Table 3.

State Medicaid Officials’ Expectations Regarding Costs and the Medicaid Expansion¹⁰⁸

Survey Item	Number
Effect of Medicaid expansion on your state’s budget over next decade
— Impose a cost to the state budget	6 (29%)
— Be budget neutral for the state	3 (14%)
— Result in savings for the state budget	12 (57%)
Likelihood of federal government reducing the match rate (FMAP) in the next decade
— Nearly impossible	4 (18%)
— Somewhat unlikely	2 (9%)
— Possible	10 (45%)
— Somewhat likely	5 (23%)
— Nearly certain	1 (5%)
Impact of the Medicaid expansion on state spending for uncompensated care
— No impact	1 (5%)
— Small reduction in state spending	8 (36%)
— Medium reduction in state spending	11 (50%)
— Large reduction in state spending	2 (9%)
Most promising approaches for controlling program costsa
— Implementing new payment models and/or new care delivery models	21 (95%)
— Expanding Medicaid managed care	12 (55%)
— Otherb	8 (36%)
— Increasing copayments	1 (5%)
— Limits on optional Medicaid benefits	0 (0%)
— Scaling back Medicaid eligibility for certain groups	0 (0%)
— Restricting rates paid to providers	0 (0%)
Proportion of newly-eligible individuals who will be in Medicaid managed care
— 0%	1 (5%)
— 1–25%	0 (0%)
— 26–50%	0 (0%)
— 51–75%	1 (5%)
— 76–99%	11 (50%)
— 100%	9 (41%)

^aOfficials were asked to select up to two options for this item.

^b“Other”: approaches included improved fraud-detection, educating providers about cost-effectiveness, and incentivizing healthy behaviors for patients.