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THE FUTURE OF MEDICAID
Medicaid
Expenditures
The Kaiser Commission on
Beneficiaries
National and State
Profiles and Trends
1990-1995
THE HENRY J.
KAISER
FAMILY
FOUNDATION
The Henry J. Kaiser Family Foundation
The Henry J. Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national
health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation's
work is focused on four main areas: health, policy, reproductive health, and HIV/AIDS policy in the United
States, and health and development in South Africa.
The Kaiser Commission on the Future of Medicaid
The Kaiser Commission on the Future of Medicaid was established by the Henry J. Kaiser Family Foundation
in 1991 to function as a Medicaid policy institute and serve as a forum for analyzing, debating, and evaluating
future directions for Medicaid and other health reforms with the overarching goal of improving access to care
for low-income Americans.
James R. Tallon, Chairman
Ronald J. Anderson, M.D.
Judith E. Jones
Henry Bellmon
Charles McC. Mathias, LL.B
Edward N. Brandt, Jr., M.D., Ph.D.
James J. Mongan, M.D.
Molly Joel Coye, M.D., M.P.H.
Rudolph G. Penner, Ph.D.
Karen Davis, Ph.D.
Richard W. Riley, J.D. (1991-1993)
Jennifer L. Howse, Ph.D.
Trish Riley
Sylvia Drew Ivie, J.D.
Steven A. Schroeder, M.D.
Diane Rowland, Sc.D., Executive Director
Medicaid Expenditures and Beneficiaries
National and State Profiles and Trends, 1990-1995
Third Edition
November 1997
David Liska*
Brian Bruen*
Alina Salganicoff**
Peter Long**
Bethany Kessler*
* The Urban Institute
**Kaiser Commission on the Future of Medicaid
A Report of the Kaiser Commission on the Future of Medicaid
Support for this report was provided by the Henry J. Kaiser Family Foundation and the Kaiser Commission on the
Future of Medicaid. The Henry J. Kaiser Family Foundation is an independent, non-profit philanthropy and is not
associated with the Kaiser Permanente Medical Care Program or Kaiser Industries.
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
FOREWORD
lost the ability to analyze spending on services for
different eligibility groups using existing data
sources. As a result, much of the information pre-
The Kaiser Commission on the Future of Medicaid
sented in this report relies on claims data made un-
was established in 1991 by the Henry J. Kaiser Fam-
der fee-for-service arrangements. In light of pro-
ily Foundation to examine issues critical to access to
jected growth in Medicaid managed care enrollment,
health care and financing for the nation's poor and
this raises concern about our continuing ability ana-
disabled. The Commission's goal is to serve as a
lyze Medicaid spending and enrollment in the future.
focal point for Medicaid policy and research and as a
national forum for analyzing, debating, and evaluat-
We are grateful to all those who have contributed to
ing future directions for financing health and long-
this report. In particular, David Liska, Brian Bruen,
term care services for low-income Americans. To
and Bethany Kessler of the Urban Institute and Alina
support its mission, the Commission conducts stud-
Salganicoff and Peter Long of the Kaiser Commis-
ies, sponsors meetings and public forums, and is-
sion staff deserve special recognition for their pain-
sues fact-finding papers and reports.
staking efforts in preparing, analyzing, and describ-
ing the vast amounts of detailed data presented
As part of our ongoing efforts to provide timely in-
here. We would like to also thank John Holahan and
formation about the Medicaid program, we are
Joshua Wiener for reviewing earlier drafts, and Lynn
pleased to release Medicaid Expenditures and
Lewis, Patricia Seliger Keenen, and Lynda Bogatz
Beneficiaries: National and State Profiles and Trends
for their editorial assistance. Finally, we are grateful
1990-1995. This report updates earlier editions and
to the Commission members for their guidance in
presents a comprehensive overview of Medicaid
directing our efforts.
spending and enrollment both nationally and at the
state level.
Today, Medicaid provides health and long-term care
assistance to more than 35 million low-income
Americans at a cost of $152.4 billion in state and
federal dollars. As the program has evolved, the
states and the federal government continue to face
increasing challenges as they attempt to achieve
sustainable program spending levels, implement
managed care, expand access to low-income unin-
sured persons, and ensure a high quality of care.
This report is intended to help inform the policy de-
bate on Medicaid's future by providing detailed na-
tional and state-level data. It reflects the diversity in
the program in the populations served and the dra-
matic, programmatic differences at the state level.
The Balanced Budget Act of 1997 made many im-
portant changes to the Medicaid program by broad-
ening state discretion to require beneficiaries to en-
roll in managed care organizations and to set pro-
vider payment levels. By examining historical trends
in Medicaid coverage and spending, we will continue
to track how these changes will affect enrollment and
spending at the national and state level.
On a cautionary note, the shift to managed care pre-
J-Dall
Diane Roward
sents us with many new challenges in assessing
Medicaid's role. For the 40 percent of the Medicaid
population enrolled in managed care organizations
James R. Tallon, Jr.
Diane Rowland
where payments for services are capitated, we have
Chairman
Executive Director
Kaiser Commission on the Future of Medicaid
Page iii
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
REPORT HIGHLIGHTS
stituted 27.6 percent of the Medicaid popula-
tion, but were responsible for 68.5 percent of
spending.
M
edicaid is the major public program financing
A small but significant share (12.5 percent) of
health and long-term care coverage for millions
total Medicaid spending for services went to-
of the nation's poorest and most vulnerable popula-
wards supplemental payments to hospitals
tions. Over the past 30 years, Medicaid has evolved
that provide a disproportionately large share
considerably. While its original purpose was to pro-
of care to low-income, uninsured, and Medi-
vide basic health care coverage to those on welfare,
caid patients.
the program today covers more than one in 10
Americans. In 1995, Medicaid financed health care
Medicaid spending per beneficiary varied
services for 35.2 million people: 17.5 million children
considerably by basis of eligibility. On a per
and 8.0 million adults in low-income families, 5.8 mil-
beneficiary basis, spending for low-income
lion people with disabilities, and 3.9 million elderly.
children averaged $1,451 while that for low-
For each of these groups, Medicaid serves a differ-
income adults averaged $2,080. By contrast,
ent function. For low-income adults and children, it
spending for the disabled averaged nearly
operates much like a health insurance program, pro-
$8,784 and for the elderly, $10,308. Higher
viding coverage for a comprehensive range of bene-
per beneficiary spending levels for these
fits. For the elderly and those with disabilities, Medi-
populations reflect their greater health needs
caid covers home-and community-based services,
and heavier use of both acute and long-term
and is the primary source of financing for nursing
care services.
home care. For low-income elderly and disabled
Medicare beneficiaries, Medicaid also provides sup-
Medicaid finances a wide range of services to
plementary financial assistance by paying for Medi-
meet the health and long-term care needs of
care's Part B premium and cost sharing.
its beneficiary groups. Slightly more than half
of program spending (52.1 percent) was for
acute care and a third (35.4 percent) was for
Jointly financed by state and federal governments,
long-term care. The rest (12.5 percent) fi-
Medicaid is administered by the individual states un-
nanced disproportionate share hospital
der broad federal guidelines. To participate in the
(DSH) payments.
Medicaid program, each state must provide eligible
populations with a set of mandatory benefits. How-
ever, states have some discretion to determine eligi-
State Profiles, 1995
bility criteria; the amount, scope and duration of cov-
ered services; provider payment rates; and what op-
The wide variation in state Medicaid programs stems
tional acute and long-term care services to provide.
from the fact that while their programs are designed
Because states make markedly different choices in
under broad federal guidelines, states retain a sig-
these areas, trends in enrollment and spending ex-
nificant degree of program flexibility.
hibit distinctly different patterns. To better under-
stand the variation across state Medicaid programs,
States vary considerably in setting Medicaid
the Kaiser Commission on the Future of Medicaid
eligibility criteria, which generally are based
has updated this national and state-level analysis of
on those for the Aid to Families with Depend-
Medicaid expenditures and beneficiaries for 1995.
ent Children (AFDC) program and other state
determined income levels.
States like Tennessee and Hawaii have used
National Profile, 1995
section 1115 research and demonstration
In 1995, Medicaid financed health care serv-
waivers to expand coverage to persons who
ices for 35.2 million beneficiaries at a cost of
have not traditionally met Medicaid's cate-
$152.4 billion. Total spending, including the
gorical requirements, extending eligibility to
costs of administration and adjustments was
nondisabled individuals and childless cou-
$159.5 billion.
ples. Consequently, they cover larger shares
of the low-income population compared with
Adults and children account for nearly three-
other states.
quarters (72.3 percent) of Medicaid benefici-
aries, but less than a third (31.5 percent) of
Even without 1115 waivers, the share of low-
Medicaid spending for medical services. By
income persons with Medicaid coverage var-
contrast, the elderly, blind, and disabled con-
ies considerably. For example, in many New
Kaiser Commission on the Future of Medicaid
Page V
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
England states, nearly two-thirds of people
were extremely limited in other states such as
with incomes less than 150 percent of pov-
Idaho, Montana, and South Dakota.
erty were covered by Medicaid. Nevada, in
contrast, covered 30.6 percent of its low-
National Trends, 1990-1995
income population.
How spending was distributed among the eli-
After a decade of rapid growth, the increases in
gibility groups also varied considerably by
Medicaid spending and enrollment have slowed con-
state, reflecting Medicaid eligibility policies
siderably. These trends were the product of the
and state demographics. Spending for chil-
relatively healthy state of the economy, low unem-
dren illustrates this point, ranging from a low
ployment, and state and federal efforts to limit pro-
of 8.8 percent in New Hampshire to 29.4 per-
gram spending growth.
cent in Alaska. Similarly, 42.6 percent of
North Dakota's Medicaid expenditures were
Between 1990 and 1995, the number of
for the elderly compared with 17.1 percent in
Medicaid beneficiaries climbed by 11.1 million
Alaska.
from 24.1 million to 35.2 million. In the same
period, the number of disabled beneficiaries
Average spending per Medicaid beneficiary
rose 9.5 percent compared with 4.2 percent
reflects what services are covered, benefici-
among elderly beneficiaries. Following years
ary case mix, and regional costs of medical
of steady growth, enrollment actually fell for
services. Non-DSH spending per beneficiary
beneficiaries eligible for Medicaid because of
was highest in the New England and Middle
their receipt of cash assistance either through
Atlantic regions, averaging about $6,100.
AFDC or Supplemental Security Income.
The lowest spending levels were found in
New Mexico and Tennessee. Tennessee's
Medicaid spending more than doubled during
levels were low due to the recent expansion
this five year period, increasing from $70.5
of adult Medicaid beneficiaries through a
billion to $152.4 billion. Much of this growth
section 1115 research and demonstration
occurred in the early 1990's when spending
waiver.
increased an average of 27.8 percent per
year. Recent growth has slowed to more
The federal share of Medicaid payments per
historical levels. Between 1994 and 1995,
Medicaid beneficiary and per poor person in
Medicaid spending rose only 11.2 percent.
the state differed substantially across the
states. Current federal contributions are
Several factors contributed to accelerated
based on the state's relative per capita in-
Medicaid spending between 1990 and 1995.
come level (used to determine federal
One was growth in the number of beneficiar-
matching rates) and the amount of money the
ies, which was responsible for 45.6 percent of
state spent. New England and Middle Atlan-
the total growth in spending. Additionally,
tic states received the largest federal Medi-
nominal spending per beneficiary accounted
caid payments on a per capita, per low-
for just under a third (32.9 percent) of total
income, and per beneficiary basis.
spending growth. DSH payments accounted
for the remaining 21.5 percent.
State Medicaid spending varied more than
federal contributions. While Massachusetts,
Despite the rapid rise in overall program
Connecticut, New Hampshire, and New York
spending, the rate of growth in average Medi-
spent more than $2,300 in state funds per
caid expenditures per beneficiary remained
low-income person, Mississippi and New
stable between 5 percent and 6 percent
Mexico spent about $300.
throughout most of the 1990's, although it
reached 7.7 percent in 1995. Reductions in
Relative differences in DSH payments under
the rate of medical price inflation and growth
Medicaid exhibited the most dramatic varia-
in the proportion of low-income adults and
tion across states. More than half were con-
children, who are less costly per beneficiary,
centrated in five states: California, Louisiana,
were largely responsible for this trend.
New Jersey, New York, and Texas. DSH
payments accounted for 38.7 percent of
Medicaid spending in New Hampshire and
30.7 percent in Louisiana. DSH payments
Page vi
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
State Trends, 1990-1995
The rate of growth in spending and enrollment has
not been even among states for various reasons.
Among these are fluctuations in state economies,
decisions about expanding coverage of children and
pregnant women, efforts to restrain the rate of
spending growth, and mechanisms to draw down
additional federal funds through the DSH program.
Average annual growth in Medicaid benefici-
aries was highest in Hawaii (23.2 percent)
and in Tennessee (19.4 percent) due to ex-
panded eligibility related to implementation of
1115 waivers. Growth rates were lowest in
Pennsylvania (1.1 percent) and Michigan (2.3
percent).
Medicaid spending trends also differed sub-
stantially during this period. While the aver-
age annual growth of expenditures (including
DSH) was 16.7 percent nationally, North Da-
kota reported only 8.5 growth and Oklahoma
only 9.3 percent. By contrast, several
states-usually those with higher DSH pay-
ments or beneficiary expansions-saw
spending grow as much as 29 percent (Ha-
waii) and 30 percent (New Hampshire).
Growth in spending per beneficiary (excluding
DSH payments) was lower in most states
than total spending growth. In some states-
such as Alaska, Idaho, Indiana, New Hamp-
shire, Oklahoma, Tennessee, and Virginia-
average spending per beneficiary was stable
or even decreased slightly. In contrast,
spending per beneficiary grew over 10 per-
cent per year in seven states-Alabama,
Delaware, Louisiana, Michigan, Mississippi,
Pennsylvania, and West Virginia.
Kaiser Commission on the Future of Medicaid
Page vii
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
CONTENTS
Foreword
iii
Report Highlights
V
Authors' Note
xiii
Introduction
1
National Profile, 1995
3
State Profiles, 1995
23
Beneficiaries
29
Expenditures
43
National Trends, 1990-1995
81
State Trends, 1990-1995
103
Appendices
137
A. Medicaid Fact Sheets
139
B. Program Highlights
145
C. Data Sources and Methodology
157
Kaiser Commission on the Future of Medicaid
Page ix
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
TABLES
National Profile, 1995
Table 1:
Medicaid Expenditures and Beneficiaries, by Group, 1995
7
Table 2:
Medicaid Expenditures, by Group and Type of Service, 1995
11
Table 3:
Medicaid Acute Care Expenditures, by Group and Type of Service, 1995
12
Table 4:
Medicaid Long-Term Care Expenditures, by Group and Type of Service, 1995
13
Table 5:
Medicaid Expenditures per Beneficiary, by Group and Type of Service, 1995
19
Table 6:
Medicaid Acute Care Expenditures per Beneficiary, by Group and Type of Service, 1995
20
Table 7:
Medicaid Long-Term Care Expenditures per Beneficiary, by Group and Type of Service, 1995
21
State Profiles, 1995
Beneficiaries
Table 8:
Medicaid Beneficiaries, by Group, 1995
31
Table 9:
Distribution of Medicaid Beneficiaries, by Group, 1995
32
Table 10:
Medicaid Beneficiaries and Low-income Persons as a Percentage of State Population, 1995
33
Table 11:
Medicaid Beneficiaries as a Percentage of State Population, by Group, 1995
36
Table 12:
Medicaid Beneficiaries, by Cash Assistance Status, 1995
37
Table 13:
Medicaid Child Beneficiaries, by Cash Assistance Status, 1995
38
Table 14:
Medicaid Adult Beneficiaries, by Cash Assistance Status, 1995
39
Table 15:
Medicaid Blind and Disabled Beneficiaries, by Cash Assistance Status, 1995
40
Table 16:
Medicaid Elderly Beneficiaries, by Cash Assistance Status, 1995
41
Expenditures
Table 17:
Medicaid Expenditures, by Group, 1995
45
Table 18:
Distribution of Medicaid Expenditures, by Group, 1995
46
Table 19:
Federal and State Shares of Medicaid Expenditures, 1995
47
Table 20:
Medicaid Expenditures per Beneficiary, by Group, 1995
48
Table 21:
Federal and State Shares of Medicaid Expenditures per Beneficiary, 1995
50
Table 22:
Federal and State Shares of Medicaid Expenditures per Capita, 1995
51
Table 23:
Federal and State Shares of Medicaid Expenditures, per Low-income Person, 1995
52
Table 24:
Medicaid Expenditures, by Type of Service, 1995
55
Table 25:
Distribution of Medicaid Expenditures, by Type of Service, 1995
56
Table 26:
Medicaid Acute Care Expenditures, by Group, 1995
57
Table 27:
Distribution of Medicaid Acute Care Expenditures, by Group, 1995
58
Table 28:
Medicaid Acute Care Expenditures, by Type of Service, 1995
59
Table 29:
Distribution of Medicaid Acute Care Expenditures, by Type of Service, 1995
60
Table 30:
Medicaid Acute Care Expenditures per Beneficiary, by Type of Service, 1995
61
Table 31:
Federal and State Shares of Medicaid Acute Care Expenditures, per Beneficiary and per
Low-income Person, 1995
62
Table 32:
Medicaid Acute Care Expenditures per Beneficiary, by Cash Assistance Status, 1995
63
Table 33:
Medicaid Acute Care Expenditures per Child Beneficiary, by Cash Assistance Status, 1995
64
Table 34:
Medicaid Acute Care Expenditures per Adult Beneficiary, by Cash Assistance Status, 1995
65
Table 35:
Medicaid Acute Care Expenditures per Blind & Disabled Beneficiary, by Cash Assistance
Status, 1995
66
Table 36:
Medicaid Acute Care Expenditures per Elderly Beneficiary, by Cash Assistance Status, 1995
67
Table 37:
Medicaid Long-Term Care Expenditures, by Group, 1995
68
Table 38:
Distribution of Medicaid Long-Term Care Expenditures, by Group, 1995
69
Table 39:
Medicaid Long-Term Care Expenditures, by Type of Service, 1995
70
Table 40:
Distribution of Medicaid Long-Term Care Expenditures, by Type of Service, 1995
71
Table 41:
Medicaid Long-Term Care Expenditures per Beneficiary, by Cash Assistance Status, 1995
72
Table 42:
Medicaid Long-Term Care Expenditures per Adult and Child Beneficiary, 1995
73
Table 43:
Medicaid Long-Term Care Expenditures per Blind & Disabled Beneficiary, by Cash Assistance
Status, 1995
74
Table 44:
Medicaid Long-Term Care Expenditures per Elderly Beneficiary, by Cash Assistance
Status, 1995
75
Table 45:
Medicaid Payments to Medicare and Managed Care Organizations, per Beneficiary, 1995
76
Table 46:
Federal and State Shares of Medicaid Disproportionate Share Hospital Payments, per Low-income
Person and Uninsured Person, 1995
77
Page X
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
National Trends, 1990-1995
Table 47:
Medicaid Beneficiaries, by Group, 1990-1995
87
Table 48:
Medicaid Expenditures, by Group, 1990-1995
89
Table 49:
Medicaid Expenditures, by Type of Service, 1990-1995
92
Table 50:
Medicaid Acute Care Expenditures, by Group and Type of Service, 1990-1995
95
Table 51:
Medicaid Long-Term Care Expenditures, by Group and Type of Service , 1990-1995
97
Table 52:
Medicaid Expenditures per Beneficiary, by Group, 1990-1995
99
Table 53:
Factors Influencing Medicaid Expenditure Growth, 1990-1995
100
State Trends, 1990-1995
Table 54:
Medicaid Beneficiaries, 1990-1995
107
Table 55:
Medicaid Child Beneficiaries, 1990-1995
109
Table 56:
Medicaid Adult Beneficiaries, 1990-1995
110
Table 57:
Medicaid Blind and Disabled Beneficiaries, 1990-1995
111
Table 58:
Medicaid Elderly Beneficiaries, 1990-1995
112
Table 59:
Medicaid Expenditures for Benefits and DSH, 1990-1995
113
Table 60:
Medicaid Expenditures for Benefits Only, 1990-1995
115
Table 61:
Total Medicaid Expenditures, 1990-1995
116
Table 62:
Medicaid Expenditures per Beneficiary, 1990-1995
117
Table 63:
Medicaid Expenditures per Child Beneficiary, 1990-1995
119
Table 64:
Medicaid Expenditures per Adult Beneficiary, 1990-1995
120
Table 65:
Medicaid Expenditures per Blind and Disabled Beneficiary, 1990-1995
121
Table 66:
Medicaid Expenditures per Elderly Beneficiary, 1990-1995
122
Table 67:
Total Medicaid Acute Care Expenditures, 1990-1995
123
Table 68:
Medicaid Expenditures for Inpatient Services, 1990-1995
124
Table 69:
Medicaid Expenditures for Physician, Lab, and X-Ray Services, 1990-1995
125
Table 70:
Medicaid Expenditures for Outpatient and Clinic Services, 1990-1995
126
Table 71:
Medicaid Expenditures for Prescription Drugs, 1990-1995
127
Table 72:
Medicaid Expenditures for Other Acute Care Services, 1990-1995
128
Table 73:
Medicaid Payments to Medicare, 1990-1995
129
Table 74:
Medicaid Payments to Managed Care Organizations, 1990-1995
130
Table 75:
Total Medicaid Long-Term Care Expenditures, 1990-1995
131
Table 76:
Medicaid Expenditures for SNF/ICF-Other Services, 1990-1995
132
Table 77:
Medicaid Expenditures for ICF/MR Services, 1990-1995
133
Table 78:
Medicaid Expenditures for Mental Health Services, 1990-1995
134
Table 79:
Medicaid Expenditures for Home Health Care Services, 1990-1995
135
Table 80:
Medicaid Disproportionate Share Hospital Payments, 1990-1995
136
Appendices
B. Program Highlights
Table B-1:
Status of Section 1115 Waivers by State, as of August 1997
147
Table B-2:
Medicaid Spending as a Percentage of Total State Budgets and Federal Grants-in-Aid, 1995
149
Table B-3:
Annualized Medicaid Eligibility Thresholds for AFDC, Medically Needy, and SSI Beneficiaries,
1995-1996
152
Table B-4:
Expanded Medicaid Coverage of Pregnant Women, Infants, and Children: Income and Age Limits
as of June 1, 1997
153
Table B-5:
Number and Percentage of Births Paid for by Medicaid, 1995
154
Table B-6:
Medicaid Beneficiaries, Enrollees, and Full-Year Equivalent Enrollees, 1995
155
Kaiser Commission on the Future of Medicaid
Page xi
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
FIGURES
National Profile, 1995
Figure 1:
Medicaid Expenditures and Beneficiaries, by Group, 1995
8
Figure 2:
Medicaid Beneficiaries, by Group and Cash Assistance Status, 1995
9
Figure 3:
Medicaid Expenditures, by Group and Cash Assistance Status, 1995
10
Figure 4:
Medicaid Expenditures, by Type of Service, 1995
14
Figure 5:
Medicaid Expenditures for Child Beneficiaries, by Type of Service, 1995
15
Figure 6:
Medicaid Expenditures for Adult Beneficiaries, by Type of Service, 1995
16
Figure 7:
Medicaid Expenditures for Blind and Disabled Beneficiaries, by Type of Service, 1995
17
Figure 8:
Medicaid Expenditures for Elderly Beneficiaries, by Type of Service, 1995
18
Figure 9:
Medicaid Expenditures per Beneficiary, by Group, Cash Assistance Status, and Type of Service, 1995
22
State Profiles, 1995
Beneficiaries
Figure 10:
Medicaid Beneficiaries as a Percentage of State Population, 1995
34
Figure 11:
Medicaid Beneficiaries as a Percentage of Low-income Population, 1995
35
Expenditures
Figure 12:
Medicaid Expenditures per Beneficiary, 1995
49
Figure 13:
Federal Medicaid Spending per Low-income Person, 1995
53
Figure 14:
State Medicaid Spending per Low-income Person, 1995
54
Figure 15:
Federal and State Shares of Medicaid Disproportionate Share Hospital Payments, per Low-income
Person, 1995
78
Figure 16:
Federal and State Shares of Medicaid Disproportionate Share Hospital Payments, per Uninsured
Person, 1995
79
National Trends, 1990-1995
Figure 17:
Medicaid Beneficiaries, by Group, 1990-1995
88
Figure 18:
Medicaid Expenditures, by Group, 1990-1995
90
Figure 19:
Annual Increase in Medicaid Expenditures, by Group, 1990-1995
91
Figure 20:
Medicaid Expenditures, by Type of Service, 1990-1995
93
Figure 21:
Annual Increase in Medicaid Expenditures, by Type of Service, 1990-1995
94
Figure 22:
Medicaid Acute Care Expenditures, by Type of Service, 1990-1995
96
Figure 23:
Medicaid Long-Term Care Expenditures, by Type of Service, 1990-1995
98
Figure 24:
Factors Influencing Medicaid Expenditure Growth, 1990-1995
101
State Trends, 1990-1995
Figure 25:
Average Annual Growth in Medicaid Beneficiaries, 1990-1995
108
Figure 26:
Average Annual Growth in Medicaid Expenditures for Benefits and DSH, 1990-1995
114
Figure 27:
Average Annual Growth in Medicaid Expenditures per Beneficiary, 1990-1995
118
Appendices
B. Program Highlights
Figure B-1: States with Section 1115 Waivers, as of August 1997
148
Figure B-2: Total Medicaid Spending as a Percentage of Total State Budgets, 1995
150
Figure B-3: Federal Medicaid Spending as a Percentage of Federal Grants-in-Aid, 1995
151
Page xii
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Authors' Note
The growing use of managed care in many states makes it increasingly complex to identify the
particular recipients of certain categories of Medicaid spending. States with operational section 1115
waivers tend to report many expenditures as payments to managed care organizations without
specifying what services were actually provided. At this time, the only states affected to a significant
degree are Arizona, Hawaii, Oregon, and Tennessee.
Today, an estimated 40 percent of Medicaid beneficiaries are enrolled in managed care; two thirds of
these individuals' care is paid for on a capitated basis. Existing national data sources tell us very
little about who these beneficiaries are, what types of services they use, and how much was spent on
these services. As more beneficiaries are enrolled into managed care plans, this problem will be
exacerbated. To compensate for this gap in information, we have had to estimate how payments to
managed care programs in every state were divided among different beneficiary groups, instead of
reporting this spending category as a separate expenditure.
It should also be noted that spending per beneficiary does not translate into spending per enrollee.
This report reflects the costs of care for persons who actually used services; the number of persons
enrolled in the program was considerably higher. What this means is that the amount reported as
spending per beneficiary should not be used to estimate managed care costs per enrollee, which
should be considerably lower.
Kaiser Commission on the Future of Medicaid
Page xiii
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
INTRODUCTION
waivers from various federal Medicaid requirements
under the authority of sections 1115 (research and
demonstration) and 1915(b) (freedom of choice) of
F
or several years, the structure and financing of
Medicaid have been a central issue in the na-
the Social Security Act. This authority permits them
to increase the use of managed care to improve ac-
tional debates about balancing the budget, state and
federal responsibilities, the role of federal oversight,
cess and control costs. With 1115 waivers, they
and entitlements to health and welfare benefits. Be-
may also extend coverage to previously ineligible
low-income children and adults.
cause the program is so complex and diverse, policy
and financing changes at the federal level are likely
to play out quite differently at the state level.
Under the Balanced Budget Act of 1997, states will
no longer need these waivers to mandate enrollment
To participate in the Medicaid program and receive
of most Medicaid beneficiaries into managed care,
federal matching payments, each state must cover
though the waivers will still be required for mandatory
enrollment of children with special needs, Medicare
certain categorically eligible groups and offer a
beneficiaries, and Native Americans. The Act con-
minimum set of medical services. Apart from these
federal guidelines, states have significant leeway in
tained several other important changes. One pro-
vides additional funds to expand Medicaid assis-
designing their individual programs; they can choose
tance to low-income children and Medicare benefici-
which optional populations to cover; set income eli-
gibility levels; determine the amount, duration, and
aries. Another reduces federal payments to states
scope of services; and decide which optional acute
for DSH spending, including significant reduction of
and long-term care services to offer. As a result of
these payments to mental health facilities. In addi-
these state choices, Medicaid in reality comprises
tion, the Act repeals the Boren Amendment, which
more than 50 distinct programs.
restricted the ability of states to reduce some pay-
ments to hospitals and nursing homes, and provides
for phasing out cost-based reimbursement for Fed-
Even when looking at an individual state, however, it
erally Qualified Health Centers.
is difficult to characterize Medicaid as a single, uni-
fied program. Under the state Medicaid program
umbrella are:
This update is intended to help inform the policy de-
bate on Medicaid's future by providing national and
acute care services for low-income, non-
state-level data. The first section gives an overview
disabled adults and children;
of national expenditures and beneficiaries for 1995.
The second section details coverage and spending
prenatal care, delivery services, and post-
patterns in individual states by eligibility categories,
natal care for low-income pregnant women;
cash assistance status, and type of service for 1995.
The third section examines trends in Medicaid
acute and long-term care services for the
disabled of all ages;
spending nationwide between 1990 and 1995, ana-
lyzing factors that contributed to growth. The final
long-term care for low-income elderly;
section presents state-level trends during the five
year period 1990 to 1995, highlighting information on
financial assistance to low-income elderly for
beneficiary and expenditure growth, as well as
meeting Medicare's cost-sharing obligations;
population groups served and services offered.
and
financial assistance to qualifying hospitals
The appendix contains several fact sheets on the
that serve disproportionately high numbers of
Medicaid program, additional state-level eligibility
Medicaid beneficiaries and low-income indi-
and financial data, a description of the data sources
viduals without health insurance.
used for this report, and a summary of the analytic
methodology.
Far from being a static program, Medicaid has
evolved continuously to meet the needs of vulnerable
populations in the face of federal and state budget-
ary pressures. The states and the federal govern-
ment have used a number of different strategies to
control Medicaid spending, expand eligibility, and
improve access to care for beneficiaries. In recent
years for example, many states have applied for
Kaiser Commission on the Future of Medicaid
Page 1
National Profile, 1995
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
NATIONAL PROFILE, 1995
eligibility criteria established by federal policy. States
have the option to cover other "medically needy" per-
sons who incur large medical or long-term care ex-
M
edicaid, the publicly-financed program providing
penses, yet do not qualify for other assistance. Fi-
health and long-term care coverage to millions
nally, states have used section 1115 research and
of the nation's poor, served more than 35.2 million
demonstration waivers to expand coverage to groups
people in 1995, at a cost of $152.4 billion (Table 1,
who do not meet Medicaid's categorical eligibility
Figure 1). Total program expenditures, including
criteria, such as non-disabled adults and childless
administration, accounting adjustments, and the U.S.
couples. These groups accounted for the remaining
Territories were $159.5 billion.
44.0 percent of beneficiaries.
Nearly half of all Medicaid beneficiaries were children
The Personal Responsibility and Work Opportunity
(17.5 million), for whom the program was a major
Act of 1996 eliminated the automatic link between
source of health insurance. Non-disabled, low-
receipt of AFDC and Medicaid eligibility. Under the
income adults including pregnant women were the
new welfare law, AFDC was replaced by the Tempo-
second-largest beneficiary group at 8.0 million.
rary Assistance to Needy Families (TANF) program.¹
Some 3.9 million low-income elderly persons relied
Persons who meet TANF eligibility requirements are
on Medicaid to supplement their Medicare premiums
not automatically eligible for Medicaid and must ap-
and cost-sharing and to help finance institutional and
ply separately.
community-based long-term care. Medicaid also
paid for acute and long-term care services provided
To meet the diverse health needs of its beneficiaries,
to 5.8 million blind and disabled beneficiaries of all
Medicaid finances a comprehensive set of acute and
ages.
long-term care services. Slightly more than half of
Medicaid spending (52.1 percent) covered acute
Although adults and children in low-income families
care services (Table 2, Figure 4). These services
made up 72.3 percent of Medicaid beneficiaries, they
include inpatient hospital care; physician care; labo-
accounted for only 31.5 percent of spending, ex-
ratory and X-ray services; outpatient services; other
cluding payments to disproportionate share hospitals
medical services; prescription drugs; early and peri-
(DSH). Elderly, blind, and disabled beneficiaries, by
odic screening, diagnosis, and treatment (EPSDT);
contrast, constituted only 27.6 percent of total bene-
and premiums paid to managed care organizations
ficiaries, yet were responsible for 68.5 percent of
(MCOs) and to Medicare. Another 35.4 percent of
total spending, excluding DSH payments. The dis-
Medicaid spending was for long-term care, including
parity between enrollment and spending is a result of
institutional, home health, and mental health services
the differing health care needs of these populations.
(Table 4, Figure 4).
Historically, Medicaid coverage has been tied to eli-
Some of Medicaid's expenditures are not directly
gibility for cash assistance welfare payments, pri-
linked to beneficiaries' use of services and thus can-
marily Aid to Families with Dependent Children
not be attributed to a particular group or service.
(AFDC) or Supplemental Security Income (SSI).
Medicaid DSH payments provide additional financial
Persons who qualified for cash assistance through
assistance for hospitals and institutions for mental
SSI or AFDC were automatically enrolled in Medi-
disease that serve large percentages of low-income
caid. In 1995, 56.0 percent of all Medicaid benefici-
and Medicaid beneficiaries. These payments totaled
aries qualified for Medicaid due to their cash assis-
$19.0 billion in 1995-about 12.5 percent of Medi-
tance status (Figure 2). Children receiving cash as-
caid expenditures (Table 1, Figure 1). An additional
sistance were the largest group of beneficiaries (26.1
$6.6 billion covered miscellaneous expenditures,
percent), but blind and disabled beneficiaries ac-
including program administration and accounting
counted for the largest share of program expendi-
adjustments.
tures (21.8 percent).
¹The Personal Responsibility and Work Opportunity Reconcilia-
tion Act of 1996 (P.L. 104-193) replaced Aid to Families with
In recent years, Congress and many states broad-
Dependent Children with Temporary Assistance for Needy Fami-
ened Medicaid eligibility criteria to cover additional
lies, a new federal block grant to states. Before TANF, anyone
low-income groups that do not qualify for cash as-
who received an AFDC check was automatically entitled to Medi-
sistance, especially children and pregnant women.
caid. The new law severed this link. Instead, the new law re-
quires states to use the AFDC eligibility criteria of July 1996 (just
Thirty-four states have moved beyond the mandatory
before the law changed) to determine Medicaid eligibility for fami-
lies with children, regardless of TANF eligibility requirements.
Kaiser Commission on the Future of Medicaid
Page 5
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Most care that Medicaid beneficiaries receive is pro-
children primarily used acute care services rather
vided on a fee-for-service basis. However, recent
than costlier long-term care (Table 6 and 7). The
growth in Medicaid managed care has led to un-
picture was different, though, for the elderly and for
precedented expenditures for MCOs. In 1995 alone,
the disabled. Many in these groups needed expen-
Medicaid paid $9.9 billion to MCOs, or 6.7 percent of
sive long-term care services. Medicaid spending
total spending. (Figure 4). Medicaid also paid $3.9
reflected these needs. In 1995, spending averaged
billion to Medicare to cover premiums and cost
$10,308 per elderly beneficiary and $8,784 per blind
sharing for low-income elderly and disabled "dual-
or disabled beneficiary.
eligible" beneficiaries² (Table 3).
Low-income children, adults, the disabled, and the
elderly use different types and amounts of Medicaid
services. For instance, of the $25.4 billion spent for
services to non-disabled children, more than 93 per-
cent was for acute care (Figure 5). Only 6.3 percent
went toward long-term care most of which was for
mental health services. A similar pattern was seen
for non-disabled adults. Of the $16.6 billion spent for
this group, almost all (98.5 percent) was for acute
care (Figure 6). These figures reflect Medicaid's role
as a provider of basic acute care for adults and chil-
dren in low-income families.
For persons with disabilities and for the elderly, how-
ever, Medicaid fills a very different need. Although
acute care services still represent most (57.9 per-
cent) of the $51.4 billion spent on the disabled, 42.1
percent was for long-term care (Figure 7). For eld-
erly beneficiaries, long-term care accounted for 75.9
percent of the $40.1 billion in total spending (Figure
8). This group's reliance on Medicaid for long-term
care is a direct result of the high costs of long-term
care that can rapidly impoverish an individual and the
lack of coverage for such coverage under Medicare.
Medicare pays for the bulk of acute care for the
Medicaid elderly.
The different health needs of the populations Medi-
caid covers translate into vastly dissimilar levels of
spending per beneficiary across eligibility categories.
In 1995, Medicaid spent, on average, $1,451 per
child beneficiary and $2,080 per adult beneficiary
(Table 5 and Figure 9).³ Non-disabled adults and
2 Dual eligibles refer to those individuals who receive assistance
from both Medicaid and Medicare. There are no data to deter-
mine exactly how payments to Medicare are spent on the differ-
ent groups eligible for such coverage: cash assistance elderly
(SSI), Qualified Medicare Beneficiaries, Special Low-income
Medicare Beneficiaries, and certain persons with disabilities.
3 Note that spending per beneficiary will overstate average
spending per person enrolled in the Medicaid program, since
people who do not use services are not counted. Furthermore,
some Medicaid enrollees participate in the program for only part
$1,178; adjusting for partial-year participation, spending per child
of the year, which can lead to an understatement of true spending
enrollee was approximately $1,524. The term beneficiaries is
per person on an annual basis. For example, spending per child
used throughout this report, since these data are more historically
beneficiary was $1,451, while spending per child enrollee was
complete. See Appendix C for more detail.
Page 6
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 1
Medicaid Beneficiaries and Expenditures, by Group, 1995
Beneficiaries
% of Total
Expenditures
% of Total Expenditures
Expenditures per
Beneficiary Group
(thousands)
Beneficiaries
(millions)
with DSH
without DSH
Beneficiary
Total
35,214
100.0%
$152,423
100.0%
100.0%
-
All Beneficiaries (benefits only)
35,214
100.0%
$133,435
87.5%
100.0%
$3,789
Cash Assistance
19,737
56.0
64,461
42.3
48.3
3,266
Other Beneficiaries
15,477
44.0
68,974
45.3
51.7
4,456
Elderly
3,889
11.0%
$40,087
26.3%
30.0%
$10,308
Cash Assistance
1,640
4.7
8,620
5.7
6.5
5,255
Other Beneficiaries
2,248
6.4
31,468
20.6
23.6
13,996
Blind and Disabled
5,849
16.6%
$51,379
33.7%
38.5%
$8,784
Cash Assistance
4,518
12.8
33,254
21.8
24.9
7,361
Other Beneficiaries
1,331
3.8
18,125
11.9
13.6
13,615
Adults
7,960
22.6%
$16,557
10.9%
12.4%
$2,080
Cash Assistance
4,389
12.5
8,977
5.9
6.7
2,045
Other Beneficiaries
3,571
10.1
7,580
5.0
5.7
2,123
Children
17,516
49.7%
$25,411
16.7%
19.0%
$1,451
Cash Assistance
9,189
26.1
13,610
8.9
10.2
1,481
Other Beneficiaries
8,327
23.6
11,800
7.7
8.8
1,417
DSH
-
-
$18,988
12.5%
-
-
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Temtones Total spending including these categories was about $159.5 billion in 1995. Figures may not sum to
totals due to rounding. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. "Cash assistance" refers to beneficianes who receive AFDC or SSI.
"Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible under Medicaid 1115 waivers. "DSH" refers to disproportionate share hospital
payments. States do not report payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare were distributed among the aged, blind,
and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
Kaiser Commission on the Future of Medicaid
Page 7
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 1
Medicaid Expenditures and Beneficiaries, by Group, 1995
100.0%
11.0%
12.5%
80.0%
16.6%
26.3%
DSH
Elderly
60.0%
22.6%
Blind & Disabled
Adults
Children
33.7%
40.0%
49.7%
10.9%
20.0%
16.7%
0.0%
Beneficiaries
Expenditures
Total = 35.2 million
Total = $152.4 billion
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5 billion in
1995. Percentages may not sum to 100 due to rounding. "DSH" refers to disproportionate share hospital payments. Beneficiaries are people enrolled in the
Medicaid program who actually receive medical services. States do not report payments to Medicare or to managed care organizations by beneficiary group.
In most states. payments to Medicare were distributed among the aged. blind. and disabled. Payments to MCOs were distributed among adults and children.
The methodology used is described in Appendix C.
Page 8
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 2
Medicaid Beneficiaries, by Group and Cash Assistance Status, 1995
Elderly: Other
6.4%
Elderly: Cash
4.7%
Children: Cash
Blind/Disabled: Other
26.1%
3.8%
Blind/Disabled: Cash
12.8%
Adult: Other
10.1%
Children: Other
23.6%
Adult: Cash
12.5%
Total Beneficiaries = 35.2 million people
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the US Territories. Percentages may not sum to 100 due to rounding. Beneficiaries are people enrolled in the Medicaid program who
actually receive medical services. "Cash" refers to beneficiaries who receive AFDC or SSI. "Other" beneficiaries include the medically needy, poverty-related
expansion groups, and people eligible under Medicaid 1115 waivers.
Kaiser Commission on the Future of Medicaid
Page 9
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 3
Medicaid Expenditures, by Group and Cash Assistance Status, 1995
Children: Cash
DSH
8.9%
12.5%
Children: Other
7.7%
Adult: Cash
5.9%
Elderly: Other
20.6%
Adult: Other
5.0%
Elderly: Cash
5.7%
Blind/Disabled: Cash
21.8%
Blind/Disabled: Other
11.9%
Total Expenditures = $152.4 billion
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5 billion in
1995 Percentages may not sum to 100 due to rounding. "DSH" refers to disproportionate share hospital payments. "Cash" refers to beneficiaries who receive
AFDC or SSI. "Other" beneficiaries include the medically needy, poverty-related expansion groups. and people eligible under Medicaid 1115 waivers. States do
not report payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare were distributed among the
aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
Page 10
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 2
Medicaid Expenditures, by Group and Type of Service, 1995
Total
Acute Care
Long-Term Care
% of Total
% of Total
% of Total
Acute Care
Long-Term Care
Beneficiary Group
(millions)
Spending
(millions)
Spending
(millions)
Spending
DSH
Total
$152,423
100.0%
$79,439
100.0%
$53,996
100.0%
$18,988
Elderly
$40,087
26.3%
$9,674
12.2%
$30,414
56.3%
Cash Assistance
8,620
5.7
4,313
5.4
4,307
8.0
Other Beneficiaries
31,468
20.6
5,361
6.7
26,107
48.3
Blind and Disabled
$51,379
33.7%
$29,761
37.5%
$21,619
40.0%
Cash Assistance
33,254
21.8
22,617
28.5
10,637
19.7
Other Beneficiaries
18,125
11.9
7,144
9.0
10,981
20.3
Adults
$16,557
10.9%
$16,301
20.5%
$256
0.5%
Cash Assistance
8,977
5.9
8,877
11.2
100
0.2
Other Beneficiaries
7,580
5.0
7,424
9.3
156
0.3
Children
$25,411
16.7%
$23,703
29.8%
$1,708
3.2%
Cash Assistance
13,610
8.9
12,802
16.1
808
1.5
Other Beneficiaries
11,800
7.7
10,901
13.7
900
1.7
DSH
$18,988
12.5%
-
-
-
-
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Temtories Total spending including these categories was about $159.5 billion in 1995. Figures may not sum to
totals due to rounding. Acute care services include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning, dental, vision, hospice, other practitioners' care,
payments to managed care organizations, and payments to Medicare. Long-term care services include skilled nursing facilities, intermediate care facilities for the mentally retarded, other
intermediate care facilities, mental health, and home health services. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy,
poverty-related expansion groups, and people eligible under Medicaid 1115 waivers. "DSH" refers to disproportionate share hospital payments. States do not report payments to Medicare
or to MCOs by beneficiary group. In most states, payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were distributed among adults and children.
The methodology used is described in Appendix C.
Kaiser Commission on the Future of Medicaid
Page 11
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 3
Medicaid Acute Care Expenditures, by Group and Type of Service, 1995
Acute Care Service (millions)
Total
Acute Care
Physician,
Outpatient/
Prescription
Other Acute
Payments to
Payments
to
Beneficiary Group
(millions)
Inpatient Lab & X-Ray
Clinic
Drugs
Care (1)
Medicare (2)
MCOs (2)
Total
$79,439
$26,936
$8,460
$10,723
$8,445
$11,116
$3,855
$9,903
Elderly
$9,674
$2,083
$685
$746
$2,453
$1,130
$2,506
$71
Cash Assistance
4,313
1,039
331
372
1,057
430
1,047
37
Other Beneficiaries
5,361
1,045
354
374
1,396
700
1,459
34
Blind and Disabled
$29,761
$11,730
$2,485
$4,760
$4,140
$4,312
$1,349
$985
Cash Assistance
22,617
8,634
1,971
3,726
3,136
3,347
1,041
761
Other Beneficiaries
7,144
3,095
514
1,034
1,004
965
308
224
Adults
$16,301
$5,902
$2,713
$2,313
$829
$1,903
$0
$2,641
Cash Assistance
8,877
2,782
1,379
1,360
596
1,134
-
1,627
Other Beneficiaries
7,424
3,120
1,334
953
233
769
-
1,014
Children
$23,703
$7,221
$2,578
$2,904
$1,023
$3,773
$0
$6,205
Cash Assistance
12,802
2,798
1,177
1,575
529
2,142
1
4,582
Other Beneficiaries
10,901
4,423
1,401
1,329
494
1,631
-
1,623
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "DSH" refers to disproportionate share hospital
payments. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible
under Medicaid 1115 waivers.
(1) "Other acute care" includes case management, family planning. dental, EPSDT, vision, other practitioners' care, and all other unspecified acute care services.
(2) States do not report payments to Medicare or to managed care organizations by beneficiary group In most states, payments to Medicare were distributed among the aged, blind,
and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
Page 12
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 4
Medicaid Long-Term Care Expenditures by Group and Type of Service, 1995
Long-Term Care Service (millions)
Total
Long-Term Care
SNF/
Mental
Home
Beneficiary Group
(millions)
ICF-Other
ICF/MR
Health
Health
Total
$53,996
$30,486
$10,003
$3,076
$10,431
Elderly
$30,414
$25,572
$616
$1,107
$3,119
Cash Assistance
4,307
2,183
176
303
1,645
Other Beneficiaries
26,107
23,389
440
804
1,474
Blind and Disabled
$21,619
$4,813
$9,321
$881
$6,603
Cash Assistance
10,637
1,948
3,456
693
4,539
Other Beneficiaries
10,981
2,865
5,865
188
2,064
Adults (1)
$256
$54
$9
$48
$145
Cash Assistance
100
-
-
-
-
Other Beneficiaries
156
-
-
-
-
Children (1)
$1,708
$47
$57
$1,040
$564
Cash Assistance
808
-
-
-
-
Other Beneficiaries
900
-
-
-
-
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territones. Figures may not sum to totals due to rounding. "SNF/ICF-Other" refers to skilled
nursing facilities and other intermediate care facilities. "ICF/MR" refers to intermediate care facilities for the mentally retarded. "DSH" refers to disproportionate share
hospital payments. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficianes" include the medically needy. poverty-related expansion
groups, and people eligible under Medicaid 1115 waivers.
(1) Expenditures for long-term care services are not shown by cash assistance status for adult and child beneficianes because actual spending was only for a small
number of individuals and does not necessarily represent the group as a whole.
Kaiser Commission on the Future of Medicaid
Page 13
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 4
Medicaid Expenditures, by Type of Service, 1995
DSH
Inpatient
12.5%
17.7%
Home Health
6.8%
Physician Services
Mental Health
5.6%
2.0%
ICF/MR
6.6%
Outpatient/Clinic
7.0%
Drugs
5.5%
SNF/ICF-Other
Other Acute Care
20.0%
7.3%
Medicare
2.5%
MCOs
6.5%
Total Expenditures = $152.4 billion
Acute Care = 52.1%
Long-Term Care = 35.4%
DSH = 12.5%
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5 billion in
1995. Percentages may not sum to 100 due to rounding. "DSH" refers to disproportionate share hospital payments. "MCOs" refers to managed care
organizations. "Other acute care" includes case management, family planning, dental. EPSDT, vision, other practitioners' care, and all other unspecified acute
care services. "ICF/MR" refers to intermediate care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing facilities and other intermediate
care facilities.
Page 14
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 5
Medicaid Expenditures for Child Beneficiaries, by Type of Service, 1995
Long-Term Care
6.7%
Inpatient
28.4%
MCOs*
24.4%
Physician Services
10.1%
Other Acute Care
14.8%
Outpatient/Clinic
11.4%
Drugs
4.0%
Total Expenditures = $25.4 billion
Acute Care = 93.3%
Long-Term Care = 6.7%
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports
Does not include Disproportionate Share Hospital payments. administrative costs. accounting adjustments, or the U.S. Territories. Percentages may not sum to
100 due to rounding. "Other acute care" includes case management, family planning, dental, EPSDT, vision, other practitioners' care, and all other unspecified
acute care services.
*Payments to managed care organizations were distributed among adults and children; see Appendix C
Kaiser Commission on the Future of Medicaid
Page 15
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 6
Medicaid Expenditures for Adult Beneficiaries, by Type of Service, 1995
Long-Term Care
1.5%
MCOs*
16.0%
Inpatient
35.6%
Other Acute Care
11.5%
Drugs
5.0%
Outpatient/Clinic
Physician Services
14.0%
16.4%
Total Expenditures = $16.6 billion
Acute Care = 98.5%
Long-Term Care = 1.5%
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Percentages may not sum to
100 due to rounding. "Other acute care" includes case management, family planning, dental. EPSDT, vision, other practitioners' care, and all other unspecified
acute care services.
*Payments to managed care organizations were distributed among adults and children; see Appendix C.
Page 16
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 7
Medicaid Expenditures for Blind & Disabled Beneficiaries, by Type of
Service, 1995
Home Health
12.9%
Inpatient
22.8%
Mental Health
1.7%
ICF/MR
18.1%
Physician Services
4.8%
Outpatient/Clinic
9.3%
SNF/ICF-Other
9.4%
Drugs
8.1%
Medicare & MCOs*
4.5%
Other Acute Care
8.4%
Total Expenditures = $51.4 billion
Acute Care = 57.9%
Long-Term Care = 42.1%
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments. administrative costs, accounting adjustments. or the U.S. Territories. Percentages may not sum to
100 due to rounding. "Other acute care" includes case management. family planning. dental, EPSDT, vision, other practitioners' care. and all other unspecified
acute care services. "ICF/MR" refers to intermediate care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing facilities and other
intermediate care facilities.
*Payments to Medicare were distributed among the aged, blind, and disabled. A few states enroll blind and disabled beneficiaries in managed care
organizations. Payments to MCOs are combined with those to Medicare in this figure, see Appendix C.
Kaiser Commission on the Future of Medicaid
Page 17
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 8
Medicaid Expenditures for Elderly Beneficiaries, by Type of Service, 1995
Physician Services
1.7%
Inpatient
Home Health
Outpatient/Clinic
Mental Health
5.2%
7.8%
1.9%
2.8%
Drugs
ICF-MR
6.1%
1.5%
Other Acute Care
2.8%
Medicare & MCOs*
6.4%
SNF/ICF
63.8%
Total Expenditures = $40.1 billion
Acute Care = 24.1%
Long-Term Care = 75.9%
Source: Urban Institute calculations based on HCFA-2082 and HCFA-64 data.
Does not include disproportionate share hospital payments. administrative costs, accounting adjustments, or the U.S. Territories. Percentages may not sum to
100 due to rounding. "Other acute care" includes case management, dental. vision, other practitioners' care, and all other unspecified acute care services.
"ICF/MR" refers to intermediate care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing facilities and other intermediate care facilities.
*Payments to Medicare were distributed among the aged, blind, and disabled A few states enroll elderly beneficiaries in managed care organizations. Payments
to MCOs are combined with those to Medicare in this figure, see Appendix C.
Page 18
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 5
Medicaid Expenditures per Beneficiary, by Group and Type of Service, 1995
Total
Acute Care
Long-Term
Spending per
Spending per
Care Spending
Beneficiary Group
Beneficiary
Beneficiary
per Beneficiary
Total
$3,789
$2,256
$1,533
Elderly
$10,308
$2,488
$7,821
Cash Assistance
5,255
2,629
2,626
Other Beneficiaries
13,996
2,384
11,612
Blind and Disabled
$8,784
$5,088
$3,696
Cash Assistance
7,361
5,006
2,355
Other Beneficiaries
13,615
5,366
8,249
Adults
$2,080
$2,048
$32
Cash Assistance
2,045
2,022
23
Other Beneficiaries
2,123
2,079
44
Children
$1,451
$1,353
$97
Cash Assistance
1,481
1,393
88
Other Beneficiaries
1,417
1,309
108
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due
to rounding. Acute care services include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning, dental, vision, hospice, other
practitioners' care, payments to managed care organizations, and payments to Medicare. Long-term care services include skilled nursing facilities, intermediate care
facilities for the mentally retarded, other intermediate care facilities, mental health, and home health services. "Cash assistance" refers to beneficiaries who receive
AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible under Medicaid 1115 waivers. States do not
report payments to Medicare or to MCOs by beneficiary group. In most states, payments to Medicare were distributed among the aged, blind, and disabled.
Kaiser Commission on the Future of Medicaid
Page 19
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 6
Medicaid Acute Care Expenditures per Beneficiary, by Group and Type of Service, 1995
Acute Care Service
Total
Acute
Physician,
Outpatient/
Prescription
Other Acute
Payments
to
Payments to
Beneficiary Group
Care
Inpatient Lab & X-Ray
Clinic
Drugs
Care (1)
Medicare (2)
MCOs (2)
Total
$2,256
$765
$240
$305
$240
$316
$109
$281
Elderly
$2,488
$536
$176
$192
$631
$290
$644
$18
Cash Assistance
2,629
633
202
227
644
262
638
23
Other Beneficiaries
2,384
465
157
166
621
311
649
15
Blind and Disabled
$5,088
$2,005
$425
$814
$708
$737
$231
$168
Cash Assistance
5,006
1,911
436
825
694
741
230
169
Other Beneficiaries
5,366
2,325
386
777
754
725
232
168
Adults
$2,048
$741
$341
$291
$104
$239
$0
$332
Cash Assistance
2,022
634
314
310
136
258
-
371
Other Beneficiaries
2,079
874
374
267
65
215
-
284
Children
$1,353
$412
$147
$166
$58
$215
$0
$354
Cash Assistance
1,393
304
128
171
58
233
-
499
Other Beneficiaries
1,309
531
168
160
59
196
-
195
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
"Cash assistance" refers to beneficiary groups who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people
eligible under Medicaid 1115 waivers.
(1) "Other acute care" includes case management, family planning. dental, EPSDT, vision, other practitioners' care, and all other unspecified acute care services.
(2) States do not report payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare were distributed among the aged,
blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
Page 20
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 7
Medicaid Long-Term Care Expenditures per Beneficiary, by Group and Type of Service, 1995
Long-Term Care Service
Total
Long-Term
SNF/
Mental
Home
Beneficiary Group
Care
ICF-Other
ICF/MR
Health
Health
Total
$1,533
$866
$284
$87
$296
Elderty
$7,821
$6,576
$158
$285
$802
Cash Assistance
2,626
1,330
107
185
1,003
Other Beneficiaries
11,612
10,403
196
358
656
Blind and Disabled
$3,696
$823
$1,594
$151
$1,129
Cash Assistance
2,355
431
765
153
1,005
Other Beneficiaries
8,249
2,152
4,405
141
1,550
Adults (1)
$32
$7
$1
$6
$18
Cash Assistance
23
-
-
-
-
Other Beneficiaries
44
-
-
-
-
Children (1)
$97
$3
$3
$59
$32
Cash Assistance
88
-
-
-
-
Other Beneficiaries
108
-
-
-
-
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to
rounding. "SNF/ICF-Other" refers to skilled nursing facilities/other intermediate care facilities. "ICF/MR" refers to intermediate care facilities for the mentally retarded.
"Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible
under Medicaid 1115 waivers.
(1) Expenditures for long-term care services are not shown by cash assistance status for adult and child beneficiaries because actual spending was only for a small number of
individuals and does not necessarily represent the group as a whole.
Kaiser Commission on the Future of Medicaid
Page 21
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 9
Medicaid Expenditures per Beneficiary, by Group, Cash Assistance
Status, and Type of Service, 1995
$16,000
Long-Term Care
Acute Care
$13,996
$14,000
$13,615
$12,000
$10,308
$10,000
$8,784
$8,000
$7,361
$6,000
$5,255
$4,000
$2,045 $2,123 $2,080
$2,000
$1,481 $1,417 $1,451
$0
Cash Other Total
Cash Other Total
Cash Other Total
Cash Other Total
Children
Adults
Blind &
Elderly
Disabled
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA -64 reports.
Does not include disproportionate share hospital payments. the U.S. Territories, accounting adjustments, or administrative costs. Beneficiaries are people
enrolled in the Medicaid program who actually receive medical services. "Cash" refers to individuals who receive AFDC or SSI. "Other" beneficiaries include
the medically needy, poverty-related expansion groups, and people eligible under Medicaid 1115 waivers. Payments to Medicare are included in spending for
the elderly, blind, and disabled. Payments to managed care organizations are included in spending for all groups, but most of these payments are for children
and adults; see Appendix C.
Page 22
Kaiser Commission on the Future of Medicaid
State Profiles, 1995
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
STATE PROFILES, 1995
The extent of Medicaid coverage within a state is
related to both poverty rates and program eligibility
guidelines. Louisiana, whose population is relatively
Medicaid's design-joint federal-state funding but
poor, provides Medicaid coverage to an above-
with states largely responsible for administration-
average percentage of all its residents but a below-
has led to wide variations among individual
average share of those with low-incomes. By con-
programs. Many factors influence each program's
trast, Connecticut, with a wealthier population than
size, scope and spending levels. Among these are
other states, provides Medicaid coverage to a
the state's demographic characteristics, poverty
smaller percentage of its residents, but a larger per-
rates, per capita income, cash assistance eligibility
centage of low-income residents.
thresholds, Medicaid eligibility outreach efforts,
provider participation rates and reimbursement
State policies on eligibility also differ significantly.
levels; and political environment.
Some states have expanded coverage for children
and pregnant women beyond the federally mandated
Beneficiaries
floor. Others have more restrictive eligibility levels for
AFDC and offer optional coverage to few categories
of individuals (Table B-3). These policies, combined
While totals varied from state to state, there were
with state demographics lead to variations in cover-
some patterns in the number and distribution of
age by states. Whereas, 51.5 percent of children in
Medicaid beneficiaries. Non-disabled children for
the District of Columbia were covered by Medicaid
example, were the largest group in almost every
for example, only 12.8 percent were covered in Colo-
state, accounting for nearly half of all beneficiaries
rado (Table 11).
nationwide. In New Mexico, children made up 60.2
percent of enrollment, in contrast to Oregon's 35.1
percent (Tables 8 and 9). Non-disabled adults gen-
Other variables that affect coverage of adults are the
erally were the second largest beneficiary group,
use of section 1115 waivers and AFDC eligibility lev-
averaging just under 23 percent of the national total.
els. Hawaii's and Tennessee's Medicaid programs
Medicaid programs in Hawaii, Oregon, and Tennes-
each covered 13.8 percent of all adults as a result of
see have higher shares of non-disabled adults be-
their 1115 waivers. Maryland covered only 2.3 per-
cause they used section 1115 waivers to extend
cent of adults. These factors also influenced the
coverage to certain people who typically are not eli-
proportion of Medicaid beneficiaries that were cov-
gible for Medicaid.1 Aged beneficiaries (65 and
ered because they received cash assistance through
older) usually represent the smallest eligibility group,
AFDC or SSI (Tables 12 through 16).
though this varies markedly from state to state. In
South Carolina for instance, the elderly accounted
Expenditures
for 15.5 percent of enrollment, compared with only
5.0 percent in Arizona.
