As the patchwork of state decisions about Medicaid expansion unfolds across the country, several states have yet to finalize their decisions. Governors of both Arizona and Ohio support Medicaid expansion but face opposition from their legislatures. The Arizona Senate voted 19-11 on May 16 to approve an $8.8 billion state budget that includes a proposal for expansion. The expansion plan would cover people earning up to 138 percent of the federal poverty level. An additional 300,000 Arizonians would join the already 1.2 million people on Medicaid.

“That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas.”

This is how the Kaiser Health News described the reaction to the Obama administration announcement that the anticipated reduction in special Medicaid payments to hospitals for care of the uninsured will not penalize states that have not expanded their Medicaid eligibility guidelines.

10 Questions with Oregon Gov. John Kitzhaber: Coordinating Care to Cut Medicaid Costs

Oregon Gov. John Kitzhaber, a physician, says his state’s new approach to Medicaid under a federal waiver has fundamentally changed the way health care is organized and delivered. It established coordinated care organizations, which are moving away from a fee-for-service model.

Stateline Midwest ~ May 2013

• State-by-state trends in Medicaid enrollment over the last decade »

Since its inception in 1965, Medicaid has been a critical part of our nation’s safety net. And as both enrollment and spending have been steadily increasing — and a new federal health law is poised to take full effect — the strength of that net is being tested.

Technology Offers Savings, Fair and Timely Justice
Article by National Association of Medicaid Directors Executive Director Matt Salo

The question of how to produce savings in Medicaid is almost as old as the program itself. While Medicaid traditionally has sought cost savings via cutting eligibility, benefits or reimbursement rates, state Medicaid directors are recognizing that we cannot continue to cut our way out of this problem. In fact, there is growing awareness that the solutions lie along a different path, that of a broader delivery system and payment reforms.

U.S. health care costs are likely to be around $2.8 trillion in 2013. In 2010, U.S. spending on health was 17.6 percent of gross domestic product; for comparison, the Netherlands spent 12 percent of GDP, the next highest spender of developed nations. The Centers for Medicare and Medicaid Services expects health spending to hit $4.6 trillion by 2020—19.8 percent of GDP. While spending growth has slowed in recent years—it has been near 4 percent for about four years and has reached a 14-year low—many believe the spending levels are unsustainable.

In a second vote in as many days, the Arkansas House today passed an appropriations bill that provides funding for expanding Medicaid, according to the Arkansas Times. Arkansas is closely watched as the federal government has given approval to the state to expand Medicaid by using funds to purchase private health insurance policies for newly eligible individuals through the health insurance exchange.

Lively debate is underway in several states over whether to take up the Medicaid eligibility expansion to 138 percent of the federal poverty level. The U.S. Supreme Court decision last summer left the decision in the hands of state policymakers, some of whom are wary of taking on what could be a costly long-term commitment if the promise of generous federal matching funds doesn’t hold in years to come.

Below is a rundown of the debate in some state capitols across the nation.