Medicaid spending in New Mexico

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Medicaid spending in New Mexico
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Overview
Number of enrollees:
787,1101
Total spending:
$5.36 billion3
Spending per enrollee:
$5,7814
Percent of state budget:
30.3%4
Medicaid eligibility limit:
300% FPL3
Expansion?:
Yes2
CHIP spending:
$116.1 million4
CHIP eligibility limit:
305% FPL2

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Data years
1March 20172201832016
4201552013
Medicaid spending in the U.S.MedicareMedicaidObamacare overview


New Mexico's Medicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children's Health Insurance Program (CHIP), which covers low-income children above the poverty line and is sometimes operated in conjunction with a state's Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

This page provides information about Medicaid in New Mexico, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.

HIGHLIGHTS
  • New Mexico expanded Medicaid under the Affordable Care Act in 2014.[1]
  • Governor Susana Martinez (R) expressed support for Medicaid expansion in 2013, saying, "I may be a Republican, but I make decisions based on what’s best for New Mexicans."[1]
  • Background[edit]

    Established in 1965, Medicaid is the primary source of health insurance coverage for low-income and disabled individuals and the largest source of financing for the healthcare services they need. In 2014, about 80 million individuals were enrolled in Medicaid, or 25.9 percent of the total United States population. According to the Kaiser Family Foundation, Medicaid accounted for one-sixth of healthcare spending in the United States during that year.[2][3][4]

    The federal Centers for Medicare and Medicaid Services (CMS) monitors state Medicaid programs and establishes requirements for service delivery, quality, funding, and eligibility standards. Medicaid does not provide healthcare directly. Instead, it pays hospitals, physicians, nursing homes, health plans, and other healthcare providers for covered services that they deliver to eligible patients.[4][5]

    The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $16,643 for individuals and $33,948 for a family of four in 2017. A 2012 United States Supreme Court decision made the Medicaid expansion voluntary on the part of the states.[6][7]

    Eligibility[edit]

    Eligibility for each state's Medicaid program is subject to minimum federal standards, both in the population groups states must cover and the maximum amount of income enrollees can make. States are required to cover the following population groups and income levels:[7][8]

    • states must cover pregnant women up to at least 138 percent of the federal poverty level ($16,643 for an individual, $33,948 for a family of four in 2017)
    • states must cover preschool-age children up to at least 138 percent of the federal poverty level ($16,643 for an individual, $33,948 for a family of four in 2017)
    • states must cover school-age children up to at least 100 percent of the federal poverty level ($12,060 for an individual, $24,600 for a family of four in 2017)
    • states must cover elderly and disabled individuals up to at least 75 percent of the federal poverty level ($9,045 for an individual, $18,450 for a family of four in 2017)
    • states must cover working parents up to at least 28 percent of the federal poverty level ($3,376 for an individual, $6,888 for a family of four in 2017)

    The Affordable Care Act authorized states to expand their Medicaid programs to offer coverage to childless adults up to 138 percent of the federal poverty level, though they were not required to do so. As of November 2018, a total of 36 states and Washington, D.C., had expanded or voted to expand their Medicaid programs.New Mexico opted to fully expand its Medicaid program, covering childless adults earning incomes up to 138 percent FPL. Full details on Medicaid eligibility for New Mexico and three of its neighboring states are provided in the table below.[9]

    Medicaid eligibility by population category, 2016
    State Children Pregnant women Adults
    Medicaid ages 0-1 Medicaid ages 1-5 Medicaid ages 6-18 Separate CHIP Medicaid CHIP Parent Childless adults
    New Mexico 300% 300% 240% N/A 250% N/A 46% 138%
    Arizona 147% 141% 133% 200% 156% N/A 106% 138%
    Colorado 142% 142% 142% 260% 195% 260% 68% 138%
    Texas 198% 144% 133% 201% 198% N/A 15% No
    Note: Figures represent household income as a percentage of the federal poverty level.

    Expansion under the Affordable Care Act[edit]

    The Affordable Care Act (ACA) provided for the expansion of Medicaid to cover childless adults whose income is 138 percent of the federal poverty level (FPL) or below. The provision for expanding Medicaid went into effect nationwide in 2014. As of November 2018, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid.