As with the number and distribution of beneficiaries,
relative expenditure levels vary by state. In Con-
The impact of Medicaid on health care coverage
necticut and New Hampshire for example, less than
varies considerably from state to state. The number
9 percent of total Medicaid expenditures were paid
of Medicaid beneficiaries relative to a state's total
for children while in Alaska, Arizona, Florida and
population ranged from 6.8 percent in Nevada to
Utah more than one-quarter of spending was for kids
27.5 percent in Tennessee, averaging 13.4 percent
(Tables 17 and 18). DSH payments are particularly
nationally (Table 10, Figures 10 and 11). Medicaid,
divergent; some states report none (Tennessee,
however, played a more significant role for the low-
Wyoming) while others reported that 25 percent or
income population across all states, providing cover-
more of total Medicaid spending was for DSH pay-
age to more than half (53.8 percent) of all low-
ments (Louisiana, Missouri, and New Hampshire).
income people in the United States. In Nevada,
Despite these differences, some similarities are seen
Medicaid accounted for less than one-third (30.6
in state spending patterns. For instance, almost
percent) of all low-income persons. By contrast, in
every state spends more money on the aged, blind,
Tennessee the number of beneficiaries was greater
and disabled, who account for a relatively small
than the low-income population (104.4 percent).
2 When Tennessee obtained its 1115 waiver, the Health Care
Financing Administration allowed the state to fold DSH payments
1 More information about section 1115 waivers, also called re-
into overall program spending. The state stopped reporting DSH
search and demonstration waivers, is provided in Appendix C.
as a separate line item after the waiver went into effect.
Kaiser Commission on the Future of Medicaid
Page 25
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
share of total enrollment, than on younger adults and
A high federal matching rate does not always trans-
children.
late into more federal dollars either in total or on a
per beneficiary basis. Despite low federal matching
Another variable is the share of federal and state
rates, New England and Middle Atlantic states re-
dollars that go toward Medicaid. The federal gov-
ceived the most federal Medicaid funds per benefici-
ernment's share of Medicaid expenditures in 1995
ary because they invested more state dollars in their
was $86.9 billion, while states' obligations totaled
programs compared to other states. Connecticut,
almost $64.5 billion (Table 19). The amount of fed-
Massachusetts, New Hampshire, New Jersey, and
eral dollars each state receives depends on its
the District of Columbia-each with only 50 percent
choices regarding the size and scope of its Medicaid
matching rates-received more federal dollars per
program, the use of alternative financing mecha-
beneficiary than the national average in 1995 (Table
nisms, and the state's matching rate, called the fed-
21, Figure 12). On the other hand, states like Idaho,
eral medical assistance percentage, or FMAP.³
Kentucky, Mississippi, New Mexico, and Oklahoma
Each state's FMAP is based on per capita income
fell below the national average of federal funds de-
and ranges from 50 percent to nearly 79 percent
spite matching rates exceeding 70 percent.
(Table 19). Under this financing arrangement, 12
states and the District of Columbia receive one dollar
A look at federal and state shares of Medicaid
in federal funds for each dollar they spend; the re-
spending per capita and per low-income individual
maining 38 states receive more money.4 Mississippi,
reveals similar patterns. On a nationwide basis,
for example, gets about four dollars in federal reim-
Medicaid spent $579 per capita and $2,327 per low-
bursement for each dollar it spends.
income person (Tables 22 and 23). New England
and the Middle Atlantic states spent the most per
Average spending per beneficiary depends on fac-
capita and per low-income person. Seven states
tors like the comprehensiveness of the state's bene-
(Connecticut, Massachusetts, Maine, New Hamp-
fit package, the composition of the state's beneficiary
shire, New Jersey, New York and Rhode Island) and
population, and state-determined provider payment
the District of Columbia spent more than $3,500 per
rates.⁵ Nationally, federal and state Medicaid
low-income person, while Oklahoma and New Mex-
spending (excluding DSH payments) averaged
ico spent less than $1,200. Total federal shares
$3,789 per beneficiary (Table 20).⁸ Spending per
ranged from $683 in Nevada to over $2,450 in Con-
beneficiary was generally lower in East and West
necticut, Massachusetts, Rhode Island, and New
South Central, South Atlantic, Mountain and Pacific
York (Figures 13). State spending was even more
regions; near the national average in the East and
disparate, ranging from $297 per low-income person
West North Central regions; and higher in the New
in New Mexico to over $2,450 in Connecticut, Mas-
England and Mid Atlantic regions. Spending per
sachusetts, and New York (Figure 14).
child beneficiary ranged from $2,701 per child in
Massachusetts to $740 in Idaho. Spending for other
Expenditures by Type of Service
groups also showed wide variation across states,
especially for the elderly where spending per benefi-
Another way to examine Medicaid spending is by
ciary ranged $19,965 in Connecticut to $5,565 in
Tennessee.
major service category: acute care (including pay-
ments to MCOs and Medicare), long-term care, and
DSH payments (Tables 24 and 25). Spending for
acute care varied significantly across states, from a
quarter of the total in New Hampshire to more than
3
The FMAP, which is unique for each state and based on relative
two-thirds in Alaska, Arizona, New Mexico, and Ten-
per capital income, is that portion of Medicaid spending financed
nessee. The amount spent for acute care also var-
by the federal government.
ied considerably for the various beneficiary groups
4
The Balanced Budget Act of 1997 raised the District of Colum-
(Tables 26 and 27).
bia's FMAP from 50 percent to 70 percent (effective October
1997). Consequently, the District will pay a smaller share of its
future Medicaid costs.
To receive federal Medicaid matching payments,
5 Because of the large impact of DSH payments in selected
states must offer a minimum acute care benefit
states, spending is shown with and without these amounts.
package to their eligible populations. These services
6 This does not include DSH payments, administrative costs, or
include inpatient and outpatient hospital services,
accounting adjustments, none of which are spent directly on
physician services, rural health care, federally quali-
Medicaid beneficiaries. With DSH payments, the average is
equal to $4,328. Including accounting adjustments and admin-
fied health center services, laboratory and x-ray,
istrative costs raises the average to about $4,518 per beneficiary.
family planning and EPSDT. States can opt to cover
Page 26
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
additional optional acute care services and receive
and ranged from $144 in Minnesota to $1,231 in
federal reimbursement-including dental, vision
Connecticut.
care, hospice, clinic services, and case manage-
ment.⁷ State spending on such services varied
The final category of Medicaid spending is DSH
widely, averaging 23.5 percent of all acute care
payments, which were originally intended to assist
spending (Tables 28 and 29). This range was broad:
hospitals serving high volumes of uninsured and
Vermont, for example, spent 46.5 percent of its
Medicaid patients. Its rapid growth in recent years
acute care dollars on optional services, while Mary-
has sparked considerable controversy. The distribu-
land spent only 11.2 percent. Arizona and Hawaii
tion of total DSH payments was highly unequal
reported even less spending on optional services,
across states in 1995 (Table 46 and Figure 15 and
but these states cover some optional services
16). About half of all DSH payments were concen-
through payments to MCOs.
trated in five states-California, Louisiana, New Jer-
sey, New York and Texas. Certain states made dis-
Unlike acute care, long-term care spending for the
proportionately large DSH payments given the size
different beneficiary groups was relatively consistent
of their uninsured populations. For instance, New
with the elderly, blind, and disabled accounting for
Hampshire made DSH payments equal to $2,855 for
96.3% of the total (Tables 37 and 38). There is
every uninsured resident of the state. At the other
greater variation among states in spending for insti-
extreme, states like Arkansas and Montana had ex-
tutional long-term care. Nationally, more than 75
tremely limited DSH programs, and Wyoming re-
percent of Medicaid long-term care spending paid for
ported no DSH spending. The Balanced Budget Act
services provided in skilled nursing facilities and in-
of 1997 placed limits on aggregate DSH spending in
termediate care facilities for the mentally retarded
each state, essentially locking the existing variations
(Tables 39 and 40). In Oregon, however, institu-
in place.
tional care accounted for less than half (47.6 per-
cent) of long-term care spending with a nearly equal
amount (47.4 percent) going toward home health
care.
To expand access to care and limit spending growth,
many states have begun to enroll Medicaid benefici-
aries in managed care plans. Payments to managed
care organizations (MCOs) totaled $9.9 billion, or
12.5 percent of Medicaid acute care spending (Table
45). Despite rapidly rising enrollment in Medicaid
MCOs nationwide, figures varied substantially by
state. Indeed, twelve states reported very small or
no payments to MCOs in 1995. Some of these states
might have used managed care approaches such as
primary care case management. If they did not make
capitated payments to MCOs, then it would not be
reflected in the data.
Medicaid also makes premium and cost-sharing
payments to Medicare for low-income Medicare
beneficiaries who are eligible for both programs.
Total payments to Medicare in 1995 were highest in
California and Florida, both of which have large eld-
erly populations. Payments to Medicare averaged
$396 per elderly and disabled person nationwide,
7
In this report, payments to MCOs on behalf of Medicaid benefi-
ciaries are treated as mandatory spending. Health Maintenance
Organization benefits are likely to include some services consid-
ered to be optional in the basic Medicaid benefit package. This
will overstate the inclusion of mandatory services in states with
very high managed care penetration.
Kaiser Commission on the Future of Medicaid
Page 27
Beneficiaries
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 8
Medicaid Beneficiaries, by Group, 1995
Beneficiaries (thousands)
Blind &
Total
Children
Adults
Disabled
Elderly
United States
35,214
17,516
7,960
5,849
3,889
New England
1,603
732
349
298
223
Connecticut
366
178
86
49
53
Maine
177
81
36
37
22
Massachusetts
725
311
153
161
101
New Hampshire
102
50
23
12
17
Rhode Island
136
61
30
25
20
Vermont
97
51
21
15
10
Middle Atlantic
5,032
2,452
1,026
924
629
New Jersey
777
359
184
144
90
New York
3,024
1,521
622
511
371
Pennsylvania
1,230
573
221
269
167
South Atlantic
6,137
3,282
1,125
1,006
724
Delaware
78
44
16
13
6
District of Columbia
137
73
33
23
8
Florida
1,734
1,038
209
276
211
Georgia
1,138
600
244
190
104
Maryland
413
207
73
86
47
North Carolina
1,076
537
243
144
152
South Carolina
494
237
87
94
77
Virginia
678
364
123
106
85
West Virginia
389
183
96
75
35
East South Central
3,166
1,361
762
727
315
Alabama
537
247
88
131
71
Kentucky
622
277
126
156
63
Mississippi
519
250
77
126
67
Tennessee (1)
1,487
588
472
313
114
West South Central
4,036
2,149
819
559
509
Arkansas
350
152
58
87
53
Louisiana
761
376
143
146
97
Oklahoma
393
200
86
56
51
Texas
2,531
1,421
532
270
308
East North Central
5,235
2,664
1,163
896
512
Illinois
1,550
816
331
277
127
Indiana
557
309
115
67
66
Michigan
1,164
549
306
223
86
Ohio
1,505
781
330
224
169
Wisconsin
459
208
82
105
64
West North Central
2,009
1,013
441
302
253
lowa
304
141
75
50
38
Kansas
252
131
56
39
26
Minnesota
460
234
100
69
57
Missouri
695
348
157
98
93
Nebraska
163
92
27
23
21
North Dakota
61
29
13
9
11
South Dakota
73
38
13
13
9
Mountain
1,598
880
372
224
123
Arizona (1)
494
297
111
62
25
Colorado
293
130
77
49
37
Idaho
115
62
25
18
9
Montana
98
50
22
16
9
Nevada
105
54
23
16
11
New Mexico
283
170
58
37
17
Utah
160
88
44
19
9
Wyoming
51
28
11
6
6
Pacific
6,398
2,983
1,902
914
599
Alaska
68
39
18
7
4
California
4,942
2,322
1,392
742
486
Hawaii (1)
228
98
99
14
17
Oregon (1)
452
159
209
46
38
Washington
708
366
184
105
53
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Terntories Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ. HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state:
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 31
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 9
Distribution of Medicaid Beneficiaries, by Group, 1995
Blind &
Total
Children
Adults
Disabled
Elderly
United States
100.0%
49.7%
22.6%
16.6%
11.0%
New England
100.0%
45.7%
21.8%
18.6%
13.9%
Connecticut
100.0
48.6
23.6
13.3
14.5
Maine
100.0
46.0
20.6
20.7
12.7
Massachusetts
100.0
42.9
21,0
22.1
14.0
New Hampshire
100.0
49.0
22.5
11.9
16.6
Rhode Island
100.0
44.8
22.1
18.6
14.5
Vermont
100.0
52.6
21.9
15.1
10.4
Middle Atlantic
100.0%
48.7%
20.4%
18.4%
12.5%
New Jersey
100.0
46.2
23.6
18.5
11.6
New York
100.0
50.3
20.6
16.9
12.3
Pennsylvania
100.0
46.6
18.0
21.9
13.6
South Atlantic
100.0%
53.5%
18.3%
16.4%
11.8%
Delaware
100.0
55.8
20.2
16.2
7.8
District of Columbia
100.0
53.5
24.3
16.5
5.7
Florida
100.0
59.9
12.1
15.9
12.2
Georgia
100.0
52.7
21.4
16.7
9.1
Maryland
100.0
50.2
17.8
20.8
11.3
North Carolina
100.0
49.9
22.6
13.4
14.1
South Carolina
100.0
47.9
17.6
19.1
15.5
Virginia
100.0
53.7
18.2
15.6
12.6
West Virginia
100.0
47.1
24.8
19.2
8.9
East South Central
100.0%
43.0%
24.1%
23.0%
10.0%
Alabama
100.0
46.0
16.3
24.4
13.3
Kentucky
100.0
44.5
20.2
25.1
10.2
Mississippi
100.0
48.1
14.9
24.2
12.8
Tennessee (1)
100.0
39.5
31.7
21.1
7.7
West South Central
100.0%
53.2%
20.3%
13.9%
12.6%
Arkansas
100.0
43.5
16.5
25.0
15.0
Louisiana
100.0
49.4
18.7
19.1
12.7
Oklahoma
100.0
50.8
21.9
14.3
13.0
Texas
100.0
56.1
21.0
10.7
12.2
East North Central
100.0%
50.9%
22.2%
17.1%
9.8%
Illinois
100.0
52.6
21.3
17.9
8.2
Indiana
100.0
55.5
20.6
12.1
11.8
Michigan
100.0
47.2
26.3
19.1
7.4
Ohio
100.0
51.9
21.9
14.9
11.2
Wisconsin
100.0
45.4
17.9
22.8
14.0
West North Central
100.0%
50.4%
21.9%
15.0%
12.6%
lowa
100.0
46.5
24.7
16.5
12.4
Kansas
100.0
51.9
22.3
15.6
10.2
Minnesota
100.0
50.9
21.6
15.1
12.3
Missouri
100.0
50.1
22.5
14.0
13.4
Nebraska
100.0
56.5
16.6
14.2
12.7
North Dakota
100.0
46.7
21.4
14.2
17.6
South Dakota
100.0
51.8
17.8
18.2
12.2
Mountain
100.0%
55.0%
23.3%
14.0%
7.7%
Arizona (1)
100.0
60.1
22.5
12.5
5.0
Colorado
100.0
44.5
26.2
16.9
12.5
Idaho
100.0
54.3
21.5
16.1
8.1
Montana
100.0
51.3
22.9
16.6
9.2
Nevada
100.0
51.4
22.3
15.5
10.8
New Mexico
100.0
60.2
20.6
13.0
6.1
Utah
100.0
55.1
27.4
11.9
5.7
Wyoming
100.0
54.4
21.9
12.1
11.5
Pacific
100.0%
46.6%
29.7%
14.3%
9.4%
Alaska
100.0
57.0
26.6
9.8
6.6
California
100.0
47.0
28.2
15.0
9.8
Hawaii (1)
100.0
42.9
43.5
6.0
7.6
Oregon (1)
100.0
35.1
46.3
10.2
8.4
Washington
100.0
51.7
26.0
14.8
7.5
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Page 32
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 10
Medicaid Beneficiaries and Low-income Persons as a Percentage of State Population, 1995
Total
Low-Income
Medicaid
Total
Medicaid
Beneficiaries
Low-income
Persons as a
Beneficiaries as a
Population
Beneficiaries
as a % of
Population
% of State
% of Low-income
(thousands)
(thousands)
State Population
(thousands) (1)
Population (1)
Population (1)
United States
263,209
35,214
13.4%
65,498
24.9%
53.8%
New England
13,194
1,603
12.1%
2,480
18.8%
64.6%
Connecticut
3,240
366
11.3
579
17.9
63.2
Maine
1,214
177
14.5
253
20.8
69,9
Massachusetts
6,041
725
12.0
1,134
18.8
63.9
New Hampshire
1,137
102
9.0
183
16.1
55.8
Rhode Island
966
136
14.0
208
21.5
65,3
Vermont
595
97
16.4
123
20.7
78.9
Middle Atlantic
38,209
5,032
13.2%
8,782
23.0%
57.3%
New Jersey
7,916
777
9.8
1,372
17.3
56.6
New York
18,273
3,024
16.5
4,791
26.2
63.1
Pennsylvania
12,019
1,230
10.2
2,619
21.8
47.0
South Atlantic
46,880
6,137
13.1%
11,741
25.0%
52.3%
Delaware
698
78
11.2
132
18.9
59.3
District of Columbia
583
137
23.5
198
34.0
69.0
Florida
14,313
1,734
12.1
3,895
27.2
44.5
Georgia
7,254
1,138
15.7
1,858
25.6
61.2
Maryland
5,092
413
8.1
970
19.0
42.5
North Carolina
6,926
1,076
15.5
1,707
24.7
63.0
South Carolina
3,705
494
13.3
1,129
30.5
43.8
Virginia
6,506
678
10.4
1,289
19.8
52.6
West Virginia
1,802
389
21.6
562
31.2
69.2
East South Central
16,281
3,166
19.4%
4,804
29.5%
65.9%
Alabama
4,352
537
12.3
1,331
30.6
40.4
Kentucky
3,873
622
16.1
1,088
28.1
57.2
Mississippi
2,640
519
19.7
960
36.3
54.1
Tennessee (2)
5,416
1,487
27.5
1,425
26.3
104.4
West South Central
28,900
4,036
14.0%
8,965
31.0%
45.0%
Arkansas
2,474
350
14.1
751
30.3
46.6
Louisiana
4,339
761
17.5
1,542
35.6
49.4
Oklahoma
3,219
393
12.2
958
29.8
41.0
Texas
18,868
2,531
13.4
5,714
30.3
44.3
East North Central
43,601
5,235
12.0%
9,291
21.3%
56.4%
Illinois
11,821
1,550
13.1
2,659
22.5
58.3
Indiana
5,837
557
9.6
1,244
21.3
44.8
Michigan
9,583
1,164
12.1
2,072
21.6
56.2
Ohio
11,196
1,505
13.4
2,468
22.0
61.0
Wisconsin
5,164
459
8.9
847
16.4
54.2
West North Central
18,108
2,009
11.1%
3,932
21.7%
51.1%
lowa
2,857
304
10.6
590
20.7
51.4
Kansas
2,533
252
9.9
635
25.1
39.6
Minnesota
4,562
460
10.1
875
19.2
52.6
Missouri
5,143
695
13.5
1,190
23.1
58.4
Nebraska
1,651
163
9.9
312
18.9
52.4
North Dakota
633
61
9.7
145
22.9
42.3
South Dakota
728
73
10.1
185
25.4
39.8
Mountain
15,815
1,598
10.1%
3,883
24.6%
41.2%
Arizona (2)
4,290
494
11.5
1,262
29.4
39.1
Colorado
3,779
293
7.7
631
16.7
46.4
Idaho
1,146
115
10.0
280
24.5
41.0
Montana
859
98
11.4
218
25.4
44.7
Nevada
1,543
105
6.8
342
22.1
30.6
New Mexico
1,747
283
16.2
649
37.1
43.6
Utah
1,965
160
8.2
393
20.0
40.8
Wyoming
484
51
10.6
108
22.4
47.3
Pacific
42,223
6,398
15.2%
11,621
27.5%
55.1%
Alaska
611
68
11.1
133
21.7
51.3
California
31,924
4,942
15.5
9,356
29.3
52.8
Hawaii (2)
1,147
228
19.9
275
23.9
83.1
Oregon (2)
3,193
452
14.2
709
22.2
63.8
Washington
5,348
708
13.2
1,149
21.5
61.6
Source: Urban Institute calculations based on data from HCFA-2082 reports and the March 1996 Current Population Survey.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services.
(1) Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made
to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 33
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 10
Medicaid Beneficiaries as a Percentage of State Population, 1995
RI
DE
DC
< 10.0% (11 states)
10.0 - 14.9% (27)
15.0-19.9% (10)
20.0% + (3)
Source: Urban Institute calculations based on data from HCFA-2082 reports and the March 1996 Current Population Survey.
Does not include the U.S. Territories. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. For certain states with
active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received direcity from the state: adjustments were made
to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 34
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 11
Medicaid Beneficiaries as a Percentage of Low-income Population, 1995*
RI
DE
DC
< 44.9% (16 states)
45 - 59.9 % (20)
60 - 74.9% (12)
75% + (3)
Source: Urban Institute calculations based on data from HCFA-2082 reports and the March 1996 Current Population Survey.
Does not include the U.S. Territories. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. For certain states with
active 1115 waivers (AZ, HI. OR, TN), expenditure and beneficiary data were supplemented with data received direcity from the state; adjustments were made to
categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
*Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
Kaiser Commission on the Future of Medicaid
Page 35
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 11
Medicaid Beneficiaries as a Percentage of State Population, by Group, 1995
Children
Adults
Elderly
Beneficiaries
Residents
Percentage
Residents
Percentage
Residents
Percentage
(thousands) (1)
(thousands)
on Medicaid
(thousands)
on Medicaid
(thousands)
on Medicaid
United States
35,214
70,828
24.7%
160,918
4.9%
31,463
12.4%
New England
1,603
3,250
22.5%
8,217
4.3%
1,727
12.9%
Connecticut
366
818
21.7
1,956
4.4
466
11.4
Maine
177
288
28.2
762
4.8
164
13.7
Massachusetts
725
1,460
21.3
3,843
4.0
739
13.7
New Hampshire
102
285
17.5
711
3.2
140
12.1
Rhode Island
136
234
25.9
578
5.2
154
12.7
Vermont
97
163
31.3
367
5.8
64
15.7
Middle Atlantic
5,032
9,797
25.0%
23,339
4.4%
5,072
12.4%
New Jersey
777
2,018
17.8
4,895
3.8
1,004
9.0
New York
3,024
4,763
31.9
11,177
5.6
2,334
15.9
Pennsylvania
1,230
3,017
19.0
7,267
3.0
1,735
9.7
South Atlantic
6,137
11,761
27.9%
28,989
3.9%
6,129
11.8%
Delaware
78
164
26.6
454
3.5
80
7.6
District of Columbia
137
142
51.5
376
8.8
64
12.1
Florida
1,734
3,554
29.2
8,408
2.5
2,351
9.0
Georgia
1,138
1,991
30.1
4,505
5.4
757
13.7
Maryland
413
1,322
15.7
3,166
2.3
604
7.7
North Carolina
1,076
1,574
34.1
4,454
5.5
898
17.0
South Carolina
494
1,013
23.3
2,290
3.8
401
19.1
Virginia
678
1,609
22.6
4,211
2.9
686
12.4
West Virginia
389
392
46.7
1,123
8.6
287
12.1
East South Central
3,166
4,400
30.9%
9,931
7.7%
1,950
16.2%
Alabama
537
1,200
20.6
2,564
3.4
588
12.1
Kentucky
622
1,019
27.2
2,360
5.3
494
12.8
Mississippi
519
729
34.2
1,592
4.9
318
20.9
Tennessee (2)
1,487
1,451
40.5
3,415
13.8
549
20.8
West South Central
4,036
8,359
25.7%
17,574
4.7%
2,967
17.2%
Arkansas
350
643
23.7
1,512
3.8
320
16.5
Louisiana
761
1,229
30.6
2,661
5.4
449
21.6
Oklahoma
393
849
23.5
1,955
4.4
415
12.4
Texas
2,531
5,637
25.2
11,447
4.7
1,784
17.3
East North Central
5,235
11,996
22.2%
26,396
4.4%
5,210
9.8%
Illinois
1,550
3,218
25.4
7,220
4.6
1,384
9.2
Indiana
557
1,610
19.2
3,498
3.3
729
9.0
Michigan
1,164
2,655
20.7
5,748
5.3
1,179
7.3
Ohio
1,505
3,065
25.5
6,741
4.9
1,389
12.2
Wisconsin
459
1,448
14.4
3,189
2.6
527
12.1
West North Central
2,009
4,882
20.7%
10,978
4.0%
2,247
11.3%
lowa
304
800
17.6
1,666
4.5
390
9.6
Kansas
252
699
18.7
1,529
3.7
305
8.4
Minnesota
460
1,272
18.4
2,810
3.5
480
11.8
Missouri
695
1,231
28.3
3,201
4.9
711
13.1
Nebraska
163
480
19.2
984
2.8
187
11.1
North Dakota
61
180
15.9
371
3.5
82
13.1
South Dakota
73
220
17.2
416
3.1
91
9.8
Mountain
1,598
4,574
19.2%
9,550
3.9%
1,691
7.3%
Arizona (2)
494
1,224
24.2
2,540
4.4
527
4.7
Colorado
293
1,020
12.8
2,450
3.1
309
11.8
Idaho
115
325
19.2
692
3.6
129
7.2
Montana
98
224
22.3
514
4.4
121
7.4
Nevada
105
399
13.5
958
2.4
186
6.1
New Mexico
283
556
30.6
1,003
5.8
188
9.3
Utah
160
687
12.9
1,090
4.0
188
4.9
Wyoming
51
139
20.1
303
3.7
42
14.0
Pacific
6,398
11,810
25.3%
25,944
7.3%
4,469
13.4%
Alaska
68
196
19.8
391
4.6
24
18.7
California
4,942
9,101
25.5
19,436
7.2
3,387
14.4
Hawaii (2)
228
280
34.9
722
13.8
145
12.0
Oregon (2)
452
851
18.6
1,980
10.6
362
10.4
Washington
708
1,381
26.5
3,415
5.4
552
9.6
Source: Urban Institute calculations based on data from HCFA-2082 reports and the March 1996 Current Population Survey.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding.
(1) Includes blind and disabled beneficiaries
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 36
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 12
Medicaid Beneficiaries, by Cash Assistance Status, 1995
Total
Cash Assistance
Other Assistance
% of Total
% of Total
% of Total
Beneficiaries
Beneficiaries
Beneficiaries
(thousands)
in the State
(thousands)
in the State
(thousands)
in the State
United States
35,214
100.0%
19,737
56.0%
15,477
44.0%
New England
1,603
100.0%
943
58.8%
660
41.2%
Connecticut (1)
366
100.0
218
59.7
147
40.3
Maine
177
100.0
89
50.6
87
49.4
Massachusetts
725
100.0
434
59.9
291
40.1
New Hampshire (1)
102
100.0
66
64.5
36
35.5
Rhode Island
136
100.0
92
67.9
43
32.1
Vermont
97
100.0
43
44.1
54
55.9
Middle Atlantic
5,032
100.0%
3,157
62.7%
1,875
37.3%
New Jersey
777
100.0
484
62.3
293
37.7
New York
3,024
100.0
2,030
67.1
994
32.9
Pennsylvania
1,230
100.0
642
52.2
588
47.8
South Atlantic
6,137
100.0%
3,347
54.5%
2,790
45.5%
Delaware
78
100.0
41
52.4
37
47.6
District of Columbia
137
100.0
112
82.2
24
17.8
Florida
1,734
100.0
1,008
58.1
726
41.9
Georgia
1,138
100.0
600
52.7
538
47.3
Maryland
413
100.0
233
56.4
180
43.6
North Carolina (1)
1,076
100.0
522
48.5
554
51.5
South Carolina
494
100.0
257
52.0
237
48.0
Virginia
678
100.0
351
51.7
327
48.3
West Virginia
389
100.0
223
57.5
165
42.5
East South Central
3,166
100.0%
1,650
52.1%
1,516
47.9%
Alabama
537
100.0
293
54.4
245
45.6
Kentucky
622
100.0
366
58.9
256
41.1
Mississippi
519
100.0
323
62.3
196
37.7
Tennessee (2)
1,487
100.0
668
44.9
820
55.1
West South Central
4,036
100.0%
2,086
51.7%
1,949
48.3%
Arkansas
350
100.0
184
52.7
165
47.3
Louisiana
761
100.0
440
57.8
321
42.2
Oklahoma
393
100.0
230
58.4
164
41.6
Texas
2,531
100.0
1,232
48.7
1,299
51.3
East North Central
5,235
100.0%
3,040
58.1%
2,196
41.9%
Illinois
1,550
100.0
891
57.5
659
42.5
Indiana
557
100.0
310
55.7
247
44.3
Michigan
1,164
100.0
716
61.5
448
38.5
Ohio (1)
1,505
100.0
868
57.7
637
42.3
Wisconsin
459
100.0
255
55.5
204
44.5
West North Central
2,009
100.0%
985
49.0%
1,024
51.0%
lowa
304
100.0
159
52.5
144
47.5
Kansas
252
100.0
122
48.3
130
51.7
Minnesota
460
100.0
232
50.5
228
49.5
Missouri
695
100.0
346
49.8
349
50.2
Nebraska
163
100.0
65
39.9
98
60.1
North Dakota
61
100.0
27
43.7
34
56.3
South Dakota
73
100.0
34
45.9
40
54.1
Mountain
1,598
100.0%
811
50.7%
788
49.3%
Arizona (2)
494
100.0
264
53.4
230
46.6
Colorado
293
100.0
158
54.0
135
46.0
Idaho
115
100.0
40
34.5
75
65.5
Montana
98
100.0
53
54.2
45
45.8
Nevada
105
100.0
47
44.7
58
55.3
New Mexico
283
100.0
169
59.6
114
40.4
Utah
160
100.0
58
36.4
102
63.6
Wyoming
51
100.0
23
44.2
29
55.8
Pacific
6,398
100.0%
3,718
58.1%
2,680
41.9%
Alaska
68
100.0
44
64.6
24
35.4
California
4,942
100.0
2,995
60.6
1,947
39.4
Hawaii (1.2)
228
100.0
104
45.7
124
54.3
Oregon (2)
452
100.0
172
38.0
280
62.0
Washington
708
100.0
403
57.0
305
43.0
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding. "Cash assistance" refers to beneficiaries who receive AFDC or SSI.
"Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible under Medicaid 1115 waivers.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states.
Corrections were made where possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled
beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the
state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See
Appendix C.
Kaiser Commission on the Future of Medicaid
Page 37
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 13
Medicaid Child Beneficiaries, by Cash Assistance Status, 1995
Total
Cash Assistance
Other Assistance
% of Child
% of Child
% of Child
Beneficiaries
Beneficiaries
Beneficiaries
(thousands)
in the State
(thousands)
in the State
(thousands)
in the State
United States
17,516
100.0%
9,189
52.5%
8,327
47.5%
New England
732
100.0%
444
60.7%
288
39.3%
Connecticut
178
100.0
120
67.6
58
32.4
Maine
81
100.0
36
44.4
45
55.6
Massachusetts
311
100.0
187
60.1
124
39.9
New Hampshire
50
100.0
39
77.3
11
22.7
Rhode Island
61
100.0
45
73.5
16
26.5
Vermont
51
100.0
18
35,0
33
65.0
Middle Atlantic
2,452
100.0%
1,510
61.6%
942
38.4%
New Jersey
359
100.0
217
60.3
142
39.7
New York
1,521
100.0
1,016
66.8
505
33.2
Pennsylvania
573
100.0
278
48.5
295
51.5
South Atlantic
3,282
100.0%
1,635
49.8%
1,647
50.2%
Delaware
44
100.0
20
46.0
24
54.0
District of Columbia
73
100.0
62
84.6
11
15.4
Florida
1,038
100.0
548
52.7
491
47.3
Georgia
600
100.0
269
44.8
331
55.2
Maryland
207
100.0
109
52.5
98
47.5
North Carolina
537
100.0
278
51.8
259
48.2
South Carolina
237
100.0
104
44.0
133
56.0
Virginia
364
100.0
152
41.8
212
58.2
West Virginia
183
100.0
94
51.1
89
48.9
East South Central
1,361
100.0%
581
42.7%
781
57.3%
Alabama
247
100.0
87
35.1
160
64.9
Kentucky
277
100.0
131
47.2
146
52.8
Mississippi
250
100.0
121
48.5
129
51.5
Tennessee (1)
588
100.0
242
41.2
346
58.8
West South Central
2,149
100.0%
922
42.9%
1,227
57.1%
Arkansas
152
100.0
63
41.5
89
58.5
Louisiana
376
100.0
188
49.9
188
50.1
Oklahoma
200
100.0
111
55.8
88
44.2
Texas
1,421
100.0
559
39.4
861
60.6
East North Central
2,664
100.0%
1,549
58.2%
1,115
41.8%
Illinois
816
100.0
480
58.9
336
41.1
Indiana
309
100.0
169
54.7
140
45.3
Michigan
549
100.0
338
61.4
212
38.6
Ohio
781
100.0
476
60.9
306
39.1
Wisconsin
208
100.0
86
41.5
122
58.5
West North Central
1,013
100.0%
477
47.1%
536
52.9%
lowa
141
100.0
71
50.2
70
49.8
Kansas
131
100.0
64
48.9
67
51.1
Minnesota
234
100.0
122
52.0
112
48.0
Missouri
348
100.0
168
48.4
180
51.6
Nebraska
92
100.0
28
30.4
64
69.6
North Dakota
29
100.0
10
36.0
18
64.0
South Dakota
38
100.0
14
36.0
24
64.0
Mountain
880
100.0%
403
45.8%
477
54.2%
Arizona (1)
297
100.0
135
45.7
161
54.3
Colorado
130
100.0
70
53.7
60
46.3
Idaho
62
100.0
19
30.9
43
69.1
Montana
50
100.0
25
50.7
25
49.3
Nevada
54
100.0
27
49.6
27
50.4
New Mexico
170
100.0
87
50.9
84
49.1
Utah
88
100.0
28
32.1
60
67.9
Wyoming
28
100.0
11
40.8
17
59.2
Pacific
2,983
100.0%
1,668
55.9%
1,315
44.1%
Alaska
39
100.0
26
66.9
13
33.1
California
2,322
100.0
1,295
55.8
1,027
44.2
Hawaii (1)
98
100.0
61
62.6
37
37.4
Oregon (1)
159
100.0
95
59.9
64
40.1
Washington
366
100.0
191
52.1
175
47.9
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding. Child beneficiaries are non-disabled individuals under 18. "Cash assistance"
refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy. poverty-related expansion groups, and people eligible under
Medicaid 1115 waivers.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Page 38
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 14
Medicaid Adult Beneficiaries, by Cash Assistance Status, 1995
Total
Cash Assistance
Other Assistance
% of Adult
% of Adult
% of Adult
Beneficiaries
Beneficiaries
Beneficiaries
(thousands)
in the State
(thousands)
in the State
(thousands)
in the State
United States
7,960
100.0%
4,389
55.1%
3,571
44.9%
New England
349
100.0%
239
68.3%
111
31.7%
Connecticut
86
100.0
61
71.1
25
28.9
Maine
36
100.0
22
60.3
14
39.7
Massachusetts
153
100.0
104
68.1
49
31.9
New Hampshire
23
100.0
17
76.0
6
24.0
Rhode Island
30
100.0
23
75.3
7
24.7
Vermont
21
100.0
11
52.8
10
47.2
Middle Atlantic
1,026
100.0%
680
66.3%
346
33.7%
New Jersey
184
100.0
114
62.1
70
37.9
New York
622
100.0
438
70.5
183
29.5
Pennsylvania
221
100.0
127
57.7
93
42.3
South Atlantic
1,125
100.0%
661
58.7%
464
41.3%
Delaware
16
100.0
9
56.2
7
43.8
District of Columbia
33
100.0
29
87.1
4
12.9
Florida
209
100.0
136
64.9
74
35.1
Georgia
244
100.0
124
50.9
120
49.1
Maryland
73
100.0
47
64.2
26
35.8
North Carolina
243
100.0
147
60.5
96
39.5
South Carolina
87
100.0
38
43.9
49
56.1
Virginia
123
100.0
73
59.4
50
40.6
West Virginia
96
100.0
57
59.4
39
40.6
East South Central
762
100.0%
276
36.2%
487
63.8%
Alabama
88
100.0
41
46.3
47
53.7
Kentucky
126
100.0
65
51.7
61
48.3
Mississippi
77
100.0
53
69.1
24
30.9
Tennessee (1)
472
100.0
117
24.8
355
75.2
West South Central
819
100.0%
402
49.1%
417
50.9%
Arkansas
58
100.0
22
37.4
36
62.6
Louisiana
143
100.0
76
53.0
67
47.0
Oklahoma
86
100.0
44
51.2
42
48.8
Texas
532
100.0
261
49.0
272
51.0
East North Central
1,163
100.0%
764
65.7%
399
34.3%
Illinois
331
100.0
202
61.1
129
38.9
Indiana
115
100.0
89
77.2
26
22.8
Michigan
306
100.0
184
60.2
122
39.8
Ohio
330
100.0
236
71.6
94
28.4
Wisconsin
82
100.0
53
65.2
29.
34.8
West North Central
441
100.0%
244
55.5%
196
44.5%
lowa
75
100.0
42
55.8
33
44.2
Kansas
56
100.0
33
59.0
23
41.0
Minnesota
100
100.0
54
54.3
45
45.7
Missouri
157
100.0
89
56.5
68
43.5
Nebraska
27
100.0
14
52.3
13
47.7
North Dakota
13
100.0
6
48.3
7
51.7
South Dakota
13
100.0
6
48.4
7
51.6
Mountain
372
100.0%
193
51.9%
179
48.1%
Arizona (1)
111
100.0
61
55.3
50
44.7
Colorado
77
100.0
35
45.4
42
54.6
Idaho
25
100.0
9
38.2
15
61.8
Montana
22
100.0
12
54.0
10
46.0
Nevada
23
100.0
13
57.0
10
43.0
New Mexico
58
100.0
40
68.6
18
31.4
Utah
44
100.0
16
37.5
27
62.5
Wyoming
11
100.0
5
46.5
6
53.5
Pacific
1,902
100.0%
931
48.9%
972
51.1%
Alaska
18
100.0
12
66.9
6
33.1
California
1,392
100.0
738
53.0
654
47.0
Hawaii (1)
99
100.0
32
32.4
67
67.6
Oregon (1)
209
100.0
42
20.2
167
79.8
Washington
184
100.0
106
57.9
78
42.1
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Terntones Figures may not sum to totals due to rounding. Adult beneficiaries are non-disabled individuals between 19 and 64. "Cash
assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people
eligible under Medicaid 1115 waivers
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state:
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 39
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 15
Medicaid Blind and Disabled Beneficiaries by Cash Assistance Status, 1995
Total
Cash Assistance
Other Assistance
% of Blind
% of Blind
% of Blind
and Disabled
and Disabled
and Disabled
Beneficiaries
Beneficiaries
Beneficiaries
(thousands)
in the State
(thousands)
in the State
(thousands)
in the State
United States
5,849
100.0%
4,518
77.2%
1,331
22.8%
New England
298
100.0%
206
69.2%
92
30.8%
Connecticut (1)
49
100.0
27
55.8
22
44.2
Maine
37
100.0
25
69.1
11
30.9
Massachusetts
161
100.0
116
72.6
44
27.4
New Hampshire (1)
12
100.0
7
55.8
5
44.2
Rhode Island
25
100.0
20
77.7
6
22.3
Vermont
15
100.0
11
73.1
4
26.9
Middle Atlantic
924
100.0%
693
75.0%
231
25.0%
New Jersey
144
100.0
118
81.7
26
18.3
New York
511
100.0
400
78.3
111
21.7
Pennsylvania
269
100.0
175
65.2
94
34.8
South Atlantic
1,006
100.0%
750
74.5%
256
25.5%
Delaware
13
100.0
10
77.0
3
23.0
District of Columbia
23
100.0
18
79.1
5
20.9
Florida
276
100.0
228
82.6
48
17.4
Georgia
190
100.0
161
84.5
29
15.5
Maryland
86
100.0
59
68.5
27
31.5
North Carolina (1)
144
100.0
58
40.4
86
59.6
South Carolina
94
100.0
75
79.2
20
20.8
Virginia
106
100.0
86
81.0
20
19.0
West Virginia
75
100.0
56
75.2
19
24.8
East South Central
727
100.0%
636
87.5%
91
12.5%
Alabama
131
100.0
126
95.6
6
4.4
Kentucky
156
100.0
142
90.8
14
9.2
Mississippi
126
100.0
113
89.9
13
10.1
Tennessee (2)
313
100.0
256
81.6
58
18.4
West South Central
559
100.0%
489
87.4%
71
12.6%
Arkansas
87
100.0
77
88.4
10
11.6
Louisiana
146
100.0
125
85.8
21
14.2
Oklahoma
56
100.0
47
83.3
9
16.7
Texas
270
100.0
240
88.7
30
11.3
East North Central
896
100.0%
610
68.1%
286
31.9%
Illinois
277
100.0
182
65.8
95
34.2
Indiana
67
100.0
37
55.4
30
44.6
Michigan
223
100.0
170
76.4
53
23.6
Ohio (1)
224
100.0
125
55.8
99
44.2
Wisconsin
105
100.0
95
90.9
9
9.1
West North Central
302
100.0%
201
66.6%
101
33.4%
lowa
50
100.0
38
75.4
12
24.6
Kansas
39
100.0
23
58.9
16
41.1
Minnesota
69
100.0
44
63.0
26
37.0
Missouri
98
100.0
62
63.6
36
36.4
Nebraska
23
100.0
17
72.7
6
27.3
North Dakota
9
100.0
6
71.7
2
28.3
South Dakota
13
100.0
11
82.5
2
17.5
Mountain
224
100.0%
157
70.2%
67
29.8%
Arizona (2)
62
100.0
56
90.7
6
9.3
Colorado
49
100.0
29
58.1
21
41.9
Idaho
18
100.0
9
47.2
10
52.8
Montana
16
100.0
13
80.8
3
19.2
Nevada
16
100.0
3
15.9
14
84.1
New Mexico
37
100.0
33
89.1
4
10.9
Utah
19
100.0
11
56.6
8
43.4
Wyoming
6
100.0
5
74.4
2
25.6
Pacific
914
100.0%
776
84.9%
138
15.1%
Alaska
7
100.0
5
69.3
2
30.7
California
742
100.0
655
88.3
87
11.7
Hawaii (1.2)
14
100.0
8
55.8
6
44.2
Oregon (2)
46
100.0
22
48.2
24
51.8
Washington
105
100.0
86
82.1
19
17.9
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories Figures may not sum to totals due to rounding. The blind and disabled beneficiary group includes individuals who,
regardless of age, qualify for Medicaid because of disability. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries"
include the medically needy. poverty-related expansion groups, and people eligible under Medicaid 1115 waivers.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states.
Corrections were made where possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled
beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ. HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from
the state: adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration
See Appendix C.
Page 40
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 16
Medicaid Elderly Beneficiaries, by Cash Assistance Status, 1995
Total
Cash Assistance
Other Assistance
% of Elderly
% of Elderly
% of Elderly
Beneficiaries
Beneficiaries
Beneficiaries
(thousands)
in the State
(thousands)
in the State
(thousands)
in the State
United States
3,889
100.0%
1,640
42.2%
2,248
57.8%
New England
223
100.0%
54
24.2%
169
75.8%
Connecticut (1)
53
100.0
10
18.2
43
81.8
Maine
22
100.0
6
26.8
16
73.2
Massachusetts
101
100.0
27
26.8
74
73.2
New Hampshire (1)
17
100.0
3
17.7
14
82.3
Rhode Island
20
100.0
5
26.6
14
73.4
Vermont
10
100.0
3
29.8
7
70.2
Middle Atlantic
629
100.0%
274
43.5%
356
56.5%
New Jersey
90
100.0
35
39.3
55
60.7
New York
371
100.0
176
47.4
195
52.6
Pennsylvania
167
100.0
62
36.9
106
63.1
South Atlantic
724
100.0%
302
41.7%
422
58.3%
Delaware
6
100.0
2
38.0
4
62.0
District of Columbia
8
100.0
4
46.7
4
53.3
Florida
211
100.0
97
46.0
114
54.0
Georgia
104
100.0
46
44.4
58
55.6
Maryland
47
100.0
18
39.1
28
60.9
North Carolina (1)
152
100.0
39
25.3
114
74.7
South Carolina
77
100.0
40
52.5
36
47.5
Virginia
85
100.0
40
46.6
46
53.4
West Virginia
35
100.0
16
47.2
18
52.8
East South Central
315
100.0%
157
49.7%
159
50.3%
Alabama
71
100.0
40
55.6
32
44.4
Kentucky
63
100.0
29
45.4
34
54.6
Mississippi
67
100.0
36
53.7
31
46.3
Tennessee (2)
114
100.0
53
46.1
62
53.9
West South Central
509
100.0%
274
53.8%
235
46.2%
Arkansas
53
100.0
22
42.7
30
57.3
Louisiana
97
100.0
52
53.7
45
46.3
Oklahoma
51
100.0
27
53.3
24
46.7
Texas
308
100.0
172
55.8
136
44.2
East North Central
512
100.0%
116
22.7%
396
77.3%
Illinois
127
100.0
27
21.1
100
78.9
Indiana
66
100.0
15
22.8
51
77.2
Michigan
86
100.0
24
28.0
62
72.0
Ohio (1)
169
100.0
31
18.2
138
81.8
Wisconsin
64
100.0
20
30.7
44
69.3
West North Central
253
100.0%
62
24.6%
191
75.4%
lowa
38
100.0
9
23.6
29
76.4
Kansas
26
100.0
1
5.5
24
94.5
Minnesota
57
100.0
13
22.3
44
77.7
Missouri
93
100.0
27
28.8
66
71.2
Nebraska
21
100.0
6
29.4
15
70.6
North Dakota
11
100.0
4
36.0
7
64.0
South Dakota
9
100.0
3
29.3
6
70.7
Mountain
123
100.0%
58
46.8%
66
53.2%
Arizona (2)
25
100.0
11
44.7
14
55.3
Colorado
37
100.0
25
67.8
12
32.2
Idaho
9
100.0
2
23.6
7
76.4
Montana
9
100.0
2
25.6
7
74.4
Nevada
11
100.0
4
37.3
7
62.7
New Mexico
17
100.0
9
51.6
8
48.4
Utah
9
100.0
3
30.1
6
69.9
Wyoming
6
100.0
1
23.6
5
76.4
Pacific
599
100.0%
344
57.4%
255
42.6%
Alaska
4
100.0
1
27.8
3
72.2
California
486
100.0
307
63.2
179
36.8
Hawaii (1,2)
17
100.0
3
17.7
14
82.3
Oregon (2)
38
100.0
12
31.9
26
68.1
Washington
53
100.0
20
37.6
33
62.4
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding. Elderly beneficiaries are people aged 65 and over. The elderly most
likely include some disabled individuals who have spent down their assets to become Medicaid eligible and were not onginally considered disabled. "Cash
assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and
people eligible under Medicaid 1115 waivers.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states.
Corrections were made where possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled
beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the
state; adjustments were made to categonze these numbers in the same manner as other states report to the Health Care Financing Administration See
Appendix C.
Kaiser Commission on the Future of Medicaid
Page 41
Expenditures
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 17
Medicaid Expenditures, by Group, 1995
Expenditures (millions)
Blind &
Total
Children
Adults
Disabled
Elderly
DSH
United States
$152,423
$25,411
$16,557
$51,379
$40,087
$18,988
New England
$11,571
$1,425
$802
$3,978
$3,603
$1,763
Connecticut
2,838
252
178
901
1,057
450
Maine
949
110
71
308
295
165
Massachusetts
5,600
840
414
2,098
1,639
610
New Hampshire
848
74
42
176
228
329
Rhode Island
999
100
67
368
292
171
Vermont
336
49
30
128
91
37
Middle Atlantic
$35,853
$5,055
$2,730
$12,378
$10,695
$4,995
New Jersey
5,391
501
518
1,802
1,283
1,287
New York
23,525
3,407
1,761
8,478
6,962
2,917
Pennsylvania
6,937
1,146
451
2,098
2,450
792
South Atlantic
$22,501
$4,562
$2,587
$7,635
$5,716
$2,001
Delaware
334
65
36
145
81
7
District of Columbia
793
140
74
343
185
50
Florida
6,134
1,630
506
1,909
1,755
334
Georgia
3,581
644
616
1,263
649
410
Maryland
2,465
545
240
944
575
160
North Carolina
3,891
688
582
1,142
1,050
429
South Carolina
2,016
279
169
684
445
440
Virginia
2,058
363
194
704
653
145
West Virginia
1,227
208
171
501
322
25
East South Central
$9,016
$1,400
$1,442
$3,324
$2,029
$820
Alabama
1,954
223
185
630
498
417
Kentucky
2,155
292
276
871
495
220
Mississippi
1,524
246
139
556
400
183
Tennessee (1)
3,383
638
842
1,267
636
0
West South Central
$15,150
$2,543
$1,805
$4,377
$3,625
$2,800
Arkansas
1,205
194
81
547
381
3
Louisiana
4,117
516
346
1,241
749
1,265
Oklahoma
1,130
246
112
400
353
18
Texas
8,698
1,587
1,267
2,188
2,143
1,513
East North Central
$22,188
$3,987
$2,110
$8,172
$6,029
$1,891
Illinois
5,986
1,170
629
2,643
1,131
413
Indiana
2,529
408
204
762
756
398
Michigan
5,114
983
623
1,939
1,131
438
Ohio
6,143
970
504
1,955
2,083
630
Wisconsin
2,416
454
150
873
927
12
West North Central
$8,894
$1,422
$739
$3,043
$2,848
$843
lowa
1,179
237
136
473
329
5
Kansas
945
137
95
372
267
74
Minnesota
2,749
507
240
1,011
967
24
Missouri
2,765
343
182
701
810
729
Nebraska
640
124
43
226
238
9
North Dakota
300
33
20
118
128
1
South Dakota
316
41
23
142
109
1
Mountain
$5,761
$1,238
$797
$1,954
$1,206
$565
Arizona (1)
1,601
466
260
477
275
122
Colorado
1,525
220
168
447
335
355
Idaho
338
46
41
156
91
4
Montana
360
45
32
144
138
<1
Nevada
464
99
56
151
84
74
New Mexico
745
185
105
313
135
7
Utah
555
147
110
197
98
3
Wyoming
172
29
24
67
51
0
Pacific
$21,489
$3,779
$3,545
$6,518
$4,337
$3,311
Alaska
303
89
57
87
52
18
California
16,188
2,799
2,401
4,879
3,195
2,915
Hawaii (1)
730
160
296
111
162
1
Oregon (1)
1,438
261
360
469
321
28
Washington
2,830
470
432
973
607
348
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5
billion in 1995. Figures may not sum to totals due to rounding. "DSH" refers to disproportionate share hospital payments. States do not report
payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare were distributed among the
aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
(1) For certain states with active 1115 waivers (AZ. HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly
from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing
Administration. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 45
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 18
Distribution of Medicaid Expenditures, by Group, 1995
Blind &
Total
Children
Adults
Disabled
Elderly
DSH
United States
100.0%
16.7%
10.9%
33.7%
26.3%
12.5%
New England
100.0%
12.3%
6.9%
34.4%
31.1%
15.2%
Connecticut
100.0
8.9
6.3
31.8
37.2
15.9
Maine
100.0
11.6
7.4
32.4
31.1
17.4
Massachusetts
100.0
15.0
7.4
37.5
29.3
10.9
New Hampshire
100.0
8.8
4.9
20.7
26.9
38.7
Rhode Island
100.0
10.0
6.8
36.8
29.3
17.2
Vermont
100.0
14.6
9.0
38.1
27.2
11.1
Middle Atlantic
100.0%
14.1%
7.6%
34.5%
29.8%
13.9%
New Jersey
100.0
9.3
9.6
33.4
23.8
23.9
New York
100.0
14.5
7.5
36.0
29.6
12.4
Pennsylvania
100.0
16.5
6.5
30.2
35.3
11.4
South Atlantic
100.0%
20.3%
11.5%
33.9%
25.4%
8.9%
Delaware
100.0
19.4
10.7
43.5
24.3
2.1
District of Columbia
100.0
17.7
9.3
43.3
23.3
6.3
Florida
100.0
26.6
8.2
31.1
28.6
5.4
Georgia
100.0
18.0
17.2
35.3
18.1
11.4
Maryland
100.0
22.1
9.8
38.3
23.3
6.5
North Carolina
100.0
17.7
14.9
29.3
27.0
11.0
South Carolina
100.0
13.8
8.4
33.9
22.1
21.8
Virginia
100.0
17.6
9.4
34.2
31.7
7.1
West Virginia
100.0
17.0
13.9
40.8
26.2
2.0
East South Central
100.0%
15.5%
16.0%
36.9%
22.5%
9.1%
Alabama
100.0
11.4
9.5
32.3
25.5
21.4
Kentucky
100.0
13.6
12.8
40.4
23.0
10.2
Mississippi
100.0
16.1
9.1
36.5
26.3
12.0
Tennessee (1)
100.0
18.9
24.9
37.4
18.8
0.0
West South Central
100.0%
16.8%
11.9%
28.9%
23.9%
18.5%
Arkansas
100.0
16.1
6.7
45.4
31.6
0.3
Louisiana
100.0
12.5
8.4
30.1
18.2
30.7
Oklahoma
100.0
21.8
9.9
35.4
31.3
1.6
Texas
100.0
18.2
14.6
25.2
24.6
17.4
East North Central
100.0%
18.0%
9.5%
36.8%
27.2%
8.5%
Illinois
100.0
19.6
10.5
44.1
18.9
6.9
Indiana
100.0
16.2
8.1
30.1
29.9
15.8
Michigan
100.0
19.2
12.2
37.9
22.1
8.6
Ohio
100.0
15.8
8.2
31.8
33.9
10.3
Wisconsin
100.0
18.8
6.2
36.2
38.4
0.5
West North Central
100.0%
16.0%
8.3%
34.2%
32.0%
9.5%
lowa
100.0
20.1
11.5
40.1
27.9
0.4
Kansas
100.0
14.5
10.0
39.4
28.3
7.8
Minnesota
100.0
18.4
8.7
36.8
35.2
0.9
Missouri
100.0
12.4
6.6
25.3
29.3
26.4
Nebraska
100.0
19.3
6.8
35.4
37.1
1.4
North Dakota
100.0
11.0
6.7
39.2
42.6
0.4
South Dakota
100.0
12.8
7.2
45.1
34.5
0.3
Mountain
100.0%
21.5%
13.8%
33.9%
20.9%
9.8%
Arizona (1)
100.0
29.1
16.3
29.8
17.2
7.6
Colorado
100.0
14.4
11.0
29.3
22.0
23.3
Idaho
100.0
13.7
12.1
46.2
26.8
1.2
Montana
100.0
12.6
8.8
40.1
38.4
0.1
Nevada
100.0
21.4
12.1
32.6
18.0
15.9
New Mexico
100.0
24.9
14.1
42.1
18.1
0.9
Utah
100.0
26.4
19.8
35.6
17.6
0.6
Wyoming
100.0
17.1
14.1
38.9
29.8
0.0
Pacific
100.0%
17.6%
16.5%
30.3%
20.2%
15.4%
Alaska
100.0
29.4
18.7
28.6
17.1
6.1
California
100.0
17.3
14.8
30.1
19.7
18.0
Hawaii (1)
100.0
21.9
40.5
15.2
22.3
0.1
Oregon (1)
100.0
18.1
25.0
32.6
22.3
2.0
Washington
100.0
16.6
15.3
34.4
21.5
12.3
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "DSH"
refers to disproportionate share hospital payments. States do not report payments to Medicare or to managed care organizations by beneficiary
group. In most states, payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were distributed among
adults and children. The methodology used is described in Appendix C.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly
from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing
Administration. See Appendix C.
Page 46
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 19
Federal and State Shares of Medicaid Expenditures, 1995
Total
Federal
State
Expenditures
FMAP
Share
Share
(millions)
1995 (1)
(millions)
(millions)
United States
$152,423
57.0%
$86,956
$65,467
New England
$11,571
51.6%
$5,970
$5,601
Connecticut
2,838
50.0
1,419
1,419
Maine
949
62.0
588
361
Massachusetts
5,600
50.0
2,800
2,800
New Hampshire
848
50.0
424
424
Rhode Island
999
53.9
538
461
Vermont
336
59.6
200
136
Middle Atlantic
$35,853
50.9%
$18,246
$17,607
New Jersey
5,391
50.0
2,696
2,696
New York
23,525
50.0
11,762
11,762
Pennsylvania
6,937
54.6
3,788
3,149
South Atlantic
$22,501
59.2%
$13,320
$9,181
Delaware
334
50.0
167
167
District of Columbia
793
50.0
396
396
Florida
6,134
54.8
3,360
2,774
Georgia
3,581
62.5
2,237
1,344
Maryland
2,465
50.0
1,233
1,233
North Carolina
3,891
65.1
2,535
1,356
South Carolina
2,016
71.1
1,433
583
Virginia
2,058
50.0
1,029
1,029
West Virginia
1,227
75.7
929
298
East South Central
$9,016
70.9%
$6,393
$2,623
Alabama
1,954
71.2
1,392
562
Kentucky
2,155
70.9
1,528
627
Mississippi
1,524
78.9
1,202
322
Tennessee
3,383
67.2
2,272
1,111
West South Central
$15,150
68.0%
$10,301
$4,850
Arkansas
1,205
74.5
898
308
Louisiana
4,117
73.5
3,025
1,091
Oklahoma
1,130
70.4
795
335
Texas
8,698
64.2
5,583
3,116
East North Central
$22,188
57.1%
$12,679
$9,509
Illinois
5,986
50.0
2,993
2,993
Indiana
2,529
63.5
1,606
923
Michigan
5,114
56.4
2,883
2,231
Ohio
6,143
60.8
3,737
2,406
Wisconsin
2,416
60.5
1,461
955
West North Central
$8,894
59.8%
$5,318
$3,576
lowa
1,179
63.3
747
432
Kansas
945
59.5
563
383
Minnesota
2,749
54.7
1,503
1,247
Missouri
2,765
60.6
1,677
1,088
Nebraska
640
62.0
397
243
North Dakota
300
71.1
213
86
South Dakota
316
69.5
219
96
Mountain
$5,761
64.1%
$3,691
$2,070
Arizona
1,601
65.9
1,055
546
Colorado
1,525
54.3
828
697
Idaho
338
70.9
240
98
Montana
360
71.1
256
104
Nevada
464
50.3
233
231
New Mexico
745
74.2
552
192
Utah
555
74.4
413
142
Wyoming
172
65.6
113
59
Pacific
$21,489
51.4%
$11,039
$10,450
Alaska
303
50.0
152
152
California
16,188
50.0
8,094
8,094
Hawaii
730
50.0
365
365
Oregon
1,438
62.1
893
545
Washington
2,830
54.2
1,535
1,295
Source: Urban Institute calculations based on data from HCFA-64 reports. FMAPs are from Federal Register 58(242):66362-66363, Dec. 20, 1993
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5
billion in 1995. Figures may not sum to totals due to rounding.
(1) FMAP = Federal Medical Assistance Percentage.
