The elderly and adults with disabilities account for roughly two-thirds of Medicaid spending even though they constitute a small fraction of total recipients. The following data present a snapshot of recent annual expenditure statistics, such as expenditures by service category and state. For FY 2011, national per enrollee spending was $5,790. Per enrollee spending growth between FY 2000 and FY 2011 also varies across eligibility groups. Thus we see that not only does spending per enrollee grow differently based upon the eligibility group, but within each eligibility group spending per enrollee grows differently across states, the level of spending in the base year is correlated with the rate of growth in the subsequent years, and the strength of this correlation varies across eligibility groups. Federal spending limits for each state based in part on past spending levels would lock-in variation in total or per enrollee spending based on state historical decisions about how to administer Medicaid. This 5.1 percent decrease in per-capita Medicare spend contrasts with 43 states that experienced an increase in per-capita Medicare spend over this period (2013-2019), with the national average . In this paper, we analyze the effect of two per capita cap approaches: that in the AHCA and that in Speaker of the House Paul Ryan's "Better Way" health care plan, released in June 2016. How much do state and local governments spend on public welfare? It is common for beneficiaries with a MH condition or a SUD to have at least one co-occurring physical health (PH) condition. Thus, if we consider spending as a share of the low-income population, state spending looks different. Share on Facebook. Newborns with NAS develop symptoms, such as tremors, irritability, fast breathing, and difficulty with feeding, within the first few hours or days of life. Per enrollee spending is higher among the aged and individuals with disabilities due to the higher use of complex acute services and long-term care ($17,522 and $18,518 respectively for FY 2011). Stan Dorn, Norton Francis, Laura Snyder, and Robin Rudowitz (2015), Assessing Fiscal Capacities of States: A Representative Revenue SystemRepresentative Expenditure System Approach, Fiscal Year 2012 This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. L. No. While not as dramatic, per enrollee spending growth rates also vary across groups. Average per enrollee spending across states also varies across eligibility groups. The SUPPORT Act also requires a description of the quality and completeness of the data used in the SUD Data Book. 2Direct general spending refers to all direct spending (or spending excluding transfers to other governments) except spending specially enumerated as utility, liquor store, employee-retirement, or insurance trust. The AHCA would reduce federal spending by $457 billion, or 9.8 percent. Figure 5: Growth in Medicaid spending varies widely across states. This claims-based algorithm can be used to identify Medicaid and CHIP infants with NAS. This is partly due to the . All dates in sections about expenditures reference the fiscal year unless explicitly stated otherwise. Following a 2012 Supreme Court decision, states were given the choice to either expand Medicaid coverage with new federal funding or retain pre-ACA eligibility levels. Media reports suggest that Senate Republicans will retain the per capita cap without major changes in their version of the House bill. Growth in Medicaid spending per enrollee from FY 2000 to FY 2011 was greater than GDP and Medical CPI in most states but lower than national health expenditures per capita and private health insurance spending per enrollee (Figure 4).2, Figure 4: Average annual spending varies by eligibility group, 2000-2011. In FY 2011, total national Medicaid spending per enrollee was $5,790. However, PDMP access is only the first step in addressing the opioid overdose epidemic. The tool offers enhanced flexibility for users over the static display of information in the SUD Data Book report. Under a per capita cap, states alone would bear those costs once they exceeded the cap amount. Historically, states have had significant flexibility to expand Medicaid beyond federal minimums for benefits and coverage and to determine how care is delivered and how much providers are paid. Understanding the complexity of variation in per enrollee spending and spending growth is critical in assessing the implications of federal policy changes, particularly those that would alter the underlying financing structure of the program. Matthew Buettgens (2018), Welfare Rules Databook: State TANF Policies as of July 2017 This is shown in Figures 6 through 9, where for each eligibility group, we plot the spending per enrollee in FY 2000 against the average annual growth rate from FY 2000 through FY 2011. States