Twenty nine of 30 states who had projections for fiscal year 2021 anticipated total Medicaid spending would continue to increase over the previous year's numbers, thanks to rising enrollment.

A few short months ago, buoyed by a robust economy, U.S. states anticipated little to no growth in Medicaid spending.

But that changed around March, when public efforts to stem the spread of COVID-19 led businesses, municipalities, states and entire countries to cut jobs and halt key revenue-generating operations. Now, officials say health care and public finances are about to collide in a way no one anticipated at the start of the year.

"The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid, a counter-cyclical program," according to Kaiser Family Foundation and Health Management Associates, which sent a rapid survey to Medicaid directors in all 50 states and the District of Columbia. "During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling."