Medicaid per enrollee spending: variation across states
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (Henry J. Kaiser Family Foundation)
- Author(s):
- Young, Katherine, author Rudowitz, Robin, author Rouhani, Saman, author Garfield, Rachel, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Menlo Park, CA : Henry J. Kaiser Family Foundation, January 2015
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Expenditures -- statistics & numerical data Health Expenditures -- trends Medicaid -- economics Medicaid -- statistics & numerical data Medicaid -- trends United States
- Genre(s):
- Technical Report
- Abstract:
- Medicaid, the nation's public health insurance program for low-income people, provided health and long-term care services for over 68 million Americans in FY 2011 including many children, working families, low-income elderly, and individuals with disabilities. Historically, states have had significant flexibility to expand Medicaid beyond federal minimums for benefits and coverage and to determine how care is delivered and how much providers are paid. These policy choices--as well as other factors such as a state's ability to raise revenue, the need for public services, the health care markets in which Medicaid operates, and each state's policy process--all lead to state variation in Medicaid. This brief examines variation in Medicaid spending per enrollee across eligibility groups, across states, and over time, and discusses implications for program policy and financing. We use the most recent available administrative data (FY 2011). Key findings include the following: (1) In FY 2011, total national Medicaid spending per enrollee was $5,790. When excluding "partial-benefit enrollees," national spending per enrollee was $6,502. In general, states in the south tend to have lower spending per enrollee, while states in the northeast have higher spending per enrollee. (2) Per enrollee spending is higher among the aged and individuals with disabilities due to the higher use of complex acute services and long-term care ($17,522 and $18,518 respectively for FY 2011). Average spending per Medicaid enrollee was less for adults and children ($4,141 and $2,492 respectively). For each eligibility group, there is considerable variation across states in per enrollee spending. (3) In addition to variation across states, there was also considerable variation within states for each eligibility group, particularly for individuals with disabilities. For example, in Kansas average spending for individuals with disabilities was $17,153 (close to the national average) but ranged from $765 for those in the first quartile to $126,727 for those in the top 5th percentile. (4) Per enrollee spending growth between FY 2000 and FY 2011 also varies across eligibility groups. Spending growth for the aged excluding prescription drug spending grew more slowly than spending for adults, children, and individuals with disabilities. States with relatively low spending per enrollee in FY 2000 had higher rates of spending growth than states with high spending per enrollee. (5) From FY 2000 to FY 2011, growth in Medicaid spending per enrollee was greater than growth in GDP or Medical CPI in most states but lower than the growth of national health expenditures per capita and private health insurance per enrollee in the same time period. Understanding the complexity of variation in per enrollee spending and spending growth is critical in assessing the implications of federal policy changes, particularly those that would alter the underlying financing structure of Medicaid. This analysis shows that changes in Medicaid financing would have dramatically different effects across states. Specifically, if federal spending limits for each state were based on past spending levels, variation in total or per enrollee spending would be "locked-in"; if federal spending limits for each state were based on national averages there would be large redistributions in funds across states. Proposals that limit federal Medicaid financing based on national growth targets such as GDP plus a percentage or CPI plus population growth would not account for the fact that spending growth varies significantly across states and eligibility groups. Another important factor for consideration is that changes in Medicaid enrollment and state choices since the implementation of the ACA have likely led to even greater variation than that highlighted in this report.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (12 pages, 1 unnumbered page))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101670589 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101670589