Medicaid Enrollment & Spending: FY25 & FY26 Trends
Key Takeaways from the Medicaid Spending Report:
Here’s a summary of the key points from the provided text regarding Medicaid spending and challenges states are facing:
Rising Costs & Pressures (FY 2025 & 2026):
* Higher Acuity Enrollees: Nearly half of states report those retaining Medicaid coverage after the unwinding of pandemic-era protections have higher healthcare needs and utilize more services.
* Long-Term Care: Over a third of states are seeing increases in long-term care enrollment and utilization,driving up spending.
* Pharmacy Costs: Rising pharmacy costs, notably due to expensive specialty drugs, are a major concern for over a third of states.
* Behavioral Health: About a quarter of states are experiencing increased behavioral health costs, linked to expanded intensive services and ccbhcs.
* General Inflation: Roughly a quarter of states cite general healthcare cost inflation as a pressure point.
* Employer Premiums: KFF’s survey shows employer-sponsored health insurance premiums are rising (2025 & projected for 2026) due to similar cost pressures (drugs,chronic disease,utilization).
* Capitation rate Challenges: States are finding it difficult to set managed care capitation rates due to these cost pressures.
Spending Growth Trends:
* Slowing Growth: State Medicaid spending growth is projected to slow from 12.2% in FY 2025 to 8.5% in FY 2026.
* Return to Pre-Pandemic Patterns: This slowdown marks a return to typical spending growth levels and the end of the shifts caused by the pandemic-era enhanced FMAP (Federal Medical Assistance Percentages).
* Historical Parallel: the pattern of spending decline during temporary FMAP increases (like during the Great Recession and COVID-19) followed by a surge when relief ends is repeating.
Funding Sources:
* The majority of the state share of Medicaid spending comes from state general funds, but there’s variation in how states utilize other non-federal funding sources.
In essence, states are facing increasing Medicaid costs driven by a complex mix of factors, and are navigating a return to more typical spending patterns after the temporary boosts provided during the pandemic.