Kaiser Commission on the Future of Medicaid
Page 47
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 20
Medicaid Expenditures per Beneficiary, by Group, 1995
Expenditures per Beneficiary
Blind &
Total
Children
Adults
Disabled
Elderly
United States
$3,789
$1,451
$2,080
$8,784
$10,308
New England
$6,120
$1,947
$2,295
$13,350
$16,144
Connecticut
6,529
1,415
2,062
18,502
19,965
Maine
4,436
1,360
1,943
8,400
13,129
Massachusetts
6,882
2,701
2,714
13,069
16,202
New Hampshire
5,092
1,488
1,809
14,434
13,470
Rhode Island
6,104
1,643
2,253
14,559
14,925
Vermont
3,069
960
1,422
8,703
9,057
Middle Atlantic
$6,133
$2,061
$2,660
$13,402
$16,994
New Jersey
5,280
1,396
2,821
12,513
14,185
New York
6,815
2,241
2,832
16,605
18,745
Pennsylvania
4,995
2,002
2,040
7,797
14,628
South Atlantic
$3,340
$1,390
$2,300
$7,592
$7,890
Delaware
4,192
1,486
2,269
11,498
13,336
District of Columbia
5,423
1,917
2,225
15,227
23,611
Florida
3,344
1,570
2,419
6,920
8,313
Georgia
2,788
1,073
2,527
6,638
6,252
Maryland
5,588
2,635
3,280
11,026
12,330
North Carolina
3,216
1,282
2,389
7,932
6,899
South Carolina
3,188
1,178
1,941
7,244
5,819
Virginia
2,821
996
1,576
6,656
7,644
West Virginia
3,093
1,138
1,777
6,712
9,259
East South Central
$2,589
$1,028
$1,892
$4,573
$6,433
Alabama
2,859
904
2,112
4,798
6,984
Kentucky
3,111
1,056
2,198
5,571
7,835
Mississippi
2,582
985
1,797
4,423
6,004
Tennessee (1)
2,274
1,086
1,785
4,042
5,565
West South Central
$3,060
$1,184
$2,205
$7,825
$7,124
Arkansas
3,435
1,272
1,398
6,261
7,236
Louisiana
3,745
1,373
2,423
8,518
7,716
Oklahoma
2,827
1,232
1,300
7,138
6,889
Texas
2,839
1,117
2,380
8,100
6,957
East North Central
$3,877
$1,496
$1,814
$9,120
$11,777
Illinois
3,595
1,434
1,903
9,540
8,930
Indiana
3,822
1,321
1,772
11,293
11,461
Michigan
4,017
1,790
2,036
8,701
13,141
Ohio
3,664
1,242
1,530
8,719
12,316
Wisconsin
5,241
2,181
1,830
8,353
14,474
West North Central
$4,008
$1,403
$1,676
$10,084
$11,241
lowa
3,868
1,680
1,815
9,445
8,761
Kansas
3,459
1,050
1,685
9,496
10,386
Minnesota
5,927
2,164
2,409
14,550
17,090
Missouri
2,927
986
1,162
7,169
8,715
Nebraska
3,864
1,341
1,599
9,743
11,447
North Dakota
4,869
1,154
1,534
13,479
11,832
South Dakota
4,286
1,067
1,738
10,654
12,134
Mountain
$3,251
$1,408
$2,144
$8,723
$9,792
Arizona (1)
2,995
1,572
2,346
7,751
11,145
Colorado
4,000
1,691
2,194
9,041
9,179
Idaho
2,906
740
1,658
8,461
9,700
Montana
3,690
908
1,420
8,918
15,490
Nevada
3,732
1,847
2,411
9,348
7,391
New Mexico
2,607
1,086
1,794
8,488
7,743
Utah
3,441
1,660
2,507
10,387
10,714
Wyoming
3,353
1,054
2,161
10,756
8,673
Pacific
$2,841
$1,267
$1,863
$7,134
$7,240
Alaska
4,184
2,301
3,135
13,009
11,656
California
2,686
1,206
1,725
6,572
6,569
Hawaii (1)
3,192
1,634
2,976
8,089
9,349
Oregon (1)
3,119
1,644
1,717
10,154
8,484
Washington
3,505
1,283
2,348
9,284
11,433
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. States do
not report payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare were
distributed among the aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is
described in Appendix C.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received
directly from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care
Financing Administration See Appendix C.
Page 48
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 12
Medicaid Expenditures per Beneficiary, 1995
RI
DE
DC
< $3,000 (12 states)
$3,000 - $3,999 (21)
$4,000 - $4,999 (8)
$5,000+ (10)
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. For certain states with active
1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made to
categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 49
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 21
Federal and State Shares of Medicaid Expenditures per Beneficiary, 1995
Total
Federal
State
Total
Non-DSH
DSH
Total
Non-DSH
DSH
Total
Non-DSH
DSH
United States
$4,328
$3,789
$539
$2,469
$2,163
$306
$1,859
$1,626
$233
New England
$7,220
$6,120
$1,100
$3,725
$3,156
$569
$3,495
$2,964
$531
Connecticut
7,760
6,529
1,231
3,880
3,264
616
3,880
3,264
616
Maine
5,372
4,436
936
3,328
2,749
580
2,043
1,687
356
Massachusetts
7,723
6,882
841
3,861
3,441
420
3,861
3,441
420
New Hampshire
8,310
5,092
3,218
4,155
2,546
1,609
4,155
2,546
1,609
Rhode Island
7,370
6,104
1,265
3,970
3,288
682
3,400
2,816
584
Vermont
3,451
3,069
382
2,055
1,827
228
1,396
1,241
155
Middle Atlantic
$7,125
$6,133
$993
$3,626
$3,123
$504
$3,499
$3,010
$489
New Jersey
6,935
5,280
1,655
3,468
2,640
828
3,468
2,640
828
New York
7,779
6,815
964
3,889
3,407
482
3,889
3,407
482
Pennsylvania
5,639
4,995
644
3,079
2,728
352
2,559
2,267
292
South Atlantic
$3,666
$3,340
$326
$2,170
$1,970
$201
$1,496
$1,371
$125
Delaware
4,283
4,192
91
2,142
2,096
46
2,142
2,096
46
District of Columbia
5,790
5,423
367
2,895
2,712
183
2,895
2,712
183
Florida
3,537
3,344
193
1,937
1,832
106
1,599
1,512
87
Georgia
3,148
2,788
360
1,967
1,742
225
1,182
1,046
135
Maryland
5,976
5,588
388
2,988
2,794
194
2,988
2,794
194
North Carolina
3,615
3,216
399
2,355
2,095
260
1,260
1,121
139
South Carolina
4,079
3,188
890
2,899
2,266
633
1,180
922
257
Virginia
3,035
2,821
214
1,517
1,410
107
1,517
1,410
107
West Virginia
3,157
3,093
64
2,391
2,342
48
767
751
16
East South Central
$2,848
$2,589
$259
$2,019
$1,831
$189
$828
$758
$70
Alabama
3,636
2,859
777
2,589
2,036
553
1,046
823
224
Kentucky
3,465
3,111
354
2,457
2,206
251
1,008
905
103
Mississippi
2,934
2,582
352
2,313
2,036
277
620
546
74
Tennessee (1)
2,274
2,274
0
1,527
1,527
0
747
747
0
West South Central
$3,754
$3,060
$694
$2,552
$2,078
$475
$1,202
$983
$219
Arkansas
3,445
3,435
9
2,565
2,558
7
880
877
2
Louisiana
5,407
3,745
1,662
3,974
2,752
1,221
1,433
993
441
Oklahoma
2,874
2,827
47
2,023
1,990
33
851
837
14
Texas
3,437
2,839
598
2,206
1,822
384
1,231
1,017
214
East North Central
$4,238
$3,877
$361
$2,422
$2,212
$209
$1,816
$1,665
$152
Illinois
3,861
3,595
266
1,931
1,797
133
1,931
1,797
-133
Indiana
4,536
3,822
715
2,880
2,426
454
1,656
1,395
261
Michigan
4,393
4,017
376
2,477
2,264
212
1,917
1,753
164
Ohio
4,083
3,664
419
2,484
2,229
255
1,599
1,435
164
Wisconsin
5,266
5,241
25
3,184
3,169
15
2,082
2,072
10
West North Central
$4,427
$4,008
$420
$2,647
$2,394
$254
$1,780
$1,614
$166
lowa
3,883
3,868
15
2,459
2,450
9
1,424
1,418
5
Kansas
3,752
3,459
292
2,233
2,059
174
1,519
1,400
118
Minnesota
5,979
5,927
53
3,268
3,239
29
2,712
2,688
24
Missouri
3,976
2,927
1,048
2,411
1,775
636
1,565
1,152
413
Nebraska
3,919
3,864
55
2,429
2,395
34
1,490
1,469
21
North Dakota
4,889
4,869
20
3,478
3,464
14
1,411
1,406
6
South Dakota
4,300
4,286
15
2,989
2,978
10
1,312
1,307
4
Mountain
$3,604
$3,251
$353
$2,309
$2,108
$201
$1,295
$1,142
$153
Arizona (1)
3,242
2,995
248
2,137
1,973
163
1,106
1,021
85
Colorado
5,212
4,000
1,212
2,830
2,172
658
2,382
1,828
554
Idaho
2,941
2,906
35
2,086
2,061
25
855
845
10
Montana
3,692
3,690
2
2,623
2,622
2
1,069
1,068
<1
Nevada
4,436
3,732
703
2,232
1,878
354
2,204
1,855
349
New Mexico
2,631
2,607
24
1,951
1,933
18
679
673
6
Utah
3,462
3,441
21
2,574
2,559
15
888
883
5
Wyoming
3,353
3,353
0
2,201
2,201
0
1,152
1,152
0
Pacific
$3,359
$2,841
$517
$1,725
$1,464
$262
$1,633
$1,377
$256
Alaska
4,455
4,184
271
2,228
2,092
135
2,228
2,092
135
California
3,276
2,686
590
1,638
1,343
295
1,638
1,343
295
Hawaii (1)
3,197
3,192
5
1,598
1,596
2
1,598
1,596
2
Oregon (1)
3,181
3,119
62
1,976
1,937
39
1,205
1,181
24
Washington
3,996
3,505
491
2,168
1,901
267
1,829
1,604
225
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. "DSH" refers to disproportionate share hospital payments. Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state: adjustments were made to
categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 50
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 22
Federal and State Shares of Medicaid Expenditures per Capita, 1995
Total
Federal
State
Total
Non-DSH
DSH
Total
Non-DSH
DSH
Total
Non-DSH
DSH
United States
$579
$507
$72
$330
$289
$41
$249
$218
$31
New England
$877
$743
$134
$452
$383
$69
$425
$360
$65
Connecticut
876
737
139
438
368
69
438
368
69
Maine
781
645
136
484
400
84
297
245
52
Massachusetts
927
826
101
463
413
50
463
413
50
New Hampshire
746
457
289
373
229
145
373
229
145
Rhode Island
1,034
857
178
557
462
96
477
395
82
Vermont
564
502
63
336
299
37
228
203
25
Middle Atlantic
$938
$808
$131
$478
$411
$66
$461
$396
$64
New Jersey
681
519
163
341
259
81
341
259
81
New York
1,287
1,128
160
644
564
80
644
564
80
Pennsylvania
577
511
66
315
279
36
262
232
30
South Atlantic
$480
$437
$43
$284
$258
$26
$196
$179
$16
Delaware
479
469
10
240
234
5
240
234
5
District of Columbia
1,359
1,273
86
680
636
43
680
636
43
Florida
429
405
23
235
222
13
194
183
11
Georgia
494
437
56
308
273
35
185
164
21
Maryland
484
453
31
242
226
16
242
226
16
North Carolina
562
500
62
366
326
40
196
174
22
South Carolina
544
425
119
387
302
84
157
123
34
Virginia
316
294
22
158
147
11
158
147
11
West Virginia
681
667
14
516
505
10
165
162
3
East South Central
$554
$503
$50
$393
$356
$37
$161
$147
$14
Alabama
449
353
96
320
251
68
129
102
28
Kentucky
556
500
57
395
354
40
162
145
17
Mississippi
577
508
69
455
401
55
122
107
15
Tennessee
625
625
0
419
419
0
205
205
0
West South Central
$524
$427
$97
$356
$290
$66
$168
$137
$31
Arkansas
487
486
1
363
362
<1
124
124
<1
Louisiana
949
657
292
697
483
214
252
174
77
Oklahoma
351
345
6
247
243
4
104
102
2
Texas
461
381
80
296
244
51
165
136
29
East North Central
$509
$466
$43
$291
$266
$25
$218
$200
$18
Illinois
506
471
35
253
236
17
253
236
17
Indiana
433
365
68
275
232
43
158
133
25
Michigan
534
488
46
301
275
26
233
213
20
Ohio
549
492
56
334
300
34
215
193
22
Wisconsin
468
466
2
283
282
1
185
184
<1
West North Central
$491
$445
$47
$294
$266
$28
$197
$179
$18
lowa
413
411
2
261
260
1
151
151
<1
Kansas
373
344
29
222
205
17
151
139
12
Minnesota
603
597
5
329
326
3
273
271
2
Missouri
538
396
142
326
240
86
212
156
56
Nebraska
388
382
5
240
237
3
147
145
2
North Dakota
473
471
2
336
335
1
137
136
<1
South Dakota
434
432
1
302
301
1
132
132
<1
Mountain
$364
$329
$36
$233
$213
$20
$131
$115
$15
Arizona
373
345
29
246
227
19
127
117
10
Colorado
404
310
94
219
168
51
184
142
43
Idaho
295
292
3
209
207
2
86
85
1
Montana
419
419
<1
298
298
<1
121
121
<1
Nevada
301
253
48
151
127
24
149
126
24
New Mexico
426
422
4
316
313
3
110
109
<1
Utah
283
281
2
210
209
1
72
72
<1
Wyoming
355
355
0
233
233
0
122
122
0
Pacific
$509
$431
$78
$261
$222
$40
$248
$209
$39
Alaska
496
466
30
248
233
15
248
233
15
California
507
416
91
254
208
46
254
208
46
Hawaii
636
635
<1
318
318
<1
318
318
<1
Oregon
450
442
9
280
274
5
171
167
3
Washington
529
464
65
287
252
35
242
212
30
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey.
Does not include administrative costs, accounting adjustments, or the U.S. Terntories. "DSH" refers to disproportionate share hospital payments. Figures may not sum to totals due to rounding.
Kaiser Commission on the Future of Medicaid
Page 51
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 23
Federal and State Shares of Medicaid Expenditures per Low-income Person, 1995 (1)
Total
Federal
State
Total
Non-DSH
DSH
Total
Non-DSH
DSH
Total
Non-DSH
DSH
United States
$2,327
$2,037
$290
$1,328
$1,163
$165
$1,000
$874
$125
New England
$4,666
$3,956
$711
$2,407
$2,040
$367
$2,259
$1,916
$343
Connecticut
4,903
4,125
778
2,451
2,062
389
2,451
2,062
389
Maine
3,755
3,101
654
2,326
1,921
405
1,428
1,179
249
Massachusetts
4,938
4,400
537
2,469
2,200
269
2,469
2,200
269
New Hampshire
4,639
2,843
1,797
2,320
1,421
898
2,320
1,421
898
Rhode Island
4,813
3,987
826
2,593
2,148
445
2,220
1,839
381
Vermont
2,723
2,422
302
1,622
1,442
180
1,102
980
122
Middle Atlantic
$4,082
$3,514
$569
$2,078
$1,789
$289
$2,005
$1,725
$280
New Jersey
3,928
2,991
937
1,964
1,495
469
1,964
1,495
469
New York
4,910
4,301
609
2,455
2,151
304
2,455
2,151
304
Pennsylvania
2,649
2,346
302
1,446
1,281
165
1,202
1,065
137
South Atlantic
$1,916
$1,746
$170
$1,135
$1,030
$105
$782
$716
$66
Delaware
2,538
2,484
54
1,269
1,242
27
1,269
1,242
27
District of Columbia
3,997
3,744
253
1,999
1,872
127
1,999
1,872
127
Florida
1,575
1,489
86
863
816
47
712
673
39
Georgia
1,928
1,707
220
1,204
1,066
138
723
641
83
Maryland
2,542
2,377
165
1,271
1,189
83
1,271
1,189
83
North Carolina
2,279
2,028
251
1,485
1,321
164
794
707
88
South Carolina
1,785
1,396
390
1,269
992
277
516
404
113
Virginia
1,597
1,484
113
798
742
56
798
742
56
West Virginia
2,184
2,140
44
1,654
1,620
34
530
519
11
East South Central
$1,877
$1,706
$171
$1,331
$1,207
$124
$546
$500
$46
Alabama
1,468.
1,154
314
1,045
822
223
422
332
90
Kentucky
1,980
1,778
202
1,404
1,261
143
576
517
59
Mississippi
1,588
1,398
190
1,252
1,102
150
336
296
40
Tennessee
2,374
2,374
0
1,594
1,594
0
780
780
0
West South Central
$1,690
$1,378
$312
$1,149
$935
$214
$541
$442
$99
Arkansas
1,606
1,602
4
1,196
1,192
3
410
409
1
Louisiana
2,669
1,849
820
1,961
1,359
603
708
490
217
Oklahoma
1,179
1,160
19
830
817
13
349
344
6
Texas
1,522
1,257
265
977
807
170
545
450
95
East North Central
$2,388
$2,185
$204
$1,365
$1,247
$118
$1,024
$938
$86
Illinois
2,251
2,096
155
1,126
1,048
78
1,126
1,048
78
Indiana
2,033
1,712
320
1,291
1,087
203
742
625
117
Michigan
2,468
2,257
211
1,391
1,272
119
1,077
985
92
Ohio
2,489
2,233
255
1,514
1,359
155
975
875
100
Wisconsin
2,852
2,838
14
1,724
1,716
8
1,127
1,122
5
West North Central
$2,262
$2,048
$214
$1,352
$1,223
$130
$910
$825
$85
lowa
1,997
1,990
8
1,265
1,260
5
732
730
3
Kansas
1,487
1,371
116
885
816
69
602
555
47
Minnesota
3,143
3,115
28
1,718
1,702
15
1,425
1,413
13
Missouri
2,323
1,710
613
1,409
1,037
371
914
673
241
Nebraska
2,054
2,026
29
1,273
1,255
18
781
770
11
North Dakota
2,066
2,057
8
1,469
1,463
6
596
594
2
South Dakota
1,710
1,704
6
1,188
1,184
4
522
520
2
Mountain
$1,484
$1,338
$146
$950
$868
$83
$533
$470
$63
Arizona
1,268
1,171
97
836
772
64
432
399
33
Colorado
2,418
1,856
562
1,313
1,008
305
1,105
848
257
Idaho
1,206
1,192
14
855
845
10
351
347
4
Montana
1,652
1,651
1
1,174
1,173
<1
478
478
<1
Nevada
1,358
1,143
215
683
575
108
675
568
107
New Mexico
1,148
1,138
10
852
844
8
297
294
3
Utah
1,414
1,406
8
1,051
1,045
6
363
361
2
Wyoming
1,588
1,588
0
1,042
1,042
0
546
546
0
Pacific
$1,849
$1,564
$285
$950
$806
$144
$899
$758
$141
Alaska
2,286
2,147
139
1,143
1,073
69
1,143
1,073
69
California
1,730
1,419
312
865
709
156
865
709
156
Hawaii
2,656
2,653
4
1,328
1,326
2
1,328
1,326
2
Oregon
2,029
1,990
40
1,260
1,236
25
769
754
15
Washington
2,463
2,160
303
1,336
1,172
164
1,127
989
139
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. "DSH" refers to disproportionate share hospital payments. Figures may not sum to totals due to rounding.
(1) Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
Page 52
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 13
Federal Medicaid Spending per Low-income Person, 1995 *
**
RI
DE
DC
< $1,000 (10 states)
$1,000 - $1,499 (26)
$1,500 - $1,999 (9)
$2,000+ (6)
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey.
Does not include administrative costs, accounting adjustments. or the U.S. Territories.
"Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
Kaiser Commission on the Future of Medicaid
Page 53
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 14
State Medicaid Spending per Low-income Person, 1995 *
RI
DE
DC
< $500 (9 states)
$500 - $999 (22)
$1,000 - $1,499 (13)
$1,500+ (7)
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey.
Does not include administrative costs, accounting adjustments, or the U.S. Territories.
*Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
Page 54
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 24
Medicaid Expenditures, by Type of Service, 1995
Expenditures (millions)
Long-Term
Total
Acute Care
Care
DSH
United States
$152,423
$79,439
$53,996
$18,988
New England
$11,571
$4,919
$4,889
$1,763
Connecticut
2,838
994
1,394
450
Maine
949
401
383
165
Massachusetts
5,600
2,682
2,309
610
New Hampshire
848
215
305
329
Rhode Island
999
460
367
171
Vermont
336
167
132
37
Middle Atlantic
$35,853
$15,537
$15,321
$4,995
New Jersey
5,391
2,155
1,950
1,287
New York
23,525
10,467
10,141
2,917
Pennsylvania
6,937
2,915
3,230
792
South Atlantic
$22,501
$13,585
$6,915
$2,001
Delaware
334
189
138
7
District of Columbia
793
472
270
50
Florida
6,134
4,031
1,769
334
Georgia
3,581
2,278
894
410
Maryland
2,465
1,557
748
160
North Carolina
3,891
2,121
1,341
429
South Carolina
2,016
1,014
562
440
Virginia
2,058
1,146
767
145
West Virginia
1,227
777
425
25
East South Central
$9,016
$5,792
$2,404
$820
Alabama
1,954
930
606
417
Kentucky
2,155
1,304
631
220
Mississippi
1,524
938
403
183
Tennessee (1)
3,383
2,620
764
0
West South Central
$15,150
$8,104
$4,246
$2,800
Arkansas
1,205
669
533
3
Louisiana
4,117
1,825
1,026
1,265
Oklahoma
1,130
605
506
18
Texas
8,698
5,005
2,180
1,513
East North Central
$22,188
$11,660
$8,637
$1,891
Illinois
5,986
3,642
1,932
413
Indiana
2,529
1,062
1,069
398
Michigan
5,114
2,942
1,734
438
Ohio
6,143
2,886
2,627
630
Wisconsin
2,416
1,128
1,276
12
West North Central
$8,894
$4,042
$4,009
$843
lowa
1,179
675
499
5
Kansas
945
426
446
74
Minnesota
2,749
1,176
1,549
24
Missouri
2,765
1,157
879
729
Nebraska
640
339
292
9
North Dakota
300
118
180
1
South Dakota
316
151
164
1
Mountain
$5,761
$3,401
$1,795
$565
Arizona (1)
1,601
1,122
357
122
Colorado
1,525
680
491
355
Idaho
338
187
147
4
Montana
360
185
175
<1
Nevada
464
266
124
74
New Mexico
745
500
238
7
Utah
555
376
176
3
Wyoming
172
85
87
0
Pacific
$21,489
$12,399
$5,780
$3,311
Alaska
303
205
80
18
California
16,188
9,176
4,097
2,915
Hawaii (1)
730
555
173
1
Oregon (1)
1,438
915
495
28
Washington
2,830
1,548
934
348
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs, accounting adjustments. or the U.S. Territories. Total spending including these categories was about $159.5
billion in 1995. Figures may not sum to totals due to rounding. "DSH" refers to disproportionate share hospital payments. Acute care services
include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning, dental, vision, hospice, other practitioners'
care, payments to managed care organizations, and payments to Medicare Long-term care services include skilled nursing facilities, intermediate
care facilities for the mentally retarded, other intermediate care facilities, mental health, and home health services.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly
from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing
Administration See Appendix C
Kaiser Commission on the Future of Medicaid
Page 55
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 25
Distribution of Medicaid Expenditures, by Type of Service, 1995
Acute
Long-Term
Total
Care
Care
DSH
United States
100.0%
52.1%
35.4%
12.5%
New England
100.0%
42.5%
42.3%
15.2%
Connecticut
100.0
35.0
49.1
15.9
Maine
100.0
42.2
40.4
17.4
Massachusetts
100.0
47.9
41.2
10.9
New Hampshire
100.0
25.3
36.0
38.7
Rhode Island
100.0
46.1
36.8
17.2
Vermont
100.0
49.8
39.1
11.1
Middle Atlantic
100.0%
43.3%
42.7%
13.9%
New Jersey
100.0
40.0
36.2
23.9
New York
100.0
44.5
43.1
12.4
Pennsylvania
100.0
42.0
46.6
11.4
South Atlantic
100.0%
60.4%
30.7%
8.9%
Delaware
100.0
56.5
41.3
2.1
District of Columbia
100.0
59.5
34.1
6.3
Florida
100.0
65.7
28.8
5.4
Georgia
100.0
63.6
25.0
11.4
Maryland
100.0
63.2
30.3
6.5
North Carolina
100.0
54.5
34.5
11.0
South Carolina
100.0
50.3
27.9
21.8
Virginia
100.0
55.7
37.3
7.1
West Virginia
100.0
63.4
34.6
2.0
East South Central
100.0%
64.2%
26.7%
9.1%
Alabama
100.0
47.6
31.0
21.4
Kentucky
100.0
60.5
29.3
10.2
Mississippi
100.0
61.6
26.5
12.0
Tennessee (1)
100.0
77.4
22.6
0.0
West South Central
100.0%
53.5%
28.0%
18.5%
Arkansas
100.0
55.5
44.2
0.3
Louisiana
100.0
44.3
24.9
30.7
Oklahoma
100.0
53.6
44.8
1.6
Texas
100.0
57.5
25.1
17.4
East North Central
100.0%
52.5%
38.9%
8.5%
Illinois
100.0
60.8
32.3
6.9
Indiana
100.0
42.0
42.3
15.8
Michigan
100.0
57.5
33.9
8.6
Ohio
100.0
47.0
42.8
10.3
Wisconsin
100.0
46.7
52.8
0.5
West North Central
100.0%
45.4%
45.1%
9.5%
lowa
100.0
57.3
42.3
0.4
Kansas
100.0
45.0
47.2
7.8
Minnesota
100.0
42.8
56.3
0.9
Missouri
100.0
41.8
31.8
26.4
Nebraska
100.0
53.0
45.6
1.4
North Dakota
100.0
39.5
60.1
0.4
South Dakota
100.0
47.8
51.9
0.3
Mountain
100.0%
59.0%
31.2%
9.8%
Arizona (1)
100.0
70.1
22.3
7.6
Colorado
100.0
44.6
32.2
23.3
Idaho
100.0
55.2
43.6
1.2
Montana
100.0
51.2
48.7
0.1
Nevada
100.0
57.4
26.8
15.9
New Mexico
100.0
67.2
31.9
0.9
Utah
100.0
67.7
31.7
0.6
Wyoming
100.0
49.6
50.4
0.0
Pacific
100.0%
57.7%
26.9%
15.4%
Alaska
100.0
67.6
26.4
6.1
California
100.0
56.7
25.3
18.0
Hawaii (1)
100.0
76.1
23.8
0.1
Oregon (1)
100.0
63.6
34.4
2.0
Washington
100.0
54.7
33.0
12.3
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
"DSH" refers to disproportionate share hospital payments. Acute care services include inpatient, physician. lab, X-ray, outpatient, clinic,
prescription drugs, EPSDT, family planning. dental, vision, hospice, other practitioners' care, payments to managed care organizations,
and payments to Medicare. Long-term care services include skilled nursing facilities, intermediate care facilities for the mentally retarded,
other intermediate care facilities, mental health, and home health services.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received
directly from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care
Financing Administration. See Appendix C.
Page 56
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 26
Medicaid Acute Care Expenditures, by Group, 1995
Expenditures (millions)
Blind &
Total
Children
Adults
Disabled
Elderly
United States
$79,439
$23,703
$16,301
$29,761
$9,674
New England
$4,919
$1,326
$785
$2,062
$746
Connecticut
994
218
173
381
221
Maine
401
91
70
179
61
Massachusetts
2,682
806
404
1,135
337
New Hampshire
215
71
41
75
27
Rhode Island
460
94
67
220
79
Vermont
167
46
30
72
20
Middle Atlantic
$15,537
$4,577
$2,684
$6,383
$1,894
New Jersey
2,155
448
511
925
271
New York
10,467
3,103
1,738
4,366
1,260
Pennsylvania
2,915
1,026
435
1,091
363
South Atlantic
$13,585
$4,343
$2,558
$4,876
$1,807
Delaware
189
58
35
81
15
District of Columbia
472
136
74
230
33
Florida
4,031
1,616
501
1,276
637
Georgia
2,278
634
614
798
231
Maryland
1,557
527
236
654
140
North Carolina
2,121
622
574
642
284
South Carolina
1,014
258
168
423
165
Virginia
1,146
322
193
431
200
West Virginia
777
171
164
340
103
East South Central
$5,792
$1,352
$1,432
$2,446
$562
Alabama
930
220
184
400
126
Kentucky
1,304
263
270
623
149
Mississippi
938
233
138
407
161
Tennessee (1)
2,620
636
840
1,017
126
West South Central
$8,104
$2,416
$1,796
$2,671
$1,221
Arkansas
669
162
79
315
112
Louisiana
1,825
451
341
769
264
Oklahoma
605
216
111
176
102
Texas
5,005
1,586
1,265
1,412
742
East North Central
$11,660
$3,668
$2,079
$4,686
$1,226
Illinois
3,642
1,132
627
1,555
328
Indiana
1,062
358
200
351
152
Michigan
2,942
885
605
1,256
196
Ohio
2,886
923
501
1,092
371
Wisconsin
1,128
372
146
431
179
West North Central
$4,042
$1,348
$707
$1,411
$577
lowa
675
217
135
225
98
Kansas
426
117
93
161
55
Minnesota
1,176
487
213
381
96
Missouri
1,157
338
180
403
236
Nebraska
339
118
42
126
53
North Dakota
118
30
20
47
21
South Dakota
151
40
23
69
19
Mountain
$3,401
$1,156
$786
$1,176
$283
Arizona (1)
1,122
456
259
335
73
Colorado
680
201
166
244
69
Idaho
187
46
41
83
17
Montana
185
39
31
88
27
Nevada
266
79
56
106
25
New Mexico
500
166
104
195
36
Utah
376
141
106
102
27
Wyoming
85
29
24
24
8
Pacific
$12,399
$3,517
$3,474
$4,050
$1,358
Alaska
205
78
57
57
13
California
9,176
2,577
2,358
3,147
1,094
Hawaii (1)
555
156
291
63
44
Oregon (1)
915
239
358
235
83
Washington
1,548
467
410
547
123
Source: Urban Institute calculations based on date from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding
Acute care services include inpatient, physician, lab, X-ray. outpatient, clinic, prescription drugs, EPSDT, family planning. dental, vision, hospice, other practitioners care, payments to
managed care organizations, and payments to Medicare States do not report payments to Medicare or to MCOs by beneficiary group In most states, payments to Medicare were
distributed among the aged, blind, and disabled Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were
made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 57
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 27
Distribution of Medicaid Acute Care Expenditures, by Group, 1995
Blind &
Total
Children
Adults
Disabled
Elderly
United States
100.0%
29.8%
20.5%
37.5%
12.2%
New England
100.0%
27.0%
16.0%
41.9%
15.2%
Connecticut
100.0
21.9
17.4
38.4
22.3
Maine
100.0
22.7
17.4
44.7
15.2
Massachusetts
100.0
30.1
15.1
42.3
12.6
New Hampshire
100.0
33.0
19.3
35.0
12.8
Rhode Island
100.0
20.4
14.6
47.8
17.2
Vermont
100.0
27.6
17.7
42.9
11.8
Middle Atlantic
100.0%
29.5%
17.3%
41.1%
12.2%
New Jersey
100.0
20.8
23.7
42.9
12.6
New York
100.0
29.6
16.6
41.7
12.0
Pennsylvania
100.0
35.2
14.9
37.4
12.5
South Atlantic
100.0%
32.0%
18.8%
35.9%
13.3%
Delaware
100.0
30.9
18.5
43.0
7.7
District of Columbia
100.0
28.7
15.6
48.7
7.0
Florida
100.0
40.1
12.4
31.7
15.8
Georgia
100.0
27.8
27.0
35.1
10.2
Maryland
100.0
33.9
15.2
42.0
9.0
North Carolina
100.0
29.3
27.0
30.3
13.4
South Carolina
100.0
25.5
16.5
41.7
16.2
Virginia
100.0
28.1
16.8
37.7
17.5
West Virginia
100.0
22.0
21.1
43.7
13.2
East South Central
100.0%
23.3%
24.7%
42.2%
9.7%
Alabama
100.0
23.6
19.8
43.0
13.6
Kentucky
100.0
20.2
20.7
47.7
11.4
Mississippi-
100.0
24.8
14.7
43.3
17.1
Tennessee (1)
100.0
24.3
32.1
38.8
4.8
West South Central
100.0%
29.8%
22.2%
33.0%
15.1%
Arkansas
100.0
24.3
11.9
47.1
16.8
Louisiana
100.0
24.7
18.7
42.1
14.5
Oklahoma
100.0
35.8
18.3
29.0
16.9
Texas
100.0
31.7
25.3
28.2
14.8
East North Central
100.0%
31.5%
17.8%
40.2%
10.5%
Illinois
100.0
31.1
17.2
42.7
9.0
Indiana
100.0
33.7
18.9
33.1
14.3
Michigan
100.0
30.1
20.6
42.7
6.7
Ohio
100.0
32.0
17.4
37.8
12.8
Wisconsin
100.0
32.9
13.0
38.2
15.9
West North Central
100.0%
33.3%
17.5%
34.9%
14.3%
lowa
100.0
32.2
20.0
33.3
14.6
Kansas
100.0
27.4
21.9
37.8
12.9
Minnesota
100.0
41.4
18.1
32.4
8.1
Missouri
100.0
29.2
15.6
34.8
20.4
Nebraska
100.0
34.8
12.5
37.0
15.7
North Dakota
100.0
25.8
16.9
39.7
17.7
South Dakota
100.0
26.8
15.0
45.8
12.4
Mountain
100.0%
34.0%
23.1%
34.6%
8.3%
Arizona (1)
100.0
40.6
23.1
29.8
6.5
Colorado
100.0
29.6
24.4
35.8
10.2
Idaho
100.0
24.4
21.9
44.4
9.3
Montana
100.0
21.1
16.9
47.4
14.7
Nevada
100.0
29.9
20.9
39.8
9.4
New Mexico
100.0
33.1
20.8
38.9
7.2
Utah
100.0
37.5
28.1
27.1
7.3
Wyoming
100.0
34.1
28.3
28.6
8.9
Pacific
100.0%
28.4%
28.0%
32.7%
11.0%
Alaska
100.0
38.2
27.6
27.9
6.3
California
100.0
28.1
25.7
34.3
11.9
Hawaii (1)
100.0
28.1
52.5
11.4
8.0
Oregon (1)
100.0
26.1
39.2
25.7
9.1
Washington
100.0
30.2
26.5
35.4
8.0
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not
sum to totals due to rounding. Acute care services include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family
planning. dental, vision, hospice, other practitioners' care, payments to managed care organizations and payments to Medicare. States do not report
payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare were distributed among the
aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
(1) For certain states with active 1115 waivers (AZ, HI. OR, TN), expenditure and beneficiary data were supplemented with data received directly from
the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration.
See data Appendix C.
Page 58
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 28
Medicaid Acute Care Expenditures, by Type of Service, 1995
Total
Mandatory (millions) (1)
Optional (millions) (2)
Acute Care
Total
Mandatory
Total
Prescription
Other Acute
(millions)
Mandatory
Services
Medicare
MCOs (3)
Optional
Drugs
Care (4)
United States
$79,439
$60,759
$47,001
$3,855
$9,903
$18,680
$8,445
$10,235
New England
$4,919
$3,233
$2,416
$286
$531
$1,686
$522
$1,164
Connecticut
994
663
538
125
<1
331
116
215
Maine
401
259
215
36
8
142
60
81
Massachusetts
2,682
1,767
1,215
96
457
915
252
662
New Hampshire
215
153
131
10
12
62
30
32
Rhode Island
460
301
236
12
53
159
38
122
Vermont
167
90
82
8
0
78
26
52
Middle Atlantic
$15,537
$11,921
$10,004
$394
$1,524
$3,616
$1,618
$1,998
New Jersey
2,155
1,703
1,489
83
132
451
296
155
New York
10,467
8,044
7,082
185
777
2,423
857
1,566
Pennsylvania
2,915
2,174
1,433
126
615
741
465
276
South Atlantic
$13,585
$10,525
$8,618
$797
$1,110
$3,060
$1,466
$1,594
Delaware
189
146
135
5
5
43
17
26
District of Columbia
472
423
325
17
81
49
24
24
Florida
4,031
3,059
2,004
334
722
972
436
535
Georgia
2,278
1,742
1,635
107
<1
536
246
290
Maryland
1,557
1,382
1,074
55
253
175
117
58
North Carolina
2,121
1,652
1,514
129
9
469
236
233
South Carolina
1,014
737
681
56
<1
277
115
162
Virginia
1,146
888
786
62
39
258
166
92
West Virginia
777
495
463
32
<1
283
110
173
East South Central
$5,792
$4,620
$2,516
$334
$1,770
$1,172
$494
$678
Alabama
930
627
551
75
<1
303
155
148
Kentucky
1,304
984
919
65
<1 <
320
203
118
Mississippi
938
766
682
84
0
172
137
36
Tennessee (5)
2,620
2,243
364
110
1,769
376
-1
377
West South Central
$8,104
$5,994
$5,516
$477
$1
$2,110
$891
$1,219
Arkansas
669
499
446
53
<1
170
82
88
Louisiana
1,825
1,430
1,350
80
0
395
243
153
Oklahoma
605
432
382
49
1
173
88
85
Texas
5,005
3,633
3,339
294
<1
1,372
478
893
East North Central
$11,660
$9,128
$7,396
$525
$1,207
$2,532
$1,370
$1,162
Illinois
3,642
2,863
2,539
170
154
779
379
400
Indiana
1,062
715
675
34
6
346
191
155
Michigan
2,942
2,435
1,839
106
490
507
254
253
Ohio
2,886
2,275
1,855
89
330
611
388
223
Wisconsin
1,128
840
488
126
226
288
158
130
West North Central
$4,042
$2,903
$2,145
$310
$448
$1,139
$549
$590
lowa
675
481
332
66
83
194
85
110
Kansas
426
304
267
37
<1
121
66
56
Minnesota
1,176
811
464
18
329
365
92
273
Missouri
1,157
859
684
147
28
297
220
78
Nebraska
339
252
215
29
7
87
53
34
North Dakota
118
79
75
3
<1
40
16
23
South Dakota
151
117
107
9
<1
34
18
16
Mountain
$3,401
$2,830
$1,685
$118
$1,026
$571
$223
$349
Arizona (5)
1,122
1,080
182
25
872
42
2
40
Colorado
680
569
460
23
85
111
64
47
Idaho
187
122
114
7
<1
65
28
37
Montana
185
125
111
14
<1
60
26
33
Nevada
266
207
179
10
18
59
17
42
New Mexico
500
354
335
19
0
146
40
106
Utah
376
302
235
17
50
75
36
38
Wyoming
85
71
68
3
<1
14
10
4
Pacific
$12,399
$9,606
$6,703
$616
$2,286
$2,793
$1,311
$1,482
Alaska
205
163
159
5
<1
42
16
26
California
9,176
7,067
5,435
530
1,103
2,109
1,058
1,051
Hawaii (5)
555
504
159
20
326
51
27
23
Oregon (5)
915
690
230
21
439
225
65
160
Washington
1,548
1,181
720
41
419
367
145
222
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
(1) Mandatory acute care services are those that states are required to offer to participate in Medicaid. These include inpatient, physician/fab/X-ray, federally qualified health center services. outpatient, rural
health centers, and EPSDT.
(2) Optional acute care services are additional services that states are not required to offer, but may do so and receive federal reimbursement These include prescription drugs, clinic services, family planning,
case management dental, vision, hospice, and other acute care (see footnote 4).
(3) Payments to managed care organizations may include some optional services.
(4) "Other acute care" includes case management, family planning, dental, vision, other practitioners' care, and all other unspecified acute care services
(5) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made to categorize these
numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 59
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 29
Distribution of Medicaid Acute Care Expenditures, by Type of Service, 1995
Mandatory (1)
Optional (2)
Total
Mandatory
Total
Prescription
Other Acute
Mandatory
Services
Medicare
MCOs (3)
Optional
Drugs
Care (4)
United States
76.5%
59.2%
4.9%
12.5%
23.5%
10.6%
12.9%
New England
65.7%
49.1%
5.8%
10.8%
34.3%
10.6%
23.7%
Connecticut
66.7
54.1
12.6
<0.1
33.3
11.7
21.6
Maine
64.7
53.7
9.0
2.0
35.3
15.0
20.3
Massachusetts
65.9
45.3
3.6
17.0
34.1
9.4
24.7
New Hampshire
71.1
60.9
4.5
5.7
28.9
14.1
14.8
Rhode Island
65.4
51.2
2.5
11,6
34.6
8.2
26.4
Vermont
53.5
49.0
4.6
0.0
46.5
15.5
31.0
Middle Atlantic
76.7%
64.4%
2.5%
9.8%
23.3%
10.4%
12.9%
New Jersey
79.0
69.1
3.8
6.1
21.0
13.8
7.2
New York
76.9
67.7
1.8
7.4
23.1
8.2
15.0
Pennsylvania
74.6
49.2
4.3
21.1
25.4
16.0
9.5
South Atlantic
77.5%
63.4%
5.9%
8.2%
22.5%
10.8%
11.7%
Delaware
77.1
71.5
2.9
2.7
22.9
9.1
13.8
District of Columbia
89.7
69.0
3.6
17.2
10.3
5.2
5.1
Florida
75.9
49.7
8.3
17.9
24.1
10.8
13.3
Georgia
76.5
71.8
4.7
<0.1
23.5
10.8
12.7
Maryland
88.8
69.0
3.5
16.3
11.2
7.5
3.7
North Carolina
77.9
71.4
6.1
0.4
22.1
11.1
11.0
South Carolina
72.7
67.1
5.6
< <0.1
27.3
11.3
16.0
Virginia
77.5
68.6
5.4
3.4
22.5
14.5
8.0
West Virginia
63.7
59.6
4.1
<0.1
36.3
14.1
22.2
East South Central
79.8%
43.4%
5.8%
30.6%
20.2%
8.5%
11.7%
Alabama
67.4
59.2
8.1
<0.1
32.6
16.7
16.0
Kentucky
75.4
70.5
5.0
<0.1
24.6
15.5
9.0
Mississippi
81.6
72.7
8.9
0.0
18.4
14.6
3.8
Tennessee (5)
85.6
13.9
4.2
67.5
14.4
0.0
14.4
West South Central
74.0%
68.1%
5.9%
0.0%
26.0%
11.0%
15.0%
Arkansas
74.6
66.6
8.0
<0.1
25.4
12.2
13.2
Louisiana
78.3
74.0
4.4
0.0
21.7
13.3
8.4
Oklahoma
71.3
63.1
8.2
0.1
28.7
14.6
14.1
Texas
72.6
66.7
5.9
<0.1
27.4
9.6
17.9
East North Central
78.3%
63.4%
4.5%
10.4%
21.7%
11.8%
10.0%
Illinois
78.6
69.7
4.7
4.2
21.4
10.4
11.0
Indiana
67.4
63.6
3.2
0.6
32.6
18.0
14.6
Michigan
82.8
62.5
3.6
16.6
17.2
8.6
8.6
Ohio
78.8
64.3
3.1
11.4
21.2
13.4
7.7
Wisconsin
74.4
43.3
11.1
20.0
25.6
14.0
11.5
West North Central
71.8%
53.1%
7.7%
11.1%
28.2%
13.6%
14.6%
lowa
71.2
49.2
9.7
12.3
28.8
12.5
16.2
Kansas
71.5
62.6
8.8
<0.1
28.5
15.5
13.1
Minnesota
69.0
39.4
1.5
28.0
31.0
7.8
23.2
Missouri
74.3
59.2
12.7
2.4
25.7
19.0
6.7
Nebraska
74.2
63.4
8.6
2.2
25.8
15.7
10.0
North Dakota
66.5
63.6
2.7
0.2
33.5
13.8
19.6
South Dakota
77.4
71.2
6.2
<0.1
22.6
11.7
10.9
Mountain
83.2%
49.6%
3.5%
30.2%
16.8%
6.6%
10.2%
Arizona (5)
96.2
16.2
2.3
77.7
3.8
0.2
3.6
Colorado
83.7
67.7
3.4
12.6
16.3
9.4
6.9
Idaho
65.3
61.2
3.9
0.2
34.7
14.8
19.9
Montana
67.7
60.1
7.4
0.2
32.3
14.2
18.1
Nevada
77.8
67.3
3.7
6.9
22.2
6.5
15.7
New Mexico
70.8
67.0
3.8
0.0
29.2
7.9
21.3
Utah
80.1
62.5
4.4
13.2
19.9
9.6
10.2
Wyoming
83.1
79.6
3.5
< <0.1
16.9
11.7
5.2
Pacific
77.5%
54.1%
5.0%
18.4%
22.5%
10.6%
11.9%
Alaska
79.7
77.4
2.4
<0.1
20.3
7.7
12.6
California
77.0
59.2
5.8
12.0
23.0
11.5
11.5
Hawaii (5)
90.9
28.6
3.5
58.7
9.1
4.9
4.2
Oregon (5)
75.4
25.1
2.3
48.0
24.6
7.1
17.5
Washington
76.3
46.5
2.7
27.1
23.7
9.4
14.3
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories Figures may not sum to totals due to rounding.
(1) Mandatory acute care services are those that states are required to offer to participate in Medicaid. These include inpatient, physician/lab/X-ray, federally qualified health center
services, outpatient, rural health centers, and EPSDT.
(2) Optional acute care services are additional services that states are not required to offer, but may do so and receive federal reimbursement These include prescription drugs,
clinic services, family planning, case management, dental, vision, hospice, and other acute care (see footnote 4).
(3) Payments to managed care organizations may include some optional services.
(4) "Other acute care" includes case management, family planning, dental, vision, other practitioners' care, and all other unspecified acute care services.
(5) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were
made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 60
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 30
Medicaid Acute Care Expenditures per Beneficiary, by Type of Service, 1995
Mandatory (1)
Optional (2)
Total
Total
Mandatory
Total
Prescription
Other Acute
Acute Care
Mandatory
Services
Medicare
MCOs (3)
Optional
Drugs
Care (4)
United States
$2,256
$1,725
$1,335
$109
$281
$530
$240
$291
New England
$3,069
$2,017
$1,508
$178
$331
$1,052
$326
$726
Connecticut
2,717
1,813
1,471
342
<1
904
317
587
Maine
2,268
1,467
1,218
203
45
801
341
460
Massachusetts
3,698
2,437
1,675
132
630
1,261
348
913
New Hampshire
2,103
1,495
1,281
94
120
609
297
312
Rhode Island
3,395
2,219
1,739
85
395
1,176
279
897
Vermont
1,718
920
841
79
0
798
266
532
Middle Atlantic
$3,088
$2,369
$1,988
$78
$303
$719
$322
$397
New Jersey
2,772
2,191
1,915
106
169
581
381
200
New York
3,461
2,660
2,342
61
257
801
283
518
Pennsylvania
2,369
1,767
1,165
102
500
602
378
225
South Atlantic
$2,214
$1,715
$1,404
$130
$181
$499
$239
$260
Delaware
2,422
1,868
1,731
70
67
554
220
334
District of Columbia
3,448
3,093
2,377
123
593
355
178
177
Florida
2,324
1,764
1,155
192
416
560
252
309
Georgia
2,002
1,531
1,437
94
<1
471
216
255
Maryland
3,776
3,351
2,605
133
614
424
283
141
North Carolina
1,971
1,535
1,407
120
8
436
219
217
South Carolina
2,051
1,491
1,377
114
<1
560
232
328
Virginia
1,689
1,309
1,159
91
58
380
245
135
West Virginia
2,000
1,273
1,192
81
<1
727
282
445
East South Central
$1,829
$1,459
$795
$105
$559
$370
$156
$214
Alabama
1,731
1,166
1,025
140
1
564
288
276
Kentucky
2,097
1,582
1,478
104
<1
515
326
189
Mississippi
1,806
1,474
1,313
161
0
332
264
68
Tennessee (5)
1,761
1,508
245
74
1,189
253
0
253
West South Central
$2,008
$1,485
$1,367
$118
<$1
$523
$221
$302
Arkansas
1,912
1,426
1,274
152
<1
486
234
252
Louisiana
2,397
1,878
1,773
105
0
519
319
200
Oklahoma
1,539
1,098
971
126
2
441
224
217
Texas
1,977
1,435
1,319
116
<1
542
189
353
East North Central
$2,227
$1,744
$1,413
$100
$231
$484
$262
$222
Illinois
2,349
1,847
1,638
109
100
502
244
258
Indiana
1,904
1,283
1,210
61
12
621
342
279
Michigan
2,527
2,092
1,580
91
421
436
218
217
Ohio
1,918
1,512
1,233
59
219
406
258
149
Wisconsin
2,460
1,831
1,065
274
493
629
345
283
West North Central
$2,012
$1,445
$1,068
$154
$223
$567
$273
$294
lowa
2,224
1,584
1,095
216
273
640
279
361
Kansas
1,689
1,208
1,058
149
<1
482
261
221
Minnesota
2,558
1,764
1,009
39
716
793
199
594
Missouri
1,663
1,236
984
211
41
428
316
112
Nebraska
2,078
1,543
1,319
179
45
536
327
209
North Dakota
1,931
1,285
1,229
52
5
647
267
379
South Dakota
2,053
1,588
1,462
126
<1
465
241
224
Mountain
$2,128
$1,770
$1,054
$74
$642
$358
$139
$218
Arizona (5)
2,272
2,187
369
52
1,766
85
5
81
Colorado
2,323
1,944.
1,573
79
292
378
218
160
Idaho
1,624
1,060
994
63
3
563
240
324
Montana
1,892
1,281
1,137
139
4
612
269
343
Nevada
2,545
1,981-
1,712
93
176
564
164
399
New Mexico
1,768
1,251
1,185
66
0
516
140
376
Utah
2,346
1,880
1,466
104
310
466
226
240
Wyoming
1,664
1,382
1,324
58
<1
282
195
86
Pacific
$1,938
$1,501
$1,048
$96
$357
$437
$205
$232
Alaska
3,010
2,400
2,329
71
<1
610
232
379
California
1,857
1,430
1,100
107
223
427
214
213
Hawaii (5)
2,432
2,210
696
86
1,428
222
119
103
Oregon (5)
2,024
1,526
509
46
972
497
144
353
Washington
2,186
1,667
1,017
58
591
519
205
313
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. Beneficiaries are
people enrolled in the Medicaid program who actually receive medical services.
(1) Mandatory acute care services are those that states are required to offer to participate in Medicaid These include inpatient. physician/lab/X-ray federally qualified health center services,
outpatient, rural health centers, and EPSDT.
(2) Optional acute care services are additional services that states are not required to offer, but may do so and receive federal reimbursement These include prescription drugs. clinic services,
family planning. case management, dental, vision, hospice, and other acute care (see footnote 4).
(3) Payments to managed care organizations may include some optional services.
(4) "Other acute care" includes case management, family planning. dental, vision, other practitioners' care. and all other unspecified acute care services.
(5) For certain states with active 1115 waivers (AZ. HI, OR, TN). expenditure and beneficiary date were supplemented with data received directly from the state; adjustments were made to
categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 61
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 31
Federal and State Shares of Medicaid Acute Care Expenditures, per Beneficiary and
per Low-Income Person, 1995
per Beneficiary
per Low-Income Person (1)
Federal
State
Federal
State
Total
Share
Share
Total
Share
Share
United States
$2,256
$1,291
$965
$1,213
$694
$519
New England
$3,069
$1,595
$1,474
$1,984
$1,031
$953
Connecticut
2,717
1,359
1,359
1,717
858
858
Maine
2,268
1,436
832
1,585
1,004
582
Massachusetts
3,698
1,849
1,849
2,365
1,182
1,182
New Hampshire
2,103
1,052
1,052
1,174
587
587
Rhode Island
3,395
1,884
1,511
2,217
1,230
987
Vermont
1,718
1,045
673
1,356
824
531
Middle Atlantic
$3,088
$1,569
$1,519
$1,769
$899
$870
New Jersey
2,772
1,386
1,386
1,570
785
785
New York
3,461-
1,731
1,731
2,185
1,092
1,092
Pennsylvania
2,369
1,286
1,084
1,113
604
509
South Atlantic
$2,214
$1,310
$904
$1,157
$685
$473
Delaware
2,422
1,211
1,211
1,435
718
718
District of Columbia
3,448
1,724
1,724
2,380
1,190
1,190
Florida
2,324
1,308
1,016
1,035
582
452
Georgia
2,002
1,246
756
1,226
763
463
Maryland
3,776
1,888
1,888
1,606
803
803
North Carolina
1,971
1,275
696
1,242
804
438
South Carolina
2,051
1,450
601
898
635
263
Virginia
1,689
845
845
889
444
444
West Virginia
2,000
1,492
508
1,383
1,032
351
East South Central
$1,829
$1,277
$553
$1,206
$842
$364
Alabama
1,731
1,219
511
699
492
207
Kentucky
2,097
1,459
638
1,199
834
365
Mississippi
1,806
1,419
387
978
768
209
Tennessee (2)
1,761
1,171
590
1,838
1,223
616
West South Central
$2,008
$1,341
$667
$904
$604
$300
Arkansas
1,912
1,410
502
891
657
234
Louisiana
2,397
1,741
656
1,183
860
324
Oklahoma
1,539
1,078
461
632
442
189
Texas
1,977
1,252
725
876
555
321
East North Central
$2,227
$1,259
$969
$1,255
$709
$546
Illinois
2,349
1,174
1,174
1,370
685
685
Indiana
1,904
1,200
704
853
538
315
Michigan
2,527
1,437
1,091
1,420
807
613
Ohio
1,918
1,164
754
1,169
710
460
Wisconsin
2,460
1,471
989
1,332
797
535
West North Central
$2,012
$1,191
$821
$1,028
$609
$419
lowa
2,224
1,393
831
1,144
716
428
Kansas
1,689
995
694
670
394
275
Minnesota
2,558
1,388
1,170
1,344
730
615
Missouri
1,663
995
668
972
582
390
Nebraska
2,078
1,255
823
1,090
658
431
North Dakota
1,931
1,327
604
816
561
255
South Dakota
2,053
1,398
656
817
556
261
Mountain
$2,128
$1,375
$753
$876
$566
$310
Arizona (2)
2,272
1,509
763
889
590
299
Colorado
2,323
1,233
1,089
1,078
572
505
Idaho
1,624
1,139
485
666
467
199
Montana
1,892
1,340
552
846
599
247
Nevada
2,545
1,272
1,272
779
390
390
New Mexico
1,768
1,296
472
771
566
206
Utah
2,346
1,723
622
958
704
254
Wyoming
1,664
1,046
618
788
495
293
Pacific
$1,938
$991
$946
$1,067
$546
$521
Alaska
3,010
1,505
1,505
1,544
772
772
California
1,857
928
928
981
490
490
Hawaii (2)
2,432
1,216
1,216
2,021
1,011
1,011
Oregon (2)
2,024
1,262
762
1,291
805
486
Washington
2,186
1,136
1,050
1,347
700
647
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals
due to rounding. Beneficianes are people enrolled in the Medicaid program who actually receive medical services. Acute care services include inpatient, physician,
lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning. dental, vision, hospice, other practitioners' care, payments to managed care organizations,
and payments to Medicare.
(1) Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 62
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 32
Medicaid Acute Care Expenditures per Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per
per
per
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$79,439
$2,256
$48,608
$2,463
$30,830
$1,992
New England
$4,919
$3,069
$2,870
$3,043
$2,049
$3,106
Connecticut (1)
994
2,717
528
2,417
466
3,162
Maine
401
2,268
229
2,566
171
1,964
Massachusetts
2,682
3,698
1,604
3,692
1,078
3,708
New Hampshire (1)
215
2,103
129
1,956
86
2,372
Rhode Island
460
3,395
279
3,035
181
4,158
Vermont
167
1,718
101
2,345
67
1,223
Middle Atlantic
$15,537
$3,088
$10,466
$3,315
$5,071
$2,705
New Jersey
2,155
2,772
1,473
3,042
682
2,326
New York
10,467
3,461
7,121
3,507
3,347
3,367
Pennsylvania
2,915
2,369
1,872
2,914
1,043
1,774
South Atlantic
$13,585
$2,214
$7,986
$2,386
$5,599
$2,007
Delaware
189
2,422
114
2,781
75
2,027
District of Columbia
472
3,448
380
3,375
92
3,782
Florida
4,031
2,324
2,554
2,533
1,477
2,034
Georgia
2,278
2,002
1,375
2,293
902
1,678
Maryland
1,557
3,776
906
3,895
651
3,621
North Carolina
2,121
1,971
923
1,769
1,198
2,161
South Carolina
1,014
2,051
604
2,348
410
1,729
Virginia
1,146
1,689
650
1,853
496
1,514
West Virginia
777
2,000
480
2,150
297
1,798
East South Central
$5,792
$1,829
$3,475
$2,106
$2,317
$1,528
Alabama
930
1,731
589
2,013
342
1,395
Kentucky
1,304:
2,097
899
2,454
405
1,585
Mississippi
938
1,806
627
1,939
311
1,587
Tennessee (2)
2,620
1,761
n/a
n/a
n/a
n/a
West South Central
$8,104
$2,008
$4,600
$2,205
$3,504
$1,797
Arkansas
669
1,912
401
2,173
268
1,621
Louisiana
1,825
2,397
1,063
2,414
762
2,373
Oklahoma
605
1,539
336
1,464
269
1,645
Texas
5,005.
1,977
2,800
2,273
2,205
1,697
East North Central
$11,660
$2,227
$7,100
$2,336
$4,560
$2,077
Illinois
3,642
2,349
2,174
2,439
1,468
2,226
Indiana
1,062
1,904
589
1,896
473
1,914
Michigan
2,942
2,527
1,971
2,753
971
2,166
Ohio (1)
2,886
1,918
1,562
1,800
1,324
2,079
Wisconsin
1,128
2,460
804
3,158
325
1,589
West North Central
$4,042
$2,012
$2,264
$2,299
$1,778
$1,736
lowa
675
2,224
396
2,487
279
1,933
Kansas
426
1,689
208
1,710
218
1,671
Minnesota
1,176
2,558
749
3,224
427
1,877
Missouri
1,157
1,663
588
1,699
569
1,628
Nebraska
339
2,078
172
2,640
167
1,705
North Dakota
118
1,931
62
2,308
56
1,638
South Dakota
151
2,053
89
2,654
61
1,545
Mountain
$3,401
$2,128
$1,879
$2,318
$1,522
$1,933
Arizona (2)
1,122
2,272
n/a
n/a
n/a
n/a
Colorado
680
2,323
399
2,527
280
2,083
Idaho
187
1,624
79
1,988-
108
1,432
Montana
185
1,892
113
2,142
71
1,597
Nevada
266
2,545
83
1,768
184
3,172
New Mexico
500
1,768
322
1,911
178
1,556
Utah
376
2,346
158
2,704
219
2,141
Wyoming
85
1,664
46
2,009
40
1,390
Pacific
$12,399
$1,938
$7,969
$2,143
$4,430
$1,653
Alaska
205
3,010
125
2,846
80
3,309
California
9,176
1,857
6,165
2,059
3,011
1,547
Hawaii (1.2)
555
2,432
n/a
n/a
n/a
n/a
Oregon (2)
915
2,024
n/a
n/a
n/a
n/a
Washington
1,548
2,186
1,004
2,488
544
1,785
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to
totals due to rounding. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-
related expansion groups, and people eligible under Medicaid 1115 waivers. Beneficiaries are people enrolled in the Medicaid program who actually
receive medical services. Acute care services include inpatient, physician, lab, X-ray, outpatient, EPSDT. clinic, family planning, dental, vision, hospice,
other practitioners' care, payments to managed care organizations, and payments to Medicare.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficianes in the same manner as other states.
