NHeLP’s Guide for Evaluating Fiscal Analyses of the ACA’s Adult Medicaid Expans

Over a dozen states have conducted fiscal analyses of the projected impact on the state budget due to the Affordable Care Act?s Medicaid expansion for adults up to 138% of the Federal Poverty Level (FPL). Advocates, policy analysts, and academics have also been releasing their own studies. This guide will help advocates understand the major elements that comprise a robust fiscal estimate of a state-specific Medicaid expansion and highlights potential areas of concern when assessing already released fiscal reports. We have linked to a number of resources that will help advocates identify and counter inflated estimates of costs and/or develop their own estimates. This guide?s companion piece, Five Myths and Facts about the Costs of Medicaid Expansion, offers a condensed version of key themes that come out of this collection of fiscal analyses.
I. Enrollment rates
A key question for state officials considering the potential costs of the Medicaid expansion is ? how many people are expected to enroll? Numerous resources quantify how many individuals would be eligible under the expansion, as well as historic data on reasonable take up and participation rates. However, enrollment predictions can vary widely, with some fiscal analyses projecting unrealistically high participation rates that, in turn, inflate the estimated cost of expansion.

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