The Administration's Medicaid Regulations: State-By-State Impacts

On November 1, 2007, the Committee on Oversight and Government Reform held a hearing on regulations issued by the Centers for Medicare & Medicaid Services (CMS) that would make major, wide-ranging changes in federal Medicaid policy. In general, the seven regulations at issue represent unilateral actions by CMS neither directed nor authorized by the Congress. The Committee heard testimony from the principal author of the regulations, Dennis Smith, the Director of the Center for Medicaid and State Operations within CMS. According to the Administration, the regulations would reduce federal Medicaid payments to states by a total of more than $15 billion over the next five years.

On January 16, 2008, the Committee wrote to each state Medicaid Director requesting a state-specific analysis of the impact of each of the regulations. The Committee received responses from 43 states and the District of Columbia, accounting for close to 95% of total Medicaid spending. This report analyzes these responses. It is the first state-specific assessment of the impact of the CMS regulations.

The report finds that the state estimates of the fiscal impacts of the regulatory changes are significantly higher than the $15 billion impact projected by the Administration. According to the states who responded to the Committee, the regulations would reduce federal payments to them by $49.7 billion over the next five years, more than three times the Administration's estimate. In the case of one regulation, the state estimates of lost federal funds are more than ten times the Administration's estimate.

Click here to download the full report.
Click here to download summaries of state responses.

(Wyoming responded too late to be included in the full report but information for the state is included below.)

Move your mouse over a state to view its estimated Medicaid cuts, and click on a state for a more detailed look at the impact of the proposed regulations on that state and the full report from that state's Medicaid director.