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 corridor
National Journal
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Clara Ritger
Feb. 19, 2014, 12:22 p.m.

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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