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Higher-than-expected Medicaid enrollment numbers prompt state budget worries

A dozen states that chose to expand Medicaid coverage under the Affordable Care Act have seen their enrollment numbers far outpace projections, raising budget concerns as the federal government gets set to reduce its funding for the expansions, The Associated Press reported Sunday.

Under the ACA, states had the option to extend Medicaid coverage to include all adults whose income is at or below 138 percent of the federal poverty level. Thirty states, and the District of Columbia, have opted to do so.

Under the law, the federal government covers all the costs of the expansions through 2016. But next year the federal government will start to shift some of that burden to the states involved, which will have to bear 10 percent of the cost by 2020.

That responsibility concerns some lawmakers in affected states, who worry that high Medicaid costs stemming from unexpectedly high enrollment numbers could cause gaps in state budgets, leaving less money available for state services like education.

In Kentucky, nearly 311,000 people enrolled in the program during the 2014 fiscal year, more than double what the state expected. As a result of its high enrollment numbers, Kentucky has revised its 2017 Medicaid cost estimate from $33 million to $74 million. That figure is projected to rise to $363 million in 2021.

“That is a monstrous hole that we have got to figure out how to plug, and we don’t know how to do it,” Kentucky state Sen. Chris McDaniel, who opposed the expansion, told the AP.

Supporters of the expansion say that states that opt in will ultimately save money because the expanded Medicaid coverage will allow them to get rid of some redundant state-run health services and to reduce costly payments to hospitals and other institutions that provide medical treatment to uninsured.

Some states, including Arkansas and West Virginia, have reported lower-than-expected costs from the program. But New Mexico, which saw higher enrollment numbers than were expected, will not make as much savings as projected, due to the difficulty implementing cost-cutting measures, according to the AP.

“When you’re looking at a state budget and there are only so many dollars to go around, obviously it’s a concern,” New Mexico state Sen. Howie Morales told the AP.

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