5 percent of Medicaid enrollees accounted for half of program’s spending: Gov’t study

A small-but-expensive fraction of Medicaid recipients accounted for nearly half of all spending for the program each year from 2009 to 2011, according to a new government report that studied people who do not also receive Medicare.

“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,” the Government Accountability Office said Friday in a report to Congress.

Medicaid had roughly 72 million enrollees and spending about $460 billion in fiscal 2013, although some also receive Medicare, a separate government-sponsored program. These “dual eligibles” accounted for about 13 percent of the Medicaid population and were excluded from the GAO study.

The most expensive 1 percent of Medicaid-only enrollees accounted for about a quarter of spending among that population, and the priciest 5 percent accounted for nearly half, the GAO found.

From there, the most expensive quarter of enrollees chalked up 75 percent of the expenditures.

By contrast, the GAO found that the least expensive half of Medicaid-only enrollees accounted for less than 8 percent of spending.

The GAO conducted the study as some states expand Medicaid under the Affordable Care Act.

In 2012, the Supreme Court said states can choose whether to extend the federal-state benefits to those making up to 138 percent of the federal poverty level. The federal government picks up the tab for expansion until 2016, a share that scales down to 90 percent in 2020 and beyond.

The Congressional Budget Office has estimated that 8 million additional people could get Medicaid or Children’s Health Insurance Program as a result of Obamacare by 2016, when compared to 2012.

“As Medicaid enrollment increases, more extensive information about high expenditure enrollees who are not dually eligible for Medicare — that is, Medicaid-only enrollees — could enhance efforts to manage expenditures and facilitate improvements to care,” the GAO said.