A Take a look at Variation in Medicaid Spending Per Enrollee by Group and Throughout States

Over the approaching years, state Medicaid packages may even see vital reductions to their Medicaid enrollment and spending, leading to adjustments to their spending per enrollee, throughout eligibility teams because of the lately enacted budget reconciliation package deal as soon as known as the “One Huge, Lovely Invoice,” signed by President Trump on July 4^th. The brand new legislation is estimated by the Congressional Funds Workplace (CBO) to chop federal Medicaid spending by $911 billion – or 14% of federal Medicaid spending – over the following ten years and increase the uninsured price by 10 million, with a few of the improve attributed to people shedding Medicaid protection. Provisions within the new legislation may have totally different results on Medicaid spending and enrollment throughout the states. For instance, over half of the reductions in federal spending (related to many of the projected enrollment declines) stem from insurance policies that solely would have an effect on states which have expanded Medicaid beneath the Inexpensive Care Act (ACA). How states reply to reductions in federal funding will impression the quantity of spending reductions and the distribution of enrollment losses, which is able to have an effect on Medicaid’s spending per enrollee. 

This information be aware supplies an outline of complete Medicaid (state and federal shares) spending per enrollee for full-benefit Medicaid enrollees by eligibility group and state in 2023. Information from 2023 are probably the most present Medicaid information accessible on the time of this evaluation. Full-benefit Medicaid enrollees are people who qualify for a full vary of Medicaid providers comparable to physician’s visits, hospitalizations, prescribed drugs, and residential well being providers. A small variety of complete enrollees (8% of all enrollees in 2023) qualify for under a restricted set of Medicaid advantages comparable to household planning or remedy of an emergency medical situation and will not be included on this evaluation. References to Medicaid enrollees on this information be aware confer with full-benefit enrollees. See strategies for extra particulars. Detailed state-level data are additionally accessible on State Well being Information.

Nationwide Medicaid spending per enrollee is $7,909, although that varies extensively by eligibility group (Determine 1). 

General, youngsters account for 35% of full-benefit enrollment, however 15% of the spending, whereas adults ages 65 and older and folks eligible due to a incapacity account for 19% of enrollment however 51% of the spending (information not proven). The disproportionate spending on sure eligibility teams stems from variation in spending per enrollee throughout the eligibility teams. Spending per enrollee is highest for individuals with disabilities ($20,950), and older adults ($20,194) (Determine 1). These teams have per-enrollee spending roughly six occasions greater than baby enrollees ($3,321), which have the bottom spending of any eligibility group (Determine 1). Variations in spending per enrollee mirror variations in well being care wants and utilization. For instance, older adults and folks eligible on the premise of incapacity are likely to have higher rates of chronic conditions, more complex health care needs and usually tend to utilize long-term care (LTC) than different enrollees. Most older adults and folks with disabilities enrolled in Medicaid are additionally dually eligible for Medicare. For dual-eligible people, Medicare is the first payer for acute care providers whereas Medicaid pays for providers that Medicare doesn’t, together with imaginative and prescient, dental, and most LTC. Medicaid spending per enrollee accounts for less than half of all spending for full-benefit dual-eligible people which can be 65 and older.

Flexibility for states to find out eligibility ranges, advantages, and supplier funds within the Medicaid program results in extensive variation in per-enrollee spending throughout states (Determine 2).

Different components contributing to variation in per-enrollee spending embrace variation in state populations and demographics, means and energy to boost income, and variation in well being care prices and markets. Throughout states, Medicaid spending per enrollee ranges from $4,780 to $12,295, with a median spending of $7,909 (Determine 2). Alabama, Florida, Georgia, and Nevada report a few of the lowest spending per enrollee, whereas Washington, D.C., Minnesota, Pennsylvania, and North Dakota report the very best spending per enrollee. Roughly one in seven states have spending higher than $10,000 per enrollee (Determine 2).

Inside every eligibility group, there’s additionally appreciable variation in spending per enrollee throughout states (Determine 3).

Folks with disabilities have the widest variation throughout states for per-enrollee spending, starting from $5,040 in Florida to $57,900 in Minnesota (Determine 3). States have appreciable flexibility to resolve the populations and services covered for long-term care (LTC), which drives giant variation in per-enrollee spending for older adults and folks with disabilities, who’re extra seemingly to make use of LTC. In distinction, per-enrollee spending for youngsters ranges from $2,227 in Alabama to $5,457 in Alaska (Determine 3). All states should present complete protection for youngsters by the Early Periodic Screening Analysis and Remedy (EPSDT), which contributes to considerably much less variation in per-enrollee spending for youngsters.

Many—however not all—states which have comparatively excessive or low total per-enrollee spending are likely to see those self same patterns throughout eligibility teams within the state (Determine 3). Some states with the bottom total per-enrollee spending (e.g. Alabama, Oklahoma) fall among the many states with the bottom per-enrollee spending for many eligibility teams (Determine 3). Others, comparable to Florida and Nevada are extra blended throughout eligibility teams. For instance, Florida, has low per-enrollee spending throughout all eligibility teams besides for youngsters, the place it has one of many highest per-enrollee spending. Equally, some states with the very best total per-enrollee spending (e.g. Washington, D.C., Delaware) fall among the many states with the very best per-enrollee spending for all eligibility teams. Nonetheless, states like Pennsylvania and Massachusetts are much less persistently excessive throughout all eligibility teams (Determine 3).

Even inside a given state and eligibility group, there’s extensive variation in spending (Desk 1). For instance, amongst individuals with disabilities in Virginia, 25% have spending lower than $12,506 and 5% have spending greater than $130,130 – ten occasions greater (Desk 1). Moreover, 25% of seniors in Colorado have spending lower than $1,817, and 25% have spending sixteen occasions higher ($29,406) (Desk 1). Regardless of the commonly decrease prices for non-disabled grownup and baby enrollees, the variation in spending for these eligibility teams is extensive in Ohio, Vermont, and Idaho as properly.

Per-enrollee spending in states that expanded Medicaid is greater for all eligibility teams than in non-expansion states (Determine 4).

Growth states spend on common $8,444 per enrollee – almost $1,000 extra per enrollee when in comparison with non-expansion states, which spend $7,591 per enrollee (Determine 4). Throughout debate over the reconciliation invoice, some argued that the 90% match price for enlargement adults encourages enlargement states to prioritize providers for enlargement adults of these of different populations—youngsters, mother and father, individuals with disabilities, and older adults. Nonetheless, throughout all non-expansion eligibility teams, common per-enrollee spending is greater in enlargement states than in non-expansion states. As an example, enlargement states have a median spending of $29,259 per enrollee eligible based mostly on incapacity, whereas non-expansion states spend on common $19,289 per enrollee in the identical eligibility group. Equally, enlargement states spend $22,350 per older grownup enrollee in comparison with $18,288 for non-expansion states (Determine 4). These variations in spending might mirror state coverage decisions about advantages and eligibility, along with fee charges, regional variation in well being care prices, and state demographics.