State budget projections are improving, but a failure by Congress to provide extra funding for Medicaid could make matters much more stark, according to a report by the National Conference of State Legislatures (NCSL).
Twenty-five states, including Iowa, have already crafted budgets that include an increased federal share of Medicaid expenses. The American Recovery and Reinvestment Act, more commonly known as the federal stimulus, temporarily provided states with a 6.2 percent increase in the portion of Medicaid financed by the federal government. That increase, however, expires in December, right in the middle of Iowa’s fiscal year.
Republicans in the U.S. Senate helped kill a bill that would have extended the Medicaid funding, along with unemployment insurance and numerous tax credits. While Democrats were able to pass the extension of unemployment benefits as a stand-alone bill, the rest of the bill — including the Medicaid portion — remains stuck in political gridlock.
In Iowa, a failure of the extension will shoot a $121 million hole in the state’s budget, according to the nonpartisan Legislative Services Agency.
“States are in a tenuous fiscal position, teetering between delicate revenue improvement and the end of the federal stimulus funds,” said Corina Eckl, NCSL’s fiscal program director. “If Congress decides not to extend enhanced [Federal Medical Assistance Percentages] rates for six months, it will be another blow to the states’ fragile fiscal recovery.”
Jess Benson, a fiscal analyst with the Legislative Services Agency, told The Iowa Independent last month that federal requirements for Medicaid would mean lawmakers wouldn’t be able to fill the $121 million budget hole with adjustments to Medicaid alone, meaning either they would be forced to raise more revenues through fees or taxes, tap the state’s cash reserves or institute cuts to other state departments.