    New Mexico expanded Medicaid under the Affordable Care Act in 2014. Governor Susana Martinez (R) expressed support for Medicaid expansion in 2013, saying, "I may be a Republican, but I make decisions based on what's best for New Mexicans."[1]

    Support[edit]

    Arguing in support of the expansion of Medicaid eligibility in an April 2013 article, the Center for American Progress states that the expansion helps increase the number of people with health insurance and benefits states economically. The organization argues that by providing health insurance to those who would otherwise be uninsured, Medicaid expansion allows low-income families to spend more money on food and housing:[10]

    Medicaid coverage translates into financial flexibility for families and individuals, allowing limited dollars to be spent on basic needs, including breakfast for the majority of the month or a new pair of shoes for a job interview.[11]
    —Center for American Progress

    Regarding financial costs for states, the organization argues that "states that expand their Medicaid coverage will not incur unsustainable costs," citing a Congressional Budget Office report that estimated an increase in spending of 2.8 percent. The organization also argues that states will offset these costs with increased revenues and other financial gains:

    Sources of increased revenues include state sales taxes, insurance taxes, and prescription-drug rebates. States will also incur savings, as the federal government will be paying a much higher share of the cost for populations that were previously ineligible and therefore solely paid for by states. This will free up billions of dollars from state budgets.[11]
    —Center for American Progress

    Marilyn Tavenner, President and CEO of the health insurance trade association America's Health Insurance Plans, also spoke in support of Medicaid expansion in September 2016, saying she would like to see all states expand the program. "Medicaid is going to become the bigger issue [from the] affordability perspective," Tavenner said, arguing that Medicaid expansion would pressure the country to address rising health costs.[12]

    Opposition[edit]

    Arguing against Medicaid expansion in a February 2014 article, Michael Tanner, a fellow at the Cato Institute, states that Medicaid expansion is costly for states and does not provide better access to healthcare for low income individuals. Tanner argues that although states are required to pay at most 10 percent of costs for enrollees who became eligible under expanded programs, this still represents a significant cost increase for states. Tanner also argues that states will see greater costs than predicted as previously unenrolled individuals discover they are eligible under the traditional eligibility limits.[13]

    Regarding healthcare access, Tanner cites a study from the Oregon Health Insurance Exchange, which "concluded that 'Medicaid coverage generated no significant improvements in measured physical-health outcomes.'" Tanner also states that "Other studies show that, in some cases, Medicaid patients actually wait longer and receive worse care than the uninsured." Tanner argues that this is due to Medicaid's level of reimbursement to doctors:[13]

    While Medicaid costs taxpayers a lot of money, it pays doctors little. On average, Medicaid reimburses doctors only 72 cents out of each dollar of costs. As a result, many doctors limit the number of Medicaid patients they serve or refuse to take them at all.[11]
    —Michael Tanner

    The National Federation of Independent Business (NFIB) also advocated against Medicaid expansion in February 2017, arguing that the federal government may not always agree to cover 90 percent of the costs:[14]

    Our small business members have looked at this issue from every perspective and believe expanding an underfunded, cumbersome, and poorly administered program like Medicaid would be irresponsible. The bottom line is this: Does anyone really believe that Washington will continue to pick up 90 percent of new costs after 2020?[11]
    —Gregg Thompson, state director of the North Carolina NFIB chapter

    Benefits[edit]

    In large part, the states "determine the type, amount, duration, and scope" of benefits offered to individuals enrolled in Medicaid, according to the Centers for Medicare and Medicaid Services. However, benefits are subject to federal minimum standards. The federal government has outlined 16 benefits that are required of all Medicaid programs:[15][16][17]

    • Hospital services for inpatients
    • Hospital services for outpatients
    • Health screenings for individuals and children under age 21
    • Nursing facility care
    • Home healthcare
    • Physician checkups and other services
    • Rural health clinic visits
    • Visits to federally qualified health centers
    • Laboratory tests and X-rays
    • Family planning
    • Nurse midwife care
    • Maternity and newborn care
    • Visits to pediatric and family nurse practitioners
    • Visits to licensed freestanding birth centers
    • Emergency and non-emergency medical transportation
    • Tobacco cessation programs for pregnant women
    Healthcare policy blood pressure.jpg

    In addition, the Affordable Care Act required that all Medicaid enrollees who became eligible under expanded programs receive coverage for prescription drugs, substance abuse treatment, and mental health treatment. Beyond the required benefits, there are several other optional benefits states may choose to offer enrollees, such as dental care and physical therapy. Other services may be offered with approval from the secretary of the United States Department of Health and Human Services. Benefits offered may not differ from person to person due to diagnoses or condition of health.[15][17][18]


