The Government Accountability Office last week released findings showing 5% of Medicaid-only eligible enrollees accounted for nearly 50% of the billions of government dollars paid in Medicaid-only eligible claims. The period examined was 2009-2011.
“Studies on healthcare spending generally find that a small percentage of individuals account for a large portion of expenditures, and Medicaid … is no exception,” the OIG declared in its May 8 report to the Senate Finance Committee.
In contrast to the high-cost 5% group, the least expensive 50% of Medicaid-only enrollees accounted for less than 8% of the expenditures for those enrollees. Medicaid expenditures for fiscal 2013 totaled about $460 billion, covering about 72 million enrollees, some of whom were also eligible for Medicare.
Medicaid is far and away the No. 1 payer of skilled nursing care in the United States.
The GAO noted that the distribution of high-expenditure Medicaid-only enrollees’ expenditures among categories of service in fiscal 2011 varied widely across states. Expenditures for managed care and premium assistance varied most widely (from 0% to 75%).
The GAO suggested that CMS improve efforts to manage expenditures and facilitate improvements to care by identifying additional information about Medicaid-only eligible enrollees responsible for a high proportion of expenditures.