Expand chart
Adapted from KFF; Chart: Axios Visuals 

Medicaid spending is rising even though enrollment is flat, according to the Kaiser Family Foundation’s annual survey of state Medicaid directors.

Why it matters: This is unusual. Historically, enrollment is the key driver of overall Medicaid spending, and the two have tended to rise or fall roughly in tandem.

Why it’s happening: Enrollment is flat largely because the economy is doing well. Medicaid’s rolls generally swell during a recession; low unemployment keeps the program steady.

  • Spending growth is outpacing enrollment growth because of high prescription drug costs, Kaiser says, particularly drugs to treat hepatitis and HIV.
  • Many states have also bolstered their coverage for mental health and addiction treatment services, in light of the opioid crisis.

What's next: Enrollment is being pulled in both directions.

  • Red states’ embrace of work requirements will shrink their Medicaid programs.
  • But a combination of ballot initiatives and competitive governor’s races this year could bring more states into the Affordable Care Act’s Medicaid expansion, potentially causing an enrollment bump in 2019 or 2020.

Go deeper

Court allows North Carolina mail-in ballots deadline extension

An absentee ballot election worker stuffs ballot applications at the Mecklenburg County Board of Elections office in Charlotte, North Carolina, in September. Photo: Logan Cyrus/AFP via Getty Images

North Carolina can accept absentee ballots that are postmarked Nov. 3 on Election Day until Nov. 12, a federal appeals court decided Tuesday in a 12-3 majority ruling.

Why it matters: The 4th Circuit Court of Appeals' ruling against state and national Republican leaders settles a lawsuit brought by a group representing retirees, and it could see scores of additional votes counted in the key battleground state.

Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Politics: Americans feel Trump's sickness makes him harder to trustFlorida breaks record for in-person early voting — McConnell urges White House not to strike stimulus deal before election — Republican senators defend Fauci as Trump escalates attacks.
  2. Health: The next wave is gaining steam.
  3. Education: Schools haven't become hotspots — University of Michigan students ordered to shelter-in-place.
  4. World: Ireland moving back into lockdown — Argentina becomes 5th country to report 1 million infections.

Report: Goldman to settle DOJ probe into Malaysia's 1MDB for over $2B

Illustration: Lazaro Gamio/Axios

Goldman Sachs has agreed with the Department of Justice to pay over $2 billion for the bank's role in Malaysia's multi-billion dollar scandal at state fund 1MDB, Bloomberg first reported.

Why it matters: The settlement, expected to be announced within days, would allow Goldman Sachs to avoid a criminal conviction in the U.S. over the bribery and money laundering scandal that saw three of its former bankers banned for life from the banking industry by the Federal Reserve Board.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Subscription failed
Thank you for subscribing!