In June 2009 nearly 3.3 million more people were enrolled in state Medicaid programs than in the previous June—an increase of 7.5%. In terms of absolute numbers, it was the largest one-year increase in the history of the program, according to a new analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. A total of 46.9 million people were Medicaid enrollees in June 2009, or about 15.2% of the U.S. population. Because children are significantly more likely than adults to be eligible for public coverage, most of the growth (61%) occurred among children—2.0 million of the 3.3 million total growth.

It was the first time since the early 1990s that every state experienced an increase in Medicaid enrollment, according to a six-page Kaiser "data snapshot," which includes data breakouts by state. In 32 states enrollment grew at least twice as fast as the year before. The four states with the largest jumps saw rates above 15%: for Maryland, 20.4%; for Utah, 18.7%; for Wisconsin, 16.5%; and for Florida, 16.3%. Forty-four states provided data on the aged and disabled Medicaid population, including individuals who are dually eligible for Medicare. This population accounts for more than two-thirds of Medicaid spending (68% in 2006). Whereas rates for adults and children fluctuate from year to year, enrollment has risen consistently for the aged and disabled population. Between June 2000 and June 2008 the annual growth rate averaged 2.9%; however, from 2008 to 2009 the rate was 3.3%. Of the 44 states reporting current data for this population, the three with the highest rates were Wisconsin (8.3%), Florida (7.8%), and Utah (6.9%).

The nationwide increases reflect the deterioration in economic conditions and worsening unemployment, which rose from 5.5% in June 2008 to 9.5% in June 2009. Medicaid plays a role in reducing the number of people who become uninsured when the economy falters. Many people turn to the program for help after being laid off and losing their employer-based health insurance. Given historical trends, it is likely that Medicaid enrollment will continue to rise over the next year because of the continued impact of the economic recession, according to the Kaiser analysis.

In addition to the data snapshot, other Medicaid resources on the Kaiser site include a new survey of state Medicaid directors that provides a mid-fiscal-year 2010 update on key state Medicaid issues. At the halfway point 44 states and the District of Columbia reported that program enrollment and spending trends are above the levels projected at the beginning of the fiscal year. Twenty-nine states reported that midyear cuts in provider rates and program benefits are likely. The most dominant factor in preparing fiscal year 2011 budgets is the upcoming end of enhanced federal Medicaid matching funds provided to states by the American Recovery and Reinvestment Act (ARRA) of 2009. These funds, which will total an estimated $87 billion over a nine-quarter period ending in December 2010, have been critical in helping states maintain coverage. Medicaid directors in the Kaiser survey believed that the temporary ARRA enhancement of matching funds should be extended and followed by a phase-down period, to avoid an abrupt and major reduction in federal funding.

Another major concern of the Medicaid directors involves the outcome of national health care reform efforts. In bills passed by both the House and Senate, Medicaid is seen as the chief avenue for expanding health coverage to more low-income uninsured people, in particular to adults with no children. State Medicaid programs have had to lay off or furlough staff and make across-the-board spending cuts, and directors wonder how they will meet increased demands in this future reform scenario.

The package of Medicaid resources is available on the Kaiser site at www.kff.org/medicaid/kcmu021810pkg.cfm.