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.

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