In the FY 2017-18 Colorado Comprehensive Annual Financial Report (CAFR), the State Controller’s Office reports that state expenditures fell “due to decreases in the social assistance function resulting from less spending on purchased medical services.” In other words, lower Medicaid enrollment means less state spending.
Though total state expenditures grew in most other categories, the Medicaid spending decline was the biggest contributor to the total spending reduction of $1.1 billion, or 4.3 percent.
For most Colorado Medicaid patients, the state makes a per-member-per month payment even if a Medicaid enrollee uses no health care at all. Most hospitals get additional payments based on the number of Medicaid patients they treat. If there are fewer Medicaid clients, all of the providers receiving per-member-per-month payments lose money. They all have an incentive to support Medicaid program expansion in good times and in bad.