A cross-state analysis finds that recent increases in MaineCare enrollment and spending reflect broader changes happening in Medicaid programs nationwide.
Like Medicaid programs across the country, MaineCare enrollment and program costs have increased in recent years. To understand how these trends compare to other states, the Maine Department of Health and Human Services conducted an analysis that examined national changes in costs and enrollment in states' Medicaid and Children's Health Insurance Programs, (referred to collectively as "Medicaid" in this analysis), between federal fiscal years 2018 through 2024.
In addition to national trends, the Department also focused on nine states, including Maine, that recently expanded Medicaid coverage to low-income adults under the Affordable Care Act (ACA).
The analysis highlights several key findings about Medicaid cost and enrollment trends nationally and among recent expansion states:
- Medicaid program costs increased in every state between 2018 and 2024.
- National Medicaid costs grew by more than 50 percent during this period.
- Nearly one-quarter of states experienced higher cost growth than Maine.
- Among the eight other states that recently expanded Medicaid under the ACA, seven experienced faster cost growth than Maine.
MaineCare spending growth lags other recent expansion states despite higher enrollment growth
Since 2018, enrollment growth among recent ACA expansion states has outpaced national Medicaid growth, reflecting both coverage expansions and pandemic-era provisions. From 2023 to 2024, national Medicaid enrollment fell by over 10 percent as many states ended these provisions; however, total Medicaid costs rose by over six percent during this time.
This disconnect at the national level likely reflects several factors that are also occurring in Maine, including:
- The disenrollment of relatively low-cost members
- Increased health care utilization since the pandemic
- The implementation of provider payment rate increases
Medicaid cost growth has been particularly pronounced among recent expansion states, increasing by 95 percent from 2018 to 2024. By comparison, MaineCare costs grew by 67 percent over the same period despite higher enrollment growth. Even when including an additional year of MaineCare program costs through 2025, MaineCare cost growth remains below the growth observed across recent expansion states through 2024.
Medicaid cost growth occurred nationwide from 2018 to 2024; 12 states experienced higher Medicaid cost growth than Maine
From 2018 to 2024, total Medicaid program costs increased across all states. Medicaid cost growth tended to be higher among recent expansion states, which included six of the ten states with the highest growth during this period.
Overall, 12 states, including seven of the eight other recent ACA expansion states, experienced higher Medicaid cost growth than Maine between 2018 and 2024.
When measured in absolute dollars instead of percentage growth, 34 states experienced larger Medicaid cost increases from 2018 to 2024, placing Maine in roughly the bottom third of states.
This analysis places MaineCare cost and enrollment trends within a broader national context. While MaineCare enrollment and program costs have grown in recent years, these changes reflect patterns seen across Medicaid programs nationwide. Looking at trends across states provides important perspective as policymakers and key stakeholders continue evaluating how Medicaid programs are evolving and how best to support access to care for those who rely on them.