Citation URL: http://www.urban.org/DavidLiska

Medicaid spending growth has slowed to unprecedented levels and, for the first time in the program's history, enrollment has fallen. This policy brief updates earlier analyses conducted for the Kaiser Commission on Medicaid and the Uninsured by researchers at the Urban Institute. It critically examines Medicaid enrollment and spending trends from 1990 to 1996, highlighting periods of extensive growth between 1990 and 1992, moderate growth between 1992 and 1995, and limited growth between 1995 and 1996. It then reviews the primary factors contributing to the dramatic slowdown in both spending and enrollment growth between 1995 and 1996. The final section presents preliminary estimates of spending for 1997 and projects Medicaid spending growth over the next five years.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

The Medicaid disproportionate-share hospital (DSH) program has been the subject of considerable policy debate throughout the 1990s, prompting Congress to revise the program three times since 1991. The report uses Medicaid administrative data and information obtained from twelve states to examine how the study states dealt with the DSH reforms. The research found a variety of state responses, ranging from not spending their full DSH allotments to seeking new, DSH-like federal money to help support safety-net providers. (Health Affairs 1998 May/June; 17(3):118-136).

As the debate over the health care crisis continues, state policymakers can turn once again to the Databook for an up-to-date, comprehensive picture of the health system at the state level. The third edition of this invaluable sourcebook provides data on the insurance coverage of different groups; the characteristics of the uninsured; Medicaid enrollees and expenditures; health status; health care costs, access, and utilization; and state-specific demographics and economic profiles. It also reports totals for the United States and averages for the nine Census regions. Each section has a short introduction discussing the measures included and highlighting particularly significant results.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

Federal law requires state Medicaid agencies to take into account the situation of hospitals that serve a disproportionate number of low-income patients with special needs?° when determining payment rates for inpatient hospital care. Expenditures for this Medicaid disproportionate share hospital (DSH) payment now account for 1 of every 11 (federal and state) dollars spent on Medicaid in 1996. This policy brief describes the origins and evolution of DSH; discusses DSH legislation enacted during the 1990s when DSH expenditures first began to escalate; and highlights the federal DSH provisions included in the Balanced Budget Act of 1997.

The five-year plan to balance the federal budget requires Medicaid savings of approximately $16 billion. The compromise between President Clinton and Congress generated savings from increased state flexibility and limitations on disproportionate share hospital (DSH) payments rather than imposing caps on the increase in average federal Medicaid expenditures per enrollee. This paper analyzes several issues: imposition of limits on the growth in average expenditures; reduction in DSH payments; expansion of state flexibility in managing the Medicaid program; and use of some of the savings to encourage states to expand health insurance coverage for children.

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