Medicaid is a joint federal-state program that provides health insurance to low-income individuals and families, including children and their parents, people with disabilities, and the elderly. Since its creation in 1965, the program has grown into the largest insurance program in the country, covering one in four Americans. The explosive expansion of the program jeopardizes its ability to finance and provide high-quality care for the people who need it most.

Over the past decade, Mercatus Center scholars have been studying the drivers of enrollment and spending growth and proposing reforms to ensure that Medicaid adequately meets the needs of the most vulnerable.

Want to learn more about Medicaid expansion and its consequences? Check out our research and commentary resources below. New to Medicaid? Start here.

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Medicaid Expansion

Healthcare Piggy Bank

The Effect of the Affordable Care Act's Medicaid Expansion on the Mental Health Of Already-Enrolled Medicaid Beneficiaries

Markus Bjoerkheim, Liam Sigaud, and Kofi Ampaabeng find evidence that Medicaid expansion leads to deteriorating mental health outcomes among individuals who were already covered by Medicaid.

The Affordable Care Act's Medicaid Expansion Is Shifting Resources away from Low-Income Children

Charles Blahous and Liam Sigaud find that the growth of Medicaid spending on children, the elderly, and people with disabilities has been less in expansion states compared with the same eligibility groups in non-expansion states. See the illustrated one-page summary, op-ed, and podcast. You can also access the research summary and policy spotlight.

The ACA's Medicaid Expansion: A Review of Ineligible Enrollees and Improper Payments

Brian Blase and Aaron Yelowitz find that enrollment into Medicaid has been much higher than expected in states that adopted the expansion, that significant errors and problems permeate state eligibility determinations for Medicaid, and that many program enrollees are ineligible. Read Aaron Yelowitz’s testimony before the Pennsylvania House here.

Reforming Medicaid Reimbursement before the Next Pandemic

Charles Blahous and Elise Amez-Droz show how the enhanced federal match reduces incentives for states to invest in effective eligibility verification systems. They recommend equalizing the federal reimbursement rate across original and expansion groups. Read our blog post about it.

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Medicaid Spending & Financing

Cost of Healthcare

Why We Have Federal Deficits: An Updated Analysis

Charles Blahous shows that nearly 60% of the federal government’s long-term deficits derive from legislative changes that occurred over 50 years ago, namely the enactment of Medicare and Medicaid as well as large increases in Social Security benefits.

Medicaid Provider Taxes: The Gimmick That Exposes Flaws with Medicaid’s Financing

Brian Blase explain how provider taxes are used to artificially inflate states’ Medicaid spending in order to maximize the federal reimbursement. He then proposes solutions to minimize the use of this gimmick.

The Economics of Medicaid: Assessing the Costs and Consequences

Nine experts including Charles Blahous and Darcy Bryan discuss the escalating costs and consequences of a program that provides second-class healthcare at first-class costs.

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Medicaid Program Design

Program Design

Traumatic Brain Injury: A Case Study in Failed Incentives to Address the Needs of Medicaid Patients in California

Dr. Anthony DiGiorgio and Lisa Grabert explain how Medicaid fee-for-service policies keep traumatic brain injury patients stuck in the hospital long after becoming well enough to be discharged. They recommend that states adopt managed care for long-term services and support.

Midwifery Licensing: Medicalization of Birth and Special Interests

Lauren Hall describes the perverse incentives within Medicaid that reimburse midwives at rates that discourage them from providing care to pregnant women. Read her op-ed and her testimony before the Ohio legislature.

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