with relatively low spending per enrollee in FY 2000 had higher rates of spending growth than states with high spending per enrollee. However, there is some indication of convergence of per enrollee spending across states over time. The Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) are a research-optimized version of T-MSIS data and serve as a data source tailored to meet the broad research needs of the Medicaid and CHIP data user community. However, most state and local public welfare spending is financed by federal transfers. This was up from 55 percent in 1977. As such, while state and local governments spent $2,387 per capita nationally on public welfare in 2020, per capita spending ranged from $1,093 in Connecticut to $4,119 in New York. Because Medicaid spending typically grows faster than general inflation, indexing the per-capita limits to the CPI would lower long-term federal spending on the program by large and growing amounts. Medicaid spending (not including administrative costs) totaled $728 billion in federal fiscal year (FFY). In 2014, total Medicaid spending rose 8 percent, largely because of the Affordable Care Act's (ACA) expansion of eligibility to people with incomes up to 138 percent of the federal poverty level (about $16,000 for an individual). In other words, it tells us how well we can predict the average annual growth rate knowing just the spending per enrollee in FY 2000. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act was signed into law (Pub. Variation in states with managed care may also stem from the effect of partial year enrollment on yearly premium totals and fee-for-service spending for services not included in managed care contracts. States that have not accepted federal funds to expand Medicaid coverage generally spend relatively low amounts on overall public welfare expenditures. On the other hand, states in the top left quadrants represent the states with FY 2000 spending per enrollee that was below the national average but that grew faster than the national average annual growth rate. CMS has released a report to Congress that discusses state challenges and best practices implementing PDMP requirements under section 5042 of the SUPPORT Act. Beyond operational costs, most of the remaining 3 percent of public welfare spending went toward direct cash assistance to low-income beneficiaries for programs such as TANF, Supplemental Security Income, and the Federal Low Income Home Energy Assistance Program. In 2020, the highest share of local direct spending on public welfare was in California and New York (both 16 percent). What are key issues to watch? in the adult eligibility related to Medicaid expansion programs that may have an impact on the overall cost trends. For example, different states use different income eligibility limits for their Medicaid and Children's Health Insurance Programs, and states can additionally apply for waivers to alter the design of their programs. How does state spending differ from local spending and what does the federal government contribute? Proposals that limit federal Medicaid financing based on national growth targets such as GDP plus a percentage or CPI plus population growth would not account for the fact that spending growth varies significantly across states and eligibility groups. Lock To support policy making and program monitoring, CMS is developing research products using the TAF data in several key areas. The simplest calculation for per enrollee spending is total spending for services divided by total Medicaid enrollment (the number of Medicaid enrollees ever enrolled over the course of a. Just as there is wide variation across eligibility groups in per enrollee spending, there is also wide variation across the states in growth rates within each eligibility group (Figure 5). Information on Medicaid pharmacy policies and administration is provided in a separate data collection. Most Medicaid enrollees with disabilities in Kansas are not enrolled in comprehensive managed care, but even in states with high managed care enrollment, there is wide variation in per enrollee spending. State-level Medicaid per capita expenditureswere calculated for inclusion in the Medicaid and Childrens Health Insurance Program Scorecard. The negative number confirms that there is an inverse correlation between the two. Figure 2: Spending per full-benefit Medicaid enrollee, FY 2011. This bill will include both an itemization of all monthly State Contributions reflecting the retroactive per . The independent source for health policy research, polling, and news. The following estimates provide average annual Medicaid expenditures per enrollee for calendar years 2018 and 2019 by state for five eligibility groups: Medicaid Per Capita Expenditures | Medicaid Skip to main content In 37 states, local direct spending on