The National Association of Medicaid Directors (NAMD) recently published a white paper on Medicaid system reform efforts. Over the past year, NAMD has been working, with support from the Commonwealth Fund, to collect a growing catalog of "best practices" and innovative state initiatives. NAMD details the results of these efforts in the paper, which identifies and addresses the major barriers and the most likely pathways to Medicaid-driven and Medicaid-relevant health system reform.

The State Budget Crisis Task Force recently released a report identifying Medicaid growth as one of six major areas affecting states' fiscal stability. The others include federal deficit reduction efforts, underfunded retirement commitments, narrow and eroding tax bases, local governments' fiscal problems, and state laws. The report cited increasing enrollments, escalating health care costs, and difficulty implementing cost reduction proposals as reasons for Medicaid's rapid cost growth. The State Budget Crisis Task Force report also noted that Medicaid recently passed k-12 education as the largest area of state spending when all funds are considered. The report cites the Centers for Medicare & Medicaid Services (CMS), which found that Medicaid costs will likely grow at an average annual rate of 8.1 percent between 2012 and 2020 if the Affordable Care Act (ACA) reforms are implemented and at a rate of 6.6 percent if they are not. The U.S. Supreme Court upheld the ACA's Medicaid expansion provision but made it optional for the states.

The Center on Budget Policy and Priorities (CBPP) published an article which found that the Affordable Care Act's (ACA's) Medicaid expansion would "add very little to what states would have spent on Medicaid without health reform, while providing health coverage to 17 million more low-income adults and children." The paper reported that "contrary to claims made by some of the Medicaid expansion’s critics, the expansion does not impose substantial financial burdens on states," as the additional projected spending "equals 2.8 percent of what states would have spent on Medicaid in the absence of health reform."

In a new report, The Center on Budget and Policy Priorities takes on several studies by Milliman, Inc. commissioned by state officials critical of the health reform law. CBPP finds they "produce overstated estimates of the costs of the Medicaid expansion because they rely on a number of problematic assumptions."