Medicaid-only long-term care residents driving up state expenditures, report finds

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Sen. Charles Grassley (R-IA)
Sen. Charles Grassley (R-IA)

Among people eligible for Medicaid but not Medicare, long-term care residents are most likely to be among the costliest beneficiaries for a state, according to a new report from the Government Accountability Office.

Investigators based their analysis on fiscal year 2009 government data, such as from the Medicaid Statistical Information System. Beneficiaries whose total Medicaid charges were within the top 5% of the state's total expenditures were defined as the “high-expenditure” group.

Residents of long-term care facilities had a 24% probability of being in the high-expenditure group, the analysts found. Those with HIV/AIDS had the second-highest probability (20.8%), followed by those with disabilities.

Sen. Charles Grassley (R-IA) requested the report, noting that much research has focused on those eligible for both Medicaid and Medicare, but has largely overlooked the Medicaid-only group. The GAO findings are meant to guide policymakers' efforts to manage spending, the report states. However, it does recommend specific changes.

The high-expenditure group represented 4.3% of total Medicaid beneficiaries nationally, but accounted for 31.6% of state Medicaid spending in 2009, according to the report. Dual eligibles were a costlier group, accounting for 35.2% of spending.

The remaining third of Medicaid dollars went toward the beneficiaries who were not in the high-expenditure or dual-eligible groups — and this cohort accounts for the majority (81%) of those enrolled in Medicaid, the report notes.

However, spending per high-expenditure beneficiary varies greatly between states, the GAO found. New York and Alaska had per-capita expenditures of $55,000 or more, while 16 states had per-capita expenditures of less than $35,000.

Click here to access the complete report, released Wednesday.

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