History:
This chart gives a quick picture of what happened over a 20 year period from 1986 through the fiscal year 2006-2007 and it shows that in 1986 Medicaid was 8.6% of our general fund expenditures in the State of Nebraska.

Today, it’s almost 18% of our general fund expenditures in the State of Nebraska.

So over a 20-year period where the average growth of our our general fund revenues was 6.9%, Medicaid grew at almost 11%.

Projections:
This chart shows that if Medicaid continues growing at the same rate that it did for the last 20 years and if our general tax receipts grow at that same rate, the spending on only two state programs---state aid to education and Medicaid will overtake all of the growth in our state revenues.

State aid to education and Medicaid are the two largest spending programs in the State of Nebraska.  Those two programs alone would eat up all of the growth in our state revenues.

This graph assumes that they would grow over the next 20 years the way they grew over the last 20 years.  By the 2025 those two programs would take up 95% of our state revenues.

Historical General Fund Appropriations

General Fund Growth vs TEEOSA/Medicaid Growth

Projected Use of General Fund Receipts

NE Medicaid Expenditures & Eligibility changes from SFY04 to SFY05

NE Medicaid Expenditures by Fund

NE Medicaid Expenditures by Fund Type including Budget Programs 344 & 348

An A-typical Year:
This is a summary chart of what has happened in the last year from 2004 to 2005, the changes that have occurred in our Medicaid program in Nebraska.  While this is an a-typical year, expenditures (total federal and state dollars spending) went up about $80 million, a little over 6%.  Our general fund dollars, however, your tax dollars, went up almost 20%.

It also shows the change in the number of eligibles.  There was a little less than 1% change in the number of people on Medicaid.  This is pretty stable at this particular point in time but if you notice the individual eligibility groups, the largest growth was with the disabled which is the most expensive population we have in our Medicaid program right now.   The number of persons on Medicaid over the age of 65 was essentially stable.

Funding Sources:
This chart shows how the program is being paid for including three separate sources of funding.   The lowest level is the general funds from the Medicaid and the Children’s Health Insurance Programs.  That’s what most people think of as Medicaid.

There’s a smaller segment in the middle, which is the money that comes from other budget programs.  This segment represents intentional decisions made by the State Legislature to take money that Nebraska is spending for people’s health care (100% state dollars) and get a federal match for it.   That’s money that is being used for the developmentally disabled and the mentally ill.  Those were intentional decision to leverage that federal money. The blue portion at the top is the federal share.

The numbers across the bottom show the effective federal share of Medicaid over this period of time. In fiscal year 2004 it was actually at about 65%, not the 60% that we use as a general rule of thumb. Congress passed a special federal match requirement that was in place for about 15 months while all of the states were in fiscal crisis, therefore Nebraska received those monies in part of 2003 and all of 2004 and then it ended.   The federal share dropped from 65% to 61% in the state of Nebraska in one year.  That’s why our general fund jumped nearly 20% in that one year.

Documents in PDF format require the use of Adobe Acrobat Reader which can be dowloaded for free from Adobe Systems, Inc.