Sample Medicaid Mandates

A full compilation of specific mandate examples would take pages of print and explanation. Below is a substantial but partial listing secured by the author from the General Accounting Office, categorized by the particular legislation which created them:

Omnibus Reconciliation Act of 1980

  • Required Medicaid coverage of services furnished by licensed nurse-midwives

Omnibus Budget Reconciliation Act of 1981

  • Required that states with medically needy programs provide, at a minimum, ambulatory services to children and prenatal and delivery services to pregnant women

  • Imposed sanctions on states related to Medicaid error rates. States affected had federal financial participation rates reduced by 3 percent for FY82, 4 percent for FY83 and 4.5 percent for FY84

Deficit Reduction Act of 1984

  • Requires coverage of all children born after 9/30/83 meeting state AFDC income and resource standards, regardless of family structure

  • Requires coverage from date of medical verification of pregnancy, providing 1) the woman would qualify for AFDC once child was born, or 2) they would qualify for AFDC-UP once child was born, regardless of whether state has AFDC-UP program

  • Requires automatic coverage for one year after birth if mother already is receiving Medicaid and remains eligible, and infant resides with her

  • Mandates limited extension of Medicaid coverage if AFDC eligibility is lost due to earnings

Consolidated Omnibus Budget Reconciliation Act of 1986

  • Requires coverage if family income and resources are below state AFDC levels, regardless of family structure

  • Requires 60-day extension of coverage postpartum if eligibility was pregnancy-related

  • Requires coverage even if adoption/foster agreement was entered into in another state

  • Requires coverage regardless of income/resources of adoptive/foster parents

Omnibus Budget Reconciliation Act of 1986

  • Requires continuation of eligibility (for those who otherwise would become ineligible) if they are hospital inpatients when age limit is reached

  • Establishes new mandatory categorically needy coverage group for qualified individuals under age 65

  • Requires provision of emergency services if otherwise eligible (financially and categorically)

Immigration Reform and Control Act of 1986

  • Requires provision of emergency and pregnancy-related services for newly legalized aliens and requires full coverage for eligibles under age 18

Anti-Drug Abuse Act of 1986

  • Requires state to provide proof of eligibility for homeless individuals otherwise eligible but having no permanent address

Omnibus Budget Reconciliation Act of 1987

  • Requires states to establish preadmission screening programs for mentally ill and retarded

Family Support Act of 1988

  • Increases required period of Medicaid coverage if AFDC cash assistance is lost due to earnings

Omnibus Budget Reconciliation Act of 1989

  • Requires coverage if income is below 133 percent of poverty line

  • Requires interperiodic screenings when medical problem is suspected

Omnibus Budget Reconciliation Act of 1990

  • Requires states to receive and process applications at convenient outreach sites for pregnant women and children

The external mandates imposed on Michigan force state legislators to make tough choices among extremely important programs – ensuring the availability of health care for pregnant women, providing food for infants and children in low-income families, improving education – and for funding the programs for which the states are wholly responsible. Consider the fiscal impact on Michigan as the federal government foists its Medicaid mandates on state taxpayers:

  • The Omnibus Budget Reconciliation Act of 1987, the 1989 Health and Human Services requirements and other Medicaid mandates cost Michigan $40 million in fiscal year 1990 alone, and that figure is expected to rise to .$137 million by Fiscal Year 1995.

  • As the reader can see from the list below, the total GF/GP costs of Medicaid mandates for 1993 will exceed the combined expenses of live state departments.

Civil Rights

$11.0 Million

Civil Service

$11 .0 Million


$14.7 Million

Attorney General

$24.7 Million


$26.6 Million


$88.0 Million

Even when aggregated, these departments have a combined budget $7.3 million less than that of the $95.3 million GF/GP total that will be needed to meet the requirements of mandated legislation in just the Medicaid arena. Individually, the Military, Labor, Education, Management and Budget, Treasury, and Commerce departments are operating on Fiscal Year 1993 budgets ranging from only $28 to $61.6 million – considerably less than the aforementioned $95.3 million needed to cover the costs of federally mandated Medicaid legislation.

  • The State of Michigan, in effect, will have to devote 30 percent of its growth in General Fund/General Purpose revenue for 1993 to pay the cost of Medicaid mandates alone.

  • Medicaid mandates consumed 3.2 percent of 1990 Medicaid General Fund/General Purpose (GF/GP) expenditures and are expected to increase to 6.4 percent of the Medicaid GF/GP base by fiscal year 1993 before continuing in their seemingly unending ascent.

  • Federal Medicaid mandate costs increased from .5 percent of the total General Fund budget in Fiscal Year 1990 to 1.2 percent in Fiscal Year 1993.

  • Federal Medicaid mandates will grow at an annual rate of 49.1 percent through Fiscal Year 1995. When juxtaposed against the historical growth rate of the entire state general fund budget of 5.5 percent (1981-1990), and anticipated Fiscal Year 1993-1994 growth of 4.5-5.0 percent, it is easy to see why many legislators are growing alarmed with the situation.

Unfortunately, mandates pervade all aspects of state government. The effects of these mandates on the functions of government include, but are not limited to, the overlapping of regulation, duplication of services and the increased burden o( their implementation, the need to shift important resources from one priority to another and the huge increase in the amount of paperwork, red tape, the administrative- procedural -regulatory burden, and all of the additional costs associated with compliance.