public welfare accounted for less than 5 percent of total state and local public welfare spending, and in no state did local direct spending account for more than 20 percent. The federal government and states jointly fund and administer Medicaid and the Children's Health Insurance Program (CHIP). CMS released two sets of data tables containing enrollment and service use information for Medicaid and CHIP beneficiaries. State Administrative Accountability Federal Administrative Accountability The federal government and states jointly fund and administer Medicaid and the Children's Health Insurance Program (CHIP). As a result, in 2020, public welfare spending accounted for nearly half of state government direct expenditures (44 percent) but a small share of local government direct expenditures (3 percent). These files are based on analyses that use TAF data. Click on the topic below for additional products and resources. Medicaid Spending and Enrollment by Enrollment Group, Medicaid 12-Month Continuous Eligibility Policies, Trends in Medicaid Income Eligibility Limits, Trends in Income Eligibility Limits for Adults, Trends in Income Eligibility Limits for Children, Medicaid Eligibility for Seniors, People with Disabilities, and the Medically Needy, Streamlined Enrollment & Renewal Practices, Medicaid MCO State-Level Access Standards & Contract Requirements, Children's Health Insurance Program (CHIP), Delivery System Reform Incentive Payment Program (DSRIP), Long-Term Care: Home and Community Based Care, Institutional Care and Intensive Services, Outpatient Facility Services and/or Provider Services, The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Christine Heffernan, Ben Goehring, Ian Hecker, Linda Giannarelli, and Sarah Minton (2018), State TANF Policies: A Graphical Overview The table present the rates of NAS per 1,000 newborns whose delivery was covered by Medicaid or the Childrens Health Insurance Program (CHIP) in the year. CMS has released several information products that provide greater transparency on spending for drugs in the Medicare and Medicaid programs. This variation is multi-faceted and complex. The SUPPORT Act also authorizes the Centers for Medicare and & Medicaid Services (CMS) to match State investments in their PDMP at 100 percent for approved design, development, and implementation activities, for quarters during fiscal years 2019 and 2020. It was the second-largest expenditure from 1977 to 2014, behind only elementary and secondary education. The aged and individuals with disabilities use more complex acute care services as well as long-term care services. In these states, there may be limited variation in monthly premiums for the majority of enrollees in managed care, but there may be considerable variation among the remaining enrollees not enrolled in comprehensive managed care. A lock ( Medicaid pays for nearly half of all births in the United States. The Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) are a research-optimized version of T-MSIS data and serve as a data source tailored to meet the broad research needs of the Medicaid and CHIP data user community. CMS released the inaugural T-MSIS Substance Use Disorder (SUD) Data Book using preliminary 2017 TAF data on October 24, 2019, the 2018 SUD Data Book on January 19, 2021, the 2019 SUD Data Book on January 21, 2022, and the 2020 SUD Data Book on November 28, 2022. (For more information on spending growth see our state and local expenditures page.). Per capita spending, however, is an incomplete metric because it doesnt provide any information about a states demographics, policy decisions, administrative procedures, or residents choices. For example, average spending per disabled enrollee in Kansas is $17,153, but spending ranges from $765 for those in the first quartile to $126,727 for those in the top 5th percentile of spending. One of the changes under consideration is changing Medicaid financing to a per capita cap. The analysis also shows wide variation in average annual growth rates for per enrollee spending across states. CBO estimates that federal spending on the Medicaid expansion will be $1.45 trillion from 2024-2033 while spending on Obamacare premium subsidies, including the BHP, will be $1.05 trillion. Each SUD Data Book reports the number of Medicaid beneficiaries treated for a SUD and the services they received during the calendar year. Some proposals would place an overall cap on federal Medicaid spending or a limit on federal Medicaid spending per enrollee. In this paper, we analyze the effect of two per capita cap approaches: that in the AHCA and that in Speaker of the House Paul Ryans Better Way health care plan, released in June 2016. Distribution of Medicaid Spending by Service, Distribution of Fee-for-Service Medicaid Spending on Acute Care, Distribution of Fee-for-Service