Nevada expects to spend more on Medicaid than planned

Many more Nevadans than expected have enrolled in Medicaid after Gov. Brian Sandoval opted to expand eligibility, meaning the state will be paying more than projected once the federal government scales back its support.

State officials say 181,051 people are now receiving benefits as a direct result of the Republican governor’s decision, which extends Medicaid eligibility to all non-disabled adults with incomes at or below 138 percent of the federal poverty level — currently $16,243 for an individual.

That’s well over the 144,340 new enrollees that state officials expected to have by this time when they were making the decision in 2012.

Nevada was among 30 states and the District of Columbia to expand Medicaid under the Affordable Care Act. The federal government agreed to pay all costs for the new enrollees through 2016, but it will begin lowering its share in 2017. States will pay 10 percent of the costs by 2020.

The overrun means Nevada expects to spend $22.6 million in state general funds for new Medicaid enrollees in fiscal year 2017, rather than the $8.5 million it projected.

More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years. Nevada is one of at least seven states now increasing cost estimates for 2017, according to an Associated Press analysis.

Supporters of the expansion downplay budget concerns, predicting their states will save money in the long run because Medicaid will allow some state-run services to be eliminated and will stimulate the economy through new revenues and job creation.

While many of his fellow Republican governors have resisted expanding Medicaid, Sandoval has stood by his decision to widen eligibility. His chief of staff, Mike Willden, points to a dramatic drop in the number of uninsured Nevadans and said the higher-than-expected cost to the state general fund is a small price to pay for the major influx in federal funds the expansion has yielded.

The state paid about $522 million in general funds for newly enrolled and existing Medicaid recipients in fiscal year 2014, while it received a match of about $1.4 billion in federal funds that year. With more than 180,000 newly eligible recipients recently signed up, the state expects to pay $531 million in general funds for Medicaid this fiscal year, while receiving a federal match of $2.4 billion.