Policy & Research


What Kansas Can Learn from Medicaid Expansion in Other States (June 2019)

By Linda J. Sheppard, J.D., Sydney McClendon | June 25, 2019

What Kansas Can Learn from Medicaid Expansion in Other States (June 2019)


Almost nine years after the passage of the Affordable Care Act (ACA), 36 states and the District of Columbia have expanded their Medicaid programs. Fourteen states, including Kansas, have not. This issue brief examines different state approaches to expansion, as well as enrollment and cost trends and the effects of expansion on health outcomes and state economies.

Key points from the brief include:

  • Between mid-2013 and August 2018, total Medicaid enrollment in expansion states increased by 37.3 percent. Among non-expansion states for the same period, total enrollment increased by 11.1 percent.
  • Multiple studies suggest that Medicaid expansion can result in (1) the offsetting of state costs in other areas, such as costs related to behavioral health services and crime, (2) lower marketplace premiums, and (3) growth in the economy, in the form of new jobs.
  • According to the CMS actuary, the average per-enrollee costs for expansion adults in 2014 were $5,511. These costs grew to $6,365 in 2015, then decreased to $5,965 in 2016 and $5,813 in 2017.
  • Studies have found an association between Medicaid expansion and improved patient outcomes, including improved glucose monitoring rates for patients with diabetes, better hypertension control, improved rates of cancer screenings and reductions in self-reported rates of psychological distress and days of poor mental health.
  • For safety-net hospitals, recent studies suggest there have been reductions in uncompensated care and improved financial status of hospitals in states that have expanded Medicaid compared to those in states that have not.

*List of reference materials used in this analysis.

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.