No precedent for “cut-and-run” in Medicaid

by Adrianna McIntyre

The latest in “drives Adrianna bonkers” is the unrelenting prediction about the federal government withdrawing Medicaid funding after states decide to expand. Intuitively, I understand where the concerns come from. But what do data and history have to say on the matter?

Turns out that since Medicaid was passed in 1965, average funding levels have remained flat—and haven’t oscillated outside the 55-59% range since 1980 (with a brief bump during the recession being one exception—more on that in a moment).

Data from the graph below was pulled from this 2012 report to Congress (p22).


Yes, there’s a blip there between 2009 and 2012, I see it. That’s because the American Recovery and Reinvestment Act—which you probably know better as “the stimulus package”—was passed in February 2009 and included a deliberate and temporary boost to Medicaid funding to help states buffer against the recession. It was never meant to be a permanent increase to Medicaid federal match rates; I don’t consider it sound logic to hold temporary policy against baseline estimates. That increase was phased back down to a baseline level of 57%.

I get that the 2014 funding bump is big. The bump was big in 1965, too, and the feds haven’t backed down yet.

(and a great many thanks to Karan for putting the graph together)

Adrianna is a graduate student in public policy and public health at the University of Michigan.
Follow her on Twitter @onceuponA or subscribe to the blog.


5 thoughts on “No precedent for “cut-and-run” in Medicaid

  1. […] of the federal government “dumping” new spending on the states. Adrianna McIntyre points that out on Project Millennial, with this chart showing the federal share of Medicaid since the program […]

  2. Aquifer says:

    And there has been no precedent, ISTM, for this bipartisan attack on social programs, so, IMO, all bets are off – how does the “sequester” affect Medicaid and how, when we have a bipartisan agreement on the need to “balance the budget” and the “need” to trim “entitlements” in the name of doing so, do you think such precedent will fair –

    Methinks our current political scene is to healthcare as GW is to the environment – a disaster – we are entering into different territory than that which existed during the period of your graph … I find no comfort there …

    • I accept that I can’t change people’s propensity to speculate, but I consider the history relevant. I can at least answer your sequester question: Medicaid, along with CHIP, are entirely sheltered from sequester cuts. See Sarah Kliff’s piece here.

  3. […] concerns that the federal government may shirk on its share once the states enroll in the program, Adrianna McIntyre points out that there is “no precedent for ‘cut-and-run’ in […]

  4. Eileen Ellis, Michigan says:

    Good work. The smaller blip earlier in the last decade was also created by a temporary increase in federal funding due to a recession.

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