Medicaid Spending on Long Term Care, Federal and State Share of Medicaid Spending, Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier, Federal Medicaid Disproportionate Share Hospital (DSH) Allotments, Medicaid Spending per Enrollee (Full or Partial Benefit), Medicaid Spending Per Full-Benefit Enrollee, Full-Benefit Medicaid Enrollees by Enrollment Group, Total Monthly Medicaid & CHIP Enrollment and Pre-ACA Enrollment, Monthly Child Enrollment in Medicaid and CHIP, Status of State Adoption of 12-Months Postpartum Coverage in Medicaid, State Adoption of 12-Month Continuous Eligibility for Childrens Medicaid and CHIP, Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level, Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level, Medicaid/CHIP Coverage of Lawfully-Residing Immigrant Children and Pregnant Women, Medicaid and CHIP Income Eligibility Limits for Pregnant Women, 2003-2023, Medicaid Income Eligibility Limits for Parents, 2002-2023, Medicaid Income Eligibility Limits for Other Non-Disabled Adults, 2011-2023, Medicaid/CHIP Upper Income Eligibility Limits for Children, 2000-2023, Medicaid Income Eligibility Limits for Infants Ages 0 1, 2000-2023, Medicaid Income Eligibility Limits for Children Ages 1 5, 2000-2023, Medicaid Income Eligibility Limits for Children Ages 6 18, 2000-2023, Separate Childrens Health Insurance Program (CHIP) Income Eligibility Limits for Children, 2000-2023, Medicaid Eligibility through the Aged, Blind, Disabled Pathway, Medicaid Eligibility through the Medically Needy Pathway, Medicaid Eligibility through Buy-In Programs for Working People with Disabilities, Medicaid Eligibility for Long-Term Care Through the Special Income Rule, State Adoption of Major Optional Pathways to Full Medicaid Eligibility Based on Old Age or Disability, Integration of Medicaid and Non-Health Program Eligibility Systems, Modes of Submitting Medicaid Applications, Staff Responsible for Processing Applications and Renewals in Medicaid and CHIP, State Adoption of Selected ACA Medicaid Eligibility and Renewal Provisions for Aged/Disabled Population, Steps to Increase Ex Parte Renewals Rates in the Past Year, Actions to Align Non-MAGI with MAGI Renewal Policies, State Follow Up with Enrollees Who Have Not Responded to a Renewal Request, Premiums, Enrollment Fees, and Cost-Sharing Requirements for Children, Cost-Sharing Amounts for Selected Services for Children at Selected Income Levels, Cost-Sharing Amounts for Prescription Drugs for Children at Selected Income Levels, Cost-Sharing Requirements for Selected Medicaid Services for Section 1931 Parents, Premium and Cost-Sharing Requirements for Selected Services for Medicaid Adults, Medicaid Enrollment of Children Qualifying Through a Disability Pathway, Total SSI Beneficiaries as a Percent of Population, Average Monthly Payment for SSI Beneficiaries, Number of Dual-Eligible Individuals, Based on Medicaid Claims Data, Dual-Eligible Individuals as a Share of Medicaid Enrollment, Medicaid Spending Per Dual-Eligible Individual, Medicaid Spending For Dual-Eligible Individuals As A Share of Total Medicaid Spending, Share of Medicaid Population Covered under Different Delivery Systems, Medicaid Managed Care Penetration Rates by Eligibility Group, Medicaid MCO Enrollment by Plan and Parent Firm, 2020, Medicaid MCO Enrollment by Plan and Parent Firm, March 2022, Medicaid MCO Parent Firm Financial Information, Medicaid Managed Care Quality Initiatives, Performance Measure Focus Areas for Medicaid Managed Care Incentives, States Reporting Medicaid Managed Care Requirements for Alternative Provider Payment Models (APMs), States Reporting Social Determinant of Health Related Policies Required in Medicaid Managed Care Contracts, Medicaid Enrollment in Managed Care by Plan Type, Dual Eligible Enrollment in Medicaid Managed Care, by Plan Type, Limited Benefit Medicaid Managed Care Program Enrollment, Medicaid HCBS Spending, By Authority ($, in thousands), People Receiving Medicaid HCBS, by Authority, Medicaid Section 1915 (c) HCBS Waiver Spending, by Target Population, Medicaid Section 1915(c) HCBS Waiver Participants, by Type of Waiver, Medicaid HCBS Waiver Waiting List Enrollment, by Target Population and Whether States Screen for Eligibility, Medicaid HCBS Spending Per Person, By Authority, Average Provider Reimbursement Rates for Home Health and Personal Care State Plan Services, State Financial Eligibility Criteria for Medicaid HCBS Waivers by Target Population, Total Number of Children Ever Enrolled in CHIP Annually, Enhanced Federal Medical Assistance Percentage (FMAP) for CHIP, States Reporting Medicaid FFS Pharmacy Benefit Management Strategies for Opioids In Place, Medicaid Coverage of HIV Testing and PrEP, Delivery System Reform Incentive Payment Program (DSRIP) Waivers and Uncompensated Care Pools in Place, States Reporting At