    Optional benefits offered in New Mexico

    According to the Henry J. Kaiser Family Foundation, as of 2017, the optional benefits included in the bulleted list below were offered in New Mexico. Note that other, less common specialized services may also be offered, such as nutrition services and acupuncture. For more complete information on Medicaid benefits, links to state Medicaid offices can be found here.[17][19]

    • Freestanding ambulatory surgery centers
    • Public and mental health clinics
    • Certified registered nurse anesthetists
    • Dental care
    • Dental surgery
    • Optometrists
    • Podiatrists
    • Psychologists
    • Occupational therapy
    • Physical therapy
    • Speech/hearing/language therapy
    • Dentures
    • Eyeglasses
    • Hearing aids
    • Home medical equipment
    • Prosthetics
    • Case management
    • Home or community-based long-term care
    • Hospice care
    • Personal care
    • Program of All-Inclusive Care for the Elderly (PACE)
    • Inpatient psychiatric care for individuals under age 21
    • Inpatient care for mental diseases for individuals age 65+
    • Intermediate care for intellectual disabilities

    State and federal spending[edit]

    Total spending[edit]

    See also: Medicaid spending and enrollment statistics

    During fiscal year 2016, Medicaid spending nationwide amounted to nearly $553.5 billion. Spending per enrollee amounted to $7,067 in fiscal year 2013, the most recent year for which per-enrollee figures were available as of June 2017. Total Medicaid spending grew by 33 percent between fiscal years 2012 and 2016. The Medicaid program is jointly funded by the federal and state governments, and at least 50 percent of each state's Medicaid funding is matched by the federal government, although the exact percentage varies by state. Medicaid is the largest source of federal funding that states receive. Changes in Medicaid enrollment and the cost of healthcare can impact state budgets. For instance, in New Mexico, the percentage of the state's budget dedicated to Medicaid rose from 22.1 percent in 2010 to 30.3 percent in 2015. However, state cuts to Medicaid funding can also mean fewer federal dollars received by the state.[20][21][22]

    During fiscal year 2016, combined federal and state spending for Medicaid in New Mexico totaled about $5.36 billion. Spending on New Mexico's Medicaid program increased by about 56.4 percent between fiscal years 2012 and 2016. Hover over the points on the line graph below to view Medicaid spending figures for New Mexico. Click [show] on the red bar below the graph to view these figures as compared with three of New Mexico's neighboring states.[23][24][25][26][27]

    Spending details[edit]

    In 2013, the most recent year per enrollee spending figures were available as of June 2017, spending per enrollee in New Mexico amounted to $5,781. Total enrollment in 2017 amounted to 787,000 individuals. Total federal and state Medicaid spending for New Mexico during 2016 amounted to about $5.36 billion. The federal government paid 79.4 percent of these costs, while the state paid the remaining 20.6 percent. Medicaid accounted for 30.3 percent of New Mexico's budget in 2015.[28][29][30][31][32]

    Medicaid spending details
    State Total spending (2016) Enrollment (March 2017) Per enrollee spending (2013) FMAP percentage (2018)* Federal share (2016) State share (2016) Percent of state budget (2015)
    New Mexico $5,364,140,357 787,110 $5,781 72.2% 79.4% 20.6% 30.3%
    Arizona $11,112,248,057 1,741,301 $5,582 69.9% 75.5% 24.5% 30.3%
    Colorado $7,934,761,868 1,388,472 $6,819 50.0% 61.6% 38.4% 22.5%
    Texas $40,329,673,422 4,764,366 $5,982 56.9% 57.5% 42.5% 30.6%
    United States $553,453,647,756 74,600,261 $7,067 50.00% 63.0% 37.0% 28.2%
    Note: FMAP stands for Federal Medical Assistance Percentage and represents the percentage of state Medicaid spending that is eligible for federal matching funds.

    Medicaid spending can generally be broken up into the following categories:

    • Acute care services are those that are typically provided within a short time frame, such as inpatient hospital stays, lab tests, and prescription drugs.
    • Long-term care services are those provided over a long period of time, such as home care and mental health treatment.
    • Disproportionate Share Hospital (DSH) payments are funds given to hospitals that tend to serve more low-income and uninsured patients than other hospitals.
    • Payments to Medicare include covering Medicare premiums for individuals who are dually eligible for both Medicaid and Medicare.
    • FFS refers to fee-for-service payments, in which doctors are reimbursed for each test and service performed.
    • Managed care is the practice of paying private health plans with Medicaid funds to cover enrollees.

