While congressional Republicans and President Donald Trump havebeen seeking major cuts in federal funding of Medicaid, 26states this year expanded or enhanced benefits and at least 17 planto do so next year, according to a report released Thursday.

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The increased benefits were largely for mental health and substance abuse treatment,but states also added telemedicine and dental care, according tothe report by the Kaiser Family Foundation and the NationalAssociation of Medicaid Directors. (Kaiser Health News is aneditorially independent program of the foundation.)

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The number of states adding benefits was the highest in at leasta decade, according to the 50-state survey. Last year, 21 statesexpanded benefits.

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Just six states moved to cut Medicaid benefits in fiscal2016.

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Oregon last year became the first state to provide coverage fororal contraceptives prescribed by a pharmacist, rather than adoctor, with its Medicaid program, the report said.

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Four states — Louisiana, Virginia, South Dakota and New York —added cancer screening benefits such as paying for genetic testingfor the BRCA breast cancer gene mutation.

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Medicaid, the state-federal health insurance program for thepoor, covers nearly 75 million people and is one of the largestprograms in state budgets. States generally add benefits toMedicaid during strong economic times.

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States added the benefits while Congress debated makingsignificant changes to the program, including ending the open-endedfederal spending that has been a staple of the program since itsbeginning in 1966. The Republican efforts, including bills toreplace the Affordable Care Act, have withered after stiffopposition from advocates and Democrats and three moderateRepublicans in the Senate.

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Medicaid also faces uncertainty as the Trump administrationweighs whether to allow states for the first time to requirenon-disabled, adult enrollees to work in order to qualify forbenefits. At least six states have such a request pending with theCenters for Medicare & Medicaid Services, and a decision isexpected before end of the year.

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Robin Rudowitz, associate director for the Kaiser FamilyFoundation’s Program on Medicaid and the Uninsured, said states areadding benefits to respond to the national opioid abuse problem aswell as to continue the trend to give enrollees who are elderly orhave serious health problems the ability to remain in their homeslonger instead of going to nursing homes. She said more states havebeen expanding benefits for several years coming out of the GreatRecession, which ended in 2009.

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“We are seeing the delayed effects of the improving economy —enrollment growth is going down … and states are increasingprovider [reimbursement] rates and restoring and adding benefits,”she said.

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Continued on next page>>>

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Kaiser HealthNews (KHN) is a national health policy news service. It isan editorially independent program of the Henry J. Kaiser Family Foundation.

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Even while Maine, Indiana, Kentucky and other states want to add an adult work requirement to Medicaid, which willmake it harder for some people to qualify, some of these samestates and others are enhancing benefits, she said.

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“All of this is happening against a backdrop of majoruncertainty about what is going to happen at the federal level,”Rudowitz said.

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After three years of supersized enrollment growth that peaked in2015 as a result of most states expanding coverage under the ACA,Medicaid enrollment growth slowed to 2.7 percent nationally infiscal year 2017, which ended Sept. 30, down from 3.9 percent theyear before, according to a second Kaiser report also released Thursday.

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Overall Medicaid spending increased 3.9 percent in 2017, up from3.5 percent in 2016. States reported that increase reflected higherspending on such things as prescription drugs and long-term careservices.

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The states’ share of Medicaid spending grew by 3.5 percent alsoin 2017 but is expected to go up 6 percent in 2018. That increaseis mostly a result of states starting to pay 5 percent of the costof new enrollees covered under the ACA expansion. The federalgovernment paid the full costs for those enrollees through2016.

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The survey was conducted by analysts at the Kaiser FamilyFoundation and Health Management Associates.

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Correction: This story was updated on Oct. 19 to correct anediting error. The survey was conducted by analysts from both theKaiser Family Foundation and Health Management Associates, not justHealth Management Associates.

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Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser FamilyFoundation.

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