Least One Eligibility Expansion or Restriction, States Reporting At Least One Medicaid Benefit Expansion, States Reporting At Least One Medicaid Benefit Restriction, States Reporting Provider Rate Restrictions, States With At Least One Provider Tax in Place, States With a Hospital Provider Tax in Place, States With a Nursing Facility Provider Tax in Place, States With an Intermediate Care Facility for Those With Intellectual Disabilities (ICF-IDs) Provider Tax in Place, States that Reported Patient Centered Medical Homes In Place, States that Reported Accountable Care Organizations In Place, States that Reported Health Homes In Place, Medicaid Benefits: Inpatient Hospital Services, other than in an Institution for Mental Disease, Medicaid Benefits: Outpatient Hospital Services, Medicaid Benefits: Rural Health Clinic Services, Medicaid Benefits: Federally Qualified Health Center Services, Medicaid Benefits: Clinic Services (Excluding Mandatory FQHC and RHC Services), Medicaid Benefits: Freestanding Birth Center Services, Medicaid Benefits: Medical/Surgical Services of a Dentist, Medicaid Benefits: Nurse Midwife Services, Medicaid Benefits: Nurse Practitioner Services, Medicaid Benefits: Over-the-Counter Products, Medicaid Benefits: Tobacco Cessation Products (Other Than As Required For Pregnant Women), Medicaid Benefits: Physical Therapy Services, Medicaid Benefits: Occupational Therapy Services, Medicaid Benefits: Services for Speech, Hearing and Language Disorders, Medicaid Benefits: Prosthetic and Orthotic Devices, Medicaid Benefits: Eyeglasses and Other Visual Aids, Medicaid Benefits: Hearing Aids and Other Hearing Devices, Medicaid Benefits: Medical Equipment and Supplies (Other Than Through Home Health), Medicaid Benefits: Non-Emergency Medical Transportation Services, Medicaid Benefits: Laboratory and X-Ray Services, outside Hospital or Clinic, Medicaid Benefits: Family Planning Services, Medicaid Benefits: Diagnostic, Screening and Preventive Services, Medicaid Benefits: Rehabilitation Services Mental Health and Substance Use, Medicaid Benefits: Targeted Case Management, Medicaid Benefits: Other Medical or Remedial Care Hygienists or Dental Assistants, Medicaid Benefits: Other Medical or Remedial Care Physician Assistants, Medicaid Benefits: Home Health Services Nursing Services, Home Health Aides, and Medical Supplies/Equipment, Medicaid Benefits: Home Health Services Physical Therapy, Occupational Therapy, and/or Speech Pathology/Audiology, Medicaid Benefits: Private Duty Nursing Services, Medicaid Benefits: Personal Care Services, Medicaid Benefits: Self-Directed Personal Assistance Services, Medicaid Benefits: Program of All-Inclusive Care for the Elderly (PACE), Medicaid Benefits: Nursing Facility Services, Other Than in an Institution for Mental Disease, Age 21+, Medicaid Benefits: Services in Institutions for Mental Disease, Age 65 and Older, Medicaid Benefits: Intermediate Care Facility Services for Individuals with Intellectual Disabilities, Medicaid Behavioral Health Services: Inpatient Psychiatric Hospital, Medicaid Behavioral Health Services: 23-hour Observation, Medicaid Behavioral Health Services: Psychiatric Residential Treatment, Medicaid Behavioral Health Services: Adult Group Homes, Medicaid Behavioral Health Services: Case Management, Medicaid Behavioral Health Services: Day Treatment, Medicaid Behavioral Health Services: Partial Hospitalization, Medicaid Behavioral Health Services: Psychosocial Rehabilitation (e.g. Over the last several years, several proposals have been introduced that would alter the underlying financing structure of Medicaid. Matthew Buettgens and Urmi Ramchandani (2022), The Implications of Medicaid Expansion in the Remaining States States with high rates of Medicaid spending per capita, for example, tend to have shares of Medicaid enrollees who are elderly or disabled that are higher than the national average. Opens in a new window. In 2020, state and local governments spent $791 billion on public welfare, or 23 percent of direct general expenditures.2 As a share of direct general state and local spending, public welfare was the largest expenditure in 2020. We use the most recent available administrative data (FY 2011). Spending per aged enrollee ranges from a low of $10,518 in North Carolina to a high of $32,199 in Wyoming; from $10,142 in Alabama to $33,808 in the New York for disabled enrollees; from $2,056 in Iowa to $6,928 in New Mexico for adult enrollees and from $1,656 in Wisconsin to $5,214 in Vermont for children (Figure 3). The service use data tables include data from calendar years 2018 through 2021. In addition to variation across states, there was also considerable variation within states for each eligibility group, particularly for individuals with disabilities. A PDMP ensures that providers have access to information about current and previous opioid prescriptions and other controlled substances at the time of an encounter. The District of Columbias per capita spending was $6,367.3. 