Kansas spends more money on Medicaid with fewer enrollees, report says

Politics and cultural shifts could impact Medicaid spending and enrollment next year. Current trends show flattening enrollment rates and increased state spending, but the impacts of federal cuts are uncertain. (Getty Images)

TOPEKA — Medicaid spending is increasing in Kansas as enrollment declines, and the same trend appears across the country, according to a series of reports released Thursday.

KFF, a health policy research and news nonprofit group, attributed increases in spending on public health insurance programs to higher health care costs and greater needs. Dwindling enrollment, KFF said, is mostly because of states’ “unwinding,” or eliminating people’s Medicaid coverage following the end of pandemic-era continuous enrollment policies.

States face a “tenuous fiscal climate,” one report said.

Based on KFF’s annual budget survey of Medicaid directors across the country, officials forecast flattening enrollment but a continued increase in spending in fiscal year 2026, which began in July. KFF collaborated with consulting firm Health Management Associates and the National Association of Medicaid Directors for the annual survey.

“States are also preparing for $911 billion in federal Medicaid spending cuts enacted in the budget reconciliation law earlier this year, including new financing restrictions and work requirements, which will exacerbate existing budget challenges,” said a news release summarizing KFF’s findings. “The challenging fiscal climate and the magnitude of federal Medicaid cuts will make it difficult for states to absorb or offset the reductions.”

Responding states told KFF that spending increases were related to rate hikes, retained enrollees’ higher health care needs, rising behavioral health costs, inflation, higher long-term care enrollment and rising pharmacy costs, particularly because of high-cost specialty drugs such as weight-loss GLP-1 medication.

From March 2023 to July 2025, Medicaid enrollment in Kansas decreased by 20%. 

Kansas spent $5.7 million in state and federal funds on Medicaid in fiscal year 2025 for about 406,000 enrollees in public health insurance programs. More than $2 million of that total came from state funds. The total spending made up about 22.7% of state expenditures, according to state budget surveys.

In fiscal year 2023, the state contributed nearly $1.5 million in state funds to a total $4.8 million spent on Medicaid. Enrollment that year, when a federal mandate to implement continuous enrollment was still in effect, was more than 510,000.

KFF said state Medicaid spending across the country grew 12.2% in 2025, but it predicted a slowdown to 8.5% in 2026.

Nearly two-thirds of responding state Medicaid directors thought a budget shortfall was “50-50,” “likely,” or “almost certain,” the report said.