States Spent 31% of Medicaid Funds on 4% of Beneficiaries, GAO Says
In fiscal year 2009, states spent about 31.6% of their total Medicaid funding on 4.3% of "high-expenditure" beneficiaries with the highest costs, according to a Government Accountability Office report released Wednesday, McKnight's reports (Mullaney, McKnight's, 2/20).
States in the same year -- the most recent year for which such data were available -- spent about 33.1% of Medicaid funds for 81.2% of all other Medicaid beneficiaries, according to GAO researchers, National Journal reports (Ritger, National Journal, 2/19). Individuals eligible for Medicaid and Medicare accounted for the remaining 35.2% of total state Medicaid expenditures.
For the report, researchers analyzed data from Medicaid Statistical Information System and other federal health data. GAO analysts defined beneficiaries whose total Medicaid charges were within the top 5% of the state's total expenditures as "high-expenditure." GAO produced the report at the request of Sen. Charles Grassley (R-Iowa).
The report found that individuals most likely to be high-expenditure beneficiaries included:
- Residents of long-term care facilities, with a 24% chance of being in the high-expenditure group;
- Individuals with HIV/AIDS, with a 20.8% chance of being the group;
- Individuals with disabilities (McKnight's, 2/20); and
- New mothers with infants.
Long-term care services and hospital-related services accounted for about 65% of the high-expenditure group's health care costs. By comparison, managed care organizations and premium payment assistance comprised 57.2% of costs for all other Medicaid beneficiaries (National Journal, 2/19).
According to the report, states varied substantially on their per-capita spending for the high-expenditure group. States like Alaska and New York spent about $55,000 per high-expenditure beneficiary, while 16 other states spent less than $35,000 per capita (McKnight's, 2/20).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.