In part, Kaiser said, the growth will be fueled by an improving economy. More important, however, are factors such as the PPACA, which will affect Medicaid even in states that don't offer the expanded version. Here are some of the significant conclusions of the study:

• Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013.  In FY 2014, national enrollment and spending growth are expected to rise again thanks to the economic recovery.
• States moving forward with the Medicaid expansion are expected to see higher enrollment — and average of 12 percent per state—and total spending growth of about 13 percent, driven by increases in coverage and federal funds.
• The 26 states they said "no" to the expansion anticipate a 5.3 percent Medicaid enrollment increase and a 6.8 percent spending increase. This will be partly driven by the ACA because the Act will motivate more people who are currently eligible for Medicaid to enroll.
• The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states whether they are implementing the ACA Medicaid expansion or not.
• Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs and better balance the delivery of long-term services and supports across institutional and community-based settings.
• Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity.