund to help pay Medicaid bills.
- Proposed cuts to Medicaid by Governor were not adopted.
https://www.apnews.com/b1627c06b0c44838a82bb788f89dfb95
First Look at the State Budget for Fiscal Year 2019 approved by the General Assembly
http://www.voices4kids.org/first-look-at-the-state-budget-for-fiscal-year-2019-approved-by-the-general-assembly/embed/#?secret=gusHYTFNdT
Indiana:
- No substantive changes to Medicaid reimbursement rate or budget relating to Medicaid expenditures in FY 2019 budget (passed in 2017).
https://www.in.gov/sba/files/AP_2017_0_0_0_1_The_Whole_Budget_Report.pdf
Iowa:
- Governor signed budget into law on June 1st. $60 million increase over FY2018 budget (but $15 million less than FY2017 budget).
- Mark Costello, R-Imogene, co-chair of the House-Senate HH budget subcommittee, acknowledged that legislators likely would have to pass a supplemental appropriations next session to fill the gap beyond the $55 million Medicaid increase in the fiscal 2019 budget plan — a move Democrats noted will get the underfunded GOP budget through the upcoming election cycle. “We’re basing our budgets on the most current information we have,” Upmeyer responded.
- Also note: Joe Bolkcom, D-Iowa City, said he was disappointed Jerry Foxhoven, director of the Department of Human Services, didn’t make good on his plan to have the new managed care organization rates by now.
- IA State Auditor recently announced a statewide review of Medicaid system after a Dem lawmaker requested an audit when savings estimates changed without explanation.
http://www.thegazette.com/subject/news/health/state-auditor-to-review-iowa-medicaid-program-20180607
Kansas:
- May 15th, Gov. Colyer signed FY2019 budget into law. The 2018-2019 budget includes $22.1 million to provide a 4% increase in reimbursement rates for hospitals, in addition to $17.7 million to increase reimbursement rates for nursing homes.
http://www.westernkansasnews.com/2018/05/governor-colyer-signs-state-budget-for-fy-2018-and-2019/
Kentucky: 2018-2020 budget: (Kentucky lawmakers overrode Gov. veto):
- Will require more accountability from the outside companies that run about 70 percent of Kentucky’s Medicaid program, including about $1.7 billion a year in pharmacy benefits. It also would give the state more power to set Medicaid payments for pharmacists and increase them if warranted.
Maryland:
- Maryland nursing home providers receive a 3% Medicaid rate increase with its budget enactment
- Medicaid spending is up $180 million in the FY 2019 budget.
http://baltimorepostexaminer.com/maryland-senate-passes-44-5b-budget-fiscal-2019/2018/03/16
Massachusetts:
- No agreed upon annual budget in place yet for FY2019. Lawmakers unlikely to vote on compromise budget until beginning of July at earliest according to House Speaker.
- During floor debate on the Senate’s Fiscal Year (FY) 2019 budget, the Senate added $5.6 million to proposed funding for MassHealth and Health Reform, which brought the Senate funding level to $17.49 billion, $97.2 million less than in the House proposal, largely due to differences in provider payments and assumptions about pharmaceutical costs. There are still many line items with funding differences that will have to be resolved by the budget Conference Committee.
https://www.statehousenews.com/?login=yes&trial=yes&path=cms/news.aspx&yr=2018&select=20181247
http://massbudget.org/report_window.php?loc=Budget-Monitor-Conference-Preview-FY-2019.html
Michigan:
- (FY begins Oct. 1) Michigan’s budget allotted funds for a study of alternatives to long term care expenditures
http://michiganradio.org/post/study-will-look-better-ways-run-fund-long-term-care-michigan)
Mississippi:
- Division of Medicaid budget for FY 2019 set at 2 million, cut .19% from prior year.
Missouri:
- Missouri boosted Medicaid funding for those who require highly specialized 24-hour nursing home services (proposal pending).
http://www.whig.com/20180609/nursing-home-administrators-eager-to-receive-boost-in-medicaid-funding#)
Montana:
- Montana’s Medicaid rate cuts are on hold (until July 11) pursuant to a court order following suit filed by six nursing home operators and the Montana Health Care Association seeking an injunction of Senate Bill 261, which enacted a 3.47% reduction in reimbursement rates.
http://mtpr.org/post/lawsuit-filed-stop-medicaid-cuts-montana-nursing-homes
New Jersey:
- No 2019 budget signed by Gov. yet (as of June 28). State could face govt. shutdown if budget not agreed upon by June 30th. Due to impasse, Office of Mgmt. and Budget have informed Dept. of Health that charity care payments will be delayed. Also delays in hospital reimbursement through DSRIP.