Corrections were made where possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled
beneficiaries See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the
state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration Acute
care expenditures are not available by cash assistance status because a large portion of expenditures in these states are payments to MCOs, which are not
distributed in a reliable format on HCFA-2082 reports. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 63
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 33
Medicaid Acute Care Expenditures per Child Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per Child
per Child
per Child
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$23,703
$1,353
$12,802
$1,393
$10,901
$1,309
New England
$1,326
$1,811
$793
$1,785
$533
$1,852
Connecticut
218
1,226
129
1,076
89
1,541
Maine
91
1,119
42
1,173
49
1,076
Massachusetts
806
2,592
480
2,571
326
2,624
New Hampshire
71
1,417
52
1,352
19
1,636
Rhode Island
94
1,543
67
1,493
27
1,681
Vermont
46
903
22
1,253
24
714
Middle Atlantic
$4,577
$1,866
$2,891
$1,915
$1,686
$1,788.5
New Jersey
448
1,246
271
1,249
177
1,242
New York
3,103
2,041
1,999
1,968
1,105
2,188
Pennsylvania
1,026
1,791
622
2,239
404
1,369
South Atlantic
$4,343
$1,323
$2,109
$1,290
$2,234
$1,356
Delaware
58
1,339
24
1,214
34
1,445
District of Columbia
136
1,851
120
1,937
16
1,379
Florida
1,616
1,556
827
1,511
789
1,607
Georgia
634
1,056
285
1,060
348
1,053
Maryland
527
2,548
300
2,758
228
2,315
North Carolina
622
1,159
261
939
361
1,394
South Carolina
258
1,092
99
956
159
1,198
Virginia
322
884
107
706
214
1,012
West Virginia
171
934
85
908
86
961
East South Central
$1,352
$993
$552
$951
$800
$1,025
Alabama
220
889
61
698
159
992
Kentucky
263
952
126
963
137
941
Mississippi
233
932
93
766
140
1,088
Tennessee (1)
636
1,082
n/a
n/a
n/a
n/a
West South Central
$2,416
$1,124
$881
$956
$1,535
$1,251
Arkansas
162
1,066
53
839
109
1,227
Louisiana
451
1,201
189
1,006
263
1,395
Oklahoma
216
1,083
95
854
121
1,373
Texas
1,586
1,116
544
973
1,041
1,209
East North Central
$3,668
$1,377
$2,193
$1,415
$1,476
$1,323
Illinois
1,132
1,387
646
1,345
486
1,447
Indiana
358
1,158
176
1,039
182
1,302
Michigan
885
1,610
585
1,733
300
1,414
Ohio
923
1,181
537
1,128
386
1,263
Wisconsin
372
1,785
250
2,888
122
1,002
West North Central
$1,348
$1,330
$702
$1,471
$646
$1,205
lowa
217
1,538
111
1,571
106
1,506
Kansas
117
892
50
787
66
993
Minnesota
487
2,079
323
2,656
163
1,454
Missouri
338
971
164
971
175
972
Nebraska
118
1,281
30
1,083
88
1,367
North Dakota
30
1,064
10
960
21
1,123
South Dakota
40
1,061
13
956
27
1,121
Mountain
$1,156
$1,315
$526
$1,305
$631
$1,323
Arizona (1)
456
1,536
n/a
n/a
n/a
n/a
Colorado
201
1,545
111
1,586
90
1,496
Idaho
46
731
14
728
32
732
Montana
39
776
18
713
21
841
Nevada
79
1,479
36
1,356
43
1,599
New Mexico
166
973
80
923
86
1,024
Utah
141
1,598
48
1,692
93
1,554
Wyoming
29
1,044
12
1,040
17
1,046
Pacific
$3,517
$1,179
$2,154
$1,291
$1,362
$1,036
Alaska
78
2,018
43
1,654
35
2,756
California
2,577
1,110
1,573
1,215
1,004
978
Hawaii (1)
156
1,595
n/a
n/a
n/a
n/a
Oregon (1)
239
1,504
n/a
n/a
n/a
n/a
Washington
467
1,275
285
1,493
182
1,038
Source. Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories Figures may not sum to totals due to
rounding. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficianes" include the medically needy, poverty-related expansion groups,
and people eligible under Medicaid 1115 waivers. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Acute care services
include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning. dental, vision, hospice, other practitioners' care, payments to
managed care organizations. and payments to Medicare. Child beneficiaries are non-disabled individuals under 18.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration Acute care expenditures are
not available by cash assistance status because a large portion of expenditures in these states are payments to MCOs, which are not distributed in a reliable format on
the HCFA-2082 reports. See Appendix C.
Page 64
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 34
Medicaid Acute Care Expenditures per Adult Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per Adult
per Adult
per Adult
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$16,301
$2,048
$8,877
$2,022
$7,424
$2,079
New England
$785
$2,246
$553
$2,317
$232
$2,095
Connecticut
173
2,006
130
2,126
43
1,709
Maine
70
1,915
45
2,052
25
1,706
Massachusetts
404
2,650
279
2,687
125
2,570
New Hampshire
41
1,799
31
1,793
10
1,818
Rhode Island
67
2,243
49
2,174
18
2,456
Vermont
30
1,385
17
1,550
12
1,201
Middle Atlantic
$2,684
$2,615
$1,786
$2,626
$897
$2,593
New Jersey
511
2,780
305
2,675
205
2,954
New York
1,738
2,796
1,178
2,686
560
3,059
Pennsylvania
435
1,967
303
2,376
132
1,409
South Atlantic
$2,558
$2,274
$1,410
$2,135
$1,147
$2,470
Delaware
35
2,214
18
1,982
17
2,510
District of Columbia
74
2,211
66
2,287
7
1,700
Florida
501
2,396
355
2,616
146
1,989
Georgia
614
2,520
292
2,354
322
2,693
Maryland
236
3,225
142
3,024
94
3,586
North Carolina
574
2,357
285
1,934
289
3,006
South Carolina
168
1,930
74
1,940
94
1,922
Virginia
193
1,563
94
1,284
99
1,973
West Virginia
164
1,700
85
1,478
79
2,026
East South Central
$1,432
$1,878
$515
$1,868
$917
$1,884
Alabama
184
2,097
66
1,634
118
2,496
Kentucky
270
2,145
132
2,035
138
2,263
Mississippi
138
1,788
91
1,708
47
1,966
Tennessee (1)
840
1,781
n/a
n/a
n/a
n/a
West South Central
$1,796
$2,193
$758
$1,887
$1,037
$2,489
Arkansas
79
1,375
25
1,159
54
1,504
Louisiana
341
2,388
158
2,094
182
2,719
Oklahoma
111
1,286
44
991
67
1,597
Texas
1,265
2,376
531
2,038
734
2,701
East North Central
$2,079
$1,788
$1,361
$1,781
$718
$1,801
Illinois
627
1,897
393
1,945
235
1,823
Indiana
200
1,742
155
1,747
45
1,726
Michigan
605
1,978
380
2,067
224
1,844
Ohio
501
1,519
320
1,355
181
1,931
Wisconsin
146
1,785
113
2,119
33
1,160
West North Central
$707
$1,603
$417
$1,705
$290
$1,477
lowa
135
1,806
80
1,914
55
1,670
Kansas
93
1,658
51
1,528
43
1,845
Minnesota
213
2,137
141
2,604
72
1,581
Missouri
180
1,150
98
1,109
82
1,203
Nebraska
42
1,565
27
1,881
16
1,219
North Dakota
20
1,525
10
1,540
10
1,511
South Dakota
23
1,735
11
1,667
12
1,800
Mountain
$786
$2,116
$391
$2,029
$395
$2,210
Arizona (1)
259
2,331
n/a
n/a
n/a
n/a
Colorado
166
2,170
78
2,242
88
2,111
Idaho
41
1,646
16
1,661
25
1,637
Montana
31
1,392
16
1,366
15
1,423
Nevada
56
2,384
30
2,242
26
2,573
New Mexico
104
1,779
66
1,645
38
2,073
Utah
106
2,408
38
2,301
68
2,472
Wyoming
24
2,150
10
1,993
14
2,286
Pacific
$3,474
$1,826
$1,685
$1,810
$1,790
$1,842
Alaska
57
3,121
33
2,756
23
3,857
California
2,358
1,695
1,233
1,672
1,125
1,720
Hawaii (1)
291
2,934
n/a
n/a
n/a
n/a
Oregon (1)
358
1,710
n/a
n/a
n/a
n/a
Washington
410
2,229
220
2,070
190
2,447
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to
rounding. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups,
and people eligible under Medicaid 1115 waivers. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Acute care services
include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning, dental, vision, hospice, other practitioners' care, payments to
managed care organizations, and payments to Medicare. Adult beneficiaries are non-disabled individuals between 19 and 64.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration Acute care expenditures are
not available by cash assistance status because a large portion of expenditures in these states are payments to MCOs, which are not distributed in a reliable format on
HCFA-2082 reports. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 65
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 35
Medicaid Acute Care Expenditures per Blind & Disabled Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per Blind &
per Blind &
per Blind &
Disabled
Disabled
Disabled
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$29,761
$5,088
$22,617
$5,006
$7,144
$5,366
New England
$2,062
$6,921
$1,355
$6,574
$707
$7,700
Connecticut (1)
381
7,829
222
8,166
159
7,404
Maine
179
4,892
125
4,942
54
4,781
Massachusetts
1,135
7,070
766
6,576
369
8,377
New Hampshire (1)
75
6,176
40
5,915
35
6,504
Rhode Island
220
8,709
148
7,535
72
12,805
Vermont
72
4,882
54
5,027
18
4,489
Middle Atlantic
$6,383
$6,910
$4,767
$6,879
$1,615
$7,004
New Jersey
925
6,422
770
6,546
154
5,867
New York
4,366
8,552
3,204
8,011
1,163
10,507
Pennsylvania
1,091
4,056
793
4,523
298
3,183
South Atlantic
$4,876
$4,849
$3,675
$4,903
$1,201
$4,692
Delaware
81
6,428
66
6,772
15
5,277
District of Columbia
230
10,196
178
9,989
52
10,981
Florida
1,276
4,626
1,093
4,796
183
3,819
Georgia
798
4,197
698
4,343
100
3,398
Maryland
654
7,637
408
6,948
246
9,138
North Carolina (1)
642
4,460
292
5,009
351
4,087
South Carolina
423
4,485
337
4,503
87
4,418
Virginia
431
4,080
351
4,106
80
3,969
West Virginia
340
4,555
252
4,499
87
4,722
East South Central
$2,446
$3,365
$2,133
$3,351
$314
$3,465
Alabama
400
3,047
387
3,084
13
2,228
Kentucky
623
3,982
573
4,035
50
3,459
Mississippi
407
3,231
365
3,222
42
3,312
Tennessee (2)
1,017
3,245
n/a
n/a
n/a
n/a
West South Central
$2,671
$4,776
$2,318
$4,742
$354
$5,011
Arkansas
315
3,604
279
3,618
36
3,496
Louisiana
769
5,278
574
4,589
195
9,447
Oklahoma
176
3,134
144
3,077
32
3,416
Texas
1,412
5,225
1,321
5,508
91
2,996
East North Central
$4,686
$5,229
$3,221
$5,280
$1,465
$5,121
Illinois
1,555
5,614
1,045
5,735
510
5,383
Indiana
351
5,205
218
5,820
133
4,439
Michigan
1,256
5,637
947
5,563
310
5,878
Ohio (1)
1,092
4,870
624
4,988
468
4,720
Wisconsin
431
4,127-
387
4,073
44
4,661
West North Central
$1,411
$4,674
$989
$4,921
$422
$4,184
lowa
225
4,486
179
4,737
46
3,714
Kansas
161
4,103
103
4,445
58
3,614
Minnesota
381
5,481
264
6,029
117
4,548
Missouri
403
4,123
252
4,055
151
4,240
Nebraska
126
5,405
96
5,678
30
4,677
North Dakota
47
5,382
35
5,633
12
4,745
South Dakota
69
5,166
60
5,458
9
3,784
Mountain
$1,176
$5,248
$826
$5,252
$350
$5,238
Arizona (2)
335
5,438
n/a
n/a
n/a
n/a
Colorado
244
4,925
163
5,679
80
3,880
Idaho
83
4,489
44
5,038
39
3,998
Montana
88
5,405
71
5,397
17
5,438
Nevada
106
6,545
9
3,324
97
7,156
New Mexico
195
5,271
157
4,782
37
9,267
Utah
102
5,362
62
5,727
40
4,885
Wyoming
24
3,924
21
4,541
3
2,134
Pacific
$4,050
$4,433
$3,334
$4,298
$716
$5,190
Alaska
57
8,574
45
9,645
13
6,156
California
3,147
4,239
2,666
4,070
481
5,514
Hawaii (1.2)
63
4,620
n/a
n/a
n/a
n/a
Oregon (2)
235
5,090
n/a
n/a
n/a
n/a
Washington
547
5,223
446
5,189
101
5,377
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "Cash assistance"
refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy. poverty-related expansion groups, and people eligible under Medicaid 1115 waivers.
Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Acute care services include inpatient, physician, lab. X-ray, outpatient, clinic, prescription drugs,
EPSDT, family planning, dental, vision, hospice, other practitioners' care, payments to managed care organizations, and payments to Medicare. The blind and disabled beneficiary group includes
individuals who, regardless of age, qualify for Medicaid because of disability.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states. Corrections were made where possible by
adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made to
categorize these numbers in the same manner as other states report to the Health Care Financing Administration Acute care expenditures are not available by cash assistance status because
a large portion of expenditures in these states are payments to MCOs, which are not distributed in a reliable format on HCFA-2082 reports. See Appendix C.
Page 66
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 36
Medicaid Acute Care Expenditures per Elderly Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per Elderly
per Elderly
per Elderly
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$9,674
$2,488
$4,313
$2,629
$5,361
$2,384
New England
$746
$3,341
$169
$3,126
$577
$3,409
Connecticut (1)
221
4,180
46
4,785
175
4,046
Maine
61
2,716
17
2,787
44
2,690
Massachusetts
337
3,330
78
2,885
259
3,494
New Hampshire (1)
27
1,617
5
1,710
22
1,597
Rhode Island
79
4,050
16
3,032
64
4,420
Vermont
20
1,950
7
2,242
13
1,826
Middle Atlantic
$1,894
$3,010
$1,021
$3,734
$873
$2,454
New Jersey
271
3,001
126
3,554
145
2,644
New York
1,260
3,392
741
4,205
519
2,657
Pennsylvania
363
2,169
154
2,493
209
1,979
South Atlantic
$1,807
$2,495
$791
$2,616
$1,017
$2,408
Delaware
15
2,391
6
2,602
9
2,263
District of Columbia
33
4,205
15
4,121
18
4,279
Florida
637
3,020
279
2,870
359
3,148
Georgia
231
2,228
100
2,167
132
2,278
Maryland
140
2,999
56
3,099
83
2,935
North Carolina (1)
284
1,864
86
2,231
198
1,739
South Carolina
165
2,150
93
2,325
71
1,957
Virginia
200
2,343
97
2,441
103
2,257
West Virginia
103
2,958
58
3,542
45
2,437
East South Central
$562
$1,781
$275
$1,753
$287
$1,809
Alabama
126
1,773
74
1,879
52
1,641
Kentucky
149
2,351
68
2,365
81
2,339
Mississippi
161
2,411
78
2,192
82
2,666
Tennessee (2)
126
1,102
n/a
n/a
n/a
n/a
West South Central
$1,221
$2,399
$643
$2,347
$578
$2,460
Arkansas
112
2,136
43
1,928
69
2,290
Louisiana
264
2,721
142
2,730
122
2,710
Oklahoma
102
1,997
53
1,957
49
2,042
Texas
742
2,410
404
2,348
338
2,489
East North Central
$1,226
$2,395
$325
$2,799
$901
$2,276
Illinois
328
2,586
91
3,394
237
2,370
Indiana
152
2,304
40
2,655
112
2,201
Michigan
196
2,282
59
2,460
137
2,213
Ohio (1)
371
2,192
82
2,651
289
2,090
Wisconsin
179
2,797
54
2,745
125
2,821
West North Central
$577
$2,278
$157
$2,514
$421
$2,201
lowa
98
2,620
26
2,941
72
2,522
Kansas
55
2,132
4
3,098
51
2,076
Minnesota
96
1,687
21
1,635
75
1,702
Missouri
236
2,535
74
2,759
162
2,444
Nebraska
53
2,566
19
3,143
34
2,326
North Dakota
21
1,939
7
1,792
14
2,021
South Dakota
19
2,082
6
2,103
13
2,073
Mountain
$283
$2,294
$136
$2,358
$147
$2,237
Arizona (2)
73
2,957
n/a
n/a
n/a
n/a
Colorado
69
1,889
48
1,921
21
1,821
Idaho
17
1,858
5
2,353
12
1,705
Montana
27
3,034
8
3,480
19
2,881
Nevada
25
2,219
8
1,919
17
2,397
New Mexico
36
2,076
19
2,112
17
2,039
Utah
27
2,998
10
3,715
17
2,689
Wyoming
8
1,290
2
1,593
5
1,196
Pacific
$1,358
$2,267
$796
$2,317
$562
$2,199
Alaska
13
2,881
4
3,383
9
2,687
California
1,094
2,250
693
2,254
402
2,243
Hawaii (1.2)
44
2,556
n/a
n/a
n/a
n/a
Oregon (2)
83
2,199
n/a
n/a
n/a
n/a
Washington
123
2,322
52
2,599
71
2,155
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
"Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible under
Medicaid 1115 waivers. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Acute care services include inpatient, physician, lab, X-ray,
outpatient, EPSDT, clinic, family planning. dental, vision, hospice, other practitioners' care, payments to managed care organizations, and payments to Medicare. Elderly beneficiaries
are people aged 65 and over. The elderly most likely include some disabled individuals who have spent down their assets to become Medicaid eligible and were not originally
considered disabled
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states. Corrections were made
where possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration Acute care expenditures are not available by
cash assistance status because a large portion of expenditures in these states are payments to MCOs, which are not distributed in a reliable format on HCFA-2082 reports.
See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 67
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 37
Medicaid Long-Term Care Expenditures, by Group, 1995
Expenditures (millions)
Children
Blind and
Total
and Adults
Disabled
Elderty
United States
$53,996
$1,964
$21,619
$30,414
New England
$4,889
$116
$1,916
$2,857
Connecticut
1,394
38
520
836
Maine
383
21
128
234
Massachusetts
2,309
44
963
1,302
New Hampshire
305
4
101
201
Rhode Island
367
6
148
213
Vermont
132
4
56
72
Middle Atlantic
$15,321
$525
$5,996
$8,800
New Jersey
1,950
61
877
1,011
New York
10,141
327
4,112
5,702
Pennsylvania
3,230
137
1,007
2,087
South Atlantic
$6,915
$248
$2,758
$3,908
Delaware
138
7
64
67
District of Columbia
270
5
113
152
Florida
1,769
19
633
1,117
Georgia
894
12
465
418
Maryland
748
22
290
435
North Carolina
1,341
74
500
766
South Carolina
562
21
260
281
Virginia
767
42
272
453
West Virginia
425
45
161
219
East South Central
$2,404
$58
$878
$1,468
Alabama
606
5
230
371
Kentucky
631
36
248
347
Mississippi
403
14
150
239
Tennessee (1)
764
4
250
510
West South Central
$4,246
$137
$1,705
$2,404
Arkansas
533
33
232
268
Louisiana
1,026
70
472
485
Oklahoma
506
31
225
251
Texas
2,180
3
777
1,400
East North Central
$8,637
$349
$3,486
$4,803
Illinois
1,932
41
1,088
804
Indiana
1,069
54
411
604
Michigan
1,734
117
683
935
Ohio
2,627
51
863
1,712
Wisconsin
1,276
86
442
748
West North Central
$4,009
$106
$1,632
$2,270
lowa
499
21
248
230
Kansas
446
22
211
212
Minnesota
1,549
47
630
872
Missouri
879
7
298
574
Nebraska
292
6
101
184
North Dakota
180
3
71
107
South Dakota
164
<1
73
90
Mountain
$1,795
$92
$779
$924
Arizona (1)
357
12
142
202
Colorado
491
21
204
266
Idaho
147
<1
73
73
Montana
175
7
57
111
Nevada
124
20
45
59
New Mexico
238
20
119
99
Utah
176
10
96
70
Wyoming
87
<1
43
44
Pacific
$5,780
$332
$2,468
$2,979
Alaska
80
11
30
39
California
4,097
264
1,732
2,101
Hawaii (1)
173
8
47
118
Oregon (1)
495
24
234
237
Washington
934
25
426
484
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories.
Figures may not sum to totals due to rounding. Long-term care services include skilled nursing facilities, intermediate care facilities
for the mentally retarded, other intermediate care facilities, mental health, and home health services.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data
received directly from the state; adjustments were made to categorize these numbers in the same manner as other states report
to the Health Care Financing Administration See Appendix C.
Page 68
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 38
Distribution of Medicaid Long-Term Care Expenditures, by Group, 1995
Blind &
Total
Children
Disabled
Elderly
United States
100.0%
3.6%
40.0%
56.3%
New England
100.0%
2.4%
39.2%
58.4%
Connecticut
100.0
2.7
37.3
60.0
Maine
100.0
5.4
33.5
61.1
Massachusetts
100.0
1.9
41.7
56.4
New Hampshire
100.0
1.2
33.0
65.8
Rhode Island
100.0
1.7
40.2
58.0
Vermont
100.0
2.8
42.7
54.5
Middle Atlantic
100.0%
3.4%
39.1%
57.4%
New Jersey
100.0
3.1
45.0
51.9
New York
100.0
3.2
40.5
56.2
Pennsylvania
100.0
4.2
31.2
64.6
South Atlantic
100.0%
3.6%
39.9%
56.5%
Delaware
100.0
5.3
46.4
48.3
District of Columbia
100.0
1.9
42.0
56.1
Florida
100.0
1.1
35.8
63.2
Georgia
100.0
1.3
51.9
46.7
Maryland
100.0
3.0
38.8
58.2
North Carolina
100.0
5.5
37.3
57.2
South Carolina
100.0
3.8
46.3
49.9
Virginia
100.0
5.5
35.5
59.0
West Virginia
100.0
10.5
37.9
51.6
East South Central
100.0%
2.4%
36.5%
61.0%
Alabama
100.0
0.8
37.9
61.3
Kentucky
100.0
5.6
39.4
55.0
Mississippi
100.0
3.5
37.2
59,4
Tennessee (1)
100.0
0.5
32.7
66.8
West South Central
100.0%
3.2%
40.2%
56.6%
Arkansas
100.0
6.1
43.6
50.3
Louisiana
100.0
6.8
46.0
47.2
Oklahoma
100.0
6.1
44.3
49.5
Texas
100.0
0.1
35.6
64.2
East North Central
100.0%
4.0%
40.4%
55.6%
Illinois
100.0
2.1
56.3
41.6
Indiana
100.0
5.0
38.4
56.5
Michigan
100.0
6.7
39.4
53.9
Ohio
100.0
2.0
32.9
65.2
Wisconsin
100.0
6.8
34.6
58.6
West North Central
100.0%
2.6%
40.7%
56.6%
lowa
100.0
4.1
49.7
46.1
Kansas
100.0
5.0
47.4
47.7
Minnesota
100.0
3.0
40.7
56.3
Missouri
100.0
0.8
33.9
65.3
Nebraska
100.0
2.2
34.6
63.2
North Dakota
100.0
1.5
39.2
59.3
South Dakota
100.0
0.2
44.8
55.1
Mountain
100.0%
5.1%
43.4%
51.5%
Arizona (1)
100.0
3.5
39.9
56.6
Colorado
100.0
4.3
41.5
54.3
Idaho
100.0
0.6
49.8
49.6
Montana
100.0
4.1
32.4
63.5
Nevada
100.0
16.4
36.5
47.1
New Mexico
100.0
8.5
50.0
41.5
Utah
100.0
5.6
54.3
40.1
Wyoming
100.0
0.5
49.1
50.4
Pacific
100.0%
5.7%
42.7%
51.5%
Alaska
100.0
14.0
37.0
49.0
California
100.0
6.5
42.3
51.3
Hawaii (1)
100.0
4.6
27.4
68.0
Oregon (1)
100.0
4.8
47.2
48.0
Washington
100.0
2.7
45.6
51.8
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures
may not sum to totals due to rounding. Long-term care services include skilled nursing facilities, intermediate care facilities for the mentally
retarded, other intermediate care facilities, mental health, and home health services.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received
directly from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care
Financing Administration See Appendix C
Kaiser Commission on the Future of Medicaid
Page 69
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 39
Medicaid Long-Term Care Expenditures, by Type of Service, 1995
Long-Term Care Expenditures (millions)
Total
SNF/
Long-Term Care
ICF-Other
ICF/MR
Mental Health
Home Health
United States
$53,996
$30,486
$10,003
$3,076
$10,431
New England
$4,889
$2,936
$650
$142
$1,161
Connecticut
1,394
814
187
41
353
Maine
383
237
52
27
66
Massachusetts
2,309
1,402
351
53
503
New Hampshire
305
196
9
10
91
Rhode Island
367
216
47
12
93
Vermont
132
72
4
<1
55
Middle Atlantic
$15,321
$7,783
$2,921
$965
$3,652
New Jersey
1,950
1,097
380
74
399
New York
10,141
4,598
2,042
580
2,920
Pennsylvania
3,230
2,088
500
310
332
South Atlantic
$6,915
$4,097
$1,284
$315
$1,219
Delaware
138
64
28
11
35
District of Columbia
270
156
66
30
19
Florida
1,769
1,211
247
15
297
Georgia
894
619
122
25
128
Maryland
748
460
79
11
198
North Carolina
1,341
718
363
34
225
South Carolina
562
245
193
49
75
Virginia
767
388
152
105
122
West Virginia
425
236
35
35
119
East South Central
$2,404
$1,681
$389
$86
$248
Alabama
606
428
79
18
82
Kentucky
631
389
70
40
131
Mississippi
403
276
90
24
13
Tennessee (1)
764
588
150
3
22
West South Central
$4,246
$2,313
$1,071
$166
$697
Arkansas
533
285
103
50
95
Louisiana
1,026
561
310
79
76
Oklahoma
506
271
99
37
100
Texas
2,180
1,197
559
0
425
East North Central
$8,637
$5,427
$1,782
$442
$986
Illinois
1,932
1,201
527
43
161
Indiana
1,069
684
291
47
47
Michigan
1,734
985
226
200
323
Ohio
2,627
1,767
521
112
227
Wisconsin
1,276
790
217
40
228
West North Central
$4,009
$2,302
$854
$116
$736
lowa
499
257
171
21
50
Kansas
446
223
102
22
98
Minnesota
1,549
929
317
38
265
Missouri
879
498
160
18
203
Nebraska
292
197
35
2
57
North Dakota
180
103
39
8
30
South Dakota
164
94
31
6
33
Mountain
$1,795
$975
$264
$108
$447
Arizona (1)
357
205
67
18
67
Colorado
491
278
31
27
156
Idaho
147
80
42
0
26
Montana
175
105
14
14
42
Nevada
124
65
24
22
14
New Mexico
238
114
32
19
72
Utah
176
85
45
7
39
Wyoming
87
44
10
<1
32
Pacific
$5,780
$2,971
$786
$737
$1,285
Alaska
80
50
9
11
9
California
4,097
2,115
561
639
781
Hawaii (1)
173
127
11
0
35
Oregon (1)
495
160
76
25
235
Washington
934
519
129
62
225
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories Figures may not
sum to totals due to rounding. "ICF/MR" refers to intermediate care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing
facilities and other intermediate care facilities.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly
from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing
Administration See Appendix C.
Page 70
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 40
Distribution of Medicaid Long-Term Care Expenditures, by Type of Service, 1995
SNF/
Total
ICF-Other
ICF/MR
Mental Health
Home Health
United States
100.0%
56.5%
18.5%
5.7%
19.3%
New England
100.0%
60.1%
13.3%
2.9%
23.8%
Connecticut
100.0
58.4
13.4
2.9
25.3
Maine
100.0
61.9
13.6
7.2
17.3
Massachusetts
100.0
60.7
15.2
2.3
21.8
New Hampshire
100.0
64.1
2.9
3.1
29.8
Rhode Island
100.0
58.8
12.7
3.2
25.4
Vermont
100.0
54.8
3.1
<0.1
42.0
Middle Atlantic
100.0%
50.8%
19.1%
6.3%
23.8%
New Jersey
100.0
56.3
19.5
3.8
20.5
New York
100.0
45.3
20.1
5.7
28.8
Pennsylvania
100.0
64.6
15.5
9.6
10.3
South Atlantic
100.0%
59.3%
18.6%
4.5%
17.6%
Delaware
100.0
46.5
20.1
7.9
25.5
District of Columbia
100.0
57.6
24.4
11.2
6.9
Florida
100.0
68.4
13.9
0.8
16.8
Georgia
100.0
69.2
13.6
2.8
14.3
Maryland
100.0
61.5
10.5
1.4
26.5
North Carolina
100.0
53.6
27.1
2.5
16.8
South Carolina
100.0
43.6
34.3
8.8
13.4
Virginia
100.0
50.6
19.9
13.7
15.9
West Virginia
100.0
55.5
8.2
8.3
28.0
East South Central
100.0%
69.9%
16.2%
3.6%
10.3%
Alabama
100.0
70.6
13.0
3.0
13.4
Kentucky
100.0
61.7
11.1
6.4
20.7
Mississippi
100.0
68.5
22.3
5.9
3.3
Tennessee (1)
100.0
77.0
19.7
0.4
2.9
West South Central
100.0%
54.5%
25.2%
3.9%
16.4%
Arkansas
100.0
53.4
19.4
9.3
17.9
Louisiana
100.0
54.7
30.2
7.7
7.4
Oklahoma
100.0
53.4
19.5
7.3
19.8
Texas
100.0
54.9
25.6
0.0
19.5
East North Central
100.0%
62.8%
20.6%
5.1%
11.4%
Illinois
100.0
62.2
27.3
2.2
8.3
Indiana
100.0
63.9
27.2
4.4
4.4
Michigan
100.0
56.8
13.0
11.5
18.6
Ohio
100.0
67.3
19.8
4.3
8.6
Wisconsin
100.0
61.9
17.0
3.2
17.9
West North Central
100.0%
57.4%
21.3%
2.9%
18.4%
lowa
100.0
51.6
34.2
4.3
9.9
Kansas
100.0
50.1
22.8
5.0
22.1
Minnesota
100.0
60.0
20.5
2.5
17.1
Missouri
100.0
56.7
18.2
2.1
23.1
Nebraska
100.0
67.7
12.1
0.7
19.5
North Dakota
100.0
57.2
21.6
4.6
16.6
South Dakota
100.0
57.3
18.9
3.6
20.2
Mountain
100.0%
54.3%
14.7%
6.0%
24.9%
Arizona (1)
100.0
57.4
18.7
5.2
18.7
Colorado
100.0
56.5
6.2
5.5
31.8
Idaho
100.0
54.0
28.2
0.0
17.8
Montana
100.0
60.1
7.8
8.2
23.8
Nevada
100.0
52.4
19.2
17.4
10.9
New Mexico
100.0
47.9
13.6
8.1
30.3
Utah
100.0
48.3
25.8
3.9
22.0
Wyoming
100.0
50.8
11.8
0.2
37.3
Pacific
100.0%
51.4%
13.6%
12.8%
22.2%
Alaska
100.0
63.0
11.5
14.2
11.3
California
100.0
51.6
13.7
15.6
19.1
Hawaii (1)
100.0
73.2
6.5
0.0
20.3
Oregon (1)
100.0
32.3
15.3
5.0
47.4
Washington
100.0
55.5
13.8
6.6
24.1
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories Figures may not sum to
totals due to rounding. "ICF/MR" refers to intermediate care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing facilities and
other intermediate care facilities.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from
the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration
See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 71
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 41
Medicaid Long-Term Care Expenditures per Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per
per
per
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$53,996
$1,533
$15,853
$803
$38,143
$2,464
New England
$4,889
$3,051
$991
$1,051
$3,898
$5,910
Connecticut (1)
1,394
3,811
296
1,356
1,098
7,451
Maine
383
2,168
72
806
311
3,560
Massachusetts
2,309
3,184
399
919
1,910
6,566
New Hampshire (1)
305
2,988
61
927
244
6,740
Rhode Island
367
2,709
110
1,196
257
5,915
Vermont
132
1,351
53
1,224
79
1,451
Middle Atlantic
$15,321
$3,045
$4,902
$1,553
$10,419
$5,557
New Jersey
1,950
2,508
583
1,205
1,367
4,661
New York
10,141
3,353
3,538
1,743
6,603
6,643
Pennsylvania
3,230
2,626
780
1,215
2,450
4,167
South Atlantic
$6,915
$1,127
$2,113
$631
$4,802
$1,721
Delaware
138
1,770
48
1,175
90
2,426
District of Columbia
270
1,975
112
999
158
6,469
Florida
1,769
1,020
533
529
1,236
1,702
Georgia
894
786
261
434
634
1,179
Maryland
748
1,812
251
1,080
496
2,760
North Carolina (1)
1,341
1,245
332
636
1,009
1,819
South Carolina
562
1,138
184
716
378
1,595
Virginia
767
1,131
243
692
525
1,602
West Virginia
425
1,093
148
664
277
1,672
East South Central
$2,404
$759
$1,054
$639
$1,350
$890
Alabama
606
1,128
175
598
431
1,761
Kentucky
631
1,014
216
589
415
1,624
Mississippi
403
776
123
381
280
1,429
Tennessee (2)
764
513
n/a
n/a
n/a
n/a
West South Central
$4,246
$1,052
$1,155
$553
$3,092
$1,586
Arkansas
533
1,524
199
1,080
334
2,019
Louisiana
1,026
1,348
134
305
892
2,780
Oklahoma
506
1,288
118
514
388
2,375
Texas
2,180
861
703
571
1,477
1,137
East North Central
$8,637
$1,650
$2,127
$700
$6,511
$2,965
Illinois
1,932
1,246
558
626
1,374
2,084
Indiana
1,069
1,917
268
863
801
3,242
Michigan
1,734
1,490
536
748
1,199
2,675
Ohio (1)
2,627
1,746
438
505
2,189
3,437
Wisconsin
1,276
2,781
327
1,286
948
4,644
West North Central
$4,009
$1,996
$973
$988
$3,036
$2,965
lowa
499
1,644
128
806
371
2,568
Kansas
446
1,770
71
584
375
2,878
Minnesota
1,549
3,369
381
1,640
1,168
5,133
Missouri
879
1,264
232
672
647
1,851
Nebraska
292
1,785
91
1,395
201
2,045
North Dakota
180
2,938
46
1,730
134
3,877
South Dakota
164
2,232
22
665
141
3,560
Mountain
$1,795
$1,123
$548
$676
$1,246
$1,582
Arizona (2)
357
722
n/a
n/a
n/a
n/a
Colorado
491
1,677
209
1,322
282
2,094
Idaho
147
1,282
23
568
125
1,659
Montana
175
1,798
49
925
127
2,829
Nevada
124
1,188
10
205
115
1,982
New Mexico
238
839
91
541
146
1,278
Utah
176
1,096
39
669
137
1,340
Wyoming
87
1,689
24
1,068
63
2,181
Pacific
$5,780
$903
$1,991
$536
$3,788
$1,414
Alaska
80
1,174
28
639
52
2,149
California
4,097
829
1,468
490
2,629
1,350
Hawaii (1.2)
173
760
n/a
n/a
n/a
n/a
Oregon (2)
495
1,095
n/a
n/a
n/a
n/a
Washington
934
1,319
317
786
617
2,026
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports, and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments. administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "Cash
assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible under Medicaid
1115 waivers. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Long-term care services include skilled nursing facilities, intermediate
care facilities for the mentally retarded, other intermediate care facilities, mental health, and home health services.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states. Corrections were made where
possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made
to categorize these numbers in the same manner as other states report to the Health Care Financing Administration Acute care expenditures are not available by cash assistance status
because a large portion of expenditures in these states are payments to MCOs, which are not distributed in a reliable form on the HCFA 2082. See Appendix C.
Page 72
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 42
Medicaid Long-Term Care Expenditures per Adult and Child Beneficiary, 1995
Total
per Adult & Child
(millions)
Beneficiary
United States
$1,963.7
$77.1
New England
$116.3
$107.6
Connecticut
38.3
144.9
Maine
20.6
175.5
Massachusetts
43.5
93.9
New Hampshire
3.8
52.0
Rhode Island
6.4
70.5
Vermont
3.7
51.1
Middle Atlantic
$524.7
$150.8
New Jersey
61.3
112.9
New York
326.5
152.4
Pennsylvania
136.9
172.5
South Atlantic
$248.3
$56.3
Delaware
7.3
123.0
District of Columbia
5.2
49.3
Florida
19.2
15.4
Georgia
11.8
14.0
Maryland
22.1
78.9
North Carolina
74.1
95.0
South Carolina
21.3
65.8
Virginia
42.5
87.2
West Virginia
44.7
160.2
East South Central
$58.2
$27.4
Alabama
4.8
14.4
Kentucky
35.6
88.5
Mississippi
13.9
42.6
Tennessee (1)
3.9
n/a
West South Central
$136.7
$46.1
Arkansas
32.6
155.4
Louisiana
69.9
134.8
Oklahoma
31.0
108.5
Texas
3.2
1.6
East North Central
$348.7
$91.1
Illinois
40.6
35.4
Indiana
53.9
127.0
Michigan
116.6
136.3
Ohio
51.5
46.3
Wisconsin
86.1
296.9
West North Central
$106.2
$73.0
lowa
20.6
95.5
Kansas
22.1
118.1
Minnesota
47.0
140.9
Missouri
7.0
13.9
Nebraska
6.4
53.9
North Dakota
2.7
64.5
South Dakota
.3
5.0
Mountain
$92.4
$73.8
Arizona (1)
12.5
30.6
Colorado
20.9
101.2
Idaho
is
9.8
Montana
7.2
99.8
Nevada
20.4
264.6
New Mexico
20.2
88.5
Utah
9.9
74.5
Wyoming
.4
10.5
Pacific
$332.2
$68.0
Alaska
11.2
197.1
California
264.5
71.2
Hawaii (1)
8.0
40.7
Oregon (1)
23.7
64.5
Washington
24.8
45.0
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not
sum to totals due to rounding. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Long-term care
services include skilled nursing facilities, intermediate care facilities for the mentally retarded, other intermediate care facilities, mental health, and
home health services.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly
from the state; adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing
Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 73
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 43
Medicaid Long-Term Care Expenditures per Blind & Disabled Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other
per Blind &
per Blind &
per Blind &
Disabled
Disabled
Disabled
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$21,619
$3,696
$10,637
$2,355
$10,981
$8,249
New England
$1,916
$6,429
$775
$3,760
$1,141
$12,418
Connecticut (1)
520
10,673
225
8,274
295
13,703
Maine
128
3,508
57
2,237
72
6,353
Massachusetts
963
5,999
303
2,599
660
14,988
New Hampshire (1)
101
8,259
54
7,931
47
8,672
Rhode Island
148
5,850
93
4,730
55
9,757
Vermont
56
3,820
44
4,106
12
3,045
Middle Atlantic
$5,996
$6,491
$2,991
$4,316
$3,005
$13,030
New Jersey
877
6,091
425
3,607
453
17,194
New York
4,112
8,054
2,049
5,123
2,063
18,645
Pennsylvania
1,007
3,741
518
2,951
489
5,222
South Atlantic
$2,758
$2,743
$1,435
$1,914
$1,324
$5,170
Delaware
64
5,070
34
3,521
30
10,261
District of Columbia
113
5,032
73
4,080
41
8,638
Florida
633
2,293
403
1,767
230
4,792
Georgia
465
2,442
205
1,273
260
8,834
Maryland
290
3,388
162
2,769
128
4,735
North Carolina
500
3,472
191
3,281
309
3,602
South Carolina
260
2,759
129
1,728
131
6,691
Virginia
272
2,576
136
1,589
136
6,776
West Virginia
161
2,158
102
1,815
59
3,195
East South Central
$878
$1,208
$608
$956
$270
$2,983
Alabama
230
1,751
130
1,035
100
17,360
Kentucky
248
1,589
167
1,178
81
5,672
Mississippi
150
1,192
93
818
57
4,533
Tennessee (2)
250
797
n/a
n/a
n/a
n/a
West South Central
$1,705
$3,049
$703
$1,438
$1,003
$14,201
Arkansas
232
2,657
149
1,932
83
8,162
Louisiana
472
3,240
83
664
389
18,832
Oklahoma
225
4,005
79
1,697
145
15,507
Texas
777
2,875
391
1,632
385
12,674
East North Central
$3,486
$3,890
$1,637
$2,684
$1,849
$6,462
Illinois
1,088
3,926
481
2,641
606
6,395
Indiana
411
6,089
175
4,669
236
7,855
Michigan
683
3,064
412
2,422
271
5,137
Ohio (1)
863
3,849
302
2,412
561
5,665
Wisconsin
442
4,227
267
2,812
175
18,403
West North Central
$1,632
$5,409
$713
$3,550
$919
$9,116
lowa
248
4,959
109
2,879
140
11,343
Kansas
211
5,393
57
2,486
154
9,556
Minnesota
630
9,069
314
7,183
316
12,280
Missouri
298
3,047
132
2,116
166
4,676
Nebraska
101
4,338
52
3,085
49
7,680
North Dakota
71
8,097
31
5,031
39
15,874
South Dakota
73
5,488
18
1,601
56
23,846
Mountain
$779
$3,475
$338
$2,153
$440
$6,589
Arizona (2)
142
2,314
n/a
n/a
n/a
n/a
Colorado
204
4,116
101
3,503
103
4,964
Idaho
73
3,972
15
1,756
58
5,955
Montana
57
3,513
29
2,243
28
8,868
Nevada
45
2,803
2
586
44
3,224
New Mexico
119
3,217
72
2,186
47
11,652
Utah
96
5,025
29
2,694
67
8,068
Wyoming
43
6,832
21
4,477
22
13,663
Pacific
$2,468
$2,702
$1,436
$1,852
$1,032
$7,478
Alaska
30
4,434
17
3,647
13
6,212
California
1,732
2,333
1,077
1,644
655
7,513
Hawaii (1.2)
47
3,468
n/a
n/a
n/a
n/a
Oregon (2)
234
5,064
n/a
n/a
n/a
n/a
Washington
426
4,061
256
2,978
170
9,022
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "Cash assistance" refers to
beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy. poverty-related expansion groups, and people eligible under Medicaid 1115 waivers. Beneficiaries are people
enrolled in the Medicaid program who actually receive medical services. Long-term care services include skilled nursing facilities, intermediate care facilities for the mentally retarded, other intermediate care
facilities, mental health, and home health services. The blind and disabled beneficiary group includes individuals who, regardless of age, qualify for Medicaid because of disability.
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states. Corrections were made where possible by adjusting
these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI. OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made to categorize these
numbers in the same manner as other states report to the Health Care Financing Administration. Long-term care expenditures are not available by cash assistance status because a large portion of
expenditures in these states are payments to MCOs, which are not distributed in a reliable format on HCFA-2082 reports. See Appendix C.
Page 74
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 44
Medicaid Long-Term Care Expenditures per Elderly Beneficiary, by Cash Assistance Status, 1995
Total
Cash Assistance
Other Assistance
per Elderty
per Elderly
per Elderly
(millions)
Beneficiary
(millions)
Beneficiary
(millions)
Beneficiary
United States
$30,414
$7,821
$4,307
$2,626
$26,107
$11,612
New England
$2,857
$12,803
$174
$3,229
$2,683
$15,860
Connecticut (1)
836
15,785
56
5,766
780
18,012
Maine
234
10,413
5
845
229
13,913
Massachusetts
1,302
12,872
88
3,226
1,215
16,412
New Hampshire (1)
201
11,853
6
1,903
195
13,987
Rhode Island
213
10,875
14
2,648
199
13,860
Vermont
72
7,107
7
2,216
65
9,182
Middle Atlantic
$8,800
$13,984
$1,545
$5,647
$7,256
$20,394
New Jersey
1,011
11,184
108
3,029
904
16,452
New York
5,702
15,354
1,254
7,118
4,448
22,787
Pennsylvania
2,087
12,459
183
2,958
1,904
18,022
South Atlantic
$3,908
$5,395
$587
$1,940
$3,322
$7,870
Delaware
67
10,945
10
4,472
56
14,905
District of Columbia
152
19,406
35
9,732
116
27,867
Florida
1,117
5,293
120
1,236
997
8,754
Georgia
418
4,023
51
1,115
367
6,342
Maryland
435
9,331
81
4,455
354
12,456
North Carolina (1)
766
5,036
124
3,213
643
5,654
South Carolina
281
3,669
48
1,187
233
6,412
Virginia
453
5,302
89
2,247
363
7,971
West Virginia
219
6,301
27
1,648
192
10,452
East South Central
$1,468
$4,652
$422
$2,688
$1,046
$6,596
Alabama
371
5,210
44
1,101
328
10,357
Kentucky
347
5,484
34
1,198
312
9,054
Mississippi
239
3,593
23
640
217
7,016
Tennessee (2)
510
4,463
n/a
n/a
n/a
n/a
West South Central
$2,404
$4,724
$404
$1,475
$2,000
$8,511
Arkansas
268
5,100
45
2,003
223
7,404
Louisiana
485
4,995
22
432
462
10,291
Oklahoma
251
4,892
27
982
224
9,348
Texas
1,400
4,547
310
1,800
1,091
8,021
East North Central
$4,803
$9,382
$348
$2,996
$4,454
$11,257
Illinois
804
6,344
65
2,449
738
7,384
Indiana
604
9,157
61
4,045
543
10,664
Michigan
935
10,859
67
2,794
868
13,990
Ohio (1)
1,712
10,124
108
3,527
1,604
11,591
Wisconsin
748
11,676
46
2,354
701
15,798
West North Central
$2,270
$8,963
$234
$3,758
$2,036
$10,660
lowa
230
6,141
16
1,793
215
7,481
Kansas
212
8,254
8
5,976
204
8,385
Minnesota
872
15,403
57
4,500
815
18,533
Missouri
574
6,180
98
3,667
476
7,200
Nebraska
184
8,881
36
5,928
148
10,112
North Dakota
107
9,893
14
3,573
93
13,454
South Dakota
90.3
10,052
5
1,791
86
13,481
Mountain
$924
$7,499
$172
$2,989
$752
$11,458
Arizona (2)
202
8,188
n/a
n/a
n/a
n/a
Colorado
266
7,290
99
4,006
167
14,207
Idaho
73
7,842-
7
3,162
66
9,284
Montana
111
12,456
16
7,016
95
14,324
Nevada
59
5,172
3
698
56
7,831
New Mexico
99
5,667
8
910
90
10,737
Utah
70
7,716
7
2,725
63
9,868
Wyoming
44
7,382
3
2,353
40
8,939
Pacific
$2,979
$4,973
$422
$1,227
$2,557
$10,014
Alaska
39
8,776
3
2,670
36
11,132
California
2,101
4,319
294
957
1,807
10,092
Hawaii (1.2)
118
6,793
n/a
n/a
n/a
n/a
Oregon (2)
237
6,284
n/a
n/a
n/a
n/a
Washington
484
9,111
48
2,403
436
13,161
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "Cash
assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible under Medicaid 1115
waivers. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services. Long-term care services include skilled nursing facilities, intermediate care facilities
for the mentally retarded, other intermediate care facilities, mental health, and home health services. Elderly beneficiaries are people aged 65 and over. The elderly most likely includes some
disabled individuals who have spent down their assets to become Medicaid eligible and were not originally considered disabled
(1) Some states exercising the 209-b option do not categorize elderly, blind, and disabled Medicaid beneficiaries in the same manner as other states. Corrections were made where
possible by adjusting these numbers to better reflect the actual number of cash and non-cash aged and blind/disabled beneficiaries. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made
to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. Long-term care expenditures are not available by cash assistance
status because a large portion of expenditures in these states are payments to MCOs, which are not distributed in a reliable format on HCFA-2082 reports. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 75
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 45
Medicaid Payments to Medicare and Managed Care Organizations, per Beneficiary, 1995
Payments to Medicare (1)
Payments to MCOs (2)
per Elderty and
per
Blind / Disabled
Adult & Child
(thousands)
Beneficiary
(thousands)
Beneficiary
United States
$3,854,827
$396
$9,902,698
$389
New England
$285,654
$548
$530,509
$491
Connecticut
125,175
1,231
14
<1
Maine
35,915
608
7,983
68
Massachusetts
95,745
366
456,810
986
New Hampshire
9,596
330
12,214
167
Rhode Island
11,553
258
53,488
590
Vermont
7,671
310
0
0
Middle Atlantic
$393,611
$253
$1,523,642
$438
New Jersey
82,786
353
131,623
242
New York
185,251
210
777,031
363
Pennsylvania
125,574
288
614,988
775
South Atlantic
$796,782
$461
$1,109,914
$252
Delaware
5,477
292
5,192
88
District of Columbia
16,795
553
81,148
762
Florida
333,544
685
721,957
579
Georgia
106,669
363
319
<1
Maryland
54,908
415
253,094
903
North Carolina
129,476
437
8,616
11
South Carolina
56,435
330
90
<1
Virginia
61,928
324
39,496
81
West Virginia
31,549
288
2
<1
East South Central
$333,580
$320
$1,769,927
$833
Alabama
75,474
372
672
2
Kentucky
64,842
295
54
<1
Mississippi
83,535
434
0
0
Tennessee (3)
109,729
257
1,769,200
1,669
West South Central
$476,757
$446
$719
$0
Arkansas
53,338
381
5
<1
Louisiana
79,831
329
0
0
Oklahoma
49,393
460
712
2
Texas
294,194
509
2
<1
East North Central
$524,940
$373
$1,206,842
$315
Illinois
169,760
421
154,468
135
Indiana
34,155
256
6,461
15
Michigan
106,052
343
489,770
573
Ohio
89,258
227
330,210
297
Wisconsin
125,716
746
225,933
779
West North Central
$309,553
$558
$448,401
$308
lowa
65,697
750
82,948
384
Kansas
37,438
577
185
<1
Minnesota
18,107
144
329,359
987
Missouri
146,689
769
28,226
56
Nebraska
29,169
663
7,392
62
North Dakota
3,167
162
277
7
South Dakota
9,287
416
14
<1
Mountain
$117,784
$339
$1,026,342
$820
Arizona (3)
25,474
296
872,052
2,140
Colorado
23,210
270
85,431
413
Idaho
7,301
262
303
3
Montana
13,600
541
424
6
Nevada
9,770
355
18,375
238
New Mexico
18,806
346
0
0
Utah
16,662
592
49,739
376
Wyoming
2,961
244
19
<1
Pacific
$616,166
$407
$2,286,402
$468
Alaska
4,826
433
7
<1
California
529,759
431
1,102,510
297
Hawaii (3)
19,536
629
325,873
1,653
Oregon (3)
20,727
247
439,148
1,193
Washington
41,318
262
418,864
761
Source: Urban Institute calculations based on data from HCFA-2082 reports, HCFA-64 reports. and the March 1996 Current Population Survey.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Temtories Figures may not sum to totals due
to rounding. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services.
(1) Payments to Medicare were distributed among the aged, blind, and disabled as described in Appendix C.
(2) Payments to managed care organizations were distributed among adults and children as described in Appendix C.
(3) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 76
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 46
Federal and State Shares of Medicaid Disproportionate Share Hospital Payments, per Low-income and
Uninsured Person, 1995
Total
Federal
State
per
per
per
per
per
per
Low-income
Uninsured
Low-income
Uninsured
Low-income
Uninsured
(millions)
Person (1)
Person
(millions)
Person (1)
Person
(millions)
Person (1)
Person
United States
$18,988
$290
$533
$10,791
$165
$303
$8,198
$125
$230
New England
$1,763
$711
$1,296
$911
$367
$670
$851
$343
$626
Connecticut
450
778
1,561
225
389
781
225
389
781
Maine
165
654
1,212
102
405
751
63
249
461
Massachusetts
610
537
918
305
269
459
305
269
459
New Hampshire
329
1,797
2,855
164
898
1,428
164
898
1,428
Rhode Island
171
826
1,798
92
445
969
79
381
829
Vermont
37
302
617
22
180
367
15
122
249
Middle Atlantic
$4,995
$569
$1,043
$2,534
$289
$529
$2,461
$280
$514
New Jersey
1,287
937
1,279
643
469
639
643
469
639
New York
2,917
609
1,099
1,458
304
550
1,458
304
550
Pennsylvania
792
302
701
433
165
383
360
137
318
South Atlantic
$2,001
$170
$309
$1,232
$105
$190
$769
$66
$119
Delaware
7
54
76
4
27
38
4
27
38
District of Columbia
50
253
519
25
127
259
25
127
259
Florida
334
86
147
183
47
81
151
39
67
Georgia
410
220
399
256
138
250
154
83
150
Maryland
160
165
253
80
83
126
80
83
126
North Carolina
429
251
517
280
164
337
150
88
180
South Carolina
440
390
851
313
277
605
127
113
246
Virginia
145
113
188
73
56
94
73
56
94
West Virginia
25
44
106
19
34
80
6
11
26
East South Central
$820
$171
$416
$597
$124
$303
$223
$46
$113
Alabama
417
314
658
297
223
469
120
90
189
Kentucky
220
202
416
156
143
295
64
59
121
Mississippi
183
190
397
144
150
313
39
40
84
Tennessee (2.3)
0
0
0
0
0
0
0
0
0
West South Central
$2,800
$312
$481
$1,916
$214
$329
$884
$99
$152
Arkansas
3
4
8
2
3
6
1
1
2
Louisiana
1,265
820
1,580
930
603
1,162
335
217
419
Oklahoma
18
19
35
13
13
25
5
6
10
Texas
1,513
265
371
971
170
238
542
95
133
East North Central
$1,891
$204
$436
$1,097
$118
$253
$794
$86
$183
Illinois
413
155
351
206
78
176
206
78
176
Indiana
398
320
618
253
203
393
145
117
226
Michigan
438
211
499
247
119
282
191
92
218
Ohio
630
255
507
383
155
308
247
100
199
Wisconsin
12
14
29
7
8
18
5
5
12
West North Central
$843
$214
$475
$509
$130
$287
$334
$85
$188
lowa
5
8
18
3
5
11
2
3
7
Kansas
74
116
249
44
69
148
30
47
101
Minnesota
24
28
65
13
15
35
11
13
29
Missouri
729
613
1,236
442
371
749
287
241
486
Nebraska
9
29
62
6
18
38
3
11
24
North Dakota
1
8
23
1
6
16
0
2
7
South Dakota
1
6
16
1
4
11
0
2
5
Mountain
$565
$146
$239
$321
$83
$136
$244
$63
$104
Arizona (2)
122
97
166
81
64
109
42
33
57
Colorado
355
562
758
193
305
412
162
257
346
Idaho
4
14
26
3
10
18
1
4
8
Montana
0
1
2
0
1
2
0
0
1
Nevada
74
215
315
37
108
158
37
107
156
New Mexico
7
10
17
5
8
13
2
3
4
Utah
3
8
17
2
6
13
1
2
4
Wyoming (3)
0
0
0
0
0
0
0
0
0
Pacific
$3,311
$285
$494
$1,674
$144
$249
$1,637
$141
$244
Alaska
18
139
280
9
69
140
9
69
140
California
2,915
312
523
1,458
156
261
1,458
156
261
Hawaii (2)
1
4
15
1
2
7
1
2
7
Oregon (2)
28
40
72
17
25
45
11
15
27
Washington
348
303
576
189
164
312
159
139
264
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey.
Does not include administrative costs, accounting adjustments, or the U.S. Temtones Figures may not sum to totals due to rounding "DSH" refers to disproportionate share hospital payments.
(1) Low-income defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments were made to categorize
these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(3) No DSH payments reported in 1995.
Kaiser Commission on the Future of Medicaid
Page 77
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 15
Federal and State Shares of Medicaid Disproportionate Share Hospital
Payments, per Low-income Person, 1995 *
Alabama
Alaska
Federal Share
Arizona
Arkansas
State Share
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
$0
$500
$1,000
$1,500
$2,000
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey
Does not include administrative costs, accounting adjustments, or the U.S. Territories.
*Low-income - defined as under 150% of the federal poverty guideline; the poverty guideline was $12,590 for a family of three in 1995.
Page 78
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 16
Federal and State Shares of Medicaid Disproportionate Share Hospital
Payments, per Uninsured Person, 1995
Alabama
Alaska
Federal Share
Arizona
Arkansas
State Share
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
Source: Urban Institute calculations based on data from HCFA-64 reports and the March 1996 Current Population Survey.
Does not include administrative costs, accounting adjustments. or the US Territories.
Kaiser Commission on the Future of Medicaid
Page 79
National Trends, 1990-1995
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
NATIONAL TRENDS, 1990-1995
between 1990 and 1995 and actually fell by 0.6 per-
cent from 1994 to 1995. By contrast, the number of
"other" beneficiaries-those eligible because of state
M
edicaid has changed considerably since 1990,
and federal eligibility expansions or because they
as reflected in the differential growth in Medi-
were medically needy-climbed an average 14.3
caid expenditure and beneficiary levels. Federal and
percent per year. Growth peaked between 1990 and
state expansions of coverage broadened eligibility to
1992 period reaching nearly 20 percent, before
millions of low-income children and pregnant women
slowing to 8 percent between 1994 and 1995.
who might have otherwise been uninsured. In addi-
tion, numerous state health reform efforts stimulated
It is informative to examine the rates of growth of the
Medicaid's enrollment. Economic conditions, par-
categorically eligible groups as well. Between 1990
ticularly the recession of the early 1990s, also helped
and 1995, growth was slowest among the elderly,
increase Medicaid rolls. In 1995, however, these
rising on average by 4.2 percent per year. The
very same forces are now acting to slow enrollment
growth rate was highest for the blind and disabled
growth to the lowest level in a decade.
category, which increased an average of 9.5 percent
per year. This trend was partly due to eligibility
This growth in enrollment over the entire 1990-1995
changes for SSI and for children, in addition to court
period, however, was outpaced by Medicaid spend-
decisions that led to an easing of SSI eligibility crite-
ing growth on a per person basis. Subject to some
ria for children. It is also notable that the number of
of the same pressures found in the private sector,
non-disabled adults and children who received Medi-
rising health care costs were a significant factor ex-
caid because of their cash assistance status (AFDC)
plaining overall spending growth. Furthermore,
fell by 4.0 percent and 3.1 percent, respectively, re-
States' use of alternative financing mechanisms-
flecting the national trend in declining AFDC rolls.
provider taxes, donations, and intergovernmental
transfers-combined with stepped-up use of DSH
Expenditures
payments also contributed to overall spending
growth. After this rapid expansion, however, spend-
ing growth has stabilized and returned to more his-
Between 1990 and 1995, state and federal Medicaid
torical levels. This section provides an overview of
expenditures increased from $70.5 billion to $152.4
national beneficiary and expenditure trends from
billion-an average annual increase of 16.7 percent
1990 to 1995.
nationwide and more than twice the growth rate of
the beneficiary population (Table 48, Figure 18).
Mirroring the trend for beneficiaries, expenditure
Beneficiaries
growth was greatest between 1990 and 1992, when
it skyrocketed, on average, by 27.8 percent per year.
The number of Medicaid beneficiaries rose by 11.1
Also reflecting higher enrollment, spending on chil-
million people between 1990 and 1995, or 7.9 per-
dren rose by more than 24.7 percent per year during
cent annually. The most rapid growth was in the
this period, and by 16.5 percent and 17.6 percent,
early years, where the number of beneficiaries grew
respectively, for elderly and blind and disabled bene-
by an average of 11.3 percent. This increase was
ficiaries. After 1992, growth rates began to fall for all
largely the result of the combination of expansions in
groups; total spending increased on average by 9.1
federal and state eligibility for pregnant women and
percent annually from 1992 to 1994. Between 1994
children and the economic recession of the same
and 1995, expenditures rose 11.2 percent, from
period. Beneficiary growth slowed considerably be-
$137.1 billion to $152.4 billion-a $15.3 billion in-
tween 1992 and 1994-falling to 7.1 percent per
crease (Figure 19).
year-due to fewer expansions and a healthier na-
tional economy. In fact, the number of beneficiaries
Expenditure for acute care increased on average by
increased by only 1 million people in 1995, a growth
16.7 percent, and long-term care expenditures by
rate of only 3% (Table 47, Figure 17).
