An overview of the variation in medical expenses by registration per group and between states

In the coming years, state medicaid programs may see significant reductions in their registration and their medical expenses, resulting in changes in registration, through eligibility groups due to the recently promulgated budget reconciliation package, once called “a large magnificent bill”, signed by President Trump on July 4 on July 4.^th. The new law is estimated by the Congressal Budget Office (CBO) to reduce Federal Medicaid expenses by $ 911 billion – or 14% of Federal Medicaid – in the next ten years and increase the uninsured rate of 10 million, part of the increase attributed to persons losing the coverage of Medicaid. The provisions of the new law will have different effects on the expenses and inscriptions of Medicaid through the States. For example, more than half of the federal expenses reductions (associated with most of the registration decreases projected) arise from policies that would only increase the states that have widened Medicaid under the Acto Abroad (ACA). The way states react to the reductions in federal funding will have an impact on the amount of expenses for spending and the distribution of registration losses, which will affect Medicaid expenses by registration.

This data note provides an overview of total medical expenses (State and federal) by registration for registered with integral medicaid by eligibility group and state in 2023. The 2023 data is the most recent data for Medicaid available at the time of this analysis. Registered in Complete Medicaid are those that are eligible for a full range of Medicaid services such as visits to the doctor, hospitalizations, prescription drugs and home health services. A small number of total registrants (8% of all registered in 2023) are only qualified for a limited set of medication services such as family planning or the treatment of an emergency medical condition and are not included in this analysis. References to Medicaid registrants in this data note refer to complete registrants. See the methods for more details. Detailed data at the state level is also available on the facts of state health.

The national medical expenses by registration are $ 7,909, although this varies considerably depending on the eligibility group (Figure 1).

Overall, children represent 35% of complete registrations, but 15% of expenses, while adults aged 65 and over and eligible people due to a handicap represents 19% of registrations but 51% of expenditure (data not presented). Disproportionate expenses for certain eligibility groups arise from the variation in expenses by registration in eligibility groups. Registration expenses are the highest for people with disabilities ($ 20,950) and the elderly ($ 20,194) (Figure 1). These groups have spending around six times higher than children’s registrants ($ 3,321), which have the lowest expenses of all eligibility groups (Figure 1). Differences in registration expenses reflect differences in needs and use of health care. For example, the elderly and eligible people on the basis of disability tend to have higher rates of chronic conditions, more complex health care needs and are more likely to use long -term care (SLC) than other registered. Most elderly people and disabled people registered in Medicaid are also doubly eligible for health insurance. For individuals with an eligible double, Medicare is the main payer of active care services while Medicaid pays for services that Medicare does not, including vision, dental and most LT. Medicaid expenditure per inscriptions represent less than half of all spending on individuals with double service with two proofs of 65 years and over.

Flexibility for states to determine the levels of eligibility, benefits and payments of providers in the Medicaid program leads to a great variation in inter -growing expenditure between states (Figure 2).

Other factors contributing to the variation of spending by-enrolled include the variation of state populations and demographic data, capacities and efforts to increase income and variation in health care costs and markets. In all states, medical expenses per registration vary from $ 4,780 to $ 12,295, with a median expenditure of $ 7,909 (Figure 2). Alabama, Florida, Georgia and Nevada report some of the weakest expenses per registration, while Washington, DC, Minnesota, Pennsylvania and Dakota from the North report the highest expenses by registration. About one in seven states spent more than $ 10,000 per registration (Figure 2).

In each eligibility group, there is also a considerable variation of expenses by registration between states (Figure 3).

Persons with disabilities have the widest variation between states for school expenses, ranging from $ 5,040 to Florida to $ 57,900 in Minnesota (Figure 3). States have considerable flexibility to decide on populations and services covered for long-term care (LTC), which leads to a wide variation in expenditure for the elderly and disabled people, who are more likely to use LTC. On the other hand, expenses per entry for children vary from $ 2,227 to Alabama to $ 5,457 in Alaska (Figure 3). All states must provide complete coverage for children through early periodic diagnosis and treatment of screening (EPSDT), which contributes to a slightly less variation of spending for children.

Many, but not all – States that have overall expenses compared to the relatively high or weak whole tend to see these same diagrams between the eligibility groups in the state (Figure 3). Certain states with the overall overall spending by the lowest (for example in Alabama, Oklahoma) fall among the states with the lowest spent spent for the most part of the eligibility groups (Figure 3). Others, such as Florida and Nevada, are more mixed with all eligibility groups. For example, Florida, has low spending in the work in all eligibility groups, with the exception of children, where it has one of the highest expenses by-enrollee. Similarly, some states with the highest overall overall expenses (for example Washington, DC, Delaware) fall among states with the highest spending for all eligibility groups. However, states like Pennsylvania and Massachusetts are less regularly high in all eligibility groups (Figure 3).

Even in a given state of state and eligibility, there is a great variation in expenses (Table 1). For example, among people with disabilities in Virginia, 25% spent less than $ 12,506 and 5% spent more than $ 130,130 – ten times higher (Table 1). In addition, 25% of the elderly in Colorado spent less than $ 1,817 and 25% have sixteen times higher ($ 29,406) (Table 1). Despite the costs generally lower than adult inscriptions and unabled children, the variation in expenditure of these eligibility groups is also wide in Ohio, Vermont and Idaho.

Interim expenses in the states that have expanded Medicaid are higher for all eligibility groups than in non -expansion states (Figure 4).

The expansion states spend an average of $ 8,444 per inscriber – almost $ 1,000 more per registration compared to the non -expansion states, which spend $ 7,591 per inscriber (Figure 4). During the debate on the reconciliation bill, some argued that the correspondence rate of 90% for expansion adults encourages expansion states to prioritize services for adults of expansion of those of other populations – children, parents, disabled and older adults. However, in all non -expanding eligibility groups, average expenses per influence are higher in states of expansion than in non -expansion states. For example, states of expansion have an average expenditure of $ 29,259 per registration, depending on disability, while non -expansion states spend an average $ 19,289 per registration in the same eligibility group. Likewise, the expansion states spend $ 22,350 per older registration, compared to $ 18,288 for non -expansion states (Figure 4). These differences in expenditure can reflect the choices of state policy concerning advantages and eligibility, in addition to payment rates, regional variations in health care costs and state demographic data.