GAO: 5% of Medicaid-only Enrollees Account for Nearly Half of Costs

A small percentage of Medicaid-only enrollees—those who were not also eligible for Medicare—consistently accounted for a large percentage of total Medicaid expenditures, according to the Government Accountability Office.

GAO analyzed data from the Medicaid Statistical Information System Annual Person Summary File for fiscal years 2009, 2010, and 2011—the most recent years for which data from almost all states were available. What auditors found was that in fiscal years 2009-2011 the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. By comparison, the least expensive 50 percent of Medicaid-only enrollees accounted for less than 8 percent of the expenditures for these enrollees.

Also See: AHRQ: Top 1% of Patients Account for 22% of Costs

“Studies on healthcare spending generally find that a small percentage of individuals account for a large proportion of expenditures, and Medicaid—a federal-state health financing program for low-income and medically needy individuals—is no exception,” states the report.

Of the Medicaid-only enrollees who were among the 5 percent with the highest expenditures within each state, the nationwide proportions of these enrollees in different eligibility groups (such as the disabled or children) and with certain conditions (such as asthma) or services (such as childbirth or delivery) were also consistent from fiscal years 2009-2011.

“Although only a small proportion of Medicaid-only enrollees were disabled (less than 10 percent), disabled enrollees were disproportionately represented in the high-expenditure group, consistently constituting about 64 percent of those with the highest expenditures,” according to GAO. “Conversely, although children were the largest group of Medicaid-only enrollees (about 50 percent), they consistently constituted about 16 percent of the high-expenditure group.”

The full GAO report can be found here.