    The largest portion—80 percent—of Medicaid spending in New Mexico in 2016 went to managed care. The next-largest portion of Medicaid spending in New Mexico went to FFS acute care, which comprised about 9 percent of spending. About 3 percent of Medicaid spending in New Mexico was used for payments to Medicare. Hover over the sections in the column chart below to view more data points for New Mexico and three of its neighboring states.[33]

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    Children's Health Insurance Program[edit]

    The Children's Health Insurance Program (CHIP) is a public healthcare program for low-income children who are ineligible for Medicaid. CHIP and Medicaid are related programs, and the former builds on Medicaid's coverage of children. States may run CHIP as an extension of Medicaid, as a separate program, or as a combination of both. Like Medicaid, CHIP is financed by both the states and the federal government, and states retain general flexibility in the administration of its benefits.[34]

    CHIP is available specifically for children whose families make too much to qualify for Medicaid, meaning they must earn incomes above 138 percent of the federal poverty level, or $33,948 for a family of four in 2017. Upper income limits for eligibility for CHIP vary by state, from 175 percent of the federal poverty level (FPL) in North Dakota to 405 percent of the FPL in New York. States have greater flexibility in designing their CHIP programs than with Medicaid. For instance, fewer benefits are required to be covered under CHIP. States can also charge a monthly premium and require cost sharing, such as copayments, for some services; the total cost of premiums and cost sharing may be no more than 5 percent of a family's annual income. As of January 2017, 14 states charged only premiums to CHIP enrollees, while nine states required only cost sharing. Sixteen states required both premiums and cost sharing. Eleven states did not require either premiums or cost sharing.[7][34][35][36][37]

    As of 2017, New Mexico served CHIP enrollees through Medicaid. Its upper eligibility limit was 305 percent of the FPL, meaning a family of four had to make less than $75,030 per year to qualify. The state imposed cost sharing beginning at 190 percent of the FPL. Below is a table with some general information about CHIP in New Mexico, including spending figures, the state's federal match percentage, and enrollment in the program. These data points are compared with those of its neighboring states.[38][39][40][41][42]

    General CHIP information for New Mexico
    State Total CHIP expenditures, 2015 (millions) Enhanced FMAP, 2017* CHIP enrollment, 2014 Program type
    Federal State Total
    New Mexico $91.5 $24.7 $116.1 100.0% 17,195 Medicaid Expansion
    Arizona $92.1 $26.2 $118.3 100.0% 38,811 Separate CHIP
    Colorado $157.3 $82.0 $239.4 88.0% 86,133 Combination
    Texas $956.4 $397.7 $1,354.1 92.3% 1,049,623 Separate CHIP
    United States $9,528.00 $3,933.40 $13,461.40 88.00% 8,129,426 N/A
    * FMAP stands for Federal Medical Assistance Percentage and reflects the percentage of state dollars spent on CHIP that are eligible for matching funds from the federal government.
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    Historical data[edit]

    Enrollment[edit]

    To view detailed historical data on Medicaid enrollment in New Mexico for 2010, click "Show more" below to expand the section.

    Show more

    According to a July 2014 report from the Pew Charitable Trusts, in 2010 there were 576,138 New Mexico residents enrolled in Medicaid. By 2013, Medicaid covered 20 percent of New Mexico residents; between 2000 and 2012, this figure had increased by 6 percentage points. The majority of enrollees were parents and children, 81 percent. In most states, most Medicaid spending is on services for elderly and disabled individuals, since this group of enrollees is "more likely to have complex health care needs that require costly acute and long-term care services." The portion of Medicaid enrollees who are elderly and disabled is a factor taken under significant consideration when state lawmakers make appropriations for the program each year. This information was not available for New Mexico.[43]

    Distribution of Medicaid enrollment and payments, 2010
    State Enrollment rates Payment for services
    Total Elderly and disabled individuals Parents and children Total (in billions) Elderly and disabled individuals Parents and children
    New Mexico 576,138 19% 81% $3.3 N/A* N/A*
    Arizona 1,531,122 16% 84% $9.2 42% 58%
    Colorado 618,334 21% 79% $3.9 65% 35%
    Utah 349,595 16% 84% $1.7 58% 42%
    United States 66,390,642 24% 76% $369.3 64% 36%
    Source: The Pew Charitable Trusts, "State Health Care Spending on Medicaid"

    Dual eligibility[edit]

    See also: Medicaid and Medicare dual eligibility

    To view detailed historical data on dual eligibility for Medicaid and Medicare in New Mexico for 2011, click "Show more" below to expand the section.

    Show more

    Enrollment[edit]

    Some individuals, such as low-income seniors, are eligible for both Medicare and Medicaid; these individuals are known as dual-eligible beneficiaries. For those enrolled in Medicare who are eligible, enrolling in Medicaid may provide some benefits not covered by Medicare, such as stays longer than 100 days at nursing facilities, prescription drugs, eyeglasses, and hearing aids. Medicaid may also be used to help pay for Medicare premiums. According to the Henry J. Kaiser Family Foundation, in 2011 there were 69,100 dual eligibles in New Mexico, or 12 percent of Medicaid enrollees. Average spending per dual eligible in New Mexico was not available.[44][45][46][47][48]

    Dual eligible enrollment, fiscal year 2011
    State Total Medicaid enrollment* Medicaid spending per enrollee Number of dual eligibles Dual eligibles as a percent of Medicaid enrollees Medicaid spending per dual eligible
    New Mexico 507,400 $5,803 69,100 12% N/A
    Arizona 1,350,700 $7,022 146,400 12% $14,824
    Colorado 620,800 $5,679 77,500 10% $21,830
    Utah 273,900 $4,890 30,200 9% $17,765
    United States 53,535,000 $5,790 9,972,300 15% $16,904
    * Data on Medicaid enrollment figures may differ depending on the source of data and the computational methods used, such as "point-in-time" figures versus "ever-enrolled" figures.
    Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

    Spending[edit]

    Total 2011 dual eligible spending information was not available for New Mexico. However, Medicaid paid $78 million toward Medicare premiums in 2011.[49]

    Medicaid spending for dual eligibles by service, fiscal year 2011 (in millions)
    State Medicare premiums Acute care Prescribed drugs Long-term care Total
    New Mexico $78 N/A N/A N/A N/A
    Arizona $203 $1,757 $0 $31 $1,990
    Colorado $95 $350 $8 $1,013 $1,466
    Utah $33 $165 $8 $259 $465
    United States $13,489 $40,190 $1,462 $91,765 $146,906
    Source: The Henry J. Kaiser Family Foundation, "State Health Facts"
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    Recent news[edit]

    The link below is to the most recent stories in a Google news search for the terms Medicaid New Mexico. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

    See also[edit]

    Medicaid in the 50 states[edit]

    Click on a state below to read more about the Medicaid program in that state.

    http://ballotpedia.org/Medicaid spending_in_STATE

    Footnotes[edit]