- Acute-care hospitals would be affected by several bills being debated along with budget. Bills would enact new county-based taxes on procedures and acute care. NJ teaching hospitals and other acute-care facilities in select and urbanized counties could have access to tens of millions of additional dollars for Medicaid patients. Impact could be countered by bill that would change what Medicaid pays for certain emergency procedures.
- NJ State Human Services Committee unanimously approved a bill, introduced in April, that would require the state Department of Human Services to conduct a detailed study of the Medicaid reimbursement schedule, assess whether it is adequate given today’s costs of care, and recommend changes.
http://www.njbiz.com/article/20180626/NJBIZ01/180629858/budget-impasse-worries-hospital-officials
North Carolina:
- 2019 budget enacted in 2017. Adjustments to 2018 budget in June/2018 include $60 million from the Medicaid Transformation Reserve to be used for start-up costs related to Medicaid Reform’s program design.
http://www.wect.com/story/38293427/gop-leaders-release-details-of-2018-budget-plan
Pennsylvania:
- Governor Wolf signed 2019 budget into law on June 22nd.Legislative officials say another $900 million is to be spent on Medicaid costs off-budget, a maneuver that critics say masks the true spending increase and the true cost of state government.
- In January 2018, the department began Community HealthChoices (CHC), the name of Pennsylvania’s new managed long-term living program. Under Community HealthChoices, individuals enroll with a managed care organization that coordinates their physical health care and long-term care needs. Individuals may choose from three CHC managed care organizations under contract with the department. The department pays each managed care organization a capitated rate per enrollee per month. CHC is being implemented in three phases.
- Phase I began Jan. 1, 2018, in the 14-county southwest region of the state. More than 85,000 individuals enrolled in CHC, exceeding the department’s estimate of 80,000 participants.
- Phase 2 was to begin July 1, 2018, in the five-county southeast region; however, the department announced in November that implementation would be delayed until Jan. 1, 2019.
- Phase 3 was to begin Jan. 1, 2019, in the rest of the state; however, that date was postponed to Jan. 1, 2020.
Rhode Island:
- Rhode Island was sued by 59 nursing homes following proposed Medicaid cuts, resulting in settlement providing for a 1.5% increase on July 1, and another 1% on October 1
South Carolina:
- As of June 29, 2018, budget for 2019 still not signed by Governor. At issue is certain Medicaid funds appropriated for family planning, including Planned Parenthood.
https://www.thestate.com/latest-news/article213980864.html
South Dakota:
- 615,895,685 2018 vs 651,540,011 2019 – medical services
https://bfm.sd.gov/budget/BiB/SD_BIB_FY2019.pdf
Tennessee:
- Amended 2018-2019 budget (April/2019) includes: $3.2 million in additional recurring dollars forpayment rate increases for state-contracted intellectual/developmental disability service providers. This more than doubles the $1.8 million in recurring increases included in the budget recommendation for the same purpose. Together, these funds will likely trigger about $9.7 million in additional federal Medicaid match dollars to increase provider rates.
https://www.sycamoreinstitutetn.org/2018/03/29/gov-haslams-fy-2018-2019-amended-budget
Texas: (FY begins Sept. 1)
- Biennial Budget 2018-2019 decreases Medicaid spending by .2 % from FY 2016-2017. The budget includes no funding for projected cost growth per Medicaid participant for 2018 or 2019.
Vermont:
- June 25th, budget deal reached.
Virginia:
- Governor signed budget into law on 6/7/18 (for FY 2019/2020) and expanding Medicaid to approx. 400k low-income adults. The Medicaid expansion includes a “provider assessment” on private acute care hospitals to cover the state’s share of expansion. Federal dollars will fund about 90 percent of the expansion under the Affordable Care Act. Provider assessment fees will fund the state share, and also increase rates of Medicaid reimbursement.
https://pilotonline.com/news/local/health/article_e066b412-64e9-11e8-85e5-b3ebf96c8bc7.html
USEFUL RESOURCES:
https://www.nasbo.org/mainsite/resources/proposed-enacted-budgets
