State Medicaid policy decisions (including the ACA coverage extension, other eligibility standards, scope of benefits, payment rates, and delivery system models) impact Medicaid expenditure, as do other factors such as demography, health needs, health care markets, and state fiscal capacity. The federal government has considerable influence over state Medicaid policies. It provides 100% of the funds for new enrollees through 2014, but only 50% of existing program spending growth from 2010-2014. It also supplies funding to cover ongoing costs for current beneficiaries. However, it does not provide any funding for states that expand their Medicaid programs under the ACA. Instead, those funds must be obtained from other sources. States can choose to receive 100% federal financing for new enrollees or some percentage less than 100%. They can also opt out of covering certain groups such as childless adults or individuals with income above a certain level. Finally, they can adopt different eligibility requirements and benefit levels depending on what options are chosen. For example, a state that covers all newly eligible individuals would likely spend more money on them due to greater need. Such a state could reduce its expenditures by limiting coverage to only serious illnesses or medical conditions. Almost every State Department of Health and Human Services (DHSS) plan calls for reducing the federal share of Medicaid expenses over time in order to bring spending into line with the Medicare reimbursement rate for hospitals.