    1. 1.0 1.1 1.2 Albuquerque Journal, "NM says it’s ready to expand Medicaid," September 30, 2013
    2. The Kaiser Commission on Medicaid and the Uninsured, "Medicaid Enrollment in 50 States," February 2010 (Note 1)
    3. Center on Budget and Policy Priorities, "Policy Basics: Introduction to Medicaid," June 19, 2015
    4. 4.0 4.1 The Henry J. Kaiser Family Foundation, "Medicaid Financing: How Does it Work and What are the Implications?" May 20, 2015
    5. Centers for Medicare and Medicaid Services
    6. Kaiser Health News, "Consumer’s Guide to Health Reform," April 13, 2010
    7. 7.0 7.1 7.2 Office of The Assistant Secretary for Planning and Evaluation, "Poverty Guidelines," accessed June 9, 2017
    8. The Henry J. Kaiser Family Foundation, "Federal Core Requirements and State Policy Options in medicaid: Current Policies and Key Issues," accessed May 13, 2017
    9. Medicaid.gov, "Medicaid & CHIP in New Mexico," accessed May 13, 2017
    10. Center for American Progress, "10 Frequently Asked Questions About Medicaid Expansion," April 2, 2013
    11. 11.0 11.1 11.2 11.3 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
    12. Bloomberg BMA, "Medicaid Expansion Will Drive Affordability, Insurance Leader Says," September 29, 2016
    13. 13.0 13.1 Cato Institute, "No Miracle in Medicaid Expansion," February 4, 2014
    14. National Federation of Independent Business, "NFIB Calls for Halt on Last-Minute Medicaid Expansion Attempt," February 1, 2017
    15. 15.0 15.1 Medicaid.gov, "Benefits," accessed June 8, 2017
    16. The Commonwealth Fund, "Medicaid Benefit Designs for Newly Eligible Adults: State Approaches," May 11, 2015
    17. 17.0 17.1 17.2 The Henry J. Kaiser Family Foundation, "KCMU Medicaid Benefits Database: General Benefits and Cost-Sharing Notes," January 2014
    18. The Henry J. Kaiser Family Foundation, "Medicaid Benefits Data Collection," accessed September 24, 2015
    19. The Henry J. Kaiser Family Foundation, "Medicaid Benefits Data Collection," accessed September 24, 2015
    20. The Henry J. Kaiser Family Foundation, "Total Medicaid Spending," accessed July 17, 2015
    21. Medicaid and CHIP Payment and Access Commission, "Medicaid Benefit Spending per Full-Year Equivalent Enrollee by State and Eligibility Group, FY 2012," accessed September 14, 2015
    22. The Pew Charitable Trusts, "State Health Care Spending on Medicaid: Table B.1," accessed July 17, 2015
    23. The Henry J. Kaiser Family Foundation, "Total Medicaid Spending - 2012," accessed July 17, 2015
    24. Kaiser Family Foundation, "Total Medicaid Spending - 2013," accessed May 31, 2017
    25. Kaiser Family Foundation, "Total Medicaid Spending - 2014," accessed May 31, 2017
    26. MACPAC, "Medicaid Spending by State, Category, and Source of Funds," accessed May 31, 2017
    27. Kaiser Family Foundation, "Total Medicaid Spending - 2016," accessed May 31, 2017
    28. MACPAC, "Medicaid Benefit Spending Per Full-Year Equivalent (FYE) Enrollee by State and Eligibility Group," accessed May 26, 2017
    29. MACPAC, "Medicaid as a Share of State Budgets Including and Excluding Federal Funds by State," accessed May 26, 2017
    30. Kaiser Family Foundation, "Federal and State Share of Medicaid Spending," accessed May 26, 2017
    31. Kaiser Family Foundation, "Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier," accessed May 26, 2017
    32. Medicaid.gov, "March 2017 Medicaid and CHIP Enrollment Data Highlights," accessed May 26, 2017
    33. The Henry J. Kaiser Family Foundation, "Distribution of Medicaid Spending by Service," accessed May 31, 2017
    34. 34.0 34.1 The Henry J. Kaiser Family Foundation, "Children’s Health Coverage: Medicaid, CHIP and the ACA," March 26, 2014
    35. Healthcare.gov, "The Children's Health Insurance Program (CHIP)," accessed March 24, 2016
    36. National Health Law Program, "Q & A: The Supreme Court's Decision on the ACA's Medicaid Expansion," July 23, 2016
    37. Kaiser Family Foundation, "Premium, Enrollment Fee, and Cost Sharing Requirements for Children, January 2017," accessed June 9, 2017
    38. The Henry J. Kaiser Family Foundation, "Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey," accessed May 31, 2017
    39. Medicaid and CHIP Payment and Access Commission, "CHIP Spending by State," accessed May 26, 2016
    40. The Henry J. Kaiser Family Foundation, "Enhanced Federal Medical Assistance Percentage (FMAP) for CHIP," accessed May 26, 2016
    41. The Henry J. Kaiser Family Foundation, "CHIP Program Name and Type," accessed May 26, 2016
    42. The Henry J. Kaiser Family Foundation, "Total Number of Children Ever Enrolled in CHIP Annually," accessed May 26, 2017
    43. The Pew Charitable Trusts, "State Health Care Spending on Medicaid," July 2014
    44. The Henry J. Kaiser Family Foundation, "Monthly Medicaid Enrollment (in thousands)," accessed September 4, 2015
    45. The Henry J. Kaiser Family Foundation, "Medicaid Spending per Enrollee (Full or Partial Benefit)," accessed September 4, 2015
    46. The Henry J. Kaiser Family Foundation, "Number of Dual Eligible Beneficiaries," accessed September 4, 2015
    47. The Henry J. Kaiser Family Foundation, "Dual Eligibles as a Percent of Total Medicaid Beneficiaries," accessed September 4, 2015
    48. The Henry J. Kaiser Family Foundation, "Medicaid Spending per Dual Eligible per Year," accessed September 4, 2015
    49. The Henry J. Kaiser Family Foundation, "Distribution of Medicaid Spending for Dual Eligibles by Service (in Millions)," accessed July 17, 2015

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