10.8 percent per year (Table 49). In addition,
spending for non-institutional care (primarily home
The overall growth rate in beneficiaries, however,
health services) grew significantly faster than that for
masks important differences between the different
institutional care, reflecting trends in the larger health
beneficiary groups covered by Medicaid. Reflecting
care system. The majority of acute care growth OC-
the improved economy, the growth rate for benefici-
curred in non-inpatient acute care services, which
aries receiving cash assistance was only 4.1 percent
include outpatient, clinic, physician, lab, and X-ray
services, as well as EPSDT, prescription drugs, and
Kaiser Commission on the Future of Medicaid
Page 83
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
other unspecified acute care services.¹ Home health
rebounded to 12.4 percent between 1994 and 1995,
expenditures were the fastest-growing portion of
however, indicating that these payments were still
long-term care expenditures (Figure 20 and 21).
important aspects of Medicaid spending.
Acute care spending rose consistently for all eligibil-
Medicaid spending per beneficiary-excluding DSH
ity groups ranging between 13.5 percent annually for
payments-grew at an average annual rate of 5.7
adults to 18.3 percent for the blind and disabled (Ta-
percent over the five-year period (Table 52). The
ble 50). Growth rates were lowest for inpatient care,
growth rate was highest between 1990 to 1992, fol-
marking a shift to outpatient procedures, and highest
lowed by slightly lower increases. Per beneficiary
for payments to MCOs as a result of the rapid
expenditures for children receiving cash assistance
spread in capitated managed care enrollment among
went up more rapidly than for other groups, by 11.0
the Medicaid population (Figure 22).
percent annually. This trend was partially attribut-
able to the fact that AFDC eligibility thresholds were
Long-term care expenditures rose from $32.4 billion
not indexed to inflation. For other children, costs per
in 1990 to nearly $54.0 billion in 1995, an average
beneficiary increased by 2.7 percent annually. Al-
annual growth rate of 10.8 percent (Table 51, Figure
though the rate of growth is highest for children,
23). Spending growth was slowest for intermediate
spending per child beneficiary remained relatively
care facilities for the mentally retarded (ICF/MR),
low at $1,451 in 1995. By contrast, per beneficiary
rising on average by 5.4 percent annually. Home
expenditures for the elderly, blind, and disabled
health spending increased the fastest, at an average
were, respectively, $10,308 and $8,784.
rate of 20.4 percent. Elderly, blind, and disabled
beneficiaries accounted for the vast majority of long-
Many factors influenced the rate of growth in Medi-
term care expenditures: more than $52 billion in
caid spending per beneficiary during the past five
1995 alone, or 96 percent of total long-term care ex-
years. Not unlike the private sector, Medicaid expe-
penditures that year (Table 51).
rienced the pressures of general medical price infla-
tion. Further, federal legislation mandates that
DSH payments are perhaps the most obvious con-
Medicaid reimbursement for particular services, such
tributor to growth in Medicaid spending since 1990.
as hospital and nursing home care must be "reason-
able" relative to the institution's costs.³ Concern over
Between 1990 and 1995, these payments increased
at an average annual rate of 69 percent, although
quality of care also has led to enactment of quality
the almost all of the growth was in 1991 and 1992.
assurance standards, leading many states to raise
In 1990, DSH payments were only 1.9 percent of
reimbursement levels to hospitals, nursing homes,
total Medicaid expenditures (Table 48); spending
and other providers. Finally, the demographics of
accelerated between 1990 and 1992, at an average
the Medicaid population have also influenced total
annual rate of 256.6 percent (Table 49).² By 1992,
expenditures per beneficiary, since different groups
DSH payments accounted for nearly 15 percent of
use different types of services.
Medicaid expenditures. Alarmed by the rising share
of Medicaid spending devoted to DSH payments, the
Factors Contributing to Medicaid Spending
federal government passed legislation in 1991 aimed
Growth
at limiting states' use of these payments. As a re-
sult, DSH payments fell, on average, by 1.8 percent
per year between 1992 and 1994. The growth rate
In simple terms, total Medicaid expenditure growth
over a fixed period of time can be attributed to three
contributing factors: increased in the caseload,
1
Services that states may report as "other care" include trans-
higher spending per beneficiary (including inflation),
portation; physical and occupational therapy; dentures, eye-
and DSH payments. In order to understand the con-
glasses, and prosthetics; services for individuals with speech,
tribution made by each factor, Medicaid spending
hearing, and language disorders; diagnostic, screening, rehabili-
was analyzed by the different categories, holding the
tative, and preventative care; and other medical or remedial care
services recognized under state law and specified by the Secre-
other two constant. This type of analysis allows one
tary of Health and Human Services. Examples of "other practitio-
to examine, for example, the effect of beneficiary
ners" include chiropractors, professional nurses, podiatrists, psy-
growth on total expenditures while holding constant
chologists, optometrists, and Christian Science practitioners.
inflation, service utilization, and DSH.
See section 2500.2(E) of the State Medicaid Manual for more
information.
2 Expenditures in this context comprise benefits and DSH pay-
ments, but do not include administrative costs or accounting
3 This provision, known as the "Boren Amendment" was repealed
adjustments.
by the Balanced Budget Act of 1997.
Page 84
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Increases in the number of Medicaid beneficiaries
accounted for 45.6 percent of total program spend-
ing growth between 1990 and 1995 (Table 53, Figure
24). Higher nominal (including inflation) spending per
beneficiary accounted for another 32.9 percent of
growth and DSH payments, the remaining 21.5 per-
cent.
The relative impact of each factor varied from year to
year. From 1990 through 1992, DSH payments were
a clear driving force behind expenditure growth. This
single factor accounted for 21.2 percent of spending
growth between 1990 and 1991, and 46.8 percent
the following year. From 1992 to 1994, expansions
in the beneficiary population-especially those in the
other category-were the major spending driver.
Indeed, this upswing was responsible for more than
70 percent of Medicaid's expenditure growth during
these two years. Between 1994 and 1995, an in-
crease in the nominal spending per beneficiary ac-
counted for 50.9 percent of total spending growth-
partially due to payments to MCOs, which
contributed 19.1 percent of total growth. Also in
1995, rising DSH payments contributed significantly
to overall expenditure growth (13.7 percent),
following two years of actual declines.
Kaiser Commission on the Future of Medicaid
Page 85
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 47
Medicaid Beneficiaries, by Group, 1990-1995
Beneficiaries (thousands)
Average Annual Growth
Beneficiary Group
1990
1991
1992
1993
1994
1995
1990-95
1990-92
1992-94
1994-95
All Beneficiaries
24,066
26,851
29,811
32,441
34,183
35,214
7.9%
11.3%
7.1%
3.0%
Cash Assistance
16,144
17,287
18,460
19,475
19,847
19,737
4.1
6.9
3.7
-0.6
Other Beneficiaries
7,922
9,565
11,351
12,966
14,336
15,477
14.3
19.7
12.4
8.0
Elderty
3,167
3,310
3,547
3,680
3,828
3,889
4.2%
5.8%
3.9%
1.6%
Cash Assistance
1,532
1,530
1,573
1,564
1,574
1,640
1.4
1.3
0.0
4.2
Other Beneficiaries
1,635
1,780
1,974
2,116
2,254
2,248
6.6
9.9
6.8
-0.2
Blind and Disabled
3,717
4,038
4,471
4,991
5,381
5,849
9.5%
9.7%
9.7%
8.7%
Cash Assistance
2,966
3,187
3,517
3,906
4,223
4,518
8.8
8.9
9.6
7.0
Other Beneficiaries
750
851
954
1,085
1,159
1,331
12.1
12.8
10.2
14.9
Adults
5,696
6,402
6,982
7,451
7,860
7,960
6.9%
10.7%
6.1%
1.3%
Cash Assistance
3,865
4,163
4,379
4,568
4,571
4,389
2.6
6.4
2.2
-4.0
Other Beneficiaries
1,831
2,239
2,603
2,884
3,288
3,571
14.3
19.2
12.4
8.6
Children
11,486
13,101
14,811
16,319
17,115
17,516
8.8%
13.6%
7.5%
2.3%
Cash Assistance
7,781
8,407
8,992
9,437
9,479
9,189
3.4
7.5
2.7
-3.1
Other Beneficiaries
3,706
4,695
5,820
6,882
7,635
8,327
17.6
25.3
14.5
9.1
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding. "Cash assistance" refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include
the medically needy, poverty-related expansion groups, and people eligible under Medicaid 1115 waivers. Beneficiaries are people enrolled in the Medicaid program who actually
receive medical services.
Kaiser Commission on the Future of Medicaid
Page 87
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 17
Medicaid Beneficiaries, by Group, 1990-1995
Millions of Beneficiaries
40.0
Elderly
Blind & Disabled
35.2
34.2
Adults
32.4
Children
29.8
30.0
26.9
24.1
20.0
10.0
0.0
1990
1991
1992
1993
1994
1995
Year
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories Beneficiaries are people enrolled in the Medicaid program who actually receive medical services.
Page 88
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 48
Medicaid Expenditures, by Group, 1990-1995
Expenditures (millions)
Average Annual Growth
Beneficiary Group
1990
1991
1992
1993
1994
1995
1990-95
1990-92
1992-94
1994-95
All Beneficiaries
$70,510
$89,074
$115,164
$127,394
$137,112
$152,423
16.7%
27.8%
9.1%
11.2%
Cash Assistance
34,623
41,494
48,151
55,074
59,936
64,461
13.2
17.9
11.6
7.5
Other Beneficiaries
34,508
42,264
49,487
55,305
60,286
68,974
14.9
19.8
10.4
14.4
Elderly
$22,924
$27,064
$31,122
$33,491
$36,121
$40,087
11.8%
16.5%
7.7%
11.0%
Cash Assistance
5,547
6,317
6,950
7,498
7,873
8,620
9.2
11.9
6.4
9.5
Other Beneficiaries
17,377
20,747
24,172
25,993
28,249
31,468
12.6
17.9
8.1
11.4
Blind and Disabled
$25,984
$30,864
$35,907
$41,275
$45,318
$51,379
14.6%
17.6%
12.3%
13.4%
Cash Assistance
16,452
19,656
23,194
27,041
30,311
33,254
15.1
18.7
14.3
9.7
Other Beneficiaries
9,532
11,208
12,713
14,234
15,007
18,125
13.7
15.5
8.6
20.8
Adults
$8,786
$11,155
$12,816
$14,574
$15,513
$16,557
13.5%
20.8%
10.0%
6.7%
Cash Assistance
5,776
7,043
7,889
8,738
8,914
8,977
9.2
16.9
6.3
0.7
Other Beneficiaries
3,010
4,112
4,927
5,836
6,598
7,580
20.3
27.9
15.7
14.9
Children
$11,438
$14,674
$17,794
$21,039
$23,270
$25,411
17.3%
24.7%
14.4%
9.2%
Cash Assistance
6,848
8,478
10,119
11,797
12,838
13,610
14.7
21.6
12.6
6.0
Other Beneficiaries
4,589
6,196
7,676
9,241
10,431
11,800
20.8
29.3
16.6
13.1
DSH
$1,378
$5,316
$17,526
$17,016
$16,890
$18,988
69.0%
256.6%
-1.8%
12.4%
Source: Urban Institute calculations based on date from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Temtories. Total spending including these categories was about $159.5 billion in 1995 Figures may not sum to totals
due to rounding. "DSH" refers to disproportionate share hospital payments. States do not report payments to Medicare or to managed care organizations by beneficiary group. In most states,
payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
Kaiser Commission on the Future of Medicaid
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 18
Medicaid Expenditures, by Group, 1990-1995
Billions of Dollars
$175.0
DSH
Elderly
$152.4
$150.0
Blind & Disabled
Adults
$137.1
Children
$127.4
$125.0
$115.2
$100.0
$89.1
$75.0
$70.5
$50.0
$25.0
$0.0
1990
1991
1992
1993
1994
1995
Year
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs. accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5 billion in
1995. "DSH" refers to disproportionate share hospital payments. States do not report payments to Medicare or to managed care organizations by beneficiary
group. In most states. payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were distributed among adults and
children. The methodology used is described in Appendix C.
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Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 19
Annual Increase in Medicaid Expenditures, by Group, 1990-1995
Billions of Dollars
$30.0
DSH
$26.1
Elderly
$25.0
Blind & Disabled
Adults
Children
$20.0
$18.6
$15.3
$15.0
$12.2
$9.7
$10.0
$5.0
$0.0
-$5.0
90-91
91-92
92-93
93-94
94-95
Year
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 data.
Does not include administrative costs, accounting adjustments. or the U.S. Territories "DSH" refers to disproportionate share hospital payments. Numbers
represent net growth. reflecting a decrease in expenditures for DSH in 1993 and 1994. States do not report payments to Medicare or to managed care
organizations by beneficiary group. In most states, payments to Medicare were distributed among the aged. blind, and disabled. Payments to MCOs were
distributed among adults and children The methodology used is described in Appendix C.
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 49
Medicaid Expenditures, by Type of Service, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-92
1992-94
1994-95
Total
$70,510
$89,074
$115,164
$127,394
$137,112
$152,423
16.7%
27.8%
9.1%
11.2%
Acute Care
$36,741
$46,809
$55,065
$65,041
$71,178
$79,439
16.7%
22.4%
13.7%
11.6%
Inpatient Services
15,981
20,467
22,245
25,593
25,862
26,936
11.0
18.0
7.8
4.2
Other Acute Services
20,760
26,341
32,820
39,448
45,316
52,502
20.4
25.7
17.5
15.9
Long-Term Care
$32,391
$36,949
$42,574
$45,337
$49,044
$53,996
10.8%
14.6%
7.3%
10.1%
Institutional
28,267
31,984
36,561
38,354
40,539
43,565
9.0
13.7
5.3
7.5
Home Health
4,124
4,965
6,013
6,983
8,505
10,431
20.4
20.7
18.9
22.6
DSH
$1,378
$5,316
$17,526
$17,016
$16,890
$18,988
69.0%
256.6%
-1.8%
12.4%
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5 billion in 1995. Figures may not sum to totals due to
rounding. Other acute services include outpatient/clinic, physician, laboratory, X-Ray, prescription drugs, case management, family planning. dental, EPSDT, vision, other practitioners' care, payments to
managed care organizations, and payments to Medicare. Institutional long-term care services include skilled nursing facilities, intermediate care facilities for the mentally retarded, other intermediate care
facilities, and mental health services. "DSH" refers to disproportionate share hospital payments.
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Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 20
Medicaid Expenditures, by Type of Service, 1990-1995
Billions of Dollars
$175.0
DSH
XX
Medicare & MCOs
$152.4
$150.0
LTC: Home Health
LTC: Institutional
$137.1
Acute: Other
$127.4
$125.0
Acute: Inpatient
$115.2
$100.0
$89.1
$75.0
$70.5
$50.0
$25.0
$0.0
1990
1991
1992
1993
1994
1995
Year
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs. accounting adjustments, or the U.S. Territories. Total spending including these categories was about $159.5 billion in
1995. "DSH" refers to disproportionate share hospital payments. "MCOs" refers to managed care organizations. "LTC" refers to long-term care. "Institutional"
long-term care services include skilled nursing facilities, intermediate care facilities, and mental health expenditures. "Other" acute care services include
outpatient. clinic, physician. laboratory. X-Ray, prescription drugs, case management, family planning. dental, EPSDT, vision, and other practitioners' care.
Kaiser Commission on the Future of Medicaid
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 21
Annual Increase in Medicaid Expenditures, by Type of Service, 1990-1995
Billions of Dollars
$30.0
DSH
$26.1
Medicare/MCOs
$25.0
LTC: Home Health
LTC: Institutional
Acute: Other
Acute: Inpatient
$20.0
$18.6
$15.3
$15.0
$12.2
$9.7
$10.0
$5.0
$0.0
-$5.0
90-91
91-92
92-93
93-94
94-95
Year
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. "DSH" refers to disproportionate share hospital payments. "MCOs" refers
to managed care organizations. "LTC" refers to long-term care. "Institutional" long-term care services include skilled nursing facilities, intermediate care
facilities, and mental health expenditures. "Other" acute care services include: outpatient. clinic. physician, laboratory, X-Ray, prescription drugs, case
management. family planning. dental, EPSDT, vision, and other practitioners' care. Numbers represent net growth, reflecting a decrease in expenditures for DSH
in 1993 and 1994.
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 50
Medicaid Acute Care Expenditures, by Group and Type of Service, 1990-1995
Acute Care Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-92
1992-94
1994-95
Total
$36,741
$46,809
$55,065
$65,041
$71,178
$79,439
16.7%
22.4%
13.7%
11.6%
Beneficiary Group
Elderly
4,806
6,066
6,769
7,787
8,447
9,674
15.0
18.7
11.7
14.5
Blind and Disabled
12,870
16,304
19,394
23,272
25,703
29,761
18.3
22.8
15.1
15.8
Adults
8,664
11,013
12,629
14,358
15,309
16,301
13.5
20.7
10.1
6.5
Children
10,401
13,426
16,273
19,624
21,719
23,703
17.9
25.1
15.5
9.1
Service
Inpatient Services
15,981
20,467
22,245
25,593
25,862
26,936
11.0
18.0
7.8
4.2
Physician, Laboratory. and X-Ray
4,720
5,945
7,373
8,110
8,297
8,460
12.4
25.0
6.1
2.0
Outpatient and Clinic Services
4,731
6,061
7,969
9,333
9,910
10,723
17.8
29.8
11.5
8.2
Prescription Drugs
4,587
5,512
6,217
6,910
7,514
8,445
13.0
16.4
9.9
12.4
Payments to Medicare
1,432
2,005
2,337
2,808
3,376
3,855
21.9
27.7
20.2
14.2
Payments to MCOs
1,937
2,382
3,164
4,710
6,804
9,903
38.6
27.8
46.6
45.6
Other Acute Care (1)
3,352
4,437
5,758
7,576
9,416
11,116
27.1
31.1
27.9
18.1
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories Figures may not sum to totals due to rounding States do not report
payments to Medicare or to managed care organizations by beneficiary group. In most states. payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were
distributed among adults and children. The methodology used is described in Appendix C.
(1) "Other acute care" includes case management, family planning, dental, EPSDT, vision, other practitioners' care, and all other unspecified acute care services.
Kaiser Commission on the Future of Medicaid
Page 95
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 22
Medicaid Acute Care Expenditures, by Type of Service, 1990-1995
Billions of Dollars
$100.0
Other Acute Care
Payments to Medicare/MCOs
Drugs
Outpatient/Clinic
$79.4
$80.0
Physician Services
Inpatient Hospital
$71.2
$65.0
$60.0
$55.1
$46.8
$40.0
$36.7
$20.0
$0.0
1990
1991
1992
1993
1994
1995
Year
Source: Urban Institute calculations based on data from HCFA-64 reports
Does not include disproportionate share hospital payments. administrative costs. accounting adjustments. or the U.S. Territories. "MCOs" refers to managed
care organizations. "Other acute care" includes case management. family planning. dental, EPSDT, vision, other practitioners' care, and all other unspecified
acute care services.
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 51
Medicaid Long-Term Care Expenditures, by Group and Type of Service, 1990-1995
Long-Term Care Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-92
1992-94
1994-95
Total
$32,391
$36,949
$42,574
$45,337
$49,044
$53,996
10.8%
14.6%
7.3%
10.1%
Beneficiary Group
Elderly
18,118
20,999
24,353
25,703
27,674
30,414
10.9
15.9
6.6
9.9
Blind and Disabled
13,115
14,561
16,513
18,003
19,615
21,619
10.5
12.2
9.0
10.2
Adults
122
142
187
217
203
256
16.0
24.1
4.2
25.9
Children
1,037
1,248
1,521
1,414
1,551
1,708
10.5
21.1
1.0
10.1
Service
SNF/ICF-Other
18,396
21,102
24,577
26,297
28,253
30,486
10.6
15.6
7.2
7.9
ICF/MR
7,679
8,357
8,907
9,502
9,417
10,003
5.4
7.7
2.8
6.2
Mental Health
2,192
2,525
3,078
2,556
2,869
3,076
7.0
18.5
-3.4
7.2
Home Health
4,124
4,965
6,013
6,983
8,505
10,431
20.4
20.7
18.9
22.6
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "ICF/MR" refers
to intermediate care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing facilities and other intermediate care facilities.
Kaiser Commission on the Future of Medicaid
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 23
Medicaid Long-Term Care Expenditures, by Type of Service, 1990-1995
Billions of Dollars
$60.0
Home Health
$54.0
Mental Health
ICF/MR
$50.0
$49.0
SNF/ICF-Other
$45.3
$42.6
$40.0
$36.9
$32.4
$30.0
$20.0
$10.0
$0.0
1990
1991
1992
1993
1994
1995
Year
Source Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. "ICF/MR" refers to intermediate
care facilities for the mentally retarded. "SNF/ICF-Other" refers to skilled nursing facilities and other intermediate care facilities.
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 52
Medicaid Expenditures per Beneficiary, by Group, 1990-1995
Expenditures per Beneficiary
Average Annual Growth
Beneficiary Group
1990
1991
1992
1993
1994
1995
1990-95
1990-92
1992-94
1994-95
All Beneficiaries
$2,873
$3,119
$3,275
$3,402
$3,517
$3,789
5.7%
6.8%
3.6%
7.7%
Cash Assistance
2,145
2,400
2,608
2,828
3,020
3,266
8.8
10.3
7.6
8.2
Other Beneficiaries
4,356
4,419
4,360
4,266
4,205
4,456
0.5
0.0
-1.8
6.0
Elderly
$7,239
$8,176
$8,774
$9,101
$9,437
$10,308
7.3%
10.1%
3.7%
9.2%
Cash Assistance
3,621
4,129
4,419
4,793
5,002
5,255
7.7
10.5
6.4
5.0
Other Beneficiaries
10,629
11,654
12,242
12,287
12,534
13,996
5.7
7.3
1.2
11.7
Blind and Disabled
$6,991
$7,644
$8,031
$8,270
$8,421
$8,784
4.7%
7.2%
2.4%
4.3%
Cash Assistance
5,547
6,168
6,595
6,923
7,178
7,361
5.8
9.0
4.3
2.5
Other Beneficiaries
12,702
13,174
13,321
13,125
12,953
13,615
1.4
2.4
-1.4
5.1
Adults
$1,542
$1,742
$1,836
$1,956
$1,974
$2,080
6.2%
9.1%
3.7%
5.4%
Cash Assistance
1,494
1,692
1,802
1,913
1,950
2,045
6.5
9.8
4.0
4.9
Other Beneficiaries
1,644
1,837
1,893
2,024
2,007
2,123
5.2
7.3
3.0
5.8
Children
$996
$1,120
$1,201
$1,289
$1,360
$1,451
7.8%
9.8%
6.4%
6.7%
Cash Assistance
880
1,008
1,125
1,250
1,354
1,481
11.0
13.1
9.7
9.4
Other Beneficiaries
1,239
1,320
1,319
1,343
1,366
1,417
2.7
3.2
1.8
3.7
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Beneficiaries are people enrolled in the Medicaid
program who actually receive medical services. States do not report payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare
were distributed among the aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used IS described in Appendix C.
Kaiser Commission on the Future of Medicaid
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 53
Factors Influencing Medicaid Expenditure Growth, 1990-1995
Share of Growth Attributable to Each Factor (1)
Average
Factors
1990-95
1990-91
1991-92
1992-93
1993-94
1994-95
Beneficiary Growth
45.6%
39.4%
35.1%
72.6%
71.1%
35.6%
Cash Assistance
15.7%
12.7%
12.6%
28.4%
24.1%
11.0%
Elderly
0.6
0.0
0.7
-0.3
0.5
2.2
Blind and Disabled
12.0
7.0
8.1
21.5
23.0
13.8
Adults
1.1
2.6
1.4
2.9
0.1
-2.4
Children
2.0
3.2
2.4
4.3
0.6
-2.7
Other Beneficiaries
29.9%
26.7%
22.5%
44.3%
47.1%
24.6%
Elderly
9.2
8.7
8.9
14.1
17.7
-0.5
Blind and Disabled
9.2
7.0
5.3
14.1
9.9
14.9
Adults
4.1
4.0
2.6
4.6
9.1
4.0
Children
7.4
7.0
5.7
11.5
10.4
6.1
Nominal Spending per Beneficiary
32.9%
39.4%
18.1%
31.5%
30.2%
50.7%
Hospital Inpatient
2.3
12.9
-2.2
8.9
-13.7
-1.5
Physician, Lab, and X-ray
1.3
3.3
2.8
0.4
-3.5
-1.2
Outpatient and Clinic
3.8
4.3
4.7
4.9
0.2
2.4
Prescription Drugs
2.0
2.9
0.7
1.4
2.1
3.6
Payments to Medicare
2.1
2.6
0.6
2.5
4.2
2.2
Payments to MCOs
7.7
1.0
1.9
10.2
18.5
19.1
SNF/ICF-other
5.1
5.9
4.7
-0.9
3.3
10.9
ICF/MR
-2.5
-0.7
-1.4
-3.7
-7.7
-2.7
Home Health
4.8
2.9
2.2
3.8
11.0
8.8
Other Services
6.3
4.4
4.2
4.0
15.7
9.1
DSH
21.5%
21.2%
46.8%
-4.2%
-1.3%
13.7%
Total Expenditure Growth
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Billions of Dollars
$80.8
$18.6
$26.1
$12.2
$9.7
$15.3
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding. "Cash assistance"
refers to beneficiaries who receive AFDC or SSI. "Other beneficiaries" include the medically needy, poverty-related expansion groups, and people eligible
under Medicaid 1115 waivers. "SNF/ICF-Other" refers to skilled nursing facilities/other intermediate care facilities. "ICF/MR" refers to intermediate care
facilities for the mentally retarded. "Other Services" includes other acute care, EPSDT, and mental health. "DSH" refers to disproportionate share hospital
payments. "MCOs" refers to managed care organizations.
(1) The figures in this table represent the share of growth attributable to each factor (beneficiary growth, nominal spending per beneficiary, and DSH),
holding the other two constant.
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Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 24
Factors Influencing Medicaid Expenditure Growth, 1990-1995*
Billions of Dollars
$30.0
DSH
$26.1
Nominal Spending per Beneficiary
$25.0
Beneficiary Growth
$20.0
$18.6
$15.3
$15.0
$12.2
$10.0
$9.7
$5.0
$0.0
-$5.0
90-91
91-92
92-93
93-94
94-95
Years
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include administrative costs, accounting adjustments. or the U.S. Territories. "DSH" refers to disproportionate share hospital payments. Beneficiaries
are people enrolled in the Medicaid program who actually receive services. Numbers represent net growth, reflecting a decrease in expenditures for DSH in
1993 and 1994.
*The bars in this graphic represent the share of growth attributable to each factor (beneficiary growth, nominal spending per beneficiary, and DSH). holding the
other two constant. Total expenditure growth during each period appears at the top of each bar.
Kaiser Commission on the Future of Medicaid
Page 101
State Trends, 1990-1995
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
STATE TRENDS, 1990-1995
Differential growth between the enrollment groups
across states (Tables 55-59) can be attributed to
variation in states' eligibility expansions (and 1115
M
edicaid is, at its core, a state-administered pro-
waivers), state demographics, cash assistance
gram. Though the federal government sets
thresholds, and regional economies. The greatest
minimum standards that states must meet to
differences in enrollment growth can be found for
receive federal matching funds, states retain consid-
adults as a result of selected state expansions of
erable control over the design of their individual pro-
eligibility beyond traditional groups.
grams. The diversity seen among these programs is
the result of numerous complex and interrelated
Expenditures
factors that influence the design of Medicaid at the
state level, among them program decisions about
eligibility and provider payments levels, benefits, per
The average annual growth rate of total Medicaid
capita income, demographics, and fluctuations in
expenditures (benefits and DSH payments) average
economic conditions.
16.7 percent per year from 1990 to 1995. Average
growth ranged from less than 10 percent in North
Dakota and Oklahoma to more than 25 percent in
Because of the wide variation in states' Medicaid
Hawaii, Nevada, and New Hampshire (Table 59,
programs, it is difficult to describe recent trends in
Figure 26). The high growth rates in several states
general terms. Differences in populations served,
(Colorado, Louisiana, New Hampshire, Missouri and
shared funding responsibilities, and program admini-
Texas) were heavily affected by large DSH pay-
stration make it hard to compare Medicaid experi-
ments. High growth rates in Hawaii, Oregon, and
ences across states. Increased use of federal waiv-
Tennessee resulted from the implementation of
ers-those for home- and community-based care,
comprehensive waivers in these states, which ex-
freedom of choice of providers (1915b), and re-
panded coverage to other low-income individuals
search and demonstrations (1115)-compounds the
who did not meet Medicaid's traditional categorical
problem by allowing even greater diversity among
requirements (Table 60).
programs. Data on state trends reflect the various
choices that states have made for their Medicaid
programs.
Growth in spending per beneficiary also varied con-
siderably across the states. Average annual growth
was 5.7 percent nationally, excluding DSH payments
Beneficiaries
(Table 62, Figure 27). Seven states saw growth in
per beneficiary spending in excess of 10 percent per
The number of Medicaid beneficiaries increased in
year (Alabama, Delaware, Louisiana, Mississippi,
every state between 1990 and 1995. Forces behind
Pennsylvania, and West Virginia). By contrast,
these increases included federally mandated eligibil-
seven states averaged less than 2 percent annual
ity expansions, court-related expansions of cover-
growth (Alaska, Idaho, Indiana, New Hampshire,
age, and individual state initiatives. Demographics,
Oklahoma, Tennessee, and Virginia.).
economic fluctuations (which affect the number of
people living in poverty), program outreach efforts,
Total acute care spending grew rapidly during this
and so-called "Medicaid maximization"1 efforts also
period (Tables 67 through 70). Growth averaged
affected enrollment and usage during this period.
16.7 percent per year nationwide, ranging from a low
Total beneficiary growth averaged 7.9 percent annu-
of 5.6 percent in Indiana to more than 36.1 percent in
ally and was highest in Idaho, Hawaii, Nevada, New
Hawaii. Most notable was the growth in payments to
Hampshire, New Mexico, and Tennessee (Table 54,
MCOs, which increased at an average rate of 38.4
Figure 25); growth in these states exceeded 16 per-
percent per year-from $1.9 billion to $9.8 billion.
cent per year. By contrast, Michigan and Pennsylva-
This growth was extremely uneven across states in
nia averaged less than 3 percent annual growth.
as much as managed care has developed and ex-
panded differently in each state.
For long-term care spending, annual growth aver-
aged 10.8 percent (Tables 75 through 79). Massa-
1 Describes states' efforts to shift programs or services previously
funded with state-only dollars to Medicaid where the federal gov-
chusetts had the lowest rate (7.2 percent), while
ernment shares in the costs. While this does not necessarily
Wyoming's was highest (29.7 percent). Reflecting a
provide "new" services to low-income populations, it does reduce
general trend in health care, home health spending
the state's cost for providing them.
Kaiser Commission on the Future of Medicaid
Page 105
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
averaged more than 10 percent growth per year in
almost every state.²
From 1990 to 1995, spending on DSH grew at an
average annual rate of 69.0 percent. At one end,
seven states (California, Connecticut, Georgia,
Kentucky, Massachusetts, Nevada, and Texas) ex-
perienced annual DSH growth rates of greater than
200 percent. By contrast, several states (Montana,
North Dakota, South Dakota, and Wyoming) experi-
enced almost no growth in the past five years and
spent less than $1 million on DSH payments in 1995.
Most of the DSH spending growth occurred between
1990 and 1993, when overall payments rose more
than 130 percent per year (Table 80). Overall
growth in DSH spending slowed dramatically in
1992, due to federal legislation designed to limit the
use of these payments as a Medicaid financing
mechanism. Total DSH spending actually fell in 1993
and 1994. Overall DSH expenditures rose again in
1995, but growth varied dramatically by state due to
caps instituted under legislation.
2 Tennessee now provides home health care through capitated
payments, so the large increase in payments to HMOs from 1994
and 1995 likely contains some home health care spending.
Page 106
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 54
Medicaid Beneficiaries, 1990-1995
Beneficiaries (thousands)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
24,066
26,851
29,811
32,441
34,183
35,214
7.9%
10.5%
4.2%
New England
1,187
1,314
1,412
1,510
1,525
1,603
6.2%
8.4%
3.0%
Connecticut
243
271
305
327
344
366
8.5
10.4
5.8
Maine
133
151
162
169
176
177
5.8
8.3
2.3
Massachusetts
591
646
678
734
704
725
4.2
7.5
-0.6
New Hampshire
43
58
70
78
83
102
18.9
22.1
14.3
Rhode Island
117
118
119
122
126
136
3.0
1.3
5.6
Vermont
60
71
78
81
92
97
10.0
10.1
9.9
Middle Atlantic
4,060
4,341
4,429
4,745
4,937
5,032
4.4%
5.3%
3.0%
New Jersey
567
614
697
782
779
777
6.5
11.3
-0.3
New York
2,326
2,461
2,557
2,740
2,903
3,024
5.4
5.6
5.0
Pennsylvania
1,167
1,266
1,175
1,223
1,255
1,230
1.1
1.6
0.3
South Atlantic
3,617
4,230
4,969
5,613
5,888
6,137
11.2%
15.8%
4.6%
Delaware
50
51
61
69
75
78
9.5
11.6
6.4
District of Columbia
93
100
108
120
127
137
8.0
8.7
6.9
Florida
989
1,209
1,530
1,745
1,727
1,734
11.9
20.8
-0.3
Georgia
649
745
863
953
1,070
1,138
11.9
13.7
9.3
Maryland
328
362
373
441
415
413
4.7
10.4
-3.3
North Carolina
563
667
785
898
983
1,076
13.9
16.9
9.5
South Carolina
316
371
427
464
483
494
9.4
13.7
3.2
Virginia
379
442
515
575
642
678
12.3
14.9
8.6
West Virginia
250
284
308
347
366
389
9.2
11.5
5.8
East South Central
1,864
2,095
2,321
2,551
2,876
3,166
11.2%
11.0%
11.4%
Alabama
352
403
467
522
538
537
8.8
14.0
1.5
Kentucky
468
525
583
617
621
622
5.9
9.7
0.4
Mississippi
433
470
487
504
526
519
3.7
5.2
1.5
Tennessee (1)
612
697
784
908
1,191
1,487
19.4
14.1
28.0
West South Central
2,540
2,910
3,366
3,745
3,997
4,036
9.7%
13.8%
3.8%
Arkansas
254
259
319
337
337
350
6.6
9.9
1.9
Louisiana
573
624
684
731
757
761
5.9
8.5
2.0
Oklahoma
271
300
356
368
388
393
7.7
10.7
3.4
Texas
1,442
1,727
2,007
2,308
2,514
2,531
11.9
17.0
4.7
East North Central
4,020
4,347
4,805
5,069
5,195
5,235
5.4%
8.0%
1.6%
Illinois
1,067
1,144
1,313
1,395
1,441
1,550
7.8
9.3
5.4
Indiana
345
413
502
560
601
557
10.1
17.5
-0.2
Michigan
1,039
1,112
1,128
1,170
1,187
1,164
2.3
4.1
-0.3
Ohio
1,178
1,263
1,424
1,474
1,496
1,505
5.0
7.8
1.0
Wisconsin
391
414
438
470
470
459
3.3
6.3
-1.2
West North Central
1,463
1,630
1,728
1,852
1,928
2,009
6.5%
8.2%
4.1%
lowa
240
261
278
288
302
304
4.9
6.3
2.7
Kansas
194
209
225
243
252
252
5.3
7.7
1.9
Minnesota
364
415
401
422
413
460
4.8
5.0
4.4
Missouri
448
503
554
609
669
695
9.2
10.8
6.8
Nebraska
118
132
148
159
159
163
6.7
10.5
1.2
North Dakota
49
53
57
62
62
61
4.6
8.2
-0.6
South Dakota
49
57
64
69
72
73
8.3
12.0
3.0
Mountain
896
1,057
1,276
1,388
1,560
1,598
12.3%
15.7%
7.3%
Arizona (1)
276
313
402
404
509
494
12.3
13.5
10.5
Colorado
191
223
259
279
287
293
9.0
13.6
2.4
Idaho
55
70
87
100
110
115
16.1
22.2
7.5
Montana
61
63
60
89
95
98
9.9
13.4
4.9
Nevada
47
59
78
88
96
105
17.4
23.4
8.8
New Mexico
129
161
212
233
258
283
16.9
21.7
10.1
Utah
108
129
137
148
157
160
8.2
11.0
4.1
Wyoming
29
37
42
46
50
51
12.1
16.8
5.5
Pacific
4,419
4,928
5,505
5,967
6,275
6,398
7.7%
10.5%
3.6%
Alaska
39
51
58
65
69
68
11.8
18.6
2.3
California
3,624
4,019
4,486
4,834
5,008
4,942
6.4
10.1
1.1
Hawaii (1.2)
81
88
98
110
119
228
23.2
10.9
44.2
Oregon (1)
227
263
295
325
411
452
14.7
12.7
17.9
Washington
448
506
569
633
668
708
9.6
12.2
5.8
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI. OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) Hawaii did not report any adult or child beneficiaries on its HCFA-2082 report for 1995; the 1995 figure shown here is based on information provided by the
state and relative spending per beneficiary data. This method of estimation likely overestimates the actual number of beneficiaries, because Hawaii's expenditures
were unusually high in 1995. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 107
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 25
Average Annual Growth in Medicaid Beneficiaries, 1990-1995
RI
DE
DC
< 5% (10 states)
5% - 9.9% (24)
10% - 14.9% (11)
15%+ (6)
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Beneficiaries are people enrolled in the Medicaid program who actually receive medical services For certain states with
active 1115 waivers (AZ. HI, OR. TN). expenditure and beneficiary data were supplemented with data received direcity from the state: adjustments were made
tto categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 108
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 55
Medicaid Child Beneficiaries, 1990-1995
Beneficiaries (thousands)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
11,486
13,101
14,811
16,319
17,115
17,516
8.8%
12.4%
3.6%
New England
529
595
650
707
710
732
6.7%
10.1%
1.8%
Connecticut
118
134
156
168
179
178
8.6
12.5
3.0
Maine
58
68
75
78
82
81
7.1
10.5
2.2
Massachusetts
254
280
296
329
306
311
4.1
9.0
-2.8
New Hampshire
21
29
35
40
42
50
18.9
23.9
11.8
Rhode Island
47
48
49
50
54
61
5.3
2.4
9.7
Vermont
31
36
40
41
47
51
10.7
10.1
11.6
Middle Atlantic
2,041
2,219
2,262
2,400
2,452
2,452
3.7%
5.5%
1.1%
New Jersey
270
294
331
371
369
359
5.8
11.1
-1.6
New York
1,182
1,277
1,327
1,415
1,472
1,521
5.2
6.2
3.7
Pennsylvania
590
648
604
613
611
573
-0.6
1.3
-3.4
South Atlantic
1,662
2,018
2,490
2,931
3,131
3,282
14.6%
20.8%
5.8%
Delaware
27
26
33
38
42
44
9.8
12.1
6.5
District of Columbia
47
51
55
63
67
73
9.1
9.9
7.8
Florida
463
604
850
1,043
1,042
1,038
17.6
31.1
-0.2
Georgia
314
360
417
467
549
600
13.8
14.1
13.4
Maryland
164
185
188
227
207
207
4.8
11.4
-4.4
North Carolina
244
303
369
434
491
537
17.1
21.2
11.2
South Carolina
132
164
199
224
233
237
12.4
19.3
2.9
Virginia
164
201
244
284
334
364
17.3
20.1
13.2
West Virginia
107
124
134
152
165
183
11.4
12.4
9.8
East South Central
826
966
1,084
1,199
1,279
1,361
10.5%
13.2%
6.6%
Alabama
131
164
203
237
247
247
13.5
21.8
2.1
Kentucky
203
240
264
277
279
277
6.4
10.9
-0.1
Mississippi
212
230
238
247
260
250
3.4
5.2
0.6
Tennessee (1)
280
333
379
438
493
588
16.0
16.1
15.8
West South Central
1,248
1,478
1,755
1,980
2,126
2,149
11.5%
16.6%
4.2%
Arkansas
113
110
130
142
144
152
6.1
8.0
3.4
Louisiana
287
314
346
363
376
376
5.6
8.2
1.8
Oklahoma
126
144
180
189
198
200
9.7
14.6
2.8
Texas
722
910
1,100
1,286
1,407
1,421
14.5
21.2
5.1
East North Central
2,001
2,180
2,432
2,576
2,635
2,664
5.9%
8.8%
1.7%
Illinois
560
599
688
733
752
816
7.8
9.4
5.5
Indiana
157
197
254
294
322
309
14.5
23.3
2.6
Michigan
527
564
565
572
573
549
0.8
2.8
-2.0
Ohio
587
627
720
753
774
781
5.9
8.7
1.9
Wisconsin
170
193
204
224
215
208
4.1
9.6
-3.6
West North Central
716
805
852
918
964
1,013
7.2%
8.6%
5.1%
lowa
112
122
131
135
142
141
4.7
6.5
2.1
Kansas
90
101
114
123
132
131
7.8
11.0
3.1
Minnesota
197
221
207
216
202
234
3.5
3.2
4.1
Missouri
213
239
263
289
329
348
10.3
10.8
9.7
Nebraska
62
71
80
89
93
92
8.4
12.9
1.8
North Dakota
21
24
27
30
31
29
6.1
12.1
-2.4
South Dakota
22
27
31
35
37
38
12.0
17.2
4.6
Mountain
468
565
689
761
863
880
13.4%
17.5%
7.5%
Arizona (1)
162
184
236
237
299
297
12.8
13.5
11.8
Colorado
95
111
129
141
145
130
6.5
14.3
-4.1
Idaho
25
35
45
53
60
62
20.0
28.3
8.6
Montana
29
30
27
46
50
50
11.3
15.8
4.7
Nevada
21
28
39
45
48
54
20.4
28.5
9.2
New Mexico
63
88
116
130
146
170
21.9
27.2
14.5
Utah
57
69
74
82
87
88
9.0
12.5
4.0
Wyoming
15
20
24
27
29
28
12.7
20.5
2.1
Pacific
1,995
2,274
2,597
2,849
2,955
2,983
8.4%
12.6%
2.3%
Alaska
22
29
32
37
39
39
12.0
18.4
3.0
California
1,606
1,823
2,084
2,272
2,346
2,322
7.6
12.2
1.1
Hawaii (1.2)
40
44
50
56
62
98
19.8
11.9
32.8
Oregon (1)
111
131
151
168
172
159
7.4
14.8
-2.8
Washington
216
247
279
317
336
366
11.2
13.7
7.5
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories Figures may not sum to totals due to rounding. Child beneficiaries are non-disabled individuals under 18.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) Hawaii did not report any adult or child beneficiaries on its HCFA-2082 report for 1995; the 1995 figure shown here is based on information provided by the
state and relative spending per beneficiary data. This method of estimation likely overestimates the actual number of beneficiaries, because Hawaii's expenditures
were unusually high in 1995. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 109
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 56
Medicaid Adult Beneficiaries, 1990-1995
Beneficiaries (thousands)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
5,696
6,402
6,982
7,451
7,860
7,960
6.9%
9.4%
3.4%
New England
268
301
323
350
342
349
5.5%
9.3%
-0.1%
Connecticut
57
64
73
78
79
86
8.8
11.3
5.1
Maine
31
36
38
38
38
36
3.1
7.0
-2.5
Massachusetts
132
145
153
170
158
153
3.0
9.0
-5.4
New Hampshire
10
14
17
19
18
23
17.9
22.7
11.0
Rhode Island
25
25
25
26
28
30
3.9
2.0
6.7
Vermont
14
16
18
18
21
21
9.2
10.1
8.0
Middle Atlantic
864
931
930
988
1,017
1,026
3.5%
4.6%
1.9%
New Jersey
131
145
177
196
186
184
7.0
14.4
-3.1
New York
465
497
515
554
593
622
6.0
6.0
5.9
Pennsylvania
267
290
238
238
238
221
-3.7
-3.8
-3.7
South Atlantic
821
975
1,101
1,164
1,146
1,125
6.5%
12.3%
-1.7%
Delaware
12
12
14
15
15
16
6.5
9.3
2.4
District of Columbia
21
23
25
27
29
33
9.5
8.4
11.1
Florida
197
249
286
269
229
209
1.2
10.9
-11.8
Georgia
150
173
200
220
240
244
10.2
13.6
5.3
Maryland
71
79
78
93
80
73
0.6
9.4
-11.3
North Carolina
142
173
203
228
241
243
11.3
17.0
3.3
South Carolina
64
78
88
89
86
87
6.4
11.9
-1.5
Virginia
86
101
114
122
125
123
7.4
12.2
0.6
West Virginia
78
88
93
101
100
96
4.3
9.1
-2.4
East South Central
371
415
461
494
674
762
15.5%
10.0%
24.3%
Alabama
69
80
91
97
94
88
5.0
12.2
-4.9
Kentucky
113
123
139
140
134
126
2.1
7.4
-5.4
Mississippi
69
75
77
80
84
77
2.4
5.2
-1.8
Tennessee (1)
120
137
153
176
363
472
31.4
13.6
63.7
West South Central
565
663
746
803
839
819
7.7%
12.4%
1.0%
Arkansas
43
47
69
64
58
58
5.9
13.6
-4.7
Louisiana
127
137
146
144
148
143
2.4
4.2
-0.3
Oklahoma
58
68
81
82
86
86
8.1
11.9
2.5
Texas
336
410
450
514
547
532
9.6
15.2
1.8
East North Central
988
1,058
1,152
1,197
1,199
1,163
3.3%
6.6%
-1.4%
Illinois
249
269
304
309
313
331
5.8
7.5
3.4
Indiana
86
105
125
136
143
115
5.9
16.6
-8.2
Michigan
293
310
308
320
317
306
0.9
3.0
-2.2
Ohio
281
300
336
351
341
330
3.2
7.7
-3.1
Wisconsin
79
75
79
81
85
82
0.7
0.6
0.8
West North Central
365
400
415
442
435
441
3.8%
6.6%
-0.1%
lowa
59
65
69
72
75
75
4.7
6.5
2.2
Kansas
58
58
54
59
59
56
-0.6
0.4
-2.3
Minnesota
90
102
100
105
93
100
2.0
5.0
-2.4
Missouri
110
123
136
149
158
157
7.4
10.8
2.4
Nebraska
25
28
31
31
24
27
1.3
6.5
-6.0
North Dakota
11
12
12
13
12
13
3.0
4.8
0.5
South Dakota
11
12
13
14
13
13
4.1
8.3
-2.0
Mountain
224
263
312
337
374
372
10.7%
14.7%
5.0%
Arizona (1)
66
77
98
99
125
111
10.9
14.3
5.9
Colorado
48
56
65
68
67
77
9.8
12.4
6.0
Idaho
13
17
21
23
24
25
13.2
19.8
4.0
Montana
14
15
12
20
21
22
9.1
11.8
5.1
Nevada
10
14
19
21
22
23
17.8
26.6
5.7
New Mexico
31
35
45
53
60
58
13.8
20.4
4.7
Utah
33
39
40
41
44
44
6.0
8.1
3.0
Wyoming
8
10
11
11
11
11
6.8
12.1
-0.6
Pacific
1,230
1,397
1,542
1,677
1,833
1,902
9.1%
10.9%
6.5%
Alaska
12
15
17
19
20
18
9.5
17.9
-1.9
California
1,010
1,143
1,266
1,376
1,447
1,392
6.6
10.9
0.6
Hawaii (1.2)
19
21
23
26
27
99
39.2
11.2
95.0
Oregon (1)
63
74
79
84
161
209
27.0
9.9
57.8
Washington
126
144
157
171
178
184
7.8
10.7
3.6
Source: Urban Institute calculations based on data from HCFA-2082 reports
Does not include the U.S. Territories Figures may not sum to totals due to rounding. Adult beneficiaries are non-disabled individuals between 19 and 64.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state:
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) Hawaii did not report any adult or child beneficiaries on its HCFA-2082 report for 1995; the 1995 figure shown here is based on information provided by the
state and relative spending per beneficiary data. This method of estimation likely overestimates the actual number of beneficiaries, because Hawaii's expenditures
were unusually high in 1995. See Appendix C.
Page 110
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 57
Medicaid Blind and Disabled Beneficiaries, 1990-1995
Beneficiaries (thousands)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
3,717
4,038
4,471
4,991
5,381
5,849
9.5%
10.3%
8.3%
New England
212
233
246
257
272
298
7.0%
6.6%
7.6%
Connecticut
36
39
42
46
50
49
6.2
8.1
3.5
Maine
23
25
28
30
33
37
9.6
9.4
9.8
Massachusetts
114
126
131
134
137
161
7.1
5.5
9.5
New Hampshire
6
8
10
11
13
12
14.1
20.5
5.2
Rhode Island
24
24
24
25
25
25
1.2
1.1
1.4
Vermont
9
11
12
12
14
15
10.1
10.1
10.1
Middle Atlantic
614
643
681
781
872
924
8.5%
8.3%
8.8%
New Jersey
93
99
110
129
137
144
9.2
11.6
5.7
New York
343
351
375
420
471
511
8.3
6.9
10.3
Pennsylvania
178
193
196
232
264
269
8.6
9.2
7.6
South Atlantic
590
654
728
831
907
1,006
11.3%
12.1%
10.0%
Delaware
6
7
9
10
11
13
14.6
15.3
13.5
District of Columbia
14
15
17
21
22
23
9.7
13.2
4.7
Florida
167
185
208
234
251
276
10.5
11.8
8.7
Georgia
109
125
145
162
177
190
11.7
14.1
8.2
Maryland
51
55
61
75
81
86
10.9
13.6
6.9
North Carolina
73
81
92
105
113
144
14.6
12.8
17.3
South Carolina
70
75
69
77
88
94
6.3
3.6
10.6
Virginia
62
68
78
88
97
106
11.4
12.4
9.8
West Virginia
37
42
49
60
67
75
14.8
17.4
11.1
East South Central
403
437
488
558
590
727
12.5%
11.5%
14.1%
Alabama
84
91
102
117
125
131
9.3
11.5
6.1
Kentucky
96
104
118
135
145
156
10.3
12.3
7.5
Mississippi
96
105
108
112
117
126
5.5
5.2
5.9
Tennessee (1)
126
138
159
194
203
313
19.9
15.4
27.1
West South Central
315
346
405
482
523
559
12.2%
15.3%
7.7%
Arkansas
53
59
69
78
83
87
10.7
14.3
5.5
Louisiana
77
84
100
132
136
146
13.5
19.4
5.2
Oklahoma
35
37
43
46
52
56
9.8
9.5
10.2
Texas
149
165
193
226
251
270
12.6
14.8
9.3
East North Central
612
669
750
817
864
896
7.9%
10.1%
4.7%
Illinois
170
185
215
241
260
277
10.3
12.4
7.1
Indiana
58
64
72
73
67
67
3.0
7.8
-3.8
Michigan
137
153
170
194
213
223
10.2
12.4
7.0
Ohio
170
183
204
209
220
224
5.7
7.2
3.5
Wisconsin
77
85
90
99
104
105
6.2
8.6
2.8
West North Central
184
211
230
251
283
302
10.4%
10.8%
9.7%
lowa
38
41
44
45
47
50
5.9
6.5
5.1
Kansas
22
25
29
33
36
39
12.5
15.4
8.3
Minnesota
31
42
42
44
65
69
17.2
11.9
25.5
Missouri
65
73
81
89
92
98
8.4
10.8
5.0
Nebraska
14
15
17
20
22
23
11.1
13.0
8.5
North Dakota
6
7
7
8
8
9
6.5
7.6
5.0
South Dakota
8
9
10
12
12
13
10.1
11.7
7.6
Mountain
120
136
166
175
198
224
13.3%
13.3%
13.3%
Arizona (1)
31
35
44
45
56
62
14.4
12.5
17.5
Colorado
25
30
34
35
39
49
14.3
11.0
19.4
Idaho
9
10
13
15
17
18
14.9
17.0
11.8
Montana
10
11
13
14
15
16
10.1
12.6
6.3
Nevada
8
9
10
12
14
16
16.1
17.0
14.8
New Mexico
22
25
32
33
34
37
10.7
14.5
5.2
Utah
11
13
15
16
17
19
11.7
13.1
9.6
Wyoming
3
4
4
5
5
6
15.1
15.1
15.1
Pacific
667
708
776
838
873
914
6.5%
7.9%
4.4%
Alaska
3
4
5
5
6
7
15.8
18.9
11.3
California
563
592
640
682
704
742
5.7
6.6
4.3
Hawaii (1.2)
12
13
14
16
18
14
3.1
10.8
-7.5
Oregon (1)
29
31
36
42
44
46
9.9
13.4
4.7
Washington
60
68
82
93
101
105
11.9
15.8
6.3
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding The blind and disabled beneficiary group includes individuals who,
regardless of age, qualify for Medicaid because of disability.
(1) For certain states with active 1115 waivers (AZ. HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) Hawaii did not report any adult or child beneficiaries on its HCFA-2082 report for 1995; the 1995 figure shown here is based on information provided by the
state and relative spending per beneficiary data. This method of estimation likely overestimates the actual number of beneficianes, because Hawaii's expenditures
were unusually high in 1995 See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 111
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 58
Medicaid Elderly Beneficiaries, 1990-1995
Beneficiaries (thousands)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
3,167
3,310
3,547
3,680
3,828
3,889
4.2%
5.1%
2.8%
New England
178
186
192
196
202
223
4.7%
3.4%
6.7%
Connecticut
32
33
34
35
37
53
10.5
3.1
22.5
Maine
21
22
22
22
23
22
1.4
2.2
0.2
Massachusetts
91
95
98
101
103
101
2.2
3.6
0.2
New Hampshire
5
7
8
8
10
17
25.3
15.7
41.2
Rhode Island
22
21
21
20
20
20
-1.9
-2.0
-1.7
Vermont
7
8
9
9
10
10
8.4
10.1
5.9
Middle Atlantic
541
548
555
577
596
629
3.1%
2.2%
4.5%
New Jersey
73
77
79
86
87
90
4.4
5.7
2.4
New York
336
336
340
351
367
371
2.0
1.5
2.8
Pennsylvania
132
135
136
139
143
167
4.9
1.9
9.7
South Atlantic
544
583
650
686
704
724
5.9%
8.1%
2.7%
Delaware
4
5
5
6
6
6
6.6
8.5
3.7
District of Columbia
10
11
11
9
9
8
-5.6
-3.8
-8.2
Florida
162
170
186
200
204
211
5.4
7.2
2.8
Georgia
75
87
101
104
104
104
6.7
11.4
0.0
Maryland
42
43
46
47
46
47
2.3
3.8
0.1
North Carolina
104
110
121
132
138
152
8.0
8.3
7.5
South Carolina
51
54
71
74
76
77
8.6
13.6
1.6
Virginia
67
72
78
82
85
85
4.8
6.6
2.2
West Virginia
28
30
32
34
35
35
4.3
6.1
1.6
East South Central
265
277
289
300
333
315
3.5%
4.2%
2.5%
Alabama
68
69
70
71
71
71
0.9
1.4
0.2
Kentucky
56
58
62
64
63
63
2.6
4.9
-0.7
Mississippi
56
61
63
65
65
67
3.5
5.2
0.9
Tennessee (1)
85
89
93
100
133
114
6.0
5.4
7.0
West South Central
413
423
460
480
509
509
4.3%
5.2%
2.9%
Arkansas
45
42
51
53
52
53
3.2
5.6
-0.2
Louisiana
82
88
92
93
97
97
3.5
4.5
1.9
Oklahoma
52
50
53
51
52
51
-0.4
-0.9
0.4
Texas
234
242
263
283
309
308
5.6
6.5
4.3
East North Central
419
439
470
479
497
512
4.1%
4.6%
3.3%
Illinois
88
91
106
111
116
127
7.6
8.2
6.7
Indiana
44
47
50
57
70
66
8.3
8.7
7.8
Michigan
82
86
85
84
84
86
0.9
0.8
1.1
Ohio
140
152
164
161
161
169
3.8
4.7
2.4
Wisconsin
64
62
65
66
66
64
0.0
1.1
-1.6
West North Central
197
214
231
242
246
253
5.1%
7.1%
2.2%
lowa
31
33
35
36
38
38
4.2
5.3
2.5
Kansas
25
26
28
27
26
26
1.0
3.7
-3.0
Minnesota
46
50
53
57
53
57
4.4
7.4
0.0
Missouri
60
68
75
82
90
93
9.0
10.8
6.3
Nebraska
17
18
19
20
20
21
3.8
5.2
1.6
North Dakota
10
10
11
11
11
11
1.5
3.5
-1.4
South Dakota
9
9
10
9
9
9
0.4
2.3
-2.3
Mountain
84
93
110
115
126
123
8.0%
11.0%
3.5%
Arizona (1)
17
18
23
23
29
25
8.1
11.8
2.7
Colorado
23
26
31
35
37
37
10.1
15.7
2.2
Idaho
7
8
9
9
9
9
6.2
8.6
2.6
Montana
7
7
8
8
9
9
5.4
6.8
3.4
Nevada
8
8
9
10
11
11
7.7
9.1
5.6
New Mexico
13
14
18
17
18
17
5.2
7.7
1.6
Utah
7
9
9
9
9
9
5.0
8.9
-0.5
Wyoming
2
3
3
3
5
6
19.5
9.4
36.2
Pacific
527
548
590
603
615
599
2.6%
4.6%
-0.4%
Alaska
2
3
3
4
4
4
14.2
22.9
2.2
California
444
461
495
504
510
486
1.8
4.3
-1.7
Hawaii (1.2)
10
11
11
12
13
17
11.5
6.6
19.2
Oregon (1)
24
26
29
31
34
38
9.6
9.2
10.1
Washington
46
48
51
52
53
53
2.9
4.1
1.1
Source: Urban Institute calculations based on data from HCFA-2082 reports.
Does not include the U.S. Terntories. Figures may not sum to totals due to rounding Elderly beneficiaries are people aged 65 and over. The alderly most likely
include some disabled individuals who have spent down their assets to become Medicaid eligible and were not originally considered disabled
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with date received directly from the state;
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) Hawaii did not report any adult or child beneficiaries on its HCFA-2082 report for 1995; the 1995 figure shown here is based on information provided by the
state and relative spending per beneficiary data. This method of estimation likely overestimates the actual number of beneficiaries, because Hawaii's expenditures
were unusually high in 1995 See Appendix C.
