When CWLA sent its recommendations for the next COVID-19 relief legislation last month (CWLA’s letter and this descriptive letter of child welfare needs) to Congressional leaders, one of its first and prominent asks was for an increase to the federal matching rates for state Medicaid health care programs, usually called the FMAP. Now trends are emerging across states over pending budget cuts while enrollments for Medicaid coverage increase.
The second COVID-19 legislation increased the Medicaid FMAP by 6.2 percent (along with a 6.2 percent increase to Title IV-E foster care and adoption assistance). Usually, states receive a match from 50 percent to as much as 83 percent. That means a fifty percent match provides one federal dollar to one state dollar, whereas an 80 percent match provides four federal dollars for one state dollar. Rates are set according to an annually adjusted formula based on a state’s economic factors. With the second COVID-19 package temporarily increasing the match by 6.2 percent, states will receive from 56 percent to as much as 89 percent.
The states need more, and recent trends are starting to demonstrate that reality.
CWLA endorsed the state’s request for an increase of at least 12 percent. CWLA is advocating for the increase to both Medicaid and Title IV-E as a way to help states replace the lost state budget revenue as the recession starts to take its grip on revenue.
According to reporting by Politico, state examples of current Medicaid problems include $229 million in state budget cuts in Colorado coming mostly from Medicaid, with a state legislative committee staffer saying that state’s Medicaid enrollment could increase by half a million people by the end of this calendar year. In Georgia, which has been more aggressive in re-opening from the COVID-19 restrictions, Medicaid enrollment is projected to rise by as much as 567,000 people. Governor Brian Kemp (R-GA) has instructed every state agency to prepare for 14 percent cuts across the board. In Alaska, Governor Mike Dunleavy (R-AK) cut state Medicaid spending $31 million last month, saying the temporary federal boost would make up the difference. That, in part, is what the FMAP increase is intended to do, replace lost state revenue while maintaining Medicaid coverage. As a condition of the 6.2 percent increase, states are not allowed to cut coverage.
According to the Politico article, other examples across the states include: Arizona in the past two months has experienced a 78,000 increase enrollment in Medicaid and the Children’s Health Insurance Program, New Mexico sign-ups in the first two weeks of April surged by about 10,000 more people, in Michigan, according to a state House appropriations committee, the state’s Medicaid enrollment could increase from 2.4 million to 2.8 million by the end of the year.
Medicaid is vital to child welfare beyond basic health care for families across the child welfare continuum from primary prevention, intervention, placement in care, to permanency to youth transitioning out of foster care. It helps to provide critical support to important services such as substance abuse treatment and mental health services. An increase in the FMAP for both Medicaid and Title IV-E will be vital in the coming months as state budgets constrict.