CAH Medicaid Payer Mix in Expansion vs. Non-Expansion States


Since the Affordable Care Act’s (ACA) enactment of Medicaid expansion in 2014, 36 states have decided to expand Medicaid – 21% of the population is now covered by Medicaid or Children’s Health Insurance Program (CHIP). The larger number of Medicaid patients has resulted in a substantial increase in Medicaid payer mix (the proportion of a hospital’s net patient revenue provided by Medicaid).

Previous studies have found an association between Medicaid expansion and payer mix among patients hospitalized for certain conditions. Change in Medicaid payer mix could have material financial consequences for CAHs. The purpose of this brief is to compare Medicaid payer mix in 2018 versus 2013 for CAHs in states that have and have not expanded Medicaid.

This study finds a similar relationship among CAHs in expansion versus non-expansion states. CAHs with the greatest positive changes in Medicaid payer mix are located in expansion states. CAHs with the smallest or negative changes in Medicaid payer mix tend to be located in non-expansion states. More specifically:

  • The 10 states with the greatest increases in median CAH Medicaid payer mix from 2013 to 2018 are all expansion states;
  • Among the 17 states with a decrease in median CAH Medicaid payer mix from 2013 to 2018, 12 were non-expansion states.