Maryland Medicaid Expansion Much Higher Than Forecast

Maryland is one of more than a dozen states where new Medicaid enrollees under President Barack Obama's health care law have surpassed initial projects, though state analysts say Maryland is actually spending less on its Medicaid population because federal health care reform is covering 100,000 people who used to get health care paid entirely by the state.

The projected newly eligible enrollment for fiscal year 2015 initially was 164,724 in Maryland. The initial estimated cost was about $31 million for fiscal year 2017, when states begin paying their share.

The actual enrollment for fiscal year 2015 ended up being about 220,442, with an estimated cost of about $54 million in fiscal year 2017. Maryland is currently in the process of setting rates for managed care organizations for calendar 2016, so the projected $54 million cost could change again later this year.

However, about 100,000 people who were covered entirely at state expense under the state's Primary Adult Care program are now covered by Medicaid with shared state and federal costs. Also, people who once received health care through PAC receive added benefits under the full range of Medicaid.

It's expected that Medicaid will take up an increasingly larger percentage of the state budget moving forward. The state has found alternative revenue sources to reduce pressure on the state budget.

Maryland has significantly increased provider taxes on hospital and nursing homes in recent years, and the state has continued to rely on other state funds sources to alleviate Maryland's reliance on general funds.

Vincent DeMarco, president of Maryland Citizens' Health Initiative, said health care reform has led to a drop in costs related to uncompensated care.

``The fact of the matter is we don't let people die in the street,'' DeMarco said. ``It's better, I think, to have it done through the taxes that go to pay for Medicaid at the federal or state level than higher premiums for uncompensated care.''

But critics of federal health care reform question whether it will truly reduce uncompensated care. Del. Anthony O'Donnell, a Calvert County Republican, said he is concerned it will worsen doctor shortages in primary care in rural parts of the state and exacerbate wait times.

``I have a lot of concern that the people that are selling the virtues of this aren't being honest about the downsides and the costs of it, and they're covering it up and they have been from the beginning,'' O'Donnell said.

Thirty states and the District of Columbia expanded Medicaid to include all non-disabled adults with incomes at or below 138 percent of the federal poverty level, currently $16,243 for an individual. The federal government agreed to pay all costs for the new enrollees through 2016, but it will begin lowering its share in 2017. States will pay 10 percent of the costs by 2020.

Copyright AP - Associated Press
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