Page 112
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 59
Medicaid Expenditures for Benefits and DSH, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$70,510
$89,074
$115,164
$127,394
$137,112
$152,423
16.7%
21.8%
9.4%
New England
$5,661
$7,832
$8,918
$9,020
$9,952
$11,571
15.4%
16.8%
13.3%
Connecticut
1,239
1,517
2,113
2,278
2,424
2,838
18.0
22.5
11.6
Maine
438
589
748
851
932
949
16.7
24.8
5.6
Massachusetts
3,159
4,496
4,269
4,044
4,696
5,600
12.1
8.6
17.7
New Hampshire
226
390
761
763
830
848
30.2
49.9
5.4
Rhode Island
446
643
782
829
787
999
17.5
23.0
9.8
Vermont
154
197
245
255
284
336
16.9
18.5
14.7
Middle Atlantic
$17,595
$22,182
$28,233
$29,947
$32,447
$35,853
15.3%
19.4%
9.4%
New Jersey
2,374
3,102
4,179
4,706
4,793
5,391
17.8
25.6
7.0
New York
12,187
15,007
18,055
19,628
21,223
23,525
14.1
17.2
9.5
Pennsylvania
3,034
4,073
5,999
5,613
6,432
6,937
18.0
22.8
11.2
South Atlantic
$9,616
$12,609
$15,881
$18,219
$20,139
$22,501
18.5%
23.7%
11.1%
Delaware
126
185
216
253
281
334
21.6
26.2
15.0
District of Columbia
406
500
600
687
790
793
14.3
19.1
7.4
Florida
2,535
3,287
4,150
4,949
5,347
6,134
19.3
25.0
11.3
Georgia
1,566
1,974
2,487
2,799
3,274
3,581
18.0
21.4
13.1
Maryland
1,182
1,434
1,890
1,960
2,246
2,465
15.8
18.4
12.1
North Carolina
1,499
2,070
2,481
2,896
3,175
3,891
21.0
24.6
15.9
South Carolina
857
1,286
1,551
1,682
1,900
2,016
18.7
25.2
9.5
Virginia
1,036
1,259
1,553
1,792
1,871
2,058
14.7
20.0
7.2
West Virginia
410
614
954
1,200
1,254
1,227
24.5
43.1
1.1
East South Central
$3,880
$5,277
$6,856
$7,373
$7,659
$9,016
18.4%
23.9%
10.6%
Alabama
804
1,056
1,500
1,637
1,769
1,954
19.4
26.8
9.3
Kentucky
1,013
1,508
1,830
1,864
1,867
2,155
16.3
22.5
7.5
Mississippi
624
817
1,084
1,196
1,330
1,524
19.6
24.3
12.9
Tennessee (1)
1,439
1,896
2,442
2,675
2,694
3,383
18.6
23.0
12.5
West South Central
$5,829
$7,831
$11,554
$12,970
$14,317
$15,150
21.1%
30.6%
8.1%
Arkansas
618
732
931
1,031
1,074
1,205
14.3
18.6
8.1
Louisiana
1,402
1,894
3,316
3,730
4,065
4,117
24.0
38.6
5.1
Oklahoma
723
857
1,044
1,090
1,041
1,130
9.3
14.6
1.8
Texas
3,085
4,349
6,262
7,119
8,137
8,698
23.0
32.1
10.5
East North Central
$11,328
$13,179
$17,398
$19,454
$20,780
$22,188
14.4%
19.8%
6.8%
Illinois
2,479
2,511
4,288
4,981
5,286
5,986
19.3
26.2
9.6
Indiana (2)
1,487
1,775
2,495
2,816
2,811
2,529
11.2
23.7
-5.2
Michigan
2,618
3,359
3,788
4,363
4,930
5,114
14.3
18.6
8.3
Ohio
3,262
3,804
4,816
5,179
5,499
6,143
13.5
16.7
8.9
Wisconsin
1,482
1,731
2,011
2,115
2,256
2,416
10.3
12.6
6.9
West North Central
$4,245
$5,610
$6,958
$7,396
$8,258
$8,894
15.9%
20.3%
9.7%
lowa
643
791
904
987
1,089
1,179
12.9
15.4
9.3
Kansas
493
609
799
890
981
945
13.9
21.8
3.1
Minnesota
1,472
1,703
1,941
2,167
2,470
2,749
13.3
13.8
12.6
Missouri
948
1,675
2,346
2,252
2,533
2,765
23.9
33.4
10.8
Nebraska
319
401
480
564
615
640
14.9
20.9
6.5
North Dakota
199
227
250
270
279
300
8.5
10.6
5.4
South Dakota
171
203
239
266
291
316
13.1
16.0
8.9
Mountain
$2,231
$2,914
$4,090
$4,681
$5,101
$5,761
20.9%
28.0%
10.9%
Arizona (1)
553
724
1,138
1,365
1,571
1,601
23.7
35.1
8.3
Colorado
541
747
993
1,092
1,119
1,525
23.1
26.4
18.2
Idaho
157
211
268
294
312
338
16.6
23.3
7.3
Montana
193
235
270
323
344
360
13.3
18.7
5.6
Nevada
150
187
372
423
418
464
25.4
41.4
4.7
New Mexico
294
370
508
571
665
745
20.4
24.7
14.2
Utah
276
347
422
478
513
555
15.0
20.1
7.8
Wyoming
67
93
121
135
158
172
20.6
26.0
13.0
Pacific
$10,125
$11,639
$15,276
$18,336
$18,458
$21,489
16.2%
21.9%
8.3%
Alaska
153
182
202
258
288
303
14.7
19.0
8.4
California
8,002
9,025
11,932
14,425
14,065
16,188
15.1
21.7
5.9
Hawaii (1.3)
207
254
314
381
458
730
28.7
22.6
38.4
Oregon (1)
537
660
805
956
1,105
1,438
21.8
21.2
22.7
Washington
1,227
1,518
2,023
2,316
2,543
2,830
18.2
23.6
10.5
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Terntones. "DSH" refers to disproportionate share hospital payments. Figures may not sum to
totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
(2) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994 See Appendix C.
(3) Sources in Hawaii reported that expenditures ballooned in 1995 because the state was catching up on fee-for-service reimbursements rendered in 1994, while also making
prospective managed care payments for 1995 services. Preliminary 1996 data from HCFA indicate that Hawaii's total expenditures were less than $700 million in 1996
(including DSH, administration, and adjustments).
Kaiser Commission on the Future of Medicaid
Page 113
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 26
Average Annual Growth in Medicaid Expenditures for Benefits and DSH,
1990-1995
RI
DE
DC
< 15% (18 states)
15% - 19.9% (19)
20% - 24.9% (11)
25%+ (3)
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs. accounting adjustments, or the U.S. Territories. "DSH" refers to disproportionate share hospital payments.
Page 114
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 60
Medicaid Expenditures for Benefits Only, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$69,131
$83,758
$97,639
$110,378
$120,222
$133,435
14.1%
16.9%
9.9%
New England
$5,657
$6,602
$7,430
$7,456
$8,343
$9,808
11.6%
9.6%
14.7%
Connecticut
1,237
1,517
1,717
1,861
2,015
2,388
14.1
14.6
13.3
Maine
436
544
609
687
767
784
12.4
16.4
6.8
Massachusetts
3,159
3,436
3,812
3,560
4,154
4,991
9.6
4.1
18.4
New Hampshire
226
339
369
380
450
520
18.1
18.9
17.0
Rhode Island
446
571
701
732
692
827
13.2
18.0
6.3
Vermont
154
196
222
237
265
299
14.2
15.5
12.3
Middle Atlantic
$17,137
$20,700
$23,052
$25,489
$28,090
$30,858
12.5%
14.1%
10.0%
New Jersey
2,339
2,879
3,085
3,618
3,759
4,105
11.9
15.7
6.5
New York
11,771
14,180
14,936
17,069
18,716
20,608
11.9
13.2
9.9
Pennsylvania
3,027
3,641
5,032
4,802
5,615
6,145
15.2
16.6
13.1
South Atlantic
$9,436
$12,143
$14,239
$16,518
$18,175
$20,500
16.8%
20.5%
11.4%
Delaware
126
185
216
248
275
327
21.0
25.3
14.9
District of Columbia
406
500
567
641
737
742
12.8
16.4
7.6
Florida
2,491
3,248
3,958
4,709
5,062
5,800
18.4
23.7
11.0
Georgia
1,565
1,923
2,186
2,489
2,918
3,172
15.2
16.7
12.9
Maryland
1,182
1,434
1,777
1,883
2,096
2,305
14.3
16.8
10.7
North Carolina
1,434
1,920
2,149
2,551
2,785
3,462
19.3
21.2
16.5
South Carolina
795
1,073
1,111
1,242
1,419
1,576
14.7
16.0
12.7
Virginia
1,029
1,245
1,405
1,661
1,732
1,913
13.2
17.3
7.3
West Virginia
410
614
870
1,095
1,150
1,202
24.0
38.8
4.8
East South Central
$3,590
$4,720
$5,591
$6,234
$6,908
$8,196
18.0%
20.2%
14.7%
Alabama
610
902
1,083
1,218
1,352
1,537
20.3
26.0
12.3
Kentucky
1,013
1,331
1,566
1,727
1,799
1,935
13.8
19.5
5.9
Mississippi
621
793
931
1,044
1,172
1,341
16.6
18.9
13.3
Tennessee (1)
1,347
1,695
2,011
2,245
2,586
3,383
20.2
18.6
22.8
West South Central
$5,700
$7,442
$8,798
$10,213
$11,450
$12,350
16.7%
21.5%
10.0%
Arkansas
617
731
929
1,029
1,071
1,202
14.3
18.6
8.1
Louisiana
1,283
1,733
2,098
2,513
2,738
2,851
17.3
25.1
6.5
Oklahoma
720
845
1,022
1,066
1,017
1,112
9.1
14.0
2.1
Texas
3,080
4,134
4,749
5,606
6,624
7,185
18.5
22.1
13.2
East North Central
$11,147
$12,741
$15,868
$18,178
$19,060
$20,297
12.7%
17.7%
5.7%
Illinois
2,416
2,434
3,974
4,741
4,985
5,574
18.2
25.2
8.4
Indiana (2)
1,482
1,755
2,284
2,782
2,516
2,130
7.5
23.3
-12.5
Michigan
2,563
3,087
3,243
3,818
4,314
4,676
12.8
14.2
10.7
Ohio
3,205
3,736
4,365
4,730
5,001
5,513
11.5
13.9
8.0
Wisconsin
1,481
1,728
2,002
2,107
2,244
2,404
10.2
12.5
6.8
West North Central
$4,157
$5,045
$5,988
$6,469
$7,320
$8,051
14.1%
15.9%
11.6%
lowa
641
789
899
983
1,083
1,174
12.9
15.3
9.3
Kansas
458
555
610
705
816
871
13,7
15.5
11.2
Minnesota
1,464
1,693
1,899
2,135
2,426
2,725
13.2
13.4
13.0
Missouri
906
1,178
1,614
1,549
1,820
2,036
17.6
19.6
14.7
Nebraska
318
400
477
561
607
631
14.7
20.8
6.1
North Dakota
199
227
250
270
278
298
8.4
10.6
5.2
South Dakota
171
203
239
266
290
315
13.0
16.0
8.7
Mountain
$2,225
$2,859
$3,877
$4,364
$4,802
$5,196
18.5%
25.2%
9.1%
Arizona (1)
553
724
1,138
1,274
1,466
1,478
21.7
32.0
7.7
Colorado
537
695
872
961
1,013
1,170
16.9
21.5
10.4
Idaho
157
211
266
293
311
334
16.3
23.1
6.9
Montana
193
235
270
323
344
360
13.3
18.7
5.6
Nevada
150
186
298
343
344
390
21.1
31.9
6.7
New Mexico
293
370
496
562
657
738
20.3
24.2
14.5
Utah
275
345
417
473
509
552
15.0
19.8
8.0
Wyoming
67
93
121
135
158
172
20.7
26.0
13.0
Pacific
$10,082
$11,506
$12,796
$15,457
$16,072
$18,178
12.5%
15.3%
8.4%
Alaska
153
182
202
244
270
285
13.2
16.8
8.1
California
7,991
8,926
9,740
11,882
12,056
13,273
10.7
14.1
5.7
Hawaii (1.3)
207
252
274
337
429
729
28.7
17.7
47.1
Oregon (1)
532
653
787
935
1,083
1,410
21.5
20.7
22.8
Washington
1,199
1,494
1,792
2,059
2,234
2,482
15.7
19.8
9.8
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI. OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
(3) Sources in Hawaii reported that expenditures ballooned in 1995 because the state was catching up on fee-for-service reimbursements rendered in 1994, while also making
prospective managed care payments for 1995 services. Preliminary 1996 data from HCFA indicate that Hawaii's total expenditures were less than $700 million in 1996
(including DSH, administration, and adjustments).
Kaiser Commission on the Future of Medicaid
Page 115
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 61
Total Medicaid Expenditures, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$72,062
$94,154
$119,596
$130,748
$143,729
$159,112
17.2%
22.0%
10.3%
New England
$5,632
$7,828
$9,014
$8,797
$9,847
$10,892
14.1%
16.0%
11.3%
Connecticut
1,238
1,506
2,291
2,058
2,408
2,568
15.7
18.5
11.7
Maine
452
599
751
851
940
962
16.3
23.5
6.4
Massachusetts
3,079
4,465
4,142
3,997
4,398
5,126
10.7
9.1
13.2
New Hampshire
239
400
773
773
970
855
29.0
47.8
5.2
Rhode Island
455
645
790
839
820
1,022
17.6
22.6
10.4
Vermont
169
212
266
279
310
358
16.1
18.1
13.3
Middle Atlantic
$18,327
$25,661
$30,418
$30,269
$34,191
$38,278
15.9%
18.2%
12.5%
New Jersey
2,446
3,302
4,643
5,024
4,902
5,577
17.9
27.1
5.4
New York
12,716
17,957
19,422
18,564
22,136
24,994
14.5
13.4
16.0
Pennsylvania
3,165
4,402
6,353
6,680
7,153
7,708
19.5
28.3
7.4
South Atlantic
$9,982
$12,963
$16,347
$18,648
$20,524
$23,030
18.2%
23.2%
11.1%
Delaware
132
194
233
265
296
352
21.7
26.2
15.3
District of Columbia
446
506
610
678
812
821
13.0
14.9
10.1
Florida
2,600
3,381
4,221
5,014
5,354
6,207
19.0
24.5
11.3
Georgia
1,605
2,034
2,547
2,875
3,337
3,609
17.6
21.5
12.0
Maryland
1,262
1,531
2,031
2,071
2,362
2,543
15.0
18.0
10.8
North Carolina
1,535
2,109
2,526
2,938
3,228
4,005
21.1
24.2
16.8
South Carolina
884
1,287
1,556
1,714
1,926
2,060
18.4
24.7
9.6
Virginia
1,098
1,325
1,658
1,864
1,934
2,121
14.1
19.3
6.7
West Virginia
420
595
965
1,231
1,275
1,312
25.6
43.1
3.2
East South Central
$3,922
$5,327
$6,911
$7,481
$7,802
$9,175
18.5%
24.0%
10.7%
Alabama
824
1,102
1,541
1,673
1,817
1,983
19.2
26.6
8.9
Kentucky
1,034
1,487
1,860
1,876
1,890
2,182
16.1
22.0
7.9
Mississippi
643
836
1,105
1,205
1,345
1,575
19.6
23.3
14.3
Tennessee (1)
1,421
1,901
2,405
2,727
2,749
3,435
19.3
24.3
12.2
West South Central
$6,124
$7,935
$11,768
$13,503
$15,020
$15,714
20.7%
30.2%
7.9%
Arkansas
639
753
959
1,055
1,107
1,228
14.0
18.2
7.9
Louisiana
1,453
2,035
3,385
3,970
4,270
4,209
23.7
39.8
3.0
Oklahoma
784
918
1,118
1,162
1,141
1,206
9.0
14.0
1.9
Texas
3,248
4,229
6,306
7,315
8,502
9,070
22.8
31.1
11.4
East North Central
$11,229
$13,524
$17,612
$20,072
$21,269
$22,821
15.2%
21.4%
6.6%
Illinois
2,552
2,591
4,411
5,169
5,470
6,288
19.8
26.5
10.3
Indiana (2)
1,486
1,794
2,259
2,830
2,523
2,135
7.5
24.0
-13.2
Michigan
2,758
3,470
4,001
4,588
5,232
5,387
14.3
18.5
8.4
Ohio
2,906
3,878
4,889
5,325
5,673
6,436
17.2
22.4
9.9
Wisconsin
1,527
1,791
2,052
2,160
2,371
2,575
11.0
12.3
9.2
West North Central
$4,414
$5,839
$7,247
$7,798
$8,542
$9,228
15.9%
20.9%
8.8%
lowa
665
810
917
999
1,094
1,195
12.4
14.5
9.3
Kansas
548
706
939
1,105
1,015
970
12.1
26.3
-6.3
Minnesota
1,505
1,768
2,028
2,257
2,605
2,918
14.2
14.5
13.7
Missouri
982
1,698
2,364
2,307
2,606
2,838
23.6
32.9
10.9
Nebraska
337
421
495
585
641
677
15.0
20.2
7.6
North Dakota
202
232
260
271
286
309
8.9
10.4
6.7
South Dakota
176
204
244
272
296
322
12.9
15.7
8.8
Mountain
$2,486
$3,290
$4,403
$5,202
$5,687
$6,050
19.5%
27.9%
7.8%
Arizona (1)
724
980
1,327
1,579
1,808
1,696
18.6
29.7
3.7
Colorado
575
778
1,024
1,311
1,151
1,569
22.2
31.6
9.4
Idaho
169
223
284
313
333
365
16.6
22.8
7.9
Montana
191
248
280
341
347
373
14.3
21.4
4.5
Nevada
160
199
378
404
399
472
24.1
36.1
8.1
New Mexico
305
391
540
606
705
810
21.6
25.7
15.6
Utah
290
373
445
506
543
590
15.3
20.4
8.0
Wyoming
71
99
126
142
163
175
19.7
25.7
11.2
Pacific
$9,946
$11,785
$15,877
$18,979
$20,847
$23,924
19.2%
24.0%
12.3%
Alaska
163
190
213
321
308
342
16.0
25.4
3.2
California
7,675
8,969
12,303
14,820
16,116
18,230
18.9
24.5
10.9
Hawaii (1,3)
220
273
360
403
474
762
28.2
22.3
37.5
Oregon (1)
600
748
883
1,032
1,216
1,551
20.9
19.8
22.6
Washington
1,289
1,604
2,119
2,403
2,734
3,040
18.7
23.1
12.5
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include the U.S. Territories. Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
(2) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
(3) Sources in Hawaii reported that expenditures ballooned in 1995 because the state was catching up on fee-for-service reimbursements rendered in 1994, while also making
prospective managed care payments for 1995 services. Preliminary 1996 data from HCFA indicate that Hawaii's total expenditures were less than $700 million in 1996
(including DSH, administration, and adjustments).
Page 116
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 62
Medicaid Expenditures per Beneficiary, 1990-1995
Expenditures per Beneficiary
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$2,873
$3,119
$3,275
$3,402
$3,517
$3,789
5.7%
5.8%
5.5%
New England
$4,767
$5,025
$5,263
$4,937
$5,469
$6,120
5.1%
1.2%
11.3%
Connecticut
5,097
5,603
5,631
5,696
5,854
6,529
5.1
3.8
7.1
Maine
3,276
3,610
3,750
4,070
4,350
4,436
6.2
7.5
4.4
Massachusetts (1)
5,348
5,320
5,625
4,847
5,903
6,882
5.2
-3.2
19.2
New Hampshire
5,278
5,831
5,276
4,863
5,440
5,092
-0.7
-2.7
2.3
Rhode Island
3,808
4,850
5,885
6,019
5,474
6,104
9.9
16.5
0.7
Vermont
2,543
2,769
2,864
2,940
2,883
3,069
3.8
5.0
2.2
Middle Atlantic
$4,221
$4,768
$5,205
$5,371
$5,689
$6,133
7.8%
8.4%
6.9%
New Jersey
4,126
4,689
4,425
4,627
4,826
5,280
5.1
3.9
6.8
New York
5,060
5,761
5,841
6,229
6,447
6,815
6.1
7.2
4.6
Pennsylvania
2,595
2,876
4,283
3,926
4,473
4,995
14.0
14.8
12.8
South Atlantic
$2,609
$2,870
$2,865
$2,943
$3,087
$3,340
5.1%
4.1%
6.5%
Delaware
2,536
3,667
3,553
3,595
3,693
4,192
10.6
12.3
8.0
District of Columbia
4,356
5,010
5,251
5,347
5,794
5,423
4.5
7.1
0.7
Florida
2,517
2,687
2,587
2,699
2,931
3,344
5.8
2.3
11.3
Georgia
2,412
2,579
2,534
2,613
2,726
2,788
2.9
2.7
3.3
Maryland
3,605
3,963
4,767
4,266
5,051
5,588
9.2
5.8
14.4
North Carolina
2,548
2,878
2,737
2,839
2,833
3,216
4.8
3.7
6.4
South Carolina
2,518
2,895
2,602
2,674
2,936.
3,188
4.8
2.0
9.2
Virginia
2,713
2,817
2,729
2,887
2,699
2,821
0.8
2.1
-1.2
West Virginia
1,637
2,163
2,824
3,156
3,143
3,093
13.6
24.4
-1.0
East South Central
$1,925
$2,253
$2,409
$2,444
$2,402
$2,589
6.1%
8.3%
2.9%
Alabama
1,732
2,236
2,319
2,336
2,512
2,859
10.5
10.5
10.6
Kentucky
2,165
2,532
2,686
2,799
2,898
3,111
7.5
8.9
5.4
Mississippi
1,435
1,688
1,912
2,070
2,228
2,582
12.5
13.0
11.7
Tennessee (2)
2,201
2,433
2,565
2,472
2,171
2,274
0.7
4.0
-4.1
West South Central
$2,244
$2,558
$2,614
$2,727
$2,865
$3,060
6.4%
6.7%
5.9%
Arkansas
2,431
2,819
2,913
3,050
3,176
3,435
7.2
7.9
6.1
Louisiana
2,240
2,779
3,068
3,435
3,616
3,745
10.8
15.3
4.4
Oklahoma
2,652
2,817
2,867
2,898
2,619
2,827
1.3
3.0
-1.2
Texas
2,136
2,394
2,367
2,428
2,635
2,839
5.9
4.4
8.1
East North Central
$2,773
$2,931
$3,302
$3,586
$3,669
$3,877
6.9%
9.0%
4.0%
Illinois
2,263
2,127
3,027
3,399
3,459
3,595
9.7
14.5
2.8
Indiana (3)
4,293
4,247
4,551
4,969
4,186
3,822
-2.3
5.0
-12.3
Michigan
2,468
2,776
2,875
3,263
3,636
4,017
10.2
9.8
11.0
Ohio
2,721
2,959
3,064
3,208
3,343
3,664
6.1
5.6
6.9
Wisconsin
3,789
4,171
4,574
4,486
4,772
5,241
6.7
5.8
8.1
West North Central
$2,842
$3,096
$3,464
$3,492
$3,796
$4,008
7.1%
7.1%
7.1%
lowa
2,675
3,024
3,235
3,414
3,589
3,868
7.7
8.5
6.5
Kansas
2,357
2,654
2,712
2,905
3,241
3,459
8.0
7.2
9.1
Minnesota
4,018
4,080
4,730
5,064
5,872
5,927
8.1
8.0
8.2
Missouri
2,021
2,340
2,911
2,541
2,721
2,927
7.7
7.9
7.3
Nebraska
2,696
3,040
3,218
3,518
3,812
3,864
7.5
9.3
4.8
North Dakota
4,069
4,325
4,376
4,343
4,451
4,869
3.7
2.2
5.9
South Dakota
3,459
3,547
3,716
3,846
4,059
4,286
4.4
3.6
5.6
Mountain
$2,483
$2,705
$3,038
$3,145
$3,077
$3,251
5.5%
8.2%
1.7%
Arizona (2)
2,002
2,313
2,830
3,153
2,880
2,995
8.4
16.4
-2.5
Colorado
2,814
3,110
3,371
3,442
3,533
4,000
7.3
6.9
7.8
Idaho
2,874
3,011
3,066
2,941
2,829
2,906
0.2
0.8
-0.6
Montana
3,178
3,700
4,516
3,643
3,625
3,690
3.0
4.7
0.6
Nevada
3,184
3,136
3,845
3,881
3,604
3,732
3.2
6.8
-1.9
New Mexico
2,266
2,293
2,341
2,409
2,551
2,607
2.8
2.1
4.0
Utah
2,539
2,665
3,038
3,194
3,238
3,441
6.3
7.9
3.8
Wyoming
2,327
2,530
2,842
2,922
3,186
3,353
7.6
7.9
7.1
Pacific
$2,282
$2,335
$2,324
$2,590
$2,561
$2,841
4.5%
4.3%
4.7%
Alaska
3,919
3,554
3,506
3,749
3,928
4,184
1.3
-1.5
5.7
California
2,205
2,221
2,171
2,458
2,408
2,686
4.0
3.7
4.5
Hawaii (2)
2,565
2,859
2,795
3,066
3,594
3,192
4.5
6.1
2.0
Oregon (2)
2,342
2,480
2,666
2,875
2,634
3,119
5.9
7.1
4.2
Washington
2,678
2,950
3,152
3,253
3,342
3,505
5.5
6.7
3.8
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments. administrative costs, accounting adjustments, or the U.S. Territones. Figures may not sum to totals due to rounding.
(1) The expenditures for Massachusetts in this table likely overstate program costs in 1994 and 1995. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(3) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 117
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure 27
Average Annual Growth in Medicaid Expenditures per Beneficiary,
1990-1995
RI
DE
DC
< 1% (5 states)
1% - 4.9% (14)
5% - 9.9% (25)
10%+ (7)
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments. administrative costs. accounting adjustments, or the U.S. Territories. Beneficiaries are people
enrolled in the Medicaid program who actually receive medical services.
Page 118
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 63
Medicaid Expenditures per Child Beneficiary, 1990-1995
Expenditures per Beneficiary
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$996
$1,120
$1,201
$1,289
$1,360
$1,451
7.8%
9.0%
6.1%
New England
$1,160
$1,298
$1,485
$1,512
$1,706
$1,947
10.9%
9.2%
13.5%
Connecticut
1,180
1,261
1,330
1,372
1,461
1,415
3.7
5.1
1.6
Maine
748
902
1,009
1,137
1,265
1,360
12.7
15.0
9.4
Massachusetts (1)
1,382
1,464
1,786
1,817
2,201
2,701
14.3
9.5
21.9
New Hampshire
1,190
1,810
1,614
1,449
1,638
1,488
4.6
6.8
1.4
Rhode Island
742
1,082
1,341
1,168
1,155
1,643
17.2
16.3
18.6
Vermont
642
764
810
843
875
960
8.4
9.5
6.7
Middle Atlantic
$1,118
$1,342
$1,506
$1,589
$1,753
$2,061
13.0%
12.4%
13.9%
New Jersey
859
1,018
1,163
1,196
1,113
1,396
10.2
11.7
8.1
New York
1,234
1,494
1,513
1,695
1,895
2,241
12.7
11.1
15.0
Pennsylvania
1,003
1,188
1,678
1,584
1,795
2,002
14.8
16.4
12.4
South Atlantic
$957
$1,140
$1,166
$1,218
$1,278
$1,390
7.8%
8.4%
6.8%
Delaware
534
1,014
1,047
1,062
1,093
1,486
22.7
25.7
18.3
District of Columbia
1,565
1,814
2,085
1,979
2,081
1,917
4.1
8.1
-1.6
Florida
983
1,196
1,200
1,302
1,403
1,570
9.8
9.8
9.8
Georgia
791
862
858
914
1,050
1,073
6.3
4.9
8.4
Maryland
1,563
1,799
2,110
1,930
2,344
2,635
11.0
7.3
16.8
North Carolina
1,038
1,240
1,142
1,152
1,137
1,282
4.3
3.6
5.5
South Carolina
875
1,238
991
1,023
1,061
1,178
6.1
5.3
7.3
Virginia
767
798
879
924
858
996
5.4
6.4
3.8
West Virginia
447
627
1,075
1,260
1,200
1,138
20.6
41.3
-5.0
East South Central
$806
$925
$970
$992
$1,088
$1,028
5.0%
7.2%
1.8%
Alabama
458
766
756
770
810
904
14.6
18.9
8.3
Kentucky
903
1,021
1,070
1,073
1,009
1,056
3.2
5.9
-0.8
Mississippi
530
625
678
773
837
985
13.2
13.4
12.9
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$894
$1,004
$1,055
$1,085
$1,146
$1,184
5.8%
6.7%
4.4%
Arkansas
1,140
1,384
1,256
1,314
1,221
1,272
2.2
4.9
-1.6
Louisiana
856
1,103
1,187
1,189
1,358
1,373
9.9
11.6
7.4
Oklahoma
1,248
1,217
1,463
1,341
1,118
1,232
-0.3
2.4
-4.1
Texas
809
889
923
993
1,085
1,117
6.7
7.1
6.1
East North Central
$1,078
$1,128
$1,233
$1,463
$1,483
$1,496
6.8%
10.7%
1.1%
Illinois
787
747
1,060
1,278
1,364
1,434
12.7
17.5
5.9
Indiana (3)
1,700
1,561
1,583
2,649
1,756
1,321
-4.9
15.9
-29.4
Michigan
1,056
1,149
1,095
1,329
1,581
1,790
11.1
8.0
16.0
Ohio
1,115
1,231
1,280
1,256
1,337
1,242
2.2
4.0
-0.6
Wisconsin
1,397
1,476
1,599
1,544
1,750
2,181
9.3
3.4
18.9
West North Central
$889
$980
$1,137
$1,204
$1,277
$1,403
9.6%
10.6%
8.0%
lowa
930
1,026
1,152
1,212
1,286
1,680
12.6
9.2
17.7
Kansas
769
910
896
962
1,064
1,050
6.4
7.7
4.5
Minnesota
1,189
1,173
1,508
1,711
1,927
2,164
12.7
12.9
12.5
Missouri
616
786
966
916
976
986
9.9
14.2
3.8
Nebraska
883
980
1,107
1,325
1,407
1,341
8.7
14.5
0.6
North Dakota
991
1,105
1,066
1,071
982
1,154
3.1
2.6
3.8
South Dakota
1,049
1,045
1,080
1,070
1,050
1,067
0.3
0.6
-0.1
Mountain
$1,078
$1,337
$1,671
$1,702
$1,647
$1,408
5.5%
16.4%
-9.0%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
886
1,116
1,291
1,370
1,399
1,691
13.8
15.6
11.1
Idaho
725
821
904
841
789
740
0.4
5.1
-6.2
Montana
1,136
1,291
1,609
1,106
1,031
908
-4.4
-0.9
-9.4
Nevada
1,097
1,141
1,582
1,527
1,433
1,847
11.0
11.6
10.0
New Mexico
762
846
1,258
1,143
1,154
1,086
7.3
14.5
-2.5
Utah
778
1,072
1,338
1,382
1,451
1,660
16.4
21.1
9.6
Wyoming
1,026
1,087
1,185
1,138
1,041
1,054
0.5
3.5
-3.8
Pacific
$939
$986
$962
$1,082
$1,142
$1,267
6.2%
4.9%
8.2%
Alaska
1,779
1,670
1,684
2,109
2,142
2,301
5.3
5.8
4.4
California
959
1,001
950
1,078
1,091
1,206
4.7
4.0
5.8
Hawaii (24)
945
1,060
1,002
1,228
1,674
n/a
n/a
9.1
n/a
Oregon (2)
761
858
1,000
1,123
1,198
1,644
16.7
13.8
21.0
Washington
794
850
936
948
1,257
1,283
10.1
6.1
16.3
Source: Urban Institute calculations based on date from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
Child beneficiaries are non-disabled individuals under 18. States do not report payments to Medicare or to managed care organizations by beneficiary group. In most states,
payments to Medicare were distributed among the aged, blind, and disabled Payments to MCOs were distributed among adults and children. The methodology used is described
in Appendix C.
(1) The expenditures for Massachusetts in this table likely overstate program costs in 1994 and 1995 See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(3) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
(4) Comparable spending per beneficiary date are not available for Hawaii in 1995 due to incomplete beneficiary and expenditure data on the state's HCFA-2082 report.
Kaiser Commission on the Future of Medicaid
Page 119
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 64
Medicaid Expenditures per Adult Beneficiary, 1990-1995
Expenditures per Beneficiary
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$1,542
$1,742
$1,836
$1,956
$1,974
$2,080
6.2%
8.2%
3.1%
New England
$1,668
$1,893
$2,090
$1,983
$2,235
$2,295
6.6%
5.9%
7.6%
Connecticut
1,366
1,674
1,886
1,915
2,059
2,062
8.6
11.9
3.8
Maine
1,220
1,500
1,481
1,783
1,972
1,943
9.8
13.5
4.4
Massachusetts (1)
2,050
2,104
2,372
2,097
2,490
2,714
5.8
0.8
13.8
New Hampshire
1,559
2,577
2,353
2,005
2,349
1,809
3.0
8.7
-5.0
Rhode Island
1,243
1,770
2,236
2,159
2,273
2,253
12.6
20.2
2.1
Vermont
1,113
1,344
1,325
1,352
1,321
1,422
5.0
6.7
2.6
Middle Atlantic
$1,774
$2,180
$2,238
$2,364
$2,459
$2,660
8.4%
10.0%
6.1%
New Jersey
2,264
2,774
2,806
2,684
2,690
2,821
4.5
5.8
2.5
New York
2,008
2,468
2,276
2,489
2,597
2,832
7.1
7.4
6.7
Pennsylvania
1,129
1,391
1,732
1,810
1,933
2,040
12.6
17.0
6.2
South Atlantic
$1,720
$1,833
$1,863
$1,994
$2,077
$2,300
6.0%
5.0%
7.4%
Delaware
1,064
1,790
1,672
1,747
1,817
2,269
16.4
18.0
14.0
District of Columbia
2,180
2,498
2,367
2,286
2,208
2,225
0.4
1.6
-1.3
Florida
1,877
1,603
1,524
1,753
2,019
2,419
5.2
-2.3
17.4
Georgia
2,171
2,325
2,317
2,404
2,504
2,527
3.1
3.5
2.5
Maryland
2,062
2,355
2,825
2,483
2,861
3,280
9.7
6.4
14.9
North Carolina
1,360
1,708
1,688
1,801
1,807
2,389
11.9
9.8
15.2
South Carolina
1,807
1,903
1,663
1,887
1,938
1,941
1.4
1.5
1.4
Virginia
1,456
1,629
1,556
1,736
1,619
1,576
1.6
6.0
-4.7
West Virginia
995
1,296
1,971
2,094
1,897
1,777
12.3
28.1
-7.9
East South Central
$1,368
$1,669
$1,798
$1,777
$1,887
$1,892
6.7%
9.1%
3.2%
Alabama
1,095
1,567
1,528
1,658
1,742
2,112
14.0
14.8
12.9
Kentucky
1,410
1,750
2,019
2,032
1,992
2,198
9.3
12.9
4.0
Mississippi
1,091
1,297
1,365
1,546
1,573
1,797
10.5
12.3
7.8
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$1,593
$1,924
$1,922
$1,980
$2,108
$2,205
6.7%
7.5%
5.5%
Arkansas
1,029
1,144
1,238
1,308
1,172
1,398
6.3
8.3
3.4
Louisiana
1,495
2,076
2,240
2,274
2,452
2,423
10.1
15.0
3.2
Oklahoma
1,842
1,734
1,693
1,697
1,307
1,300
-6.7
-2.7
-12.5
Texas
1,660
1,995
1,965
2,027
2,239
2,380
7.5
6.9
8.4
East North Central
$1,420
$1,499
$1,729
$1,873
$1,874
$1,814
5.0%
9.7%
-1.6%
Illinois
1,064
951
1,522
1,804
1,879
1,903
12.3
19.2
2.7
Indiana (3)
2,273
2,170
2,634
2,988
2,270
1,772
-4.9
9.5
-23.0
Michigan
1,458
1,707
1,695
1,770
1,912
2,036
6.9
6.7
7.3
Ohio
1,441
1,552
1,631
1,661
1,718
1,530
1.2
4.9
-4.0
Wisconsin
1,395
1,446
1,638
1,592
1,676
1,830
5.6
4.5
7.2
West North Central
$1,226
$1,373
$1,573
$1,606
$1,611
$1,676
6.4%
9.4%
2.2%
lowa
1,295
1,431
1,588
1,622
1,648
1,815.
7.0
7.8
5.8
Kansas
1,181
1,463
1,669
1,759
1,728
1,685
7.4
14.2
-2.1
Minnesota
1,653
1,646
1,988
2,190
2,201
2,409
7.8
9.8
4.9
Missouri
806
1,016
1,209
1,078
1,160
1,162
7.6
10.2
3.8
Nebraska
1,207
1,396
1,418
1,570
1,663
1,599
5.8
9.2
0.9
North Dakota
1,783
1,939
2,092
2,206
1,962
1,534
-3.0
7.4
-16.6
South Dakota
1,263
1,369
1,589
1,672
1,675
1,738
6.6
9.8
2.0
Mountain
$1,637
$1,948
$2,295
$2,379
$2,359
$2,144
5.5%
13.3%
-5.1%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
1,407
1,794
2,122
2,358
2,365
2,194
9.3
18.8
-3.5
Idaho
1,381
1,605
1,861
1,783
1,666
1,658
3.7
8.9
-3.6
Montana
1,518
1,703
2,605
1,684
1,648
1,420
-1.3
3.5
-8.2
Nevada
1,855
1,903
2,838
2,634
2,267
2,411
5.4
12.4
-4.3
New Mexico
1,639
1,591
1,622
1,638
1,699
1,794
1.8
0.0
4.7
Utah
1,806
2,132
2,454
2,599
2,581
2,507
6.8
12.9
-1.8
Wyoming
1,700
1,728
1,850
1,952
2,094
2,161
4.9
4.7
5.2
Pacific
$1,438
$1,542
$1,548
$1,790
$1,634
$1,863
5.3%
7.6%
2.0%
Alaska
3,357
3,221
3,218
3,295
3,081
3,135
-1.4
-0.6
-2.5
California
1,405
1,482
1,457
1,740
1,588
1,725
4.2
7.4
-0.4
Hawaii (24)
1,525
1,750
1,726
1,913
2,164
n/a
n/a
7.8
n/a
Oregon (2)
1,184
1,347
1,450
1,677
1,422
1,717
7.7
12.3
1.2
Washington
1,635
1,920
2,120
2,064
1,959
2,348
7.5
8.1
6.6
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territones. Figures may not sum to totals due to rounding.
Adult beneficiaries are non-disabled individuals between 19 and 64. States do not report payments to Medicare or to managed care organizations by beneficiary group. In most
states, payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were distributed among adults and children. The methodology used is
described in Appendix C.
(1) The expenditures for Massachusetts in this table likely overstate program costs in 1994 and 1995. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
(3) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
(4) Comparable spending per beneficiary data are not available for Hawaii in 1995 due to incomplete beneficiary and expenditure data on the state's HCFA-2082 report.
Page 120
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 65
Medicaid Expenditures per Blind and Disabled Beneficiary, 1990-1995
Expenditures per Beneficiary
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$6,991
$7,644
$8,031
$8,270
$8,421
$8,784
4.7%
5.8%
3.1%
New England
$11,078
$11,387
$12,238
$11,582
$12,178
$13,350
3.8%
1.5%
7.4%
Connecticut
14,393
15,767
16,753
16,521
16,262
18,502
5.2
4.7
5.8
Maine
6,990
7,356
7,561
8,487
8,720
8,400
3.7
6.7
-0.5
Massachusetts (1)
11,595
11,093
11,891
10,346
11,947
13,069
2.4
-3.7
12.4
New Hampshire
13,232
14,180
13,390
12,269
11,998
14,434
1.8
-2.5
8.5
Rhode Island
8,480
10,564
13,159
14,391
12,244
14,559
11.4
19.3
0.6
Vermont
7,190
7,890
8,148
8,146
8,112
8,703
3.9
4.2
3.4
Middle Atlantic
$10,449
$11,965
$12,438
$12,844
$12,872
$13,402
5.1%
7.1%
2.1%
New Jersey
10,893
12,315
11,571
11,859
12,010
12,513
2.8
2.9
2.7
New York
12,781
15,018
15,052
16,347
16,224
16,605
5.4
8.6
0.8
Pennsylvania
5,724
6,226
7,939
7,057
7,324
7,797
6.4
7.2
5.1
South Atlantic
$5,685
$6,443
$6,822
$6,921
$7,216
$7,592
6.0%
6.8%
4.7%
Delaware
7,566
10,497
10,957
11,341
11,342
11,498
8.7
14.4
0.7
District of Columbia
11,020
12,942
13,980
13,588
14,354
15,227
6.7
7.2
5.9
Florida
4,692
5,737
6,124
6,154
6,394
6,920
8.1
9.5
6.0
Georgia
5,308
5,582
5,408
5,681
6,229
6,638
4.6
2.3
8.1
Maryland
8,331
9,018
10,930
9,584
10,432
11,026
5.8
4.8
7.3
North Carolina
6,865
7,775
7,584
7,941
7,906
7,932
2.9
5.0
-0.1
South Carolina
5,084
5,566
6,302
6,248
6,710
7,244
7.3
7.1
7.7
Virginia
6,122
6,440
6,202
6,523
6,444
6,656
1.7
2.1
1.0
West Virginia
3,363
4,690
5,941
6,606
6,635
6,712
14.8
25.2
0.8
East South Central
$3,461
$4,127
$4,387
$4,429
$4,138
$4,573
5.7%
8.6%
1.6%
Alabama
2,889
3,809
3,960
4,105
4,322
4,798
10.7
12.4
8.1
Kentucky
4,265
5,229
5,315
5,371
5,446
5,571
5.5
8.0
1.9
Mississippi
2,430
2,755
3,186
3,627
4,055
4,423
12.7
14.3
10.4
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$5,902
$6,702
$7,029
$7,195
$7,547
$7,825
5.8%
6.8%
4.3%
Arkansas
4,456
4,715
5,650
5,557
5,783
6,261
7.0
7.6
6.1
Louisiana
6,456
7,810
8,213
8,281
8,621
8,518
5.7
8.7
1.4
Oklahoma
6,250
7,098
7,343
7,759
6,686
7,138
2.7
7.5
-4.1
Texas
6,042
6,760
6,836
7,016
7,730
8,100
6.0
5.1
7.4
East North Central
$7,425
$7,834
$8,778
$8,950
$8,862
$9,120
4.2%
6.4%
0.9%
Illinois
6,884
6,380
8,763
9,419
9,055
9,540
6.7
11.0
0.6
Indiana (3)
10,368
11,058
13,166
12,650
12,189
11,293
1.7
6.9
-5.5
Michigan
7,545
8,765
7,925
7,757
8,293
8,701
2.9
0.9
5.9
Ohio
6,991
7,316
7,855
8,370
8,352
8,719
4.5
6.2
2.1
Wisconsin
7,135
8,010
8,994
8,648
8,482
8,353
3.2
6.6
-1.7
West North Central
$8,362
$8,967
$9,294
$9,438
$9,825
$10,084
3.8%
4.1%
3.4%
lowa
7,327
8,062
8,587
9,048
9,358
9,445
5.2
7.3
2.2
Kansas
7,637
8,442
8,308
8,665
9,486
9,496
4.5
4.3
4.7
Minnesota
16,905
15,516
15,620
16,798
14,067
14,550
-3.0
-0.2
-6.9
Missouri
4,763
5,506
6,378
5,904
6,848
7,169
8.5
7.4
10.2
Nebraska
7,793
9,071
9,156
9,564
9,867
9,743
4.6
7.1
0.9
North Dakota
12,549
13,103
13,396
12,508
12,957
13,479
1.4
-0.1
3.8
South Dakota
8,558
9,182
9,335
9,874
10,320
10,654
4.5
4.9
3.9
Mountain
$6,958
$7,376
$7,667
$8,102
$7,937
$8,723
4.6%
5.2%
3.8%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
8,481
9,050
9,422
10,258
9,771
9,041
1.3
6.5
-6.1
Idaho
7,703
8,857
9,160
8,793
8,478
8,461
1.9
4.5
-1.9
Montana
7,510
8,935
8,782
9,297
10,115
8,918
3.5
7.4
-2.1
Nevada
8,413
8,518
10,583
11,043
9,698
9,348
2.1
9.5
-8.0
New Mexico
5,432
6,061
5,388
6,495
7,626
8,488
9.3
6.1
14.3
Utah
13,264
12,771
12,304
10,884
10,375
10,387
-4.8
-6.4
-2.3
Wyoming
4,427
7,881
8,596
9,134
11,156
10,756
19.4
27.3
8.5
Pacific
$5,535
$5,710
$5,758
$6,532
$6,698
$7,134
5.2%
5.7%
4.5%
Alaska
13,345
11,543
11,250
11,354
12,708
13,009
-0.5
-5.2
7.0
California
5,140
5,162
5,153
5,962
6,168
6,572
5.0
5.1
5.0
Hawaii (2)
5,923
6,580
6,529
7,216
7,776
8,089
6.4
6.8
5.9
Oregon (2)
8,115
8,667
8,554
8,611
8,869
10,154
4.6
2.0
8.6
Washington
7,515
8,626
8,817
9,379
8,895
9,284
4.3
7.7
-0.5
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories Figures may not sum to totals due to rounding.
The blind and disabled beneficiary group includes individuals who, regardless of age, qualify for Medicaid because of disability. States do not report payments to Medicare or
managed care organizations by beneficiary group. In most states, payments to Medicare were distributed among the aged, blind, and disabled. Payments to MCOs were
distributed among adults and children. The methodology used is described in Appendix C.
(1) The expenditures for Massachusetts in this table likely overstate program costs in 1994 and 1995. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(3) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 121
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 66
Medicaid Expenditures per Elderly Beneficiary, 1990-1995
Expenditures per Beneficiary
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$7,239
$8,176
$8,774
$9,101
$9,437
$10,308
7.3%
7.9%
6.4%
New England
$12,638
$14,062
$14,439
$13,828
$15,125
$16,144
5.0%
3.0%
8.0%
Connecticut
15,629
18,778
19,630
20,671
21,333
19,965
5.0
9.8
-1.7
Maine
9,186
11,297
12,030
12,169
12,931
13,129
7.4
9.8
3.9
Massachusetts (1)
13,396
13,995
13,868
12,108
14,131
16,202
3.9
-3.3
15.7
New Hampshire
18,646
18,674
17,517
17,619
18,546
13,470
-6.3
-1.9
-12.6
Rhode Island
8,295
10,517
12,546
12,963
13,165
14,925
12.5
16.0
7.3
Vermont
7,882
7,934
8,269
8,751
8,386
9,057
2.8
3.5
1.7
Middle Atlantic
$12,770
$14,591
$16,371
$16,146
$16,900
$16,994
5.9%
8.1%
2.6%
New Jersey
10,982
12,475
11,713
12,998
13,903
14,185
5.3
5.8
4.5
New York
14,843
17,182
18,002
18,304
18,386
18,745
4.8
7.2
1.2
Pennsylvania
8,466
9,364
15,011
12,650
14,907
14,628
11.6
14.3
7.5
South Atlantic
$5,662
$6,587
$6,639
$7,100
$7,455
$7,890
6.9%
7.8%
5.4%
Delaware
11,409
11,883
11,913
12,227
13,057
13,336
3.2
2.3
4.4
District of Columbia
12,416
13,815
14,378
18,842
23,715
23,611
13.7
14.9
11.9
Florida
5,425
6,251
6,604
7,221
7,495
8,313
8.9
10.0
7.3
Georgia
5,460
5,876
5,777
5,893
6,105
6,252
2.7
2.6
3.0
Maryland
8,462
9,699
10,771
10,651
11,528
12,330
7.8
8.0
7.6
North Carolina
4,693
5,621
5,666
6,144
6,495
6,899
8.0
9.4
6.0
South Carolina
4,167
5,657
4,685
4,880
5,446
5,819
6.9
5.4
9.2
Virginia
5,929
6,636
6,752
7,525
7,261
7,644
5.2
8.3
0.8
West Virginia
5,629
7,548
7,868
8,695
9,224
9,259
10.5
15.6
3.2
East South Central
$3,860
$4,806
$5,446
$5,644
$5,411
$6,433
10.8%
13.5%
6.8%
Alabama
3,394
4,438
5,496
5,584
6,236
6,984
15.5
18.1
11.8
Kentucky
4,702
5,593
6,053
6,505
7,305
7,835
10.8
11.4
9.7
Mississippi
3,560
4,345
5,052
4,929
5,335
6,004
11.0
11.5
10.4
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$4,428
$5,596
$5,796
$6,259
$6,480
$7,124
10.0%
12.2%
6.7%
Arkansas
4,663
5,770
5,669
6,096
6,634
7,236
9.2
9.3
8.9
Louisiana
4,259
5,039
5,840
7,115
7,134
7,716
12.6
18.7
4.1
Oklahoma
4,510
5,712
5,801
6,206
6,424
6,889
8.8
11.2
5.4
Texas
4,423
5,743
5,805
6,017
6,259
6,957
9.5
10.8
7.5
East North Central
$7,270
$7,868
$9,122
$10,129
$10,561
$11,777
10.1%
11.7%
7.8%
Illinois
6,136
6,029
8,455
8,757
8,762
8,930
7.8
12.6
1.0
Indiana (3)
9,417
10,847
11,972
11,865
11,633
11,461
4.0
8.0
-1.7
Michigan
6,669
6,678
8,914
11,675
12,384
13,141
14.5
20.5
6.1
Ohio
6,833
7,620
7,893
8,991
9,570
12,316
12.5
9.6
17.0
Wisconsin
9,070
10,568
11,371
11,747
12,698
14,474
9.8
9.0
11.0
West North Central
$7,767
$8,476
$9,666
$9,441
$10,597
$11,241
7.7%
6.7%
9.1%
lowa
6,054
7,351
7,636
8,216
8,843
8,761
7.7
10.7
3.3
Kansas
6,291
6,622
6,353
7,083
9,177
10,386
10.5
4.0
21.1
Minnesota
12,020
12,427
13,833
14,045
17,396
17,090
7.3
5.3
10.3
Missouri
6,218
6,797
9,104
7,290
7,636
8,715
7.0
5.4
9.3
Nebraska
7,319
8,578
9,473
10,242
10,861
11,447
9.4
11.9
5.7
North Dakota
7,822
8,731
9,240
9,881
10,450
11,832
8.6
8.1
9.4
South Dakota
7,245
8,181
9,129
9,832
11,144
12,134
10.9
10.7
11.1
Mountain
$6,188
$6,327
$6,747
$7,418
$7,396
$9,792
9.6%
6.2%
14.9%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
7,536
7,608
7,957
7,167
7,494
9,179
4.0
-1.7
13.2
Idaho
7,097
8,171
8,256
8,721
8,988
9,700
6.4
7.1
5.5
Montana
9,091
9,533
10,307
12,555
12,099
15,490
11.2
11.4
11.1
Nevada
5,484
6,339
7,811
8,245
8,035
7,391
6.1
14.6
-5.3
New Mexico
5,510
6,554
5,652
6,527
7,133
7,743
7.0
5.8
8.9
Utah
3,626
2,433
4,539
8,705
9,762
10,714
24.2
33.9
10.9
Wyoming
9,945
9,310
12,027
12,226
9,691
8,673
-2.7
7.1
-15.8
Pacific
$5,223
$5,593
$5,832
$6,460
$6,274
$7,240
6.7%
7.3%
5.9%
Alaska
14,130
12,161
11,641
10,222
11,356
11,656
-3.8
-10.2
6.8
California
4,809
5,102
5,282
5,901
5,599
6,569
6.4
7.1
5.5
Hawaii (2)
6,993
8,086
8,302
8,459
10,011
9,349
6.0
6,5
5.1
Oregon (2)
5,792
6,480
7,312
7,797
7,590
8,484
7.9
10.4
4.3
Washington
8,091
8,879
9,415
10,296
10,553
11,433
7.2
8.4
5.4
Source: Urban Institute calculations based on data from HCFA-2082 and HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S Territories. Figures may not sum to totals due to rounding.
Elderly beneficiaries are people aged 65 and over. The elderly most likely includes disabled individuals who have spent down their assets to become Medicaid eligible and were
not originally considered disabled. States do not report payments to Medicare or to managed care organizations by beneficiary group. In most states, payments to Medicare
were distributed among the aged, blind. and disabled. Payments to MCOs were distributed among adults and children. The methodology used is described in Appendix C.
