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Survey: State Medicaid Spending Rises Amid COVID-19

Following a flat Medicaid enrollment rate in fiscal year 2020, states expect to see enrollment spike more than 8 percent in fiscal year 2021 due to the COVID-19 public health crisis, according to the Kaiser Family Foundation (KFF) annual survey of state Medicaid directors.

As enrollment rapidly increases amid the pandemic, states are struggling to provide services to additional people as budgets are stretched thin.

To provide some financial relief to states, Congress authorized a 6.2 percentage point increase in the federal medical assistance percentage (FMAP) as part of the Families First Coronavirus Response Act (FFCRA). Almost all of the states reported significant adverse economic and budgetary impacts from the pandemic; most also indicated they are using the extra federal money to help pay costs related to rising Medicaid enrollment and to close Medicaid or general budget shortfalls.

Projected spending for Medicaid is hard to calculate, as certain Medicaid flexibility will continue through the duration of the public health emergency.

The KFF report includes Medicaid-related policy changes and innovations within the states. Notable findings focus on mitigating COVID-19, including:

  • targeted support to providers under financial duress:
  • expanded telehealth delivery services; and
  •  initiatives to address health inequity and social determinants of health.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Abigail Painchaud is a policy associate at America's Essential Hospitals.

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