Considerations Not in the Estimate
Some estimates of the net cost of Medicaid expansion include projections of its effect on the health care workforce and the state economy and the resulting estimated increase in tax revenues. The Kansas Hospital Association estimates expanding KanCare would generate tax revenue equaling 2.5 percent of the combined federal and state cost of new enrollees. If applied to the KHI estimate, that would produce annual revenues of $18.1 million-$22.6 million over the 10-year period.
In addition, while the KHI estimate includes savings from inpatient hospital stays for inmates in the state correctional system, it does not include estimated savings that might be expected over time in reduced recidivism and interaction with law enforcement. It also does not assume the state would reduce funding for other programs that currently provide behavioral health treatment and other medical care to uninsured Kansans, including community mental health centers and safety net clinics. Neither does it assume changes related to population trends.
Factors That Could Affect Experience
As with other estimates, this projection is based on assumptions that could change depending on policy choices, implementation processes, economic factors or even the status of the private insurance market. For example, if Kansas were to adopt work requirements as a component of Medicaid expansion, enrollment over the time studied might be lower than projected as members lose eligibility, gain income or do not enroll in the first place.
Conversely, a bad turn in the economy or destabilization of the private insurance market could drive more newly eligible people to enroll in KanCare as they either lose employment or can no longer afford coverage. Yearly changes in the regular match rate also could increase or decrease state costs.