4For an analysis of components of state and local spending using 2012 data, see the Urban Institutes interactive tool, What everyone should know about their states budget. CMS applied this algorithm to the TAF and developed data tables for calendar years 2017 through 2020 that present: (1) the overall and state-specific rates of SMM in deliveries paid for by Medicaid and CHIP and (2) the overall rate of SMM conditions. CMS drafted several technical guidance documents to support TAF users, including overviews of the Annual Demographic and Eligibility (DE) File and all four claim types. Select an indicator below to view state data. An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Individuals, Home & Community Based Services Authorities, February 2023 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Transformed Medicaid Statistical Information System (T-MSIS), Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF), TAF Technical Guidance: Annual Demographic & Eligibility (DE) File, TAF Technical Documentation: Annual Managed Care Plan (APL) File, TAF Technical Documentation: Annual Provider (APR) File, TAF Technical Guidance: How to Use Illinois Claims Data, Analogs to MAX User Support Materials: A Quick Guide, Physical and Behavioral Health Integration, SUD Data Book DQ Brief # 4062 Medicaid Only Benchmarking in 2017, SUD Data Book DQ Brief # 4132 Completeness of the CHIP and Dual Code in 2017, SUD Data Book DQ Brief # 4142 Missing and Unexpected Values in the Eligibility Group Codes in 2017, SUD Data Book DQ Brief # 5042 Using the Type of Bill Variable in 2017, SUD Data Book DQ Brief # 5132 Missing and Invalid Diagnosis Codes in 2017, SUD Data Book DQ Brief # 5162 Volume of Encounter Claims Records from CMCs in 2017, SUD Data Book DQ Brief # 5192 Identifying Service Setting in 2017, SUD Data Book DQ Brief # 5202 Usability of Procedure Codes in 2017, State-level Medicaid per capita expenditures, Data and Methodology: T-MSIS-based State Per Capita Expenditures for the 2021 Medicaid and CHIP Scorecard, Rate of NAS (per 1,000 births) in newborns whose deliveries were covered by Medicaid or CHIP, by state, 2017 - 2019, State Challenges and Best Practices Implementing PDMP Requirements Under Section 5042 of the SUPPORT Act, Number of Pregnant and Postpartum Beneficiaries, by State, 2017 - 2020, Rate of NAS (per 1,000 births) in Newborns Whose Deliveries were Covered by Medicaid or CHIP, by State, 2017 - 2020, Number and Rate of SMM Among Medicaid- and CHIP-covered Deliveries, by State, 2017 - 2020, Beneficiaries who Could Benefit from Integrated Care, by Population, 2017 - 2020, Beneficiaries Receiving a Behavioral Health Service, by Behavioral Health Condition, 2017 2020, Beneficiaries Receiving a Physical Health Service Among Beneficiaries Receiving a Mental Health Service, by Physical Health Condition, 2017 - 2020, Beneficiaries Receiving a Physical Health Service Among Beneficiaries Receiving a SUD Service, by Physical Health Condition in 2017 - 2020, Program Information for Medicaid and CHIP Beneficiaries by Month, Program Information for Medicaid and CHIP Beneficiaries by Year, Benefit Package for Medicaid and CHIP Beneficiaries by Month, Benefit Package for Medicaid and CHIP Beneficiaries by Year, Dual Status Information for Medicaid and CHIP Beneficiaries by Month, Dual Status Information for Medicaid and CHIP Beneficiaries by Year, Major Eligibility Group Information for Medicaid and CHIP Beneficiaries by Month, Major Eligibility Group Information for Medicaid and CHIP Beneficiaries by Year, Managed Care Information for Medicaid and CHIP Beneficiaries by Month, Managed Care Information for Medicaid and CHIP Beneficiaries by Year, Acute Care Services Provided to the Medicaid and CHIP Population, Behavioral Health Services Provided to the Medicaid and CHIP Population, Blood Lead Screening Services Provided to Medicaid and CHIP Beneficiaries Ages 1-2, Health Screenings Provided to Medicaid and CHIP Beneficiaries Under Age 19, Respiratory Conditions in the Medicaid and CHIP Population, Contraceptive Care Services Provided to Medicaid and CHIP Beneficiaries Ages 15 to 44, COVID Testing and Testing-Related Services Provided to Medicaid and CHIP Beneficiaries, Dental Services Provided to Medicaid and CHIP Beneficiaries Under Age 19, Perinatal Care Services Provided to Medicaid and CHIP Beneficiaries Ages 15 to 44, Pregnancy Outcomes for Medicaid and CHIP Beneficiaries Ages 15 to 44, Telehealth Services Provided to the Medicaid and CHIP Population, Vaccinations Provided to the Medicaid and CHIP Population Under Age 19. For example, in 2011 Medicaid spent an average of $6,982 per beneficiary. ), State and Local Finance