Report: 50% of Medicaid Spending Attributed to 5% of Beneficiaries
About 5% of Medicaid beneficiaries accounted for nearly 50% of the program's spending from 2009 to 2011, according to a Government Accountability Office report released Friday, The Hill reports (Sullivan, The Hill, 5/8).
For the report, GAO analyzed data from Medicaid's Statistical Information System Annual Person Summary File for fiscal years 2009 through 2011 (GAO report, May 2015). The report did not include data on dual eligibles, who qualify for both Medicaid and Medicare coverage and made up about 13% of the Medicaid population (Howell, Washington Times, 5/8).
The report found that the top 1% of the most-costly Medicaid patients accounted for about 25% of the program's costs during that time. According to the report, individuals with disabilities made up 63% of high-cost beneficiaries. In addition, the report found that of the high-cost beneficiaries:
- 52% had mental health conditions;
- 19% had substance use disorders; and
- 18% had diabetes (The Hill, 5/8).
In contrast, the report found that the least-costly 50% of Medicaid beneficiaries generated less than 8% of the program's spending from 2009 to 2011 (Washington Times, 5/8). The report also noted that 12% of Medicaid beneficiaries added nothing to the program's costs (The Hill, 5/8).
Total Spending Expected To Grow
Overall, the report found that Medicaid in FY 2013 had around 72 million beneficiaries and spent about $460 billion (Washington Times, 5/8).
The report predicted that total Medicaid costs will increase as more U.S. residents gain coverage through the Affordable Care Act's Medicaid expansion. The report suggested further study of enrollees who are driving the high expenditures to "enhance efforts to manage expenditures and facilitate improvements to care" (The Hill, 5/8).
Trend Not Isolated
According to The Hill, the trend is not exclusive to Medicaid. For example, HHS previously found that 5% of the total U.S. population accounted for 50% of total health care spending in the country in 2010 (The Hill, 5/8). The report noted, "Studies on health care spending generally find that a small percentage of individuals account for a large proportion of expenditures, and Medicaid ... is no exception" (Washington Times, 5/8).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.