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Four Percent of Medicaid Recipients Account for 30 Percent of Its Spending Four Percent of Medicaid Recipients Account for 30 Percent of Its Spen...

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Four Percent of Medicaid Recipients Account for 30 Percent of Its Spending

Long-term care patients, mothers, and infants are among the program’s most expensive participants.


Hospital-related costs and long-term care facilities account for 65 percent of spending on high-expenditure Medicaid beneficiaries, a new report says.(Popova Valeriya/

Nearly one-third of state Medicaid spending went to only 4 percent of beneficiaries, a new report finds.

Those high-expenditure beneficiaries cost states the same as another 80 percent of beneficiaries, according to 2009 data—the most recent available—from the Government Accountability Office. In a report released Wednesday, the GAO found that states spent 31.6 percent of total funds on 4.3 percent of beneficiaries and 33.1 percent of total funds on 81.2 percent of beneficiaries.


Certain characteristics of beneficiaries could explain the astronomical costs of relatively few on the program. Those who reside in long-term care facilities, who have immunodeficiency viruses or disabilities, or are new mothers/infants were more likely to be high-expenditure beneficiaries, the report concluded.

Hospital-related services and long-term care services comprised roughly 65 percent of the costs of care for high-expenditure beneficiaries. But for all other beneficiaries, the GAO found that managed care organizations and premium assistance made up 57.2 percent of the costs.

Medicaid, a state-run health insurance program for low-income Americans, will be expanded in roughly half of states to encompass more of the nation's poorest workers due to the Affordable Care Act. The GAO's report is expected to inform congressional action around the program.



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