(1) The expenditures for Massachusetts in this table likely overstate program costs in 1994 and 1995. See Appendix C.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(3) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
Page 122
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 67
Total Medicaid Acute Care Expenditures, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$36,741
$46,809
$55,065
$65,041
$71,178
$79,439
16.7%
21.0%
10.5%
New England
$2,438
$2,982
$3,479
$3,593
$4,124
$4,919
15.1%
13.8%
17.0%
Connecticut
383
487
612
695
811
994
21.0
22.0
19.6
Maine
189
246
263
344
403
401
16.2
22.1
7.9
Massachusetts
1,525
1,697
1,970
1,949
2,226
2,682
12.0
8.5
17.3
New Hampshire
68
152
160
152
179
215
26.0
31.0
18.7
Rhode Island
196
295
357
327
359
460
18.6
18.6
18.6
Vermont
76
106
117
125
147
167
17.0
17.8
15.8
Middle Atlantic
$7,278
$9,630
$10,300
$12,482
$13,700
$15,537
16.4%
19.7%
11.6%
New Jersey
1,115
1,476
1,669
1,975
1,938
2,155
14.1
21.0
4.4
New York
4,896
6,423
6,619
8,240
9,120
10,467
16.4
19.0
12.7
Pennsylvania
1,268
1,731
2,012
2,267
2,642
2,915
18.1
21.4
13.4
South Atlantic
$5,685
$7,702
$9,160
$10,850
$11,970
$13,585
19.0%
24.0%
11.9%
Delaware
53
94
115
138
155
189
28.9
37.7
16.9
District of Columbia
241
300
333
379
423
472
14.4
16.3
11.6
Florida
1,626
2,230
2,785
3,333
3,549
4,031
19.9
27.0
10.0
Georgia
1,036
1,300
1,480
1,741
2,110
2,278
17.1
18.9
14.4
Maryland
744
945
1,197
1,278
1,421
1,557
15.9
19.7
10.4
North Carolina
745
1,098
1,212
1,458
1,604
2,121
23.3
25.1
20.6
South Carolina
463
678
667
778
906
1,014
17.0
18.9
14.2
Virginia
544
684
781
979
1,022
1,146
16.1
21.6
8.2
West Virginia
233
371
590
767
780
777
27.3
48.8
0.7
East South Central
$2,312
$3,154
$3,709
$4,173
$4,638
$5,792
20.2%
21.8%
17.8%
Alabama
328
542
618
726
807
930
23.2
30.4
13.2
Kentucky
631
906
1,086
1,189
1,215
1,304
15.6
23.5
4.7
Mississippi
423
537
610
729
813
938
17.3
20.0
13.4
Tennessee (1)
931
1,170
1,394
1,529
1,803
2,620
23.0
18.0
30.9
West South Central
$3,291
$4,577
$5,538
$6,508
$7,493
$8,104
19.7%
25.5%
11.6%
Arkansas
321
400
525
571
574
669
15.8
21.2
8.3
Louisiana
751
1,105
1,350
1,585
1,770
1,825
19.4
28.3
7.3
Oklahoma
366
432
552
574
558
605
10.6
16.2
2.6
Texas
1,854
2,640
3,111
3,778
4,591
5,005
22.0
26.8
15.1
East North Central
$6,186
$7,087
$9,005
$10,587
$11,082
$11,660
13.5%
19.6%
4.9%
Illinois
1,334
1,313
2,275
2,933
3,152
3,642
22.2
30.0
11.4
Indiana (2)
809
910
1,269
1,700
1,419
1,062
5.6
28.1
-21.0
Michigan
1,625
2,043
2,152
2,357
2,769
2,942
12.6
13.2
11.7
Ohio
1,703
1,989
2,307
2,554
2,618
2,886
11.1
14.5
6.3
Wisconsin
715
832
1,003
1,042
1,124
1,128
9.6
13.4
4.0
West North Central
$1,859
$2,360
$2,793
$3,168
$3,781
$4,042
16.8%
19.5%
12.9%
lowa
351
436
506
559
631
675
14.0
16.9
9.9
Kansas
201
259
286
346
407
426
16.1
19.8
10.9
Minnesota
524
633
699
833
1,095
1,176
17.5
16.7
18.8
Missouri
477
659
853
890
1,070
1,157
19.4
23.1
14.0
Nebraska
157
195
238
300
326
339
16.6
24.0
6.4
North Dakota
74
84
98
110
113
118
9.8
14.1
3.7
South Dakota
74
94
113
129
139
151
15.2
20.2
8.0
Mountain
$1,262
$1,771
$2,547
$2,853
$3,152
$3,401
21.9%
31.2%
9.2%
Arizona (1)
342
521
870
950
1,098
1,122
26.8
40.6
8.7
Colorado
255
371
494
576
589
680
21.7
31.3
8.6
Idaho
77
110
153
166
177
187
19.5
29.5
6.0
Montana
104
132
151
170
185
185
12.2
17.8
4.3
Nevada
92
121
205
222
221
266
23.6
34.0
9.5
New Mexico
184
232
325
374
454
500
22.1
26.7
15.6
Utah
165
224
279
316
345
376
17.9
24.1
9.1
Wyoming
44
59
72
79
82
85
14.4
21.9
3.9
Pacific
$6,430
$7,545
$8,533
$10,826
$11,238
$12,399
14.0%
19.0%
7.0%
Alaska
106
133
149
179
194
205
14.1
19.0
7.1
California
5,304
6,101
6,770
8,760
8,786
9,176
11.6
18.2
2.3
Hawaii (1)
119
149
160
214
274
555
36.1
21.6
61.1
Oregon (1)
249
322
405
504
639
915
29.7
26.5
34.7
Washington
652
841
1,049
1,169
1,345
1,548
18.9
21.5
15.1
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
Acute care services include inpatient, physician, lab, X-ray, outpatient, clinic, prescription drugs, EPSDT, family planning, dental, vision, hospice, other practitioners' care, payments
to managed care organizations, and payments to Medicare.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
(2) The expenditures for Indiana in this table likely overstate program costs in 1992, 1993, and 1994. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 123
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 68
Medicaid Expenditures for Inpatient Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$15,981
$20,467
$22,245
$25,593
$25,862
$26,936
11.0%
17.0%
2.6%
New England
$1,178
$1,373
$1,494
$1,302
$1,321
$1,314
2.2%
3.4%
0.5%
Connecticut
148
176
215
245
279
291
14.5
18.4
8.8
Maine
65
92
77
107
136
87
5.9
18.1
-10.1
Massachusetts
799
788
873
728
687
682
-3.1
-3.1
-3.2
New Hampshire
21
79
62
27
31
41
14.3
9.1
22.6
Rhode Island
122
202
234
163
155
183
8.4
10.0
6.1
Vermont
23
35
34
32
34
31
6.7
11.9
-0.8
Middle Atlantic
$3,575
$4,965
$4,818
$5,516
$5,786
$6,226
11.7%
15.6%
6.2%
New Jersey
620
851
949
974
888
875
7.1
16.3
-5.2
New York
2,464
3,370
3,080
3,752
4,096
4,563
13.1
15.0
10.3
Pennsylvania
491
744
789
790
801
788
9.9
17.2
-0.1
South Atlantic
$2,625
$3,455
$3,608
$4,077
$4,252
$4,494
11.3%
15.8%
5.0%
Delaware
29
53
53
55
56
61
15.6
22.9
5.4
District of Columbia
135
170
181
214
234
214
9.7
16.7
0.0
Florida
784
890
1,012
1,109
1,033
1,071
6.4
12.3
-1.8
Georgia
420
551
583
682
799
763
12.7
17.6
5.8
Maryland
379
465
519
626
647
669
12.1
18.2
3.4
North Carolina
327
536
504
557
570
765
18.5
19.4
17.1
South Carolina
212
346
268
294
331
361
11.2
11.5
10.8
Virginia
226
270
285
357
362
397
11.9
16.4
5.5
West Virginia
113
173
204
182
219
193
11.2
17.1
2.8
East South Central (1)
$890
$1,265
$1,270
$1,387
$1,304
$1,304
7.9%
15.9%
-3.0%
Alabama
87
223
203
238
255
303
28.4
40.1
12.7
Kentucky
253
373
332
342
316
368
7.8
10.6
3.7
Mississippi
162
211
206
262
280
314
14.2
17.4
9.6
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$1,394
$1,750
$2,227
$2,712
$3,018
$3,138
17.6%
24.8%
7.6%
Arkansas
129
151
185
208
181
196
8.7
17.4
-3.1
Louisiana
308
501
605
675
731
761
19.8
29.9
6.2
Oklahoma
178
205
253
237
198
193
1.7
10.1
-9.7
Texas
780
893
1,184
1,592
1,907
1,988
20.6
26.9
11.7
East North Central
$2,478
$2,981
$3,617
$4,276
$4,320
$4,463
12.5%
19.9%
2.2%
Illinois
612
631
1,133
1,692
1,765
1,859
24.9
40.4
4.8
Indiana
275
336
464
480
389
386
7.0
20.5
-10.3
Michigan
635
899
816
811
862
903
7.3
8.5
5.5
Ohio
796
913
966
1,047
1,029
1,041
5.5
9.6
-0.3
Wisconsin
161
202
239
246
276
274
11.3
15.2
5.6
West North Central
$723
$896
$1,036
$1,104
$1,148
$1,190
10.5%
15.2%
3.9%
lowa
124
151
175
199
203
184
8.2
17.1
-3.9
Kansas
79
107
113
137
152
160
15.2
20.4
7.9
Minnesota
207
207
214
238
199
263
4.9
4.7
5.2
Missouri
187
288
367
316
369
367
14.4
19.0
7.8
Nebraska
57
64
75
113
125
116
15.3
25.7
1.2
North Dakota
32
35
41
45
44
43
5.9
12.2
-3.0
South Dakota
36
44
49
54
55
57
9.8
14.9
2.5
Mountain (1)
$368
$521
$867
$851
$876
$885
19.2%
32.3%
1.9%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
83
137
223
267
246
245
24.3
47.8
-4.1
Idaho
29
42
54
57
58
56
13.9
24.7
-0.7
Montana
40
44
50
50
55
51
5.2
8.2
0.8
Nevada
42
58
94
95
95
110
21.2
31.0
7.8
New Mexico
81
99
131
141
156
166
15.3
20.3
8.3
Utah
69
99
116
124
130
120
11.8
21.6
-1.3
Wyoming
19
26
32
33
32
33
11.4
20.1
-0.5
Pacific
$2,750
$3,261
$3,307
$4,367
$3,837
$3,921
7.3%
16.7%
-5.2%
Alaska
44
48
48
52
57
57
5.0
5.6
4.1
California
2,363
2,804
2,768
3,775
3,272
3,364
7.3
16.9
-5.6
Hawaii (2)
46
58
50
86
90
94
15.3
23.2
4.3
Oregon (2)
73
85
111
127
98
129
12.0
20.0
1.0
Washington
224
265
329
327
320
277
4.4
13.4
-7.9
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territones. Figures may not sum to totals due to rounding.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Page 124
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 69
Medicaid Expenditures for Physician, Lab, and X-Ray Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$4,720
$5,945
$7,373
$8,110
$8,297
$8,460
12.4%
19.8%
2.1%
New England
$194
$248
$299
$317
$343
$367
13.6%
17.8%
7.6%
Connecticut
29
36
49
60
67
78
22.3
28.1
14.1
Maine
20
27
33
35
35
33
10.4
20.1
-2.8
Massachusetts
121
153
178
179
181
202
10.9
14.0
6.3
New Hampshire
5
9
12
16
18
21
31.4
42.6
16.3
Rhode Island
9
9
10
9
24
13
8.8
1.8
20.4
Vermont
10
14
16
18
18
19
13.3
21.6
2.0
Middle Atlantic
$445
$495
$513
$630
$691
$772
11.7%
12.3%
10.8%
New Jersey
74
85
88
114
116
140
13.6
15.4
10.8
New York
252
271
256
325
368
383
8.8
8.9
8.6
Pennsylvania
119
138
168
191
207
249
16.0
17.1
14.3
South Atlantic
$902
$1,250
$1,662
$1,876
$1,963
$2,113
18.6%
27.6%
6.1%
Delaware
7
11
10
15
18
18
19.6
26.7
9.7
District of Columbia
24
27
25
27
27
28
3.3
3.8
2.6
Florida
220
338
430
499
470
476
16.7
31.4
-2.3
Georgia
201
239
325
368
430
514
20.6
22.2
18.2
Maryland
99
154
252
190
208
224
17.8
24.3
8.7
North Carolina
139
188
231
288
309
357
20.7
27,4
11.4
South Carolina
76
98
114
121
127
134
12.0
16.9
5.1
Virginia
106
148
183
217
227
228
16.7
27.1
2.6
West Virginia
31
47
91
153
147
135
34.6
71.1
-6.1
East South Central (1)
$448
$583
$751
$836
$696
$578
5.2%
23.1%
-16.8%
Alabama
59
77
99
119
129
130
17.1
26.2
4.7
Kentucky
118
166
254
276
270
239
15.1
32.6
-6.9
Mississippi
87
105
120
129
158
182
15.8
13.9
18.8
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$677
$925
$1,084
$1,121
$1,266
$1,331
14.5%
18.3%
9.0%
Arkansas
61
74
109
116
112
121
14.6
23.7
2.1
Louisiana
134
201
244
285
308
302
17.7
28.7
2.8
Oklahoma
64
67
89
92
85
88
6.6
13.0
-2.2
Texas
419
583
641
629
760
821
14.4
14.5
14.3
East North Central
$761
$802
$1,071
$1,137
$1,151
$1,141
8.5%
14.4%
0.2%
Illinois
188
163
281
278
295
319
11.2
13.9
7.2
Indiana
114
129
189
201
188
157
6.6
21.0
-11.8
Michigan
208
227
263
283
279
274
5.7
10.7
-1.5
Ohio
202
228
277
308
318
327
10.2
15.1
3.2
Wisconsin
49
55
61
68
71
63
5.3
11.5
-3.3
West North Central
$201
$328
$370
$401
$370
$401
14.8%
25.9%
0.0%
lowa
60
68
82
78
73
73
4.1
9.2
-3.2
Kansas
34
42
51
58
61
56
10.8
20.3
-2.0
Minnesota
13
95
95
120
86
122
56.0
108.8
0.7
Missouri
41
56
61
53
60
58
7.3
9.1
4.6
Nebraska
31
40
47
54
51
52
11.1
20.5
-1.6
North Dakota
11
13
14
17
15
16
7.4
14.3
-2.2
South Dakota
12
15
19
21
23
24
15.6
22.3
6.2
Mountain (1)
$170
$227
$313
$347
$353
$358
16.0%
26.9%
1.5%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
46
66
76
85
83
85
13.0
22.2
0.5
Idaho
14
22
29
32
36
35
21.0
32.7
5.4
Montana
16
20
26
30
26
22
5.9
22.6
-15.0
Nevada
19
22
46
48
39
43
17.1
35.4
-5.9
New Mexico
38
49
66
72
80
79
15.8
23.7
4.8
Utah
27
33
40
45
46
44
10.3
18.9
-1.4
Wyoming
9
12
15
16
20
19
15.9
19.5
10.7
Pacific
$923
$1,087
$1,310
$1,444
$1,465
$1,398
8.7%
16.1%
-1.6%
Alaska
23
33
37
44
45
46
14.4
23.6
1.9
California
735
828
994
1,086
1,112
1,115
8.7
13.9
1.3
Hawaii (2)
27
33
38
39
43
31
3.0
13.4
-10.8
Oregon (2)
36
50
64
72
79
64
12.4
26.7
-6.1
Washington
102
144
177
203
186
143
7.0
25.7
-16.0
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territones. Figures may not sum to totals due to rounding.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state: adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 125
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 70
Medicaid Expenditures for Outpatient and Clinic Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$4,731
$6,061
$7,969
$9,333
$9,910
$10,723
17.8%
25.4%
7.2%
New England
$386
$504
$588
$556
$583
$719
13.3%
13.0%
13.7%
Connecticut
73
98
114
131
142
163
17.5
21.9
11.2
Maine
28
33
42
53
71
95
27.6
23.9
33.4
Massachusetts
239
304
334
261
255
322
6.1
2.9
11.2
New Hampshire
15
25
38
48
54
68
34.9
46.5
19.1
Rhode Island
17
25
36
41
36
39
18.2
33.7
-1.6
Vermont
13
19
22
22
25
32
18.8
18.3
19.7
Middle Atlantic
$1,194
$1,622
$2,119
$2,489
$2,513
$2,691
17.6%
27.7%
4.0%
New Jersey
155
221
269
417
428
469
24.8
39.1
6.0
New York
930
1,276
1,665
1,837
1,817
1,939
15.8
25.5
2.7
Pennsylvania
109
125
186
235
268
282
20.9
29.0
9.7
South Atlantic
$673
$944
$1,291
$1,570
$1,658
$1,895
23.0%
32.6%
9.9%
Delaware
7
13
19
24
26
43
43.2
49.4
34.4
District of Columbia
45
56
64
67
71
83
12.8
14.0
11.1
Florida
136
205
312
400
399
445
26.8
43.4
5.5
Georgia
142
185
209
248
295
332
18.5
20.5
15.6
Maryland
80
101
131
143
158
173
16.7
21.3
10.1
North Carolina
99
148
201
248
283
365
29.9
36.0
21.2
South Carolina
51
77
95
122
146
177
28.2
33.6
20.6
Virginia
76
96
115
139
146
149
14.6
22.4
3.8
West Virginia
37
63
144
179
134
127
28.1
69.3
-15.7
East South Central (1)
$344
$472
$615
$708
$605
$587
11.3%
27.2%
-8.9%
Alabama
20
35
51
68
81
102
37.9
48.9
22.9
Kentucky
122
161
223
248
271
307
20.2
26.5
11.2
Mississippi
54
79
95
105
132
159
24.1
24.8
23.0
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$326
$461
$586
$696
$839
$952
23.9%
28.8%
17.0%
Arkansas
33
50
78
88
101
122
30.0
39.1
17.4
Louisiana
84
102
135
178
215
253
24.7
28.5
19.2
Oklahoma
32
42
55
72
80
95
24.5
31.0
15.3
Texas
177
267
318
358
442
483
22.2
26.5
16.1
East North Central
$795
$914
$1,279
$1,463
$1,686
$1,723
16.7%
22.5%
8.5%
Illinois
102
90
177
212
219
301
24.2
27.6
19.3
Indiana
101
139
222
253
230
127
4.7
35.9
-29.2
Michigan
291
320
387
447
650
661
17.8
15.4
21.5
Ohio
213
262
366
414
440
486
18.0
24.8
8.4
Wisconsin
88
101
127
136
148
147
10.9
15.8
4.0
West North Central
$252
$238
$326
$389
$435
$463
12.9%
15.5%
9.0%
lowa
37
47
62
65
69
72
14.0
20.2
5.5
Kansas
18
20
26
41
62
48
21.9
31.9
8.3
Minnesota
101
46
55
69
56
73
-6.3
-11.8
2.5
Missouri
61
79
121
138
165
185
24.7
31.1
15.7
Nebraska
13
18
27
35
40
43
27.2
38.6
11.8
North Dakota
11
13
17
20
20
16
8.5
23.4
-10.5
South Dakota
11
14
18
21
22
26
18.1
24.4
9.2
Mountain (1)
$141
$191
$257
$304
$353
$424
24.6%
29.0%
18.1%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
49
68
83
98
103
125
20.5
25.7
13.1
Idaho
9
13
19
22
19
22
20.1
35.9
-0.1
Montana
12
21
25
28
37
38
25.1
32.1
15.3
Nevada
7
10
18
19
20
22
25.5
39.6
7.0
New Mexico
21
29
46
56
73
85
32.5
39.3
22.9
Utah
25
34
48
57
64
71
23.0
31.7
11.0
Wyoming
6
8
9
11
13
15
18.8
19.7
17.5
Pacific
$620
$715
$908
$1,158
$1,239
$1,270
15.4%
23.2%
4.7%
Alaska
16
21
25
35
44
53
26.7
28.9
23.4
California
423
481
608
810
858
860
15.2
24.2
3.1
Hawaii (2)
10
14
20
27
29
26
21.2
40.0
-2.3
Oregon (2)
42
34
37
41
47
36
-3.0
-0.3
-6.9
Washington
129
165
217
245
260
295
18.0
23.8
9.8
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs. accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ. HI. OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Page 126
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 71
Medicaid Expenditures for Prescription Drugs, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$4,587
$5,512
$6,217
$6,910
$7,514
$8,445
13.0%
14.6%
10.5%
New England
$259
$317
$365
$358
$429
$522
15.1%
11.5%
20.7%
Connecticut
52
67
76
87
100
116
17.3
18.5
15.4
Maine
31
38
41
43
52
60
14.3
11.3
18.9
Massachusetts
128
154
187
160
196
252
14.6
7.8
25.5
New Hampshire
11
15
17
21
23
30
21.5
22.6
19.9
Rhode Island
21
26
26
28
34
38
12.0
9.7
15.5
Vermont
15
17
17
19
24
26
12.0
9.4
16.1
Middle Atlantic
$946
$1,111
$1,126
$1,255
$1,423
$1,618
11.3%
9.9%
13.5%
New Jersey
164
200
215
251
242
296
12.6
15.4
8.6
New York
550
632
613
672
762
857
9.3
6.9
12.9
Pennsylvania
232
280
298
331
418
465
14.9
12.6
18.4
South Atlantic
$730
$874
$971
$1,131
$1,259
$1,466
15.0%
15.7%
13.9%
Delaware
6
10
10
12
16
17
22.9
26.5
17.7
District of Columbia
15
17
19
20
23
24
10.7
11.3
9.7
Florida
221
261
310
342
380
436
14.5
15.6
13.0
Georgia
142
162
166
188
213
246
11.6
9.9
14.2
Maryland
69
79
88
93
105
117
11.1
10.4
12.2
North Carolina
106
127
135
158
176
236
17.3
14.2
22.1
South Carolina
60
73
76
88
106
115
13.9
13.7
14.2
Virginia
84
101
110
155
153
166
14.6
22.6
3.6
West Virginia
27
44
56
75
88
110
32.4
40.4
21.2
East South Central (1)
$315
$408
$525
$584
$482
$494
9.4%
22.9%
-8.0%
Alabama
61
75
99
122
140
155
20.4
25.7
12.9
Kentucky
67
111
143
163
178
203
24.9
34.7
11.4
Mississippi
72
85
112
107
124
137
13.8
14.4
12.9
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$424
$528
$605
$694
$813
$891
16.0%
17.8%
13.3%
Arkansas
58
66
65
63
68
82
7.2
2.6
14.4
Louisiana
120
158
176
193
221
243
15.2
17.2
12.3
Oklahoma
46
57
65
75
78
88
13.8
17.8
8.2
Texas
201
246
299
363
446
478
19.0
21.9
14.7
East North Central
$794
$902
$1,062
$1,093
$1,179
$1,370
11.5%
11.2%
12.0%
Illinois
182
167
277
282
269
379
15.8
15.7
15.9
Indiana
114
139
176
168
193
191
10.9
13.9
6.5
Michigan
182
216
203
199
240
254
6.9
3.1
13.0
Ohio
214
261
278
306
324
388
12.7
12.7
12.6
Wisconsin
103
119
127
138
154
158
9.0
10.2
7.1
West North Central
$277
$339
$383
$431
$478
$549
14.7%
15.9%
12.9%
lowa
55
65
68
67
77
85
9.1
7.2
12.0
Kansas
30
36
41
50
58
66
17.1
19.0
14.2
Minnesota
69
77
73
83
70
92
5.9
6.7
4.8
Missouri
78
103
135
163
195
220
23.1
28.2
15.9
Nebraska
27
34
42
40
48
53
14.6
14.3
15.2
North Dakota
10
11
11
13
15
16
10.0
8.2
12.8
South Dakota
9
11
12
13
16
18
14.2
13.1
15.8
Mountain (1)
$110
$139
$153
$166
$200
$223
15.2%
14.8%
15.7%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
35
44
44
50
58
64
12.7
12.2
13.4
Idaho
12
15
18
20
24
28
18.8
19.4
17.9
Montana
12
17
17
20
22
26
17.1
18.1
15.7
Nevada
8
11
12
13
14
17
15.6
14.7
17.0
New Mexico
21
25
29
29
37
40
13.4
11.1
16.9
Utah
16
20
24
27
34
36
17.1
18.3
15.2
Wyoming
5
7
7
7
9
10
13.2
11.4
15.9
Pacific
$732
$894
$1,029
$1,197
$1,250
$1,311
12.4%
17.8%
4.7%
Alaska
6
8
10
12
14
16
22.5
29.4
12.9
California
592
712
822
987
997
1,058
12.3
18.6
3.5
Hawaii (2)
15
19
20
23
28
27
12.5
14.5
9.5
Oregon (2)
37
48
54
58
74
65
11.8
16.0
5.7
Washington
82
107
124
117
138
145
12.3
12.8
11.4
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments. administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
(1) Regional totals include estimated expenditure levels from states where data were unavailable
(2) For certain states with active 1115 waivers (AZ. HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state: adjustments
were made to categonze these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 127
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 72
Medicaid Expenditures for Other Acute Care Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$3,352
$4,437
$5,758
$7,576
$9,416
$11,116
27.1%
31.2%
21.1%
New England
$234
$267
$395
$532
$821
$1,179
38.2%
31.6%
48.8%
Connecticut
39
51
88
83
120
221
41.7
29.1
63.0
Maine
25
30
39
79
68
81
26.8
47.1
1.4
Massachusetts
125
127
183
242
461
671
39.9
24.5
66.5
New Hampshire
9
16
20
24
33
32
30.1
40.0
16.6
Rhode Island
23
26
42
76
99
122
39.7
49.3
26.4
Vermont
13
18
23
28
40
52
31.3
28.6
35.6
Middle Atlantic
$722
$909
$1,014
$1,585
$1,863
$2,313
26.2%
30.0%
20.8%
New Jersey
72
85
99
139
144
160
17.1
24.2
7.2
New York
544
689
756
1,255
1,473
1,763
26.5
32.1
18.5
Pennsylvania
105
135
159
192
246
390
29.9
22.0
42.6
South Atlantic
$389
$518
$777
$1,087
$1,359
$1,711
34.5%
40.9%
25.5%
Delaware
2
6
21
29
35
40
88.9
160.4
16.7
District of Columbia
8
10
15
19
21
25
24.5
32.4
13.6
Florida
116
174
266
362
433
547
36.4
46.2
23.0
Georgia
98
96
124
172
278
317
26.5
20.6
36.0
Maryland
42
52
62
46
48
66
9.6
3.2
20.0
North Carolina
41
58
75
117
153
261
44.8
41.8
49.3
South Carolina
40
58
83
115
146
170
33.2
41.7
21.4
Virginia
32
44
59
76
83
103
26.7
33.7
16.9
West Virginia
10
21
71
152
162
181
77.4
144.8
9.4
East South Central (1)
$148
$222
$294
$371
$366
$725
37.5%
35.9%
39.9%
Alabama
42
68
90
127
135
164
31.6
45.0
13.8
Kentucky
43
67
101
117
125
122
23.3
39.8
2.1
Mississippi
17
27
32
45
50
62
29.6
38.3
17.5
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$269
$692
$782
$973
$1,147
$1,314
37.3%
53.4%
16.2%
Arkansas
16
25
50
53
66
96
43.2
49.4
34.4
Louisiana
65
101
144
198
225
186
23.4
44.8
-2.9
Oklahoma
21
32
53
60
73
91
34.3
42.5
22.9
Texas
168
535
534
662
784
941
41.2
58.1
19.2
East North Central
$578
$631
$930
$971
$1,115
$1,230
16.3%
18.9%
12.6%
Illinois
108
105
196
231
323
458
33.4
28.7
40.8
Indiana
81
82
170
131
167
161
14.6
17.3
10.7
Michigan
127
173
203
239
250
254
14.9
23.4
.3.2
Ohio
128
132
146
174
201
223
11.8
10.6
13.5
Wisconsin
133
139
215
196
174
134
0.1
13.8
-17.5
West North Central
$201
$270
$307
$370
$821
$681
27.6%
22.5%
35.6%
lowa
42
53
59
67
101
113
22.0
17.3
29.4
Kansas
27
35
34
36
44
59
16.4
9.9
26.9
Minnesota
79
111
100
113
477
279
28.7
12.7
56.9
Missouri
24
33
65
94
134
152
44.9
58.0
27.2
Nebraska
18
23
26
35
36
38
16.8
26.0
4.2
North Dakota
8
10
13
12
16
24
23.0
13.2
39.3
South Dakota
4
5
9
12
15
17
37.2
50.8
19.1
Mountain (1)
$92
$134
$235
$277
$313
$368
31.9%
44.3%
15.3%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
22
32
41
45
46
52
18.4
26.5
7.1
Idaho
11
16
28
32
34
39
28.8
42.9
10.3
Montana
18
20
24
31
33
34
13.5
19.7
4.8
Nevada
10
12
22
27
30
45
35.0
39.2
29.1
New Mexico
17
23
44
66
92
112
46.5
58.3
30.4
Utah
11
15
19
24
33
39
27.6
27.8
27.2
Wyoming
3
4
5
7
5
5
14.7
38.3
-13.3
Pacific
$720
$793
$1,025
$1,411
$1,610
$1,596
17.3%
25.2%
6.4%
Alaska
15
21
27
32
29
29
14.0
29.0
-5.2
California
575
566
743
1,037
1,197
1,148
14.8
21.7
5.2
Hawaii (2)
15
18
21
24
26
31
16.2
16.6
15.5
Oregon (2)
26
59
79
127
156
161
43.9
69.5
12.5
Washington
88
129
155
190
202
227
20.7
29.1
9.1
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
"Other acute care" includes case management, family planning. dental, EPSDT, vision, other practitioners' care, and all other unspecified acute care services.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state: adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Page 128
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 73
Medicaid Payments to Medicare, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$1,432,300
$2,004,952
$2,337,359
$2,807,565
$3,375,651
$3,854,827
21.9%
25.2%
17.2%
New England
$131,355
$184,430
$162,917
$201,660
$256,537
$285,654
16.8%
15.4%
19.0%
Connecticut
42,838
58,163
69,657
87,638
102,096
125,175
23.9
26.9
19.5
Maine
18,411
20,423
21,176
21,689
31,144
35,915
14.3
5.6
28.7
Massachusetts
59,079
90,290
53,043
69,873
96,748
95,745
10.1
5.8
17.1
New Hampshire
4,983
6,050
7,217
8,308
10,005
9,596
14.0
18.6
7.5
Rhode Island
3,621
6,650
7,371
8,730
10,103
11,553
26.1
34.1
15.0
Vermont
2,423
2,855
4,452
5,421
6,441
7,671
25.9
30.8
19.0
Middle Atlantic
$179,047
$222,574
$239,128
$286,620
$366,982
$393,611
17.1%
17.0%
17.2%
New Jersey
28,804
30,538
29,075
47,988
73,581
82,786
23.5
18.5
31.3
New York
105,775
109,307
121,101
141,854
169,303
185,251
11.9
10.3
14.3
Pennsylvania
44,467
82,729
88,952
96,778
124,097
125,574.
23.1
29.6
13.9
South Atlantic
$226,429
$431,436
$466,945
$567,862
$681,260
$796,782
28.6%
35.9%
18.5%
Delaware
1,438
1,649
1,965
3,602
4,404
5,477
30.7
35.8
23.3
District of Columbia
3,540
6,466
7,650
6,938
8,526
16,795
36.5
25.1
55.6
Florida
85,507
225,818
212,798
252,275
290,306
333,544
31.3
43.4
15.0
Georgia
33,100
66,499
73,260
83,736
95,092
106,669
26.4
36.3
12.9
Maryland
16,943
17,737
29,666
39,007
47,663
54,908
26.5
32.0
18.6
North Carolina
31,947
38,944
58,765
83,896
105,127
129,476
32.3
38.0
24.2
South Carolina
22,661
26,517
30,363
36,541
49,489
56,435
20.0
17.3
24.3
Virginia
21,194
24,836
28,904
35,788
50,266
61,928
23.9
19.1
31.5
West Virginia
10,099
22,969
23,573
26,078
30,389
31,549
25.6
37.2
10.0
East South Central
$149,997
$190,600
$221,909
$255,561
$287,517
$333,580
17.3%
19.4%
14.2%
Alabama
55,023
63,846
68,579
52,308
66,446
75,474
6.5
-1.7
20.1
Kentucky
26,530
28,528
33,157
42,106
55,700
64,842
19.6
16.6
24.1
Mississippi
27,149
30,574
46,180
80,942
70,035
83,535
25.2
43.9
1.6
Tennessee (1)
41,295
67,652
73,993
80,205
95,336
109,729
21.6
24.8
17.0
West South Central
$151,163
$219,853
$254,543
$312,189
$411,796
$476,757
25.8%
27.3%
23.6%
Arkansas
21,795
33,458
37,118
42,461
46,557
53,338
19.6
24.9
12.1
Louisiana
31,912
40,940
46,783
56,028
68,993
79,831
20.1
20.6
19.4
Oklahoma
17,872
29,158
36,375
38,901
44,410
49,393
22.5
29.6
12.7
Texas
79,584
116,298
134,267
174,799
251,836
294,194
29.9
30.0
29.7
East North Central
$181,696
$263,216
$399,836
$419,715
$430,002
$524,940
23.6%
32.2%
11.8%
Illinois
63,779
61,200
101,554
117,958
137,938
169,760
21.6
22.7
20.0
Indiana
5,368
15,279
21,731
25,290
30,109
34,155
44.8
67.6
16.2
Michigan
52,001
85,086
146,013
71,681
85,457
106,052
15.3
11.3
21.6
Ohio
0
25,115
43,686
104,652
62,083
89,258
n/a
n/a
-7.6
Wisconsin
60,549
76,536
86,852
100,134
114,416
125,716
15.7
18.3
12.0
West North Central
$146,599
$190,790
$212,218
$261,720
$327,097
$309,553
16.1%
21.3%
8.8%
lowa
32,710
50,629
58,625
80,863
105,887
65,697
15.0
35.2
-9.9
Kansas
13,910
18,807
20,731
23,057
30,426
37,438
21.9
18.3
27.4
Minnesota
13,992
17,186
23,747
26,139
31,889
18,107
5.3
23.2
-16.8
Missouri
69,784
81,697
81,976
99,304
122,602
146,689
16.0
12.5
21.5
Nebraska
12,135
15,749
19,420
22,820
25,420
29,169
19.2
23.4
13.1
North Dakota
1,485
1,706
2,085
2,585
2,718
3,167
16.4
20.3
10.7
South Dakota
2,585
5,015
5,634
6,952
8,155
9,287
29.1
39.1
15.6
Mountain
$50,401
$51,278
$69,189
$77,732
$95,058
$117,784
18.5%
15.5%
23.1%
Arizona (1)
8,134
10,676
17,281
16,573
20,706
25,474
25.6
26.8
24.0
Colorado
9,275
10,857
12,485
15,448
19,738
23,210
20.1
18.5
22.6
Idaho
2,337
3,117
4,353
4,304
5,370
7,301
25.6
22.6
30.2
Montana
4,073
7,086
8,602
10,360
11,795
13,600
27.3
36.5
14.6
Nevada
2,743
4,253
4,978
6,228
7,217
9,770
28.9
31.4
25.2
New Mexico
6,300
7,238
8,667
9,836
15,162
18,806
24.4
16.0
38.3
Utah
16,700
5,324
8,767
10,185
12,447
16,662
0.0
-15.2
27.9
Wyoming
839
2,727
4,056
4,798
2,622
2,961
28.7
78.8
-21.4
Pacific
$215,613
$250,775
$310,675
$424,506
$519,402
$616,166
23.4%
25.3%
20.5%
Alaska
1,394
2,353
2,309
2,909
3,884
4,826
28.2
27.8
28.8
California
192,606
223,491
272,491
353,271
443,332
529,759
22.4
22.4
22.5
Hawaii (1)
2,397
3,677
5,983
9,085
16,954
19,536
52.1
55.9
46.6
Oregon (1)
7,931
8,917
10,104
14,442
20,713
20,727
21.2
22.1
19.8
Washington
11,285
12,337
19,787
44,799
34,520
41,318
29.6
58.3
-4.0
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Temtones. Figures may not sum to totals due to rounding.
Payments to Medicare were distributed among the aged. blind, and disabled as described in Appendix C.
(1) For certain states with active 1115 waivers (AZ. HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state:
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 129
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 74
Medicaid Payments to Managed Care Organizations, 1990-1995
Expenditures (thousands)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$1,937,480
$2,381,951
$3,164,367
$4,710,482
$6,803,636
$9,902,698
38.6%
34.5%
45.0%
New England
$56,455
$88,199
$175,490
$324,469
$370,549
$530,509
56.5%
79.1%
27.9%
Connecticut
42
0
0
0
0
14
-20.0
n/a
n/a
Maine
1,301
5,803
9,899
4,959
10,348
7,983
43.7
56.2
26.9
Massachusetts
53,806
80,116
161,168
309,672
347,622
456,810
53.4
79.2
21.5
New Hampshire
969
1,214
3,652
8,194
10,436
12,214
66.0
103.7
22.1
Rhode Island
337
1,066
771
1,645
2,144
53,488
175.5
69.6
470.2
Vermont
0
0
0
0
0
0
n/a
n/a
n/a
Middle Atlantic
$218,211
$305,675
$471,146
$720,314
$1,057,252
$1,523,642
47.5%
48.9%
45.4%
New Jersey
904
2,738
20,563
31,465
45,057
131,623
170.8
226.5
104.5
New York
50,400
76,127
127,055
256,666
434,841
777,031
72.8
72.0
74.0
Pennsylvania
166,907
226,810
323,528
432,182
577,354
614,988
29.8
37.3
19.3
South Atlantic
$139,617
$229,587
$384,360
$541,898
$797,916
$1,109,914
51.4%
57.2%
43.1%
Delaware
0
0
0
0
609
5,192
n/a
n/a
n/a
District of Columbia
10,609
14,809
21,197
24,959
37,661
81,148
50.2
33.0
80.3
Florida
64,735
135,242
242,421
369,260
544,374
721,957
62.0
78.7
39.8
Georgia
242
0
0
<1
39
319
5.7
-95.6
> 1,000.0
Maryland
59,122
77,264
114,789
141,706
206,805
253,094
33.8
33.8
33.6
North Carolina
654
2,271
5,953
5,920
8,313
8,616
67.5
108.4
20.6
South Carolina
0
0
0
50
100
90
n/a
n/a
34.6
Virginia
0
0
0
3
15
39,496
n/a
n/a
> 1,000.0
West Virginia
4,255
0
0
0
0
2
-78.8
n/a
n/a
East South Central
$17,059
$14,164
$32,042
$31,384
$897,535
$1,769,927
153.0%
22.5%
651.0%
Alabama
3,472
250
8,277
534
527
672
-28.0
-46.4
12.2
Kentucky
216
<1
0
2
36
54
-24.1
-80.2
470.7
Mississippi
3,555
0
0
0
0
0
n/a
n/a
n/a
Tennessee (1)
9,816
13,914
23,765
30,849
896,972
1,769,200
182.6
46.5
657.3
West South Central
$49,509
$1
$4
$4
$6
$719
-57.1%
-95.8%
> 1,000.0%
Arkansas
2,131
1
4
4
6
5
-70.7
-87.9
10.7
Louisiana
8,405
0
0
0
0
0
n/a
n/a
n/a
Oklahoma
8,124
0
0
0
0
712
-38.5
n/a
n/a
Texas
30,849
0
0
0
0
2
-85.1
n/a
n/a
East North Central
$599,083
$594,132
$645,741
$1,226,396
$1,199,697
$1,206,842
15.0%
27.0%
-0.8%
Illinois
78,061
95,586
109,312
118,991
143,416
154,468
14.6
15.1
13.9
Indiana
119,725
67,622
26,442
440,575
222,557
6,461
-44.2
54.4
-87.9
Michigan
129,680
123,548
133,244
307,362
401,933
489,770
30.4
33.3
26.2
Ohio
150,642
167,669
229,302
201,107
244,833
330,210
17.0
10.1
28.1
Wisconsin
120,975
139,707
147,440
158,360
186,959
225,933
13.3
9.4
19.4
West North Central
$57,602
$98,843
$160,001
$211,124
$202,113
$448,401
50.7%
54.2%
45.7%
lowa
0
27
1,031
1,769
1,405
82,948
n/a
n/a
584.9
Kansas
41
0
0
55
167
185
35.3
10.4
83.8
Minnesota
41,176
80,165
137,314
183,109
175,386
329,359
51.6
64.4
34.1
Missouri
15,776
18,651
21,651
26,141
24,932
28,226
12.3
18.3
3.9
Nebraska
0
0
5
50
153
7,392
n/a
n/a
> 1,000.0
North Dakota
0
0
0
0
66
277
n/a
n/a
n/a
South Dakota
610
0
<1
0
4
14
-52.8
n/a
n/a
Mountain
$330,703
$506,768
$652,881
$830,276
$961,208
$1,026,342
25.4%
35.9%
11.2%
Arizona (1)
316,656
470,207
605,604
770,976
884,459
872,052
22.5
34.5
6.4
Colorado
10,080
13,308
15,359
17,397
34,399
85,431
53.3
20.0
121.6
Idaho
214
0
8
69
111
303
7.1
-
-31.6
109.9
Montana
1,457
1,793
706
192
270
424
-21.9
-49.1
48.7
Nevada
2,296
4,071
8,283
13,177
16,636
18,375
51.6
79.0
18.1
New Mexico
0
0
0
0
0
0
n/a
n/a
n/a
Utah
0
17,389
22,921
28,463
25,308
49,739
n/a
n/a
32.2
Wyoming
0
0
0
4
25
19
n/a
n/a
135.0
Pacific
$469,240
$544,582
$642,702
$824,615
$1,317,360
$2,286,402
37.3%
20.7%
66.5%
Alaska
<1
<1
4
4
8
7
54.6
65.8
39.2
California
422,595
486,302
561,911
712,079
906,262
1,102,510
21.1
19.0
24.4
Hawaii (1)
3,841
3,290
4,428
5,859
41,863
325,873
143.1
15.1
645.8
Oregon (1)
27,362
37,704
49,841
64,322
164,670
439,148
74.2
33.0
161.3
Washington
15,441
17,285
26,518
42,352
204,556
418,864
93.5
40.0
214.5
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments. administrative costs, accounting adjustments, or the U.S. Territories Figures may not sum to totals due to rounding.
Payments to MCOs were distributed among adults and children as described in Appendix C.
(1) For certain states with active 1115 waivers (AZ. HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state: adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 130
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 75
Total Medicaid Long-Term Care Expenditures, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$32,391
$36,949
$42,574
$45,337
$49,044
$53,996
10.8%
11.9%
9.1%
New England
$3,220
$3,620
$3,951
$3,863
$4,219
$4,889
8.7%
6.3%
12.5%
Connecticut
854
1,030
1,105
1,166
1,204
1,394
10.3
10.9
9.4
Maine
247
297
346
343
364
383
9.2
11.6
5.7
Massachusetts
1,634
1,739
1,842
1,611
1,928
2,309
7.2
-0.5
19.7
New Hampshire
159
187
209
228
271
305
14.0
12.8
15.7
Rhode Island
249
276
343
405
333
367
8.0
17.5
-4.7
Vermont
77
90
105
112
119
132
11.2
13.2
8.3
Middle Atlantic
$9,858
$11,071
$12,752
$13,006
$14,391
$15,321
9.2%
9.7%
8.5%
New Jersey
1,224
1,403
1,416
1,642
1,822
1,950
9.8
10.3
9.0
New York
6,875
7,757
8,317
8,830
9,596
10,141
8.1
8.7
7.2
Pennsylvania
1,759
1,910
3,020
2,534
2,973
3,230
12.9
12.9
12.9
South Atlantic
$3,752
$4,441
$5,080
$5,668
$6,205
$6,915
13.0%
14.7%
10.5%
Delaware
73
91
100
109
120
138
13.7
14.5
12.4
District of Columbia
165
200
234
261
314
270
10.4
16.6.
1.7
Florida
864
1,018
1,173
1,376
1,513
1,769
15.4
16.8
13.4
Georgia
529
623
706
748
808
894
11.1
12.3
9.3
Maryland
438
489
581
605
675
748
11.3
11.4
11.2
North Carolina
689
822
937
1,093
1,181
1,341
14.2
16.6
10.8
South Carolina
332
395
444
464
513
562
11.1
11.8
10.1
Virginia
485
561
625
682
710
767
9.6
12.0
6.0
West Virginia
177
242
280
329
371
425
19.1
22.8
13.7
East South Central
$1,278
$1,566
$1,882
$2,061
$2,270
$2,404
13.5%
17.3%
8.0%
Alabama
282
360
465
492
545
606
16.5
20.4
11.0
Kentucky
382
425
480
538
584
631
10.5
12.1
8.3
Mississippi
199
256
320
315
358
403
15.2
16.6
13.2
Tennessee (1)
415
525
617
717
783
764
12.9
19.9
3.2
West South Central
$2,409
$2,866
$3,260
$3,705
$3,957
$4,246
12.0%
15.4%
7.1%
Arkansas
296
331
404
458
497
533
12.5
15.6
7.9
Louisiana
533
628
748
928
969
1,026
14.0
20.3
5.2
Oklahoma
354
412
470
492
459
506
7.4
11.6
1.5
Texas
1,226
1,494
1,639
1,827
2,033
2,180
12.2
14.2
9.2
East North Central
$4,961
$5,653
$6,862
$7,592
$7,978
$8,637
11.7%
15.2%
6.7%
Illinois
1,082
1,121
1,699
1,808
1,833
1,932
12.3
18.7
3.4
Indiana
673
846
1,015
1,082
1,096
1,069
9.7
17.1
-0.6
Michigan
939
1,043
1,091
1,460
1,546
1,734
13.1
15.9
9.0
Ohio
1,502
1,747
2,058
2,176
2,383
2,627
11.8
13.2
9.9
Wisconsin
766
896
999
1,065
1,120
1,276
10.7
11.6
9.4
West North Central
$2,298
$2,684
$3,194
$3,300
$3,539
$4,009
11.8%
12.8%
10.2%
lowa
290
353
393
424
452
499
11.5
13.4
8.5
Kansas
257
296
324
359
409
446
11.7
11.8
11.5
Minnesota
939
1,059
1,200
1,301
1,331
1,549
10.5
11.5
9.1
Missouri
429
519
761
658
750
879
15.4
15.3
15.6
Nebraska
161
205
239
261
281
292
12.6
17.5
5.7
North Dakota
125
143
152
160
165
180
7.5
8.4
6.2
South Dakota
96
109
126
137
151
164
11.3
12.6
9.4
Mountain
$963
$1,088
$1,330
$1,511
$1,650
$1,795
13.3%
16.2%
9.0%
Arizona (1)
212
203
268
324
368
357
11.0
15.3
4.9
Colorado
282
324
378
385
424
491
11.7
10.9
12.9
Idaho
80
101
114
127
135
147
13.0
16.4
8.0
Montana
89
103
119
153
159
175
14.4
19.6
7.0
Nevada
57
65
93
121
123
124
16.7
28.3
1.3
New Mexico
109
138
171
188
203
238
16.8
19.8
12.4
Utah
109
120
138
157
163
176
9.9
12.8
5.8
Wyoming
24
34
49
56
76
87
29.7
32.9
25.0
Pacific
$3,652
$3,961
$4,263
$4,631
$4,835
$5,780
9.6%
8.2%
11.7%
Alaska
47
49
52
65
77
80
11.2
11.6
10.7
California
2,688
2,825
2,971
3,122
3,270
4,097
8.8
5.1
14.6
Hawaii (1)
87
103
114
123
154
173
14.7
12.0
18.8
Oregon (1)
283
331
382
431
444
495
11.8
15.0
7.2
Washington
547
653
744
890
889
934
11.3
17.6
2.5
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments. or the U.S. Terntories. Figures may not sum to totals due
to rounding. Long-term care services include skilled nursing facilities, intermediate care facilities for the mentally retarded, other intermediate care facilities, mental
health, and home health services.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state:
adjustments were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 131
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 76
Medicaid Expenditures for SNF/ICF-Other Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$18,396
$21,102
$24,577
$26,297
$28,253
$30,486
10.6%
12.6%
7.7%
New England
$2,072
$2,348
$2,479
$2,408
$2,687
$2,936
7.2%
5.1%
10.4%
Connecticut
550
643
690
727
768
814
8.2
9.8
5.8
Maine
158
207
230
225
238
237
8.5
12.5
2.7
Massachusetts
1,071
1,150
1,174
1,039
1,227
1,402
5.5
-1.0
16.1
New Hampshire
104
130
141
148
180
196
13.5
12.4
15.2
Rhode Island
145
166
185
203
204
216
8.3
12.0
3.0
Vermont
45
52
59
65
70
72
9.9
13.2
5.0
Middle Atlantic
$4,646
$5,255
$6,236
$6,608
$7,199
$7,783
10.9%
12.5%
8.5%
New Jersey
722
836
849
988
1,052
1,097
8.7
11.0
5.4
New York
2,947
3,346
3,646
4,095
4,275
4,598
9.3
11.6
6.0
Pennsylvania
977
1,074
1,742
1,525
1,873
2,088
16.4
16.0
17.0
South Atlantic
$2,315
$2,821
$3,178
$3,517
$3,756
$4,097
12.1%
15.0%
7.9%
Delaware
43
51
54
58
60
64
8.2
10.3
5.1
District of Columbia
98
121
138
139
155
156
9.6
12.1
6.0
Florida
648
777
884
1,012
1,065
1,211
13.3
16.0
9.4
Georgia
349
429
491
531
572
619
12.2
15.0
8.0
Maryland
294
359
384
401
420
460
9.4
10.9
7.1
North Carolina
344
427
488
586
639
718
15.9
19.5
10.7
South Carolina
131
170
202
209
233
245
13.4
16.9
8.4
Virginia
274
314
345
373
379
388
7.2
10.8
2.1
West Virginia
134
175
191
209
231
236
11.9
15.9
6.2
East South Central (1)
$819
$1,067
$1,280
$1,399
$1,551
$1,681
15.5%
19.6%
9.6%
Alabama
168
228
310
331
383
428
20.5
25.4
13.6
Kentucky
231
261
300
332
370
389
11.1
12.9
8.3
Mississippi
146
205
241
212
244
276
13.6
13.2
14.2
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$1,304
$1,644
$1,863
$2,066
$2,180
$2,313
12.1%
16.6%
5.8%
Arkansas
179
201
235
252
273
285
9.7
12.0
6.3
Louisiana
270
329
420
526
514
561
15.8
24.9
3.3
Oklahoma
178
214
228
237
253
271
8.8
10.2
6.7
Texas
677
900
980
1,050
1,141
1,197
12.1
15.8
6.7
East North Central
$3,119
$3,450
$4,318
$4,885
$5,124
$5,427
11.7%
16.1%
5.4%
Illinois
650
667
1,050
1,103
1,145
1,201
13.0
19.3
4.3
Indiana
467
574
658
713
736
684
7.9
15.2
-2.1
Michigan
449
417
611
922
954
985
17.0
27.1
3.4
Ohio
1,045
1,242
1,395
1,497
1,602
1,767
11.1
12.7
8.6
Wisconsin
508
550
604
650
687
790
9.2
8.6
10.3
West North Central
$1,330
$1,561
$1,942
$1,908
$2,102
$2,302
11.6%
12.8%
9.9%
lowa
150
193
209
223
240
257
11.4
14.0
7.5
Kansas
134
147
164
177
202
223
10.8
9.8
12.4
Minnesota
533
600
694
740
864
929
11.8
11.6
12.0
Missouri
290
346
555
418
426
498
11.4
13.0
9.2
Nebraska
104
136
162
179
188
197
13.7
20.0
5.0
North Dakota
66
77
87
93
95
103
9.2
11.7
5.4
South Dakota
53
61
72
78
87
94
12.0
13.6
9.7
Mountain (1)
$541
$560
$728
$801
$881
$975
12.5%
14.0%
10.3%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
158
182
223
220
239
278
11.9
11.7
12.3
Idaho
44
54
63
69
72
80
12.6
16.2
7.5
Montana
56
59
68
92
95
105
13.7
18.1
7.3
Nevada
38
45
61
74
73
65
11.3
24.6
-6.0
New Mexico
68
85
94
100
107
114
10.9
13.7
6.9
Utah
47
19
63
72
83
85
12.6
15.4
8.5
Wyoming
23
23
34
26
40
44
14.1
3.9
31.3
Pacific
$2,251
$2,395
$2,553
$2,705
$2,772
$2,971
5.7%
6.3%
4.8%
Alaska
35
37
40
42
51
50
7.7
6.7
9.2
California
1,704
1,782
1,864
1,949
1,949
2,115
4.4
4.6
4.2
Hawaii (2)
76
87
97
102
124
127
10.8
10.3
11.7
Oregon (2)
115
133
154
159
157
160
6.7
11.3
0.2
Washington
320
356
399
453
491
519
10.1
12.2
7.1
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
"SNF/ICF-Other" refers to skilled nursing facilities and other intermediate care facilities.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state: adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Page 132
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 77
Medicaid Expenditures for ICF/MR Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$7,679
$8,357
$8,907
$9,502
$9,417
$10,003
5.4%
7.4%
2.6%
New England
$722
$701
$745
$671
$578
$650
-2.1%
-2.4%
-1.6%
Connecticut
166
210
193
182
180
187
2.4
3.1
1.4
Maine
56
55
63
60
55
52
-1.4
2.2
-6.7
Massachusetts
393
331
375
308
290
351
-2.2
-7.9
6.8
New Hampshire
11
7
6
5
6
9
-4.4
-21.3
28.2
Rhode Island
78
78
90
105
42
47
-9.8
10.3
-33.4
Vermont
17
20
18
11
6
4
-25.2
-13.5
-39.8
Middle Atlantic
$2,240
$2,396
$2,494
$2,836
$2,869
$2,921
5.5%
8.2%
1.5%
New Jersey
267
286
276
286
357
380
7.3
2.3
15.3
New York
1,524
1,644
1,715
2,049
2,011
2,042
6.0
10.4
-0.2
Pennsylvania
449
466
503
500
501
500
2.2
3.7
-0.1
South Atlantic
$903
$968
$1,053
$1,104
$1,155
$1,284
7.3%
6.9%
7.8%
Delaware
19
24
27
27
27
28
7.5
11.3
2.2
District of Columbia
28
38
52
64
64
66
18.7
31.8
1.5
Florida
157
169
182
192
212
247
9.4
6.9
13.3
Georgia
103
110
115
116
120
122
3.5
4.3
2.4
Maryland
71
63
65
61
60
79
2.1
-5.1
13.8
North Carolina
223
251
278
317
332
363
10.3
12.4
7.1
South Carolina
139
147
165
165
172
193
6.8
6.0
8.0
Virginia
148
152
154
148
154
152
0.5
0.0
1.4
West Virginia
15
16
15
15
14
35
18.5
-0.8
54.8
East South Central (1)
$244
$281
$314
$345
$371
$389
9.8%
12.2%
6.2%
Alabama
64
73
81
79
79
79
4.2
7.2
-0.2
Kentucky
50
65
60
70
72
70
6.8
11.5
0.2
Mississippi
46
43
62
79
85
90
14.6
20.2
6.7
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$803
$873
$929
$1,054
$1,038
$1,071
5.9%
9.5%
0.8%
Arkansas
73
82
88
90
94
103
7.1
6.8
7.5
Louisiana
207
238
261
324
300
310
8.4
16.0
-2.2
Oklahoma
100
111
112
132
91
99
-0.2
9.9
-13.5
Texas
422
442
469
508
553
559
5.8
6.4
4.9
East North Central
$1,232
$1,442
$1,614
$1,622
$1,597
$1,782
7.7%
9.6%
4.8%
Illinois
347
367
500
532
489
527
8.7
15.3
-0.4
Indiana
170
199
273
284
309
291
11.3
18.5
1.3
Michigan
213
332
181
149
157
226
1.2
-11.2
23.0
Ohio
378
373
468
450
453
521
6.6
5.9
7.7
Wisconsin
123
170
193
208
188
217
12.1
19.1
2.2
West North Central
$639
$702
$745
$771
$728
$854
6.0%
6.5%
5.3%
lowa
120
137
150
161
161
171
7.4
10.4
3.0
Kansas
88
98
103
107
105
102
3.0
6.6
-2.3
Minnesota
252
267
283
289
212
317
4.7
4.6
4.8
Missouri
89
103
107
114
144
160
12.4
8.5
18.6
Nebraska
28
30
33
34
34
35
4.8
7.1
1.5
North Dakota
37
41
40
37
39
39
1.0
0.2
2.4
South Dakota
25
27
29
30
32
31
4.1
5.4
2.2
Mountain (1)
$232
$274
$251
$283
$268
$264
2.7%
6.8%
-3.2%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
52
56
55
51
39
31
-10.1
-1.0
-22.2
Idaho
28
34
36
38
40
42
7.9
10.6
3.9
Montana
11
14
13
10
14
14
4.5
-1.9
14.9
Nevada
14
13
17
27
20
24
11.9
25.3
-5.6
New Mexico
28
35
39
43
38
32
2.7
14.7
-13.1
Utah
39
72
40
45
38
45
3.0
4.9
0.2
Wyoming
0
8
3
6
7
10
n/a
n/a
28.0
Pacific
$665
$718
$760
$817
$813
$786
3.4%
7.1%
-1.9%
Alaska
10
10
10
10
12
9
-2.3
0.1
-5.7
California
409
444
478
514
545
561
6.5
7.9
4.5
Hawaii (2)
7
7
7
6
11
11
10.8
-3.0
35.1
Oregon (2)
97
98
83
80
79
76
-4.8
-6.1
-2.8
Washington
142
159
182
206
167
129
-2.0
13.3
-21.1
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to
rounding. "ICF/MR" refers to intermediate care facilities for the mentally retarded.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categonze these numbers in the same manner as other states report to the Health Care Financing Administration. See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 133
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 78
Medicaid Expenditures for Mental Health Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$2,192
$2,525
$3,078
$2,556
$2,869
$3,076
7.0%
5.3%
9.7%
New England
$55
$82
$109
$94
$108
$142
20.7%
19.3%
23.0%
Connecticut
33
41
39
37
32
41
4.2
3.5
5.2
Maine
6
7
16
15
15
27
37.4
38.0
36.5
Massachusetts
3
22
35
24
39
53
78.1
102.5
46.9
New Hampshire
6
4
6
9
10
10
8.8
11.5
4.8
Rhode Island
7
8
12
9
11
12
10.8
7.8
15.3
Vermont
1
1
2
<1
<1
<1
-38.6
9.7
-74.3
Middle Atlantic
$1,020
$1,130
$1,496
$844
$964
$965
-1.1%
-6.1%
6.9%
New Jersey
46
51
56
66
64
74
10.1
13.1
5.7
New York
760
853
843
485
576
580
-5.3
-13.9
9.4
Pennsylvania
214
227
598
294
324
310
7.8
11.2
2.8
South Atlantic
$158
$206
$232
$256
$314
$315
14.8%
17.5%
11.0%
Delaware
2
2
3
2
6
11
43.9
-4.3
165.6
District of Columbia
28
28
31
42
77
30
1.4
14.7
-15.6
Florida
10
12
13
14
14
15
8.2
13.2
1.0
Georgia
13
17
20
18
16
25
13.2
10.5
17.3
Maryland
11
9
10
11
11
11
-0.9
0.8
-3.5
North Carolina
36
42
46
34
31
34
-0.8
-1.7
0.6
South Carolina
27
41
40
39
48
49
12.5
12.8
12.0
Virginia
27
48
58
82
87
105
31.4
45.0
13.4
West Virginia
4
7
10
13
25
35
57.8
54.1
63.5
East South Central (1)
$81
$68
$94
$112
$141
$86
1.1%
11.3%
-12.6%
Alabama
6
13
21
20
19
18
24.7
49.6
-5.1
Kentucky
41
26
34
35
33
40
-0.1
-4.5
6.8
Mississippi
0
0
10
15
20
24
n/a
n/a
25.6
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$103
$111
$146
$136
$173
$166
10.0%
9.6%
10.5%
Arkansas
16
16
27
46
51
50
24.7
40.8
4.0
Louisiana
46
50
49
41
95
79
11.5
-3.5
38.5
Oklahoma
41
46
70
49
27
37
-2.0
6.1
-12.9
Texas
0
0
0
0
0
0
n/a
n/a
n/a
East North Central
$269
$344
$340
$363
$410
$442
10.5%
10.5%
10.5%
Illinois
18
21
26
34
43
43
19.3
24.5
12.0
Indiana
22
51
47
44
18
47
16.6
25.9
3.9
Michigan
142
136
106
134
142
200
7.1
-1.8
22.1
Ohio
61
103
127
116
165
112
12.9
23.8
-1.6
Wisconsin
27
33
33
35
41
40
8.4
9.2
7.3
West North Central
$85
$103
$109
$113
$107
$116
6.6%
10.1%
1.5%
lowa
11
12
17
20
23
21
15.1
23.0
4.2
Kansas
21
30
26
29
25
22
1.5
11.7
-12.0
Minnesota
34
36
37
32
26
38
2.7
-1.7
9.8
Missouri
8
10
14
12
17
18
18.9
17.8
20.6
Nebraska
5
6
8
11
8
2
-16.6
26.1
-55.2
North Dakota
3
4
2
4
3
8
23.0
13.0
39.6
South Dakota
4
4
5
5
6
6
8.7
10.3
6.5
Mountain (1)
$68
$96
$144
$184
$184
$108
9.6%
39.5%
-23.6%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
14
19
20
22
20
27
14.4
17.3
10.2
Idaho
<1
3
<1
0
0
0
-100.0
-100.0
n/a
Montana
9
10
14
20
16
14
9.3
29.9
-15.6
Nevada
<1
1
6
9
17
22
144.4
226.7
58.1
New Mexico
0
<1
14
20
19
19
n/a
n/a
-2.7
Utah
6
6
6
7
6
7
3.3
5.6
-0.1
Wyoming
1
1
1
9
< 1
< 1
-18.3
190.0
-87.8
Pacific
$353
$385
$408
$454
$469
$737
15.8%
8.7%
27.5%
Alaska
1
1
10
10
11
70.9
130.4
9.2
California
326
341
357
373
389
639
14.4
4.6
30.9
Hawaii (2)
0
0
0
0
0
0
n/a
n/a
n/a
Oregon (2)
11
13
16
17
23
25
18.3
17.5
19.6
Washington
16
30
35
54
47
62
31.6
51.1
7.1
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Temtories. Figures may not sum to totals due to rounding.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Page 134
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 79
Medicaid Expenditures for Home Health Care Services, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$4,124
$4,965
$6,013
$6,983
$8,505
$10,431
20.4%
19.2%
22.2%
New England
$371
$488
$617
$690
$846
$1,161
25.6%
23.0%
29.7%
Connecticut
106
135
183
220
225
353
27.3
27.7
26.6
Maine
27
29
38
43
55
66
19.5
16.8
23.7
Massachusetts
167
236
259
239
373
503
24.7
12.7
45.0
New Hampshire
37
47
55
66
74
91
19.5
20.9
17.3
Rhode Island
19
24
56
87
76
93
36.9
65.1
3.3
Vermont
14
17
26
35
43
55
31.0
34.4
26.1
Middle Atlantic
$1,953
$2,288
$2,525
$2,718
$3,357
$3,652
13.3%
11.6%
15.9%
New Jersey
189
230
235
302
349
399
16.1
17.0
14.8
New York
1,644
1,914
2,113
2,200
2,734
2,920
12.2
10.2
15.2
Pennsylvania
121
144
177
216
275
332
22.5
21.4
24.2
South Atlantic
$377
$445
$617
$791
$980
$1,219
26.5%
28.1%
24.2%
Delaware
8
15
17
23
27
35
32.9
39.4
23.6
District of Columbia
10
13
13
16
18
19
12.5
16.6
6.6
Florida
50
60
94
158
222
297
43.0
47.0
37.2
Georgia
64
68
79
83
101
128
15.0
9.1
24.4
Maryland
61
58
121
132
184
198
26.5
29.1
22.7
North Carolina
87
103
125
156
180
225
20.9
21.6
19.9
South Carolina
35
37
36
51
59
75
16.4
13.0
21.8
Virginia
36
47
68
80
90
122
27.4
29.9
23.6
West Virginia
25
45
64
92
100
119
37.2
55.3
13.9
East South Central (1)
$134
$150
$194
$205
$208
$248
13.1%
15.1%
10.0%
Alabama
44
47
53
61
64
82
13.2
11.9
15.2
Kentucky
60
72
86
100
109
131
16.7
18.4
14.2
Mississippi
7
8
7
9
9
13
13.0
8.5
20.2
Tennessee (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
West South Central
$199
$238
$322
$450
$566
$697
28.4%
31.2%
24.5%
Arkansas
27
32
55
71
79
95
28.5
37.5
16.2
Louisiana
9
12
18
36
60
76
52.2
57.6
44.6
Oklahoma
36
42
59
74
88
100
22.6
26.8
16.6
Texas
127
152
190
269
339
425
27.4
28.5
25.7
East North Central
$341
$418
$590
$722
$848
$986
23.7%
28.4%
16.9%
Illinois
66
67
124
139
156
161
19.4
28.0
7.5
Indiana
14
21
37
42
34
47
26.9
43.2
5.8
Michigan
135
158
193
255
292
323
19.2
23.8
12.6
Ohio
18
29
68
113
163
227
66.7
86.0
41.5
Wisconsin
108
142
169
173
203
228
16.1
16.8
15.0
West North Central
$244
$318
$399
$509
$602
$736
24.7%
27.7%
20.3%
lowa
10
12
17
20
28
50
38.5
27.8
56.4
Kansas
15
20
31
47
77
98
46.6
47.7
45.0
Minnesota
121
156
186
241
229
265
16.9
25.7
4.9
Missouri
42
59
85
114
162
203
36.7
39.0
33.4
Nebraska
24
33
36
37
51
57
18.7
15.5
23.8
North Dakota
19
22
23
26
28
30
9.6
10.6
8.0
South Dakota
14
17
20
24
27
33
19.5
21.0
17.3
Mountain (1)
$121
$158
$207
$243
$318
$447
29.8%
25.9%
35.8%
Arizona (2)
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Colorado
58
68
80
92
126
156
21.9
16.7
30.2
Idaho
7
10
14
19
22
26
29.3
38.1
17.2
Montana
14
19
25
31
34
42
25.1
31.5
16.1
Nevada
5
7
10
12
12
14
20.8
31.3
6.5
New Mexico
13
19
24
25
39
72
40.6
24.2
69.4
Utah
17
23
30
33
36
39
17.2
23.5
8.3
Wyoming
<1
2
12
15
29
32
132.5
212.4
49.2
Pacific
$383
$462
$541
$656
$781
$1,285
27.4%
19.6%
40.0%
Alaska
1
1
2
3
4
9
52.0
40.6
70.8
California
248
258
272
287
387
781
25.8
5.0
65.1
Hawaii (2)
5
8
10
15
20
35
49.1
46.3
53.4
Oregon (2)
60
87
129
174
185
235
31.3
42.5
16.1
Washington
69
107
128
177
185
225
26.5
36.7
12.7
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include disproportionate share hospital payments, administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
(1) Regional totals include estimated expenditure levels from states where data were unavailable.
(2) For certain states with active 1115 waivers (AZ, HI, OR, TN), expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to the Health Care Financing Administration See Appendix C.
