Elasticity of Medicaid Access with Respect to State Financial Distress

In 2016, total Medicaid spending, $574.2 billion, represented one-third of state budgets. Descriptive studies indicate that state policymakers adjust social welfare programs during times of financial distress, particularly Medicaid. The challenge of formally estimating this effect is that macroeconomic shocks increase Medicaid enrollment and state-level financial stress. We use an exogenous measure of Medicaid generosity to estimate the elasticity of Medicaid generosity with respect to financial conditions. We find Medicaid generosity is not adjusted during periods of fiscal distress, whether anticipated or not. Instead, we find a counter-cyclical Medicaid effect with generosity increasing with increases in the unemployment rate.