Data: Exploring the Census of Governments, What everyone should know about their states budget, 3 .7 Million People Would Gain Health Coverage in 2023 If the Remaining 12 States Were to Expand Medicaid Eligibility This analysis shows that there is considerable variation in Medicaid per enrollee spending across states, across groups of enrollees and even within groups of enrollees within a state. The simplest calculation for per enrollee spending is total spending for services divided by total Medicaid enrollment (the number of Medicaid enrollees ever enrolled over the course of a year). A .gov website belongs to an official government organization in the United States. The Medicaid and CHIP Payment and Access Commission is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children's Health Insurance Program (CHIP). The ResDAC website provides a centralized source of information on CMS datasets. In fact, 92 percent of direct spending on public welfare occurred at the state level in 2020. This same calculation can be applied for each eligibility group. We estimate that between 2019 and 2028, the Better Way proposal would reduce federal Medicaid . Published by Preeti Vankar , Oct 4, 2022. Personal health care (PHC) spending by type of good or service and by source of funding (private health insurance, Medicare, Medicaid, out-of-pocket, and all other payers and programs) is available for five age groups: 0-18, 19-44, 45-64, 65-84, and 85 and over and for males and females. By calculating the correlation coefficients between the spending per enrollee and average annual growth rates, we can see numerically what Figures 6 through 9 show us visually. However, when looking only at state and local funds (i.e., excluding federal transfers), spending on public welfare still trails spending on elementary and secondary education. The enrollment data tables include data from calendar years 2016 through 2020. This version of the per capita expenditures is a part of the Medicaid and CHIP Scorecard that was released in December 2021. Katherine Young , States together spent 17.1 cents of every state-generated dollar in fiscal year 2017 to provide Medicaid health care coverage to low-income Americansnearly 5 cents more than in fiscal 2000 and the largest amount since that year. Imposing one national growth rate across states would maintain baseline differences between states. States with high rates of Medicaid spending per capita, for example, tend to have shares of Medicaid enrollees who are elderly or disabled that are higher than the national average. California and New York are the top states with the highest Medicaid expenditures. Alternatives to try to set federal spending limits for each state based on national averages would result in large redistributions in funds that would have a limited relationship to past state Medicaid spending patterns. This was the largest spending growth of any major expenditure program over this period. We will update the text and map when both expenditure and low-income population data are published for 2021. This analysis is based on administrative data from FY 2011, so it does not capture the implementation of the major coverage provisions in the ACA. Census does not separate Medicaid spending into its own category. TAF RIF include annual files that contain demographic and eligibility information for all Medicaid and CHIP beneficiaries, claims files that contain service use and payment records, and annual files containing information on Medicaid and CHIP managed care plans and providers. . We can see that states with FY 2000 spending per enrollee above the unweighted national average that is to say, states to the right of the vertical orange line in Figures 6 through 9 tend to have grown more slowly over the following decade. U.S. states with the highest Medicaid expenditure 2021. Some of the highest levels of per capita health spending were observed in the Northeast and Mid- Atlantic regions, whereas some of the lowest levels were observed in the Southwest region. States are encouraged to report the cause of overdose death as specifically as possible (for example, prescription vs. illicit opioid). It includes topics such as enrollment, eligibility requirements, covered benefits, spending and federal matching amounts, managed care participation, home and community-based services, and Medicaid waivers. Despite the general lower cost for non-disabled adult and child enrollees, the variation in spending per child was wide in both Ohio and Tennessee as well. This statistic presents the total Medicaid spending in the United States in the federal fiscal year . DQ Atlas is an interactive, web-based tool that helps policymakers, analysts, researchers, and other stakeholders explore the quality and usability of the TAF. 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