Kaiser Commission on the Future of Medicaid
Page 135
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table 80
Medicaid Disproportionate Share Hospital Payments, 1990-1995
Expenditures (millions)
Average Annual Growth
1990
1991
1992
1993
1994
1995
1990-95
1990-93
1993-95
United States
$1,378
$5,316
$17,526
$17,016
$16,890
$18,988
69.0%
131.1%
5.6%
New England
$4
$1,230
$1,488
$1,565
$1,609
$1,763
239.6%
637.5%
6.1%
Connecticut
2
0
395
417
409
450
213.0
552.8
3.9
Maine
2
45
139
164
165
165
141.8
334.5
0.4
Massachusetts
<1
1,060
457
484
541
610
333.1
966.0
12.2
New Hampshire
0
51
392
383
380
329
n/a
n/a
-7.4
Rhode Island
0
72
81
97
95
171
n/a
n/a
32.8
Vermont
0
1
23
19
19
37
n/a
n/a
41.5
Middle Atlantic
$458
$1,481
$5,181
$4,458
$4,357
$4,995
61.2%
113.5%
5.9%
New Jersey
36
223
1,094
1,088
1,034
1,287
104.8
212.4
8.7
New York
416
828
3,119
2,559
2,507
2,917
47.6
83.2
6.8
Pennsylvania
6
431
967
811
817
792
162.8
404.3
-1.2
South Atlantic
$179
$466
$1,642
$1,701
$1,964
$2,001
62.0%
111.6%
8.5%
Delaware
0
0
0
5
6
7
n/a
n/a
17.0
District of Columbia
0
0
33
46
53
50
n/a
n/a
4.4
Florida
44
39
191
240
285
334
49.8
75.6
18.1
Georgia
1
51
301
309
355
410
211.8
506.2
15.1
Maryland
0
0
113
78
151
160
n/a
n/a
43.5
North Carolina
65
150
332
346
390
429
45.8
74.4
11.5
South Carolina
62
213
440
441
481
440
48.0
92.4
-0.1
Virginia
7
14
148
131
140
145
85.4
170.1
5.4
West Virginia
0
0
84
105
103
25
n/a
n/a
-51.4
East South Central
$290
$556
$1,266
$1,139
$751
$820
23.1%
57.8%
-15.1%
Alabama
194
154
417
419
417
417
16.6
29.3
-0.2
Kentucky
<1
178
264
137
67
220
279.3
688.0
26.7
Mississippi
3
24
153
152
158
183
135.9
293.5
9.5
Tennessee (1)
93
201
431
430
108
0
n/a
66.7
n/a
West South Central
$129
$389
$2,756
$2,757
$2,866
$2,800
85.2%
177.8%
0.8%
Arkansas
1
1
3
3
3
3
21.7
27.9
12.9
Louisiana
119
161
1,218
1,218
1,326
1,265
60.4
117.0
1.9
Oklahoma
3
12
22
23
24
18
39.8
89.7
-11.6
Texas
5
215
1,513
1,513
1,513
1,513
215.5
578.8
0.0
East North Central
$181
$439
$1,530
$1,275
$1,720
$1,891
59.9%
91.8%
21.8%
Illinois
63
77
314
240
300
413
45.5
55.9
31.1
Indiana
4
19
212
34
295
398
145.4
96.1
243.4
Michigan
54
272
544
545
615
438
51.8
115.5
-10.3
Ohio
57
67
452
449
498
630
61.7
98.9
18.5
Wisconsin
1
3
9
8
12
12
51.0
72.5
23.6
West North Central
$88
$566
$971
$927
$938
$843
57.2%
119.3%
-4.7%
lowa
2
2
5
4
6
5
19.0
28.3
6.3
Kansas
34
54
189
184
165
74
16.4
74.9
-36.8
Minnesota
9
11
42
32
44
24
23.0
55.4
-13.3
Missouri
42
498
732
703
713
729
77.0
155.9
1.8
Nebraska
< 1
1
3
3
9
9
57.5
53.5
63.6
North Dakota
0
<1
1
1
1
1
n/a
n/a
944.2
South Dakota
<1
1
1
< 1
<1
1
113.8
-22.2
873.4
Mountain
$6
$55
$212
$317
$299
$565
146.3%
270.3%
33.6%
Arizona (1)
0
0
0
91
106
122
n/a
n/a
15.9
Colorado
4
52
121
131
106
355
145.2
219.6
64.8
Idaho
0
0
1
<1
1
4
n/a
n/a
102.1
Montana
<1
1
<1
<1
<1
<1
12.6
60.2
-33.7
Nevada
<1
<1
74
80
74
74
235.9
675.7
-4.3
New Mexico
1
0
12
9
8
7
46.4
106.0
-12.4
Utah
<1
3
5
4
5
3
29.8
70.6
-13.9
Wyoming
1
1
< 1
1
0
0
n/a
38.3
n/a
Pacific
$43
$133
$2,480
$2,878
$2,386
$3,311
138.0%
304.8%
7.3%
Alaska
0
0
0
14
17
18
n/a
n/a
14.2
California
11
99
2,191
2,543
2,009
2,915
205.3
513.7
7.1
Hawaii (1)
0
2
40
44
30
1
n/a
n/a
-84.5
Oregon (1)
4
7
17
21
21
28
45.2
67.9
16.7
Washington
28
25
231
257
309
348
65.5
109.3
16.3
Source: Urban Institute calculations based on data from HCFA-64 reports.
Does not include administrative costs, accounting adjustments, or the U.S. Territories. Figures may not sum to totals due to rounding.
(1) For certain states with active 1115 waivers (AZ, HI, OR, TN). expenditure and beneficiary data were supplemented with data received directly from the state; adjustments
were made to categorize these numbers in the same manner as other states report to Health Care Financing Administration See Appendix C.
Page 136
Kaiser Commission on the Future of Medicaid
Appendices
A. Medicaid Fact Sheets
THE
KAISER
FAMILY
MEDICAID FACTS
FOUNDATION
THE KAISER COMMISSION ON THE FUTURE OF MEDICAID
November 1997
THE MEDICAID PROGRAM AT A GLANCE
What is Medicaid?
The diverse Medicaid population is comprised of:
Medicaid is the nation's major public financing program for
17.5 million children
providing health and long-term care coverage to millions of
8.0 million adults in families
low-income people. Initially designed to pay for the health
3.9 million elderly persons
care of recipients of welfare assistance and certain other
5.8 million blind and disabled persons
needy people, by 1995, 35.2 million people-more than 1
in 10 Americans-were covered by Medicaid at a cost of
Although adults and children in low-income families make up
$152.4 billion.
nearly three-fourths of beneficiaries, they account for only 28
percent of Medicaid spending. The elderly and the disabled
Authorized under Title XIX of the Social Security Act,
account for the majority (60 percent) of spending because of
Medicaid is a means-tested entitlement program financed
their intensive use of acute and long-term care services.
by the state and federal governments and administered by
Disproportionate share hospital (DSH) payments account for
the states. Federal financial assistance is provided to
about 12.5 percent of Medicaid spending (Figure 1).
states for coverage of specific groups of people and
benefits through federal matching payments based on the
What Services are Covered Under Medicaid?
state's per capita income. The federal share ranges from
Medicaid covers a broad range of services to meet the
50 to 80 percent of Medicaid expenditures.
complex needs of beneficiaries. Because of the limited
financial resources of beneficiaries, cost-sharing
Who is Covered by Medicaid?
requirements are nominal. Federally mandated services
include:
Being poor does not automatically qualify an individual for
Medicaid. Only persons who fall into particular
inpatient and outpatient hospital
"categories" such as low-income children, pregnant
physician, midwife, and certified nurse practitioner
women, the elderly and people with disabilities are eligible.
laboratory and X-ray
Under the new welfare program, Temporary Aid to Needy
nursing home and home health care
Families (TANF), Medicaid eligibility is no longer automatic
for families who receive cash assistance. Within federal
early and periodic screening, diagnosis, and treatment
(EPSDT) for children under age 21
guidelines, states set their own income and asset eligibility
family planning
criteria for Medicaid. As a result, there are large state
rural health clinics/federally qualified health centers
variations in coverage. Although Medicaid has
increasingly been used to expand coverage to the low-
States have the option to cover additional services and still
income population, it covers only half of poor Americans.
receive federal matching funds. Commonly offered services
While the new State Child Health Insurance Program will
include prescription drugs, clinic services, prosthetic
expand coverage to low-income uninsured children either
devices, hearing aids, dental care and intermediate care
through Medicaid or a separate program, millions of low-
facilities for the mentally retarded (ICF/MR).
income people will remain uninsured.
Figure 1
Figure 2
Medicaid Beneficiaries and Expenditures
Medicaid Expenditures by Service, 1995
by Enrollment Group, 1995
Payments to
Elderly
Inpatient
Medicare 2.5%
DSH
DSH Payments*
Hospital 17.7%
Payments 12.5%
11.0%
12.5%
Blind &
Disabled
Elderly
Home
16 6%
26.3%
Health 6.8%
Drugs 5%
Adults
Mental Health 2.0%
22.6%
Blind &
Disabled
Physician/
33.7%
Outpatient
ICF/MR 6.6%
12.6%
Children
Adults
Acute Care
and
52.1%
49.7%
10.9%
Long-Term Care
Children
35.4%
16.7%
Other Acute
Nursing Facility
7.3%
Payments
Care 20.0%
Beneficiaries
Expenditures*
to MCOs 6.5%
Total = 35.2 million people
Total = $152.4 billion
Total = $152.4 billion
Disproportionate share hospital payments
Note: Total expenditures exclude administrative expenses, adjustments and the territories
SOURCE: Urban Institute Estimates, 1997.
SOURCE Urban Institute Estimates. 1997.
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250
WASHINGTON, D.C. 20005
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Figure 3
Of the $152.4 billion Medicaid spent in 1995 (Figure 2):
Medicaid Beneficiary Growth by
Enrollment Group, 1988-1995
Acute care services comprised about half (52.1
Beneficianes (in millions)
35.2
34.2
32.4
percent) of spending. This includes 6.5 percent of
29.8
spending on Managed Care Organization (MCO)
26.9
premiums.
24.1
22.0
22.6
Elderly
Long-term care services accounted for 35.4 percent
Blind &
of expenditures. Medicaid pays for half of total
Disabled
Adults
nursing home care (47 percent) and 14 percent of
Children
all home health spending in the United States.
Payments to Medicare accounted for 2.5 percent.
Payments to hospitals with a disproportionately
large population of indigent patients (DSH)
1988
1989
1990
1991
1992
1993
1994
1995
comprised 12.5 percent of total expenditures.
SOURCE: Urban Institute Estimates. 1997.
How is Care Delivered Under Medicaid?
Medicaid has become a major budgetary commitment for
both the federal and state governments. Medicaid
As states try to expand insurance coverage to low-income
expenditures escalated rapidly between 1988 and
people, improve access, and contain costs, many are
1992-more than doubling (Figure 4). The rise in spending
adopting new care delivery and financing arrangements
under Medicaid. While traditional fee-for-service still
in that period was attributable to a combination of health
predominates, an increasing number of states are
care inflation, state use of alternative financing mechanisms,
and an increase in enrollment. Only a small fraction of
enrolling their Medicaid populations in managed care.
spending growth was attributable to the expansions in
As of June 1996, 13.3 million Medicaid beneficiaries were
coverage of low-income pregnant women and children.
enrolled in managed care, a fourfold increase from 2.7
million in 1991. Medicaid managed care models range
The rate of growth in Medicaid spending has now returned to
historic levels-rising 11.2 percent from 1994 to 1995. This
from HMOs that use prepaid capitated care to loosely
suggests that legislation enacted to limit states' capacity to
structured networks that contract with selected providers
for discounted services and use gatekeeping to control
raise funds through provider taxes and DSH payments has
played a role in slowing Medicaid spending growth. The BBA
utilization. States have initially targeted low-income
families for managed care enrollment rather than aged or
of 1997 further reduces the growth in DSH payments by
disabled beneficiaries.
$10.4 billion over the next five years and lowers the state-
specific ceilings on federal Medicaid DSH matching
payments.
Until recently, states have used waivers of Section
1915(b) and Section 1115 of the Social Security Act to
Figure 4
undertake mandatory managed care programs. However,
Medicaid Spending by Enrollment
the Balanced Budget Act (BBA) of 1997 permits states to
mandate managed care enrollment for most Medicaid
Group, 1988-1995
Dollars (In billions)
$152.4
beneficiaries without a waiver (except special needs
$137.1
children, Medicare beneficiaries and Indians.) As a result,
$127.4
$115.2
mandatory managed care enrollment is likely to rise.
$89
DSH
Payments*
Long-term care is a major component of Medicaid. While
$70.5
Elderly
$59.6
over three-fourths of Medicaid spending for long-term care
$52.8
Blind &
Disabled
is on institutional services, Home- and Community-Based
Adults
Services (HCBS) waivers are often used by states to
Children
deliver community-based care. Although all states have
HCBS waivers, the population served remains small.
1988
1989
1990
1991
1992
1993
1994
1995
Disproportionate Share Hospital payments
States also now have the option to provide dual eligibles
Note Total expenditures exclude administrative expenses.
SOURCE Urban Institute Estimates, 1997
(Medicaid/Medicare) with acute and community-based
long-term care services under the Program for All-
Inclusive Care for the Elderly (PACE).
Since its enactment in 1965, Medicaid has improved access
to health care for the poor, pioneered innovations in health
Recent Beneficiary and Expenditure Growth
care delivery and community-based long-term care services
and stood alone as the primary source of financial
Medicaid enrollment rose dramatically in the early 1990's,
assistance for long-term care. Medicaid has been
reaching 35.2 million beneficiaries in 1995 (Figure 3). This
consistently shown to improve access to health care for the
growth is mostly attributable to expanded coverage of low-
population it serves. Low-income people without insurance
income pregnant women and young children and
coverage use care at considerably lower levels than those
increases in blind and disabled beneficiaries. However,
with Medicaid coverage. As Medicaid struggles to meet
enrollment growth appears to have leveled somewhat,
multiple responsibilities under continued fiscal pressure, the
increasing by only 3 percent from 1994 to 1995.
program plays a critical role in providing acute and long-term
care services to our nation's most vulnerable people.
The Kaiser Commission on the Future of Medicaid was established by the Henry 1. Kaiser Family Foundation in 1991 to function as a Medicaid policy institute
and serve as a forum for analyzing. debating and proposing future directions for Medicaid and other health reforms affecting low-income Americans.
The Kaiser Family Foundation is an independent national health care philanthropy and not associated with Kaiser Permanente or Kaiser Industries.
KAISER
FAMILY
MEDICAID FACTS
FOUNDATION
THE KAISER COMMISSION ON THE FUTURE OF MEDICAID
NOVEMBER 1997
MEDICAID AND MANAGED CARE
Medicaid provided health and long-term care coverage to
MODELS OF MEDICAID MANAGED CARE
approximately 35 million low-income Americans at a cost of
$152 billion in 1995. In its role as a purchaser of health
Managed care includes a broad array of health financing and
vices for low-income families, Medicaid increasingly relies
delivery arrangements designed to reduce costs by
on managed care to deliver services. About 40% of
eliminating inappropriate and unnecessary services and
Medicaid beneficiaries, predominately poor children and their
relying more heavily on primary care and coordination of
parents, now receive health care services through a broad
care. Managed care arrangements are characterized by
array of managed care arrangements.
formal enrollment of individuals in a managed care
organization; contractual agreements between the provider
MEDICAID MANAGED CARE ENROLLMENT
and a payer; and some gatekeeping and utilization control.
Medicaid's use of managed care has grown dramatically in
The major Medicaid managed care models include:
recent years in response to pressure to contain the growth in
Medicaid spending while maintaining access to care for low-
Full-Risk Plans (HMOs or HIOs): Under a fully
income individuals. In 1996, 13.3 million Medicaid
capitated plan, a health plan is paid a fixed monthly fee
beneficiaries were enrolled in managed care, up from 2.7
per enrollee and assumes full-risk for the delivery of a
million in 1991, a four-fold increase (Exhibit 1).
comprehensive range of services. The major types of full-
risk plans are Health Maintenance Organizations
Exhibit 1
(HMOs), in which the contracting entity and the providers
Growth in Medicaid Managed Care Enrollment,
are integrated into one plan, and Health Insuring
1986-1996
Organizations (HIOs), which operate as fiscal
Millions of Medicaid Beneficiaries
16.0
intermediaries.
14.0
13.3
12.0
Limited-Risk Prepaid Health Plans (PHPs): A PHP is
9.8
10.0
an entity, usually a clinic or large group practice, that
7.8
8.0
either contracts on a non-risk basis or a prepaid,
6.0
capitated-risk basis to provide services that are not
4.8
4.0
3.6
comprehensive (often ambulatory care only).
2.7
1.7
1.8
2.0
2.0
2.3
2.0
0.0
Fee-for-Service Primary Care Case Management
1986
1967
1988
1989
1990
1991
1992
1993
1994
1995
1996
(PCCM): In a PCCM, a specific provider, usually the
CHealth Maintenance Organization/ Primary Care Case Management
Prepaid Health Plan
patient's primary care physician, is responsible for acting
Source: HCFA, 1997 and PPRC, 1997.
as a "gatekeeper" to approve and monitor the provision of
covered services to beneficiaries. These gatekeepers
Today, all states (except Alaska) are pursuing some
contract directly with State Medicaid agencies, do not
managed care initiatives. As of June 1996, 36 states and
assume financial risk for the provision of services, and
the District of Columbia had more than one-quarter of their
are paid a per-patient monthly case management fee, as
Medicaid population enrolled in managed care (Exhibit 2).
well as fee-for-service payment for medical care.
Of these, 8 states have more than 75% of their Medicaid
beneficiaries enrolled in managed care.
As of June 1996, 511 Medicaid managed care plans,
primarily full-risk HMOs, were in operation - almost double
Exhibit 2
the number of plans in 1993. The predominance of full-risk
Medicaid Managed Care Enrollment,
plans is reflected in the distribution of enrollees: 67% of all
by State, 1996
Medicaid managed care beneficiaries were enrolled in HMOs
or HIOs, 2% in PHPs, and 31% in PCCMs and other
managed care arrangements (Exhibit 3).
STATE MANAGED CARE OPTIONS
States have long had the option to voluntarily enroll Medicaid
beneficiaries in managed care plan. Legislative authority to
require mandatory enrollment has evolved over time. Until
recently, states have used Section 1915(b) freedom-of-
0-25 percent (14 states)
choice waivers or Section 1115 research and demonstration
25-50 percent (16 states)
. 50-75 percent (13 states")
waivers to undertake mandatory managed care programs.
Includes the District of Columbia.
. 75 percent + (8 states)
Source: HCFA, 1997.
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Exhibit 3
Medicaid Managed Care Enrollment,
Exhibit 4
by Type of Plan, 1996
Medicaid Managed Care
Selected Provisions in the Balanced Budget Act of 1997
HMO 63%
Enrollment/Marketing: Allows states to mandate managed
(8.0 million)
care enrollment, to guarantee managed care enrollment for 6
HIO 4%
months for adults and 12 months for children, and to "lock-in"
(0.5 million)
beneficiaries for up to 12 months; prohibits door to door
PHP 2%
marketing; and requires state default enrollment system to
(0.2 million)
consider existing beneficiary-provider relationships and
traditional Medicaid providers.
PCCM 31%
Plan Choice: Permits states to limit Medicaid beneficiaries to
(4.0 million)
a choice of two MCOs in urban areas and one MCO in rural
areas. Plans may serve Medicaid beneficiaries exclusively.
Note: Excludes enrollees in Behavioral and Dental Health Plans.
Source: PPRC, 1997.
Access: Requires MCOs to comply with a "prudent layperson"
emergency care coverage standard and prohibits physician
Under 1915(b) waivers, in place in 42 states, mandatory
"gag rules."
managed care has been implemented in part of the state or
for certain categories of beneficiaries. Section 1115 waivers
Consumer Protections: Requires MCOs to provide
have been used to implement statewide mandatory
information regarding participating providers, enrollee rights
mandatory managed care enrollment, as well as to waive the
and responsibilitites, information on covered services, and
requirement that 25% of a plan's enrollment be privately
grievance and appeals procedures (an internal grievance
insured (the 75/25 rule). As of May 1997, 10 states have
process is required).
implemented Section 1115 waivers (AZ, DE, HI, MN, OH,
MCO Payment Rates: Requires state Medicaid agency
OK, OR, RI, TN, VT).
capitation payment rates be made on an "actuarially sound
basis", and requires DSH payments go directly to providers,
The Balanced Budget Act (BBA) of 1997 gives states new
not incorporated into capitation payments.
authority to mandate enrollment in managed care
organizations (MCOs) for Medicaid beneficiaries without
Plan Requirements: Requires plans to demonstate adequate
obtaining a federal waiver (except for special needs children,
capacity, including an appropriate range of services and
Medicare beneficiaries and American Indians). Furthermore,
access to preventive and primary care services and a
sufficient number, mix, and geographic distribution of
the new law permits the establishment of Medicaid-only
providers.
plans by eliminating the 75/25 rule. Finally, the law
establishes certain new managed care consumer
Quality/Oversight: Increases the threshold for prior federal
protections, but exempts Section 1915 and Section 1115
approval of managed care contracts to $1 million; requires
waivers from the new requirements (Exhibit 4).
states to develop and implement a quality assessment and
improvement strategy by 1999 consistent with standards to be
ISSUES IN MEDICAID MANAGED CARE
established by the Secretary of HHS; and establishes external
independent review of MCO performance.
Medicaid beneficiaries are economically disadvantaged,
frequently reside in medically underserved areas, and often
have more complex health and social needs than do higher-
managed care remains low and is complicated by difficulties
income Americans. The success of managed care depends,
in setting appropriate capitation rates, limited plan
in large part, on the future adequacy of the capitation rates
experience in providing specialized services, as well as lack
and the ability of states and the federal government to
of systems to coordinate Medicare and Medicaid benefits for
monitor access and quality.
"dual eligibles."
As a public program, Medicaid has operated under tight
Changes in the delivery system can be made to accomplish
budget constraints, resulting in provider payment rates that
savings, but in order to be effective and preserve access to
are often substanially below market rates contributing to
needed services, these changes will require sufficient time to
access problems. Capitation rates need to be sufficient to
implement, the development of an adequate infrastructure to
assure that plans are able to adequately serve Medicaid
deliver care, oversight of program implementation, and more
enrollees. Adequate payment levels are particularly
experience with enrolling the elderly and disabled.
important in the context of mandatory enrollment of
beneficiaries in Medicaid-only MCOs because these plans
The BBA provides new standards to assure plan capacity
are wholly dependent on Medicaid financing and do not have
and enforce consumer protections. However, the
other payors to cover Medicaid shortfalls.
development of access and quality performance standards
for Medicaid MCOs, and the measurement of compliance
Broadened use of managed care for low-income children
with those standards, is evolving. Ensuring that plans have
and families, the target of most managed care initiatives, is
provider networks in place, educating both providers and
unlikely to accomplish large overall savings for Medicaid.
beneficiaries about managed care, and responding to the
Acute care services for low-income children and adults
unique needs of the Medicaid population are critical to
account for a quarter of program spending, whereas
assuring access and quality of care in a managed care
approximately 60% of spending is for the elderly and the
environment.
disabled. Enrollment of elderly and disabled populations into
The Kaiser Commission on the Future of Medicaid was established by the Henry J. Kaiser Family Foundation in 1991 to function as a Medicaid policy institute
and serve as a forum for analyzing, debating and evaluating future directions for Medicaid and other health reforms affecting low-income Americans.
The Kaiser Family Foundation is an independent national health care philanthropy and not associated with Kaiser Permanente or Kaiser Industries.
B. Program Highlights
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table B-1
Status of Section 1115 Waivers, as of August 1997
Submitted
Under Review
Approved
Withdrawn
Denied
United States
New England
Connecticut
Maine
Massachusetts
New Hampshire
Rhode Island
Vermont
Middle Atlantic
New Jersey
New York
Pennsylvania
South Atlantic
Delaware
District of Columbia
Florida (1)
Georgia (2)
Maryland
North Carolina
South Carolina (3)
Virginia
West Virginia
East South Central
Alabama (4)
Kentucky
Mississippi
Tennessee
West South Central
Arkansas
Louisiana (5)
Oklahoma
Texas
East North Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
West North Central
lowa
Kansas (4.6)
(7/97)
Minnesota
Missouri
Nebraska
North Dakota
South Dakota
Mountain
Arizona
Colorado
Idaho
Montana (7)
Nevada
New Mexico
Utah
Wyoming
Pacific
Alaska
California (4)
Hawaii
Oregon
Washington
Source: Health Care Financing Administration
(1) Framework approved by HCFA, but state legislature has not authorized implementation of the plan.
(2) Limited benefit package.
(3) Framework approved, but state does not plan to implement. Activity suspended April 1995.
(4) Waiver does not apply to entire state.
(5) Financial proposal disapproved June 1995.
(6) Proposal withdrawn July 1997.
(7) First proposal disapproved September 1995; concept paper for new proposal submitted January 1997.
Kaiser Commission on the Future of Medicaid
Page 147
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure B-1
States with Section 1115 Waivers, as of August 1997
RI
DE
DC
Waiver Approved (19 states)
*
Proposal Under Review (8)
Proposal Disapproved (2)
Proposal Withdrawn (1)
Source: Health Care Financing Administration
Does not include the U.S. Territories. See Table 77 for more information.
* Waivers in Alabama and California do not apply to the entire state.
Page 148
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table B-2
Medicaid Spending as a Percentage of Total State Budgets and Federal
Grants-in-Aid, 1995
State Medicaid
Federal Medicaid
Total Medicaid
Spending as a % of
Spending as a % of
Spending as a % of
State-Only Revenues (1)
Federal Grants-in-Aid (2)
Total State Budgets (3)
United States
12.7%
42.8%
20.4%
New England
Connecticut
10.4
56.8
16.2
Maine
10.3
56.5
23.0
Massachusetts
12.3
51.3
20.5
New Hampshire
25.1
46.8
32.0
Rhode Island
18.3
41.6
24.5
Vermont
12.7
37.1
20.0
Middle Atlantic
New Jersey
15.8
53.9
23.5
New York
23.1
57.9
33.1
Pennsylvania
16.6
48.6
25.5
South Atlantic
Delaware
6.5
32.2
10.1
District of Columbia
n/a
n/a
n/a
Florida
9.4
39.8
15.8
Georgia
10.0
43.9
18.7
Maryland
11.9
42.0
17.9
North Carolina
4.7
34.6
12.0
South Carolina
8.3
43.9
19.3
Virginia
7.6
36.0
12.4
West Virginia
10.9
53.1
24.4
East South Central
Alabama
7.3
42.7
17.5
Kentucky
7.7
50.7
18.6
Mississippi
7.3
50.9
22.3
Tennessee
12.4
54.9
25.9
West South Central
Arkansas
6.2
47.9
17.0
Louisiana
24.6
66.2
38.2
Oklahoma
6.5
35.4
14.3
Texas
12.0
43.7
20.8
East North Central
Illinois
16.9
50.1
24.1
Indiana
9.2
42.6
18.0
Michigan
11.1
47.1
19.7
Ohio
21.1
28.2
21.6
Wisconsin
6.8
40.2
14.3
West North Central
lowa
7.2
30.2
13.3
Kansas
5.9
29.3
11.0
Minnesota
12.3
48.9
19.5
Missouri
10.6
55.5
21.7
Nebraska
7.3
39.5
15.2
North Dakota
6.7
29.8
14.9
South Dakota
9.6
33.1
18.9
Mountain
Arizona
7.8
32.7
15.7
Colorado
11.2
45.0
18.6
Idaho
5.9
29.3
12.6
Montana
6.2
37.0
15.4
Nevada
6.8
30.5
11.0
New Mexico
4.8
36.8
13.4
Utah
4.3
36.5
11.7
Wyoming
3.5
23.2
8.4
Pacific
Alaska
3.9
12.1
6.1
California
14.8
27.6
19.2
Hawaii
6.4
30.9
9.6
Oregon
7.2
37.8
14.4
Washington
9.9
42.4
17.4
Source: National Association of State Budget Officers
(1) The percentage of state funds (excluding all federal assistance) spent on Medicaid.
(2) The percentage of all federal assistance to the state spent on Medicaid.
(3) The percentage of each state's total budget, excluding bonds, that was spent on Medicaid. "Total state budgets" include both
state and federal revenue sources. "Total Medicaid spending" includes both state and federal Medicaid expenditures.
Kaiser Commission on the Future of Medicaid
Page 149
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure B-2
Total Medicaid Spending as a Percentage of Total State Budgets, 1995
RI
DE
DC n/a
< 15% (16 states)
15% - 19.9% (18)
20% - 29.9% (11)
30% + (5)
n/a (1)
Source: Urban Institute calculations based on HCFA 64 and National Association of State Budget Officers. 1995.
Does not include the U.S. Territories. Total Medicaid spending includes both state and federal Medicaid contributions. Total state budgets include all state
and federal funding sources except bonds.
Page 150
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Figure B-3
Federal Medicaid Spending as a Percentage of Federal Grants-in-Aid,
1995
RI
DE
DC n/a
Federal Spending as a % of Federal Grants-in-Aid
< 30% (7 states)
30% - 39.9% (16)
40% - 49.9% (15)
50% + (12)
n/a (1)
Source: National Association of State Budget Officers, 1996
Does not include the U.S. Territories. Federal Medicaid spending includes only federal contributions to Medicaid spending. Federal grants-in-aid are the total
federal dollars provided to states.
Kaiser Commission on the Future of Medicaid
Page 151
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table B-3
Annualized Medicaid Eligibility Thresholds for AFDC, Medically Needy, and SSI
Beneficiaries, 1995-1996
AFDC
Medically Needy (1)
Supplemental Security
Family of 3, 1996
Family of 3, 1996
Income, 1995
Percentage
Percentage
Maximum
Income Limit
Payment
of Poverty (3)
Allowable
of Poverty (3)
Annual Income
as a Percent
State
Standard (2)
( = $12,980)
Income
( = $12,980)
Limit
of Poverty
Alabama
$ 1,968
15%
$
n/a
n/a%
$ 5,352
75%
Alaska (4)
12,336
76
n/a
n/a
5,352
75
Arizona
4,164
32
n/a
n/a
5,352
75
Arkansas
2,448
19
3,300
25
5,352
75
California
7,284
56
11,208
86
5,352
75
Colorado
5,052
39
n/a
n/a
5,352
75
Connecticut
10,464
81
9,276
71
5,352
75
Delaware
4,056
31
n/a
n/a
5,352
75
Florida
3,636
28
3,636
28
5,352
75
Georgia
5,088
39
4,500
35
5,352
75
Hawaii (4)
8,544
57
8,544
57
4,752
67
Idaho
3,804
29
n/a
n/a
5,352
75
Illinois
4,524
35
5,904
45
3,396
48
Indiana
3,456
27
n/a
n/a
5,208
73
lowa
5,112
39
6,792
52
5,352
75
Kansas
5,148
40
5,760
44
5,352
75
Kentucky
6,312
49
3,696
28
5,352
75
Louisiana
2,280
18
n/a
n/a
5,352
75
Maine
6,636
51
5,496
42
5,352
75
Maryland
4,476
34
5,208
40
5,352
75
Massachusetts
6,780
52
9,300
72
5,352
75
Michigan
5,868
45
6,804
52
5,352
75
Minnesota
6,384
49
8,508
86
5,040
71
Mississippi
4,416
34
n/a
n/a
5,352
75
Missouri
3,504
27
n/a
n/a
5,064
71
Montana
5,258
41
5,964
46
5,352
75
Nebraska
4,368
34
5,904
45
5,352
75
Nevada
4,176
32
n/a
n/a
5,352
75
New Hampshire
6,600
51
7,824
60
5,232
74
New Jersey
5,316
41
6,804
52
5,352
75
New Mexico
4,668
36
n/a
n/a
5,352
75
New York (5)
7,884
61
9,800
76
5,352
75
North Carolina
6,528
50
4,400
34
2,904
41
North Dakota
5,172
40
6,060
47
4,428
62
Ohio
4,092
32
n/a
n/a
4,488
63
Oklahoma
3,684
28
5,508
42
5,352
75
Oregon
5,520
43
7,356
57
5,352
75
Pennsylvania
5,052
39
5,604
43
5,352
75
Rhode Island
6,648
51
8,900
69
5,352
75
South Carolina
2,400
18
n/a
n/a
5,352
75
South Dakota
6,084
47
n/a
n/a
5,352
75
Tennessee
6,996
54
3,000
23
5,352
75
Texas
2,256
17
3,204
25
5,352
75
Utah
6,816
53
6,816
53
5,352
75
Vermont
7,632
59
10,500
81
5,352
75
Virginia
2,880
22
4,300
33
5,352
75
Washington
6,552
50
8,004
62
5,352
75
West Virginia
3,108
24
3,480
27
5,352
75
Wisconsin
6,204
48
8,268
64
5,352
75
Wyoming
7,080
55
n/a
n/a
5,352
75
Source: National Governors' Association, August 1996
(1) Medically needy programs target individuals who have large medical costs but have income too high to become Medicaid-eligible through the AFDC or SSI
programs. States may establish higher income or resource standards for the medically needy. If states choose to establish a medically needy program, it
must serve pregnant women and children below age 18.
(2) The payment standard is the sum from which countable income of a recipient is deducted to determine the AFDC payment for the family. In most states, the
AFDC payment standard determines the earnings level at which AFDC eligibility ends. In Alaska, Colorado, Georgia, Kentucky, Maine, Michigan, Mississippi,
Montana, North Carolina, Oklahoma, South Carolina, Tennessee, and Utah, the medically needy threshold is the state's need standard. State income or
resource requirements for medically needy populations may be established at levels up to 133 1/3 percent of the maximum payment standard under a state's
AFDC program.
(3) This poverty guideline became effective March 4. 1996.
(4) Poverty guidelines for Alaska and Hawaii differ from those of other states: Alaska (family of three) = $16,220; Hawaii (family of three) = $14,930.
(5) The payment standard in New York State varies among the counties within the state. The figures shown are for New York City.
Page 152
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table B-4
Expanded Medicaid Coverage of Pregnant Women, Infants, and Children:
Income and Age Limits as of June 1, 1997
Pregnant Women
Children Under
Children Ages
and Infants (1)
Age Six (1)
Six and Older
Percentage of federal
Percentage of federal
Percentage of federal
State
poverty guideline
poverty guideline
poverty guideline
Age Limit (2)
Federal Mandate
133%
133%
100%
13
Alabama
133
133
100
13
Alaska
133
133
100
13
Arizona
140
133
100
14
Arkansas
133
133
100
13
California
200
133
100
19
Colorado
133
133
100
13
Connecticut
185
185
185
13
Delaware
185
133
100
19
District of Columbia
185
133
100
13
Florida
185
133
100
20
Georgia
185
133
100
19
Hawaii (3)
185 [300]
133 [300]
100 [300]
19
Idaho
133
133
100
13
Illinois
133
133
100
13
Indiana
150
133
100
13
lowa
185
133
100
13
Kansas
150
133
100
18
Kentucky
185
133
100
19
Louisiana
133
133
100
13
Maine
185
133
125
19
Maryland (4)
185
133 [185]
100 [185]
13
Massachusetts
185
133
100
13
Michigan (5)
185
150
150
15
Minnesota (3)
275
133 [275]
100/68 [275]
13/20
Mississippi
185
133
100
13
Missouri
185
133
100
19
Montana
133
133
100
13
Nebraska
150
133
100
13
Nevada
133
133
100
13
New Hampshire
185
185
185
19
New Jersey
185
133
100
13
New Mexico
185
185
185
19
New York
185
133
100
13
North Carolina
185
133
100
19
North Dakota
133
133
100
18
Ohio
133
133
100
13
Oklahoma
150
133
100
13
Oregon
133
133
100
19
Pennsylvania
185
133
100
13
Rhode Island (3)
250
250
250/185/100 [250]
8/13/18
South Carolina
185
133
100
13
South Dakota
133
133
100
19
Tennessee (3)
185 [400]
133 [400]
100 [400]
18
Texas
185
133
100
13
Utah
133
133
100
19
Vermont (3)
185 [225]
185 [225]
185 [225]
18
Virginia
133
133
100
19
Washington
200
200
200
19
West Virginia
150
133
100
19
Wisconsin
185
185
100
13
Wyoming
133
133
100
13
Source: National Conference of State Legislatures
(1) An infant is a child who has not yet reached his or her first birthday. A child in the "under age 6" category is age 1 or older, but has not yet reached
his or her sixth birthday.
(2) Under the Omnibus Reconciliation Act of 1990, states are required to provide Medicaid coverage to children ages six and older born after September
30, 1983, living in families with incomes below the federal poverty level (FPL).
(3) Hawaii, Minnesota, Rhode Island, Tennessee, and Vermont impose premiums and cost-shanng requirements on families with incomes that exceed
the minimum federal mandates. This table provides multiple income and age limits for these states. The lower numbers are the levels where premiums
begin, the highest number (in brackets) is the program limit. Note that Minnesota and Rhode Island have several income limits for older children.
(4) Maryland provides full Medicaid benefits to pregnant women and infants up to 185% FPL. Children ages 1 to 6 between 133%-185% FPL and 6 to 13
between 100-185% FPL get a reduced benefit package that includes prescriptions, vision care, primary, and preventive care.
(5) The age limit in Michigan is defined as being bom after June 30, 1979.
Kaiser Commission on the Future of Medicaid
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Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table B-5
Number and Percentage of Births Paid for by Medicaid, 1995 (1)
Births Paid for by Medicaid
Number
Percent of Total Births
United States
1,375,124
39%
Alabama
27,867
46%
Alaska
3,282
32%
Arizona
31,567
44%
Arkansas
16,606
47%
California
229,158
42%
Colorado
17,277
32%
Connecticut (2)
10,931
25%
Delaware
3,145
31%
Florida
79,969
45%
Georgia
58,680
52%
Hawaii
n/a
n/a
Idaho
6,608
37%
Illinois (3)
65,000
35%
Indiana
32,686
39%
lowa
11,892
32%
Kansas
n/a
n/a
Kentucky
n/a
n/a
Louisiana
34,863
53%
Maine
n/a
n/a
Maryland (2)
23,000
32%
Massachusetts
17,335
21%
Michigan
43,986
33%
Minnesota
20,645
33%
Mississippi
25,184
61%
Missouri
29,318
42%
Montana
4,266
38%
Nebraska
6,819
29%
Nevada
6,890
27%
New Hampshire
2,099
21%
New Jersey
n/a
n/a
New Mexico
14,276
53%
New York
103,516
38%
North Carolina
44,756
44%
North Dakota
1,913
23%
Ohio (2)
56,940
40%
Oklahoma (3)
19,103
42%
Oregon
14,865
35%
Pennsylvania
n/a
n/a
Rhode Island
4,170
33%
South Carolina (2)
21,859
47%
South Dakota
3,581
34%
Tennessee
34,639
47%
Texas
151,614
47%
Utah
12,306
31%
Vermont
2,615
39%
Virginia
n/a
n/a
Washington
31,978
42%
West Virginia
21,158
55%
Wisconsin
24,025
36%
Wyoming
2,737
44%
Source: National Governors' Association, September 1997.
N/A = data not available. In some cases, the state cannot calculate the number of births paid for by Medicaid for mothers enrolled in managed care plans.
(1) Figures for calendar year 1995 were reported by the states. The National Governors' Association notes that they cross-checked the number of births
with numbers cited in National Center for Health Statistics: "Report of Final Natality Statistics, 1995." Monthly Vital Statistics Report 45(11), supplement,
June 10, 1997.
(2) Data based on the state's fiscal year, not the calendar year.
Page 154
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
Table B-6
Medicaid Beneficiaries, Enrollees, and Full-Year Equivalent Enrollees, 1995
F.Y.E.
Beneficiaries
Enrollees
Enrollees
United States
35,214,008
41,672,014
32,826,963
Alabama
537,463
621,625
449,383
Alaska
68,117
85,313
65,414
Arizona (1)
493,693
679,919
533,012
Arkansas
349,938
371,047
273,969
California
4,941,800
6,774,415
5,162,511
Colorado
292,647
368,545
268,041
Connecticut
365,744
392,289
322,338
Delaware
78,074
86,232
66,686
District of Columbia (2)
136,888
137,371
112,048
Florida
1,734,434
2,159,321
1,603,122
Georgia
1,137,580
1,234,556
976,174
Hawaii (3)
228,242
251,091
177,391
Idaho
115,014
130,942
91,917
Illinois
1,550,471
1,923,298
1,599,390
Indiana
557,482
640,508
556,752
lowa
303,628
331,714
245,000
Kansas
251,907
281,396
199,881
Kentucky
621,878
697,804
548,358
Louisiana
761,386
801,930
635,593
Maine (4)
176,646
196,362
153,823
Maryland
412,511
608,929
451,591
Massachusetts
725,178
806,429
732,107
Michigan
1,164,098
1,416,005
1,153,238
Minnesota
459,818
543,551
439,910
Mississippi
519,467
564,341
450,460
Missouri
695,458
790,362
641,061
Montana
97,555
104,064
75,471
Nebraska
163,305
178,624
137,269
Nevada
104,620
140,784
99,849
New Hampshire (4)
102,086
111,428
79,812
New Jersey
777,346
879,326
709,127
New Mexico
283,077
331,808
231,663
New York
3,024,183
3,327,395
2,773,060
North Carolina
1,076,316
1,128,946
846,087
North Dakota
61,284
69,108
54,851
Ohio
1,504,506
1,607,557
1,277,999
Oklahoma
393,127
458,558
325,591
Oregon
451,959
485,222
304,376
Pennsylvania
1,230,193
1,773,621
1,463,197
Rhode Island
135,530
151,820
128,242
South Carolina
494,379
540,682
436,374
South Dakota
73,422
83,239
61,054
Tennessee (1)
n/a
1,487,422
n/a
Texas
2,531,155
2,888,398
2,139,953
Utah
160,408
204,619
137,965
Vermont
97,361
105,096
84,969
Virginia
678,312
725,345
575,300
Washington (4)
708,177
846,177
655,296
West Virginia
388,662
449,898
297,844
Wisconsin
458,722
640,028
496,427
Wyoming
51,342
57,554
38,600
Source: HCFA-2082 reports, unless noted otherwise
"Enrollees" are people that sign up for Medicaid and are eligible to receive services; enrollees do not necessarily use services. "Beneficiaries" are enrollees
that actually use services. "Full-year equivalent enrollees" are enrollee counts adjusted to reflect the fact that not all enrollees remain in Medicaid for an
entire year.
(1) Medicaid programs in Arizona and Tennessee are almost completely capitated. Under such arrangements, total enrollee counts are a more appropriate
measure of beneficiaries than enrollees actually receiving services, since payment is not based on use of services. We used a combination of data from
HCFA-2082 reports and supplemental state data to estimate enrollee counts. See Appendix C.
(2) For certain groups in these states, the number of beneficiaries was greater than the number of enrollees; beneficiary counts were adjusted accordingly.
(3) Hawaii's HCFA-2082 report for 1995 appears to exclude data from QUEST, the state's large demonstration project. Data shown here are Urban Institute
estimates based on data from HCFA-2082 reports and supplemental state data. See Appendix C.
(4) Beneficiary counts for certain groups in these states were inexplicably low compared to past data and current enrollee levels; beneficiary counts were
adjusted accordingly.
Kaiser Commission on the Future of Medicaid
Page 155
C. Data Sources and Methodology
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
DATA SOURCES AND METHODOLOGY
reports may be edited prior to using these data in the
calculations.
Maintaining comparable data across state programs,
Data Edits
and even across years within one state, is becoming
more difficult as state Medicaid programs increas-
ingly turn to managed care, section 1115 research
Historically, HCFA-2082 reports have been problem-
and demonstration projects, and other waivers to
atic data sources, although data quality has vastly
tailor programs to meet state-specific needs. Data
improved in recent years. Still, these data often
used in creating the tables in this report come pri-
contain errors. Common errors include missing,
marily from state reports to the Health Care Financ-
zero, or negative expenditures for some services or
ing Administration (HCFA). In some cases, how-
eligibility groups; extreme shifts in expenditures or
ever, extensive use of Medicaid managed care or
enrollment patterns across years; and inconsisten-
data problems or both related to a Section 1115
cies between enrollment and expenditure levels.
demonstration necessitated data from additional
sources. States in which additional information was
To correct these errors, a number of adjustments are
used are discussed later in this section.
made. Some adjustments correct obviously errone-
ous data, while others address classification errors.
These edits do not affect total expenditures reported
Data Sources
by state, and only rarely will they affect total spend-
ing for a particular service. Rather, most edits
The primary data sources used in this report are
change the distribution of expenditures among
HCFA-2082 reports (Statistical Report on Medical
groups (spending for a given service for adults rela-
Care: Eligibles, Recipients, Payments, and Services)
tive to the spending for the same service for children,
and HCFA-64 reports (State Quarterly Statements of
for example) to better reflect how the dollars were
Medicaid Expenditures for the Medical Assistance
actually spent.
Program). HCFA-2082 reports are basic sources of
state-reported data on Medicaid population charac-
teristics and utilization. These reports contain state-
Likewise, total beneficiary counts from HCFA-2082
level data on Medicaid beneficiaries (which we define
reports are rarely affected by the edits. Most edits
as people actually receiving Medicaid services), rea-
will only change the cash and non-cash distribution
sons for enrollment, the types of medical services
of beneficiaries within groups, just as with the ex-
provided to beneficiaries, and government expendi-
penditure data. However, a few adjustments require
tures on these services. HCFA-64 reports, by con-
considerable changes to state data. These adjust-
ments are described in more detail later in this sec-
trast, are accounting statements of expenditures
made by the states for which they are entitled to re-
tion (see Section 1115 Waiver States).
ceive federal reimbursement under title XIX of the
Social Security Act. Expenditure data on HCFA-64
209(b) States
reports are considered to be more reflective of true
Medicaid spending than expenditure data from
A number of states use different Medicaid eligibility
HCFA-2082 reports, but the HCFA-64 reports lack
rules for aged, blind, and disabled persons, exercis-
enrollment data and report only aggregate spending
ing an option available under section 209(b) of the
by state and type of medical service.
Social Security Amendments of 1972. This option
allows states to continue using the financial stan-
Seeking to draw on the strengths of both sources,
dards and definitions for disability they had in effect
Urban Institute researchers developed a crosswalk.
prior to the establishment of the Supplemental Secu-
This crosswalk uses expenditure data from HCFA-
rity Income (SSI) program to determine Medicaid
2082 reports to determine relative expenditures by
eligibility for the aged, blind, and disabled. States
age, disability, and eligibility group. Total spending
not exercising the 209(b) option are required to
by state and type of service are then adjusted to
make all SSI recipients automatically eligible for
match the levels in HCFA-64 reports. Beneficiary
Medicaid.
data come only from HCFA-2082 reports (except in
Hawaii, Oregon, and Tennessee; see "1115 Waiver
One result of this option is that 209(b) states can
States" below). As discussed in the next section,
have definitions of cash and non-cash status for the
expenditure and beneficiary data from HCFA-2082
aged, blind, and disabled that are inconsistent with
Kaiser Commission on the Future of Medicaid
Page 159
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
the definition used by the vast majority of states.
For this report, payments to managed care organiza-
Whereas most states report all SSI beneficiaries un-
tions are assumed to cover primarily non-disabled
der "cash assistance," SSI recipients in 209(b) states
adults and children, except the medically needy.
could be categorized as "non-cash" since disability-
Payments to MCOs in each state are allocated to
not SSI cash assistance-is the basis of eligibility.
adults and children based on overall Medicaid en-
rollment and claims-based acute care expenditures.
Four 209(b) states had unusual distributions for
More weight is given to groups reporting high relative
aged, blind, and disabled beneficiaries in 1995
enrollment levels, but lower relative acute care
(Connecticut, Hawaii, New Hampshire, and Ohio).
spending. This method works under the assumption
These states reported few, if any, aged, blind, and
that payments to MCOs replace spending previously
disabled Medicaid beneficiaries under cash assis-
reported under specific acute care services.
tance. To keep the definition of cash assistance
consistent across states, data from other 209(b)
The following formula was typically used to estimate
states with more compatible distributions were used
the amount of payments to MCOs attributable to
to estimate cash and non-cash distributions for the
each of four eligibility groups that typically enroll in
aged, blind, and disabled in these problem states.
managed care plans:²
Note that this does mean that data from these four
states are necessarily incorrect; rather, the changes
were made because the categorization of recipients
in those states did not allow direct comparison with
other states.
*
Payments to Managed Care Organizations and
Medicare
Where:
Recent growth of capitated payments under Medi-
caid managed care makes it increasingly challenging
Pe.i=
percent of total enrollment for group i
to understand individual state Medicaid programs, or
to prepare multi-state comparison tables like the
Pa,i=
percent of total fee-for-service acute care
ones in this book. In the past, states primarily re-
expenditures for group i
ported expenditures by type of service for adults,
Xₘc=
total reported payments to MCOs and group
children, disabled, and elderly beneficiaries. For ex-
health plans for the state
ample, spending was presented as inpatient hospital,
physician services, and outpatient services for each
The percentage of total fee-for-service acute care
beneficiary group. Under managed care arrange-
expenditures for each group (Pa.i) is first adjusted to
ments, states tend to report only total payments to
reflect the fact that adults, especially pregnant
managed care organizations. Little information is
women, ordinarily cost about 50% more to cover
gathered on either HCFA-2082 or HCFA-64 reports
than children. Total payments are then distributed
as to how and for whom these dollars are spent.
based on relative enrollment (Pe.i). If a group's en-
While more detailed data are sometimes available
rollment percentage is higher or lower than its ex-
directly from state Medicaid offices, it is often difficult
pected fee-for service acute care use (Pa,i), the per-
to present these data so that they are comparable
centage is adjusted upward or downward accord-
across states.
ingly. Finally, the denominator of the equation re-
bases the percents such that they sum to 1. This
The net result of increasing managed care use is
method to was used distribute MCO spending in all
that claims-based data on acute care service utiliza-
states except those involved in section 1115 demon-
tion are being replaced by lump-sum capitated
strations, where payments to MCOs constitute a
amounts.¹ Nonetheless, it is essential to include
much larger share of total Medicaid spending.
capitated payments when determining spending per
beneficiary-especially for adults and children-so
While also growing in recent years, payments to
that these estimates are not increasingly biased
Medicare are a relatively small portion of total Medi-
downward as more people enroll in managed care.
2 The four eligibility groups are cash assistance adults, cash as-
1
Medicaid is not unique in this regard and only reflects nation-
sistance children, poverty-related adults, and poverty-related
wide trends.
children.
Page 160
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
caid spending in most states. For this report, pay-
states, MCO payments are classified as acute care
ments to Medicare in each state are distributed to
spending for non-disabled adults and children.
elderly and blind/disabled beneficiaries using a 65
There are two problems with this approach in Ari-
percent to 35 percent split, respectively. Relative
zona. First, the state provides both acute and long-
spending on cash assistance and other beneficiaries
term care services through capitated arrangements.
within each group are then based on relative benefi-
Second, both programs cover elderly, blind, and dis-
ciary levels.
abled people through capitated payments.
Section 1115 Waiver States
To address these problems, the Arizona AHCCCS
program was contacted and additional information
Section 1115 waivers, also called research and
was requested to help distribute these payments to
demonstration waivers, are increasingly being used
MCOs to the appropriate groups. Based on informa-
by states to enact a broad variety of initiatives. Un-
tion provided by the state, a portion of MCO pay-
ments were removed from acute care and distributed
der authority given in section 1115 of the Social Se-
curity Act, states can deviate from many Medicaid
among long-term care services. This adjustment
requirements in order to test new ideas. Currently
brought acute care and long-term care expenditures
approved waiver projects range from small-scale
in line with total spending for AHCCCS and ALTCS,
pilot projects testing new benefits or financing
respectively. The remaining payments to MCOs
mechanisms to major restructuring of state Medicaid
were then distributed among the aged, blind and dis-
abled, adults, and children based on nationwide
programs.
spending per beneficiary estimates.
Six states operated all or part of their Medicaid pro-
grams under section 1115 waivers in 1995: Arizona,
Hawaii
Hawaii, Minnesota, Oregon, Rhode Island, and Ten-
nessee. All of these demonstrations enrolled a sig-
Implemented in August 1994, Hawaii's QUEST pro-
nificant number of beneficiaries in managed care,
gram enrolls AFDC-related and poverty-related
requiring a deviation from the standard method of
groups in managed care.³ In 1995, coverage was
distributing payments to MCOs. Reporting problems
also extended to non-elderly, non-disabled uninsured
were also more prevalent in these states, especially
persons with incomes under 300 percent of the fed-
cases of missing or unknown data. Consequently,
eral poverty line (although some people are required
significant changes to some data from these states
to pay a premium). Hawaii's 1995 HCFA-2082 re-
were made so that they could be included in this re-
port appears to exclude recipient and expenditure
port. In all cases, considerable effort was made to
data for people covered by QUEST.4 Thus, while
maintain consistency with each state's current and
aggregate expenditure data were available from the
historical reporting. This section summarizes the
HCFA-64 report, there was no sufficient data to
changes.
categorize these expenditures by beneficiary group.
Sources other than the HCFA-2082 were required to
estimate the number of QUEST beneficiaries.
Arizona
Created in 1982, the Arizona Health Care Cost
Additional data was obtained from Hawaii, but it was
Containment System (AHCCCS) was the first state-
difficult to categorize in the same manner as other
wide, pre-paid Medicaid managed care program in
states report to HCFA. Based on these data, roughly
the nation. Primarily an acute care program,
175,000 QUEST beneficiaries were estimated to be
AHCCCS is largely funded through capitated pay-
missing from the state's HCFA-2082 report. These
ments. In 1988, Arizona added the Arizona Long-
people were categorized as either adults or children
Term Care System (ALTCS) to provide long-term
based on Hawaii's estimates of enrollment by age.
care services through capitated payments. Due to
These new beneficiaries were then given a cash and
non-cash status based on Hawaii's estimates of the
the unique structure of these two programs, Ari-
zona's Medicaid data are typically difficult to com-
pare or combine with other states. Several adjust-
3
QUEST is an acronym for the five initial goals of Hawaii's
ments were required to keep Arizona in the tables.
waiver program, which are: quality of care, universal access,
efficient utilization, stable cost, and transformation.
A very large percentage of Arizona's expenditures
4 Data were present on form 2082 for the aged, blind, and dis-
are classified as "payments to MCOs." For most
abled since these groups are still covered on fee-for-service ba-
sis.
Kaiser Commission on the Future of Medicaid
Page 161
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
number of AFDC, foster children, general assis-
nursing facilities and other medical institutions who
tance, and SHIP beneficiaries participating in
receive home- and community-based services, if
QUEST.5
their incomes were below 300 percent of SSI.
The prevalence of managed care in Hawaii also
Data problems arose in Oregon because the state's
caused a large portion of expenditures to be reported
HCFA-2082 report contained data categorized using
as payments to MCOs on the state's HCFA-64 re-
state-specific, unique Maintenance Assistance
port. Using more data obtained directly from Hawaii,
Status and Basis of Eligibility codes. As a result,
payments to adults and children were distributed
much of Oregon's expenditure and beneficiary data
based on estimated per capita costs.
are categorized as "unknown" in the HCFA-2082
data released by HCFA. Based on data from an
auxiliary HCFA-2082 report provided by Oregon, the
Minnesota
"unknown" expenditures and beneficiaries were re-
classified under adults and children receiving non-
Minnesota received approval for a managed care
cash assistance.
program to operate in 14 counties in 1995. The Pre-
paid Medical Assistance Plan (PMAP) covers all
children up to age 19 with family incomes below 275
Oregon also reports a substantial amount of pay-
percent of the federal poverty level. The state's
ments to MCOs on its 1995 HCFA-64 report. The
beneficiary data appear consistent with its current
state also enrolls elderly, blind, and disabled persons
Medicaid rules. However, Minnesota's 1995 expen-
in capitated arrangements, so the usual distribution
diture data from the HCFA-64 report include little or
formula could not be used. To provide the best pos-
no spending for most acute care services. The ex-
sible estimates of spending per beneficiary, data
ception is a very large amount of "other acute" ex-
provided by both Oregon and HCFA were used to
penditures. This other acute spending appears to
distribute payments to MCOs across all eligibility
include nearly all of the state's acute care spending
groups.
for 1995. Medicaid officials in Minnesota confirmed
that there was a problem with the HCFA-64 report
Finally, Oregon provides a large percentage of long-
due to a change in the state's computer system, but
term care through Home- and Community-Based
revised data are not yet available. Consequently, the
Service (HCBS) waivers, but the distribution of
state's historical HCFA 64 expenditure data were
HCBS spending is not recorded on HCFA-2082 re-
used to redistribute most of this other acute spend-
ports. Supplemental data from Oregon were used to
ing to specific acute care services.
redistribute HCBS waiver expenditures among eld-
erly, blind and disabled beneficiaries.
Oregon
Rhode Island
In 1994, Oregon began enrolling Medicaid-eligible
adults and children in managed care through the
Implemented in August 1994, Rhode Island's Rite
Oregon Health Plan (OHP). The OHP expanded
Care enrolls all AFDC-related and poverty-related
Medicaid eligibility to people with family incomes less
eligibles in Medicaid managed care. The state ex-
than 100 percent of the federal poverty line, or FPL.
tended coverage in 1995 to include pregnant women
The previous limit was 67 percent of the FPL. Ore-
and uninsured children age six or younger with family
gon also covers pregnant women and uninsured
incomes under 250 percent of the federal poverty
children below age 6, as long as they have family
line (with some cost sharing above 185 percent). As
incomes below 133 percent of the FPL. Initially, the
expected, Rhode Island's reported payments to
OHP excluded people age 65 and older, people with
MCOs are noticeably higher on the 1995 HCFA-64
disabilities, and foster children. In 1995, Phase II of
report than in 1994. Similarly, there are more adult
implementation extended eligibility to many of these
and child eligibles reported on the HCFA 2082 (these
people.6 The program also began enrolling people in
people show up under "non-cash assistance" in the
tables).
5 Hawaii S State Health Insurance Program (SHIP) was a prede-
There does not appear to be a problem with Rhode
cessor of QUEST.
Island's current data; no data are missing, and re-
6
Eligibility for the aged, blind, and disabled was limited to indi-
viduals receiving payments from either SSI or the Oregon Sup-
plemental Income Program (OSIP).
Page 162
Kaiser Commission on the Future of Medicaid
Medicaid Expenditures and Beneficiaries, National and State Profiles and Trends, 1990-1995
ported data are consistent with the state's Medicaid
"State Profiles" section of this report. These trends
rules. Unfortunately, Rhode Island's HCFA-2082
are a result of Indiana's previous contract with a
reports for previous years frequently contained erro-
Health Insuring Organization (HIO), an arrangement
neous or missing data that necessitated data esti-
that ended in 1994.
mation. There are some noticeable differences be-
tween Urban Institute estimates for previous years
State officials informed us that Indiana paid negoti-
and the reported 1995 data. Only one edit was
ated premiums on a per recipient basis for services.
made to the 1995 data, which was to redistribute
The HIO shared the risk with the Medicaid program.
payments to MCOs among all reported adult and
At the end of each year, actual costs were compared
child beneficiaries. Due to reporting problems in
to the premiums collected, and excesses or short-
past years, readers may notice significant differ-
falls beyond a set threshold were split by formula
ences when comparing Rhode Island's 1995 data
between the Medicaid program and the HIO in a set-
with data from other years.
tlement process. In general, the HIO returned large
amounts of money to the state. Because the state
Tennessee
recorded these settlements as accounting adjust-
ments on its HCFA-64 reports, they do not show up
One of the largest 1115 waiver programs, Tennes-
in the expenditures reported in most tables. How-
see's TennCare program enrolls all Medicaid eligi-
ever, expenditures reported in the State Profiles sec-
bles in managed care except qualified Medicare-only
tion include the initial payments to the HIO. Conse-
beneficiaries. Data problems arose with Tennessee
quently, spending in Indiana between 1992 and 1994
because the state submitted its 1115 demonstration
is likely to be overstated.
data to HCFA using state-specific, unique Mainte-
nance Assistance Status codes. Consequently, data
Massachusetts
received from HCFA contain large numbers of eligi-
bles and expenditures categorized as unknown.
Readers may also note the unusually high rate of
Other information from HCFA revealed more poten-
growth for expenditures per beneficiary in Massa-
tial problems with Tennessee's 1995 HCFA-2082
chusetts between 1993 and 1995. The growth rates
report, including:
in state level trend tables used in this report likely
inconsistent counts of aged recipients in
overstate the actual rate of growth. Two factors lead
mental health hospitals,
us to make this assertion. First, the state reported a
decrease in beneficiaries (recipients) in both 1994
excessive recipients and expenditures clas-
and 1995, but their reported enrollment grew over
sified under other acute care, and
the same period. This implies that the beneficiary
under-reported capitated payments.
count may be low.
These last two problems cause Tennessee's recipi-
Second, a closer look at Massachusetts' HCFA 64
ent counts to exceed the total enrollment count.
data reveals rapid growth in certain services from
Using data obtained from TennCare, new enrollee
1993 to 1995-especially other care. Discussions
and recipient counts for 1995 were calculated based
with state officials revealed that Massachusetts con-
on average monthly caseloads. Similarly, TennCare
tracts with an HIO to provide some services. The
provided additional managed care enrollment and
HIO receives a large payment up front, and unused
capitation rate information that allowed more accu-
funds are returned to the state during a settlement
rate distribution of payments to MCOs.
process. Money returned to the state is recorded as
an adjustment on the HCFA-64 report. The expen-
diture data used to calculate spending per benefici-
Other State-Specific Notes
ary do not include adjustments, however they include
initial payments to the HIO. Consequently, actual
Two additional states had technical issues with their
spending per beneficiary in recent years is probably
data. These are explained below.
lower than the figures shown in this report.
Indiana
Readers may note unusual spending trends in Indi-
ana between 1991 and 1995 on several tables in the
Kaiser Commission on the Future of Medicaid
Page 163
The Kaiser Commission on the Future of Medicaid
1450 G Street, N.W., Suite 250
Washington, D.C. 20005
202-347-5270
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