mmpc - National Indian Health Board

Methods
are in Attachment Table C.3, and the mean Total Payment per Recipient are provided for the
analysis groups in each IHS Area in Attachment Table C.4.
Enrollment for Less than 12 Months
Analyses are done separately for Medicaid Recipients enrolled the full 12 months of the year, and
those enrolled less than 12 months. The Mean Total Payment per Year for Recipients enrolled all 12
months of the year is greater than that for Medicaid Recipients enrolled less than 12 months because
of shorter time of coverage (Table 4). However when analyzed as Mean Total Payment per Month,
the payments for Medicaid Recipients enrolled less than 12 months is systematically larger. Reasons
offered for this bias found in many studies of program enrollees is that there is a ‘pent up demand’
for medical service in enrollees who start coverage during the year, and there is a high utilization at
end of life that occurs for enrollees who die during the year. Varying months of enrollment and
differences amounts of enrollment in managed care plans can affect this phenomenon. This
phenomenon was found to occur for IHS AIAN ($424 and $505 per Recipient per Month with nonoverlapping
95% Confidence Limits, C.L.) and Other AIAN ($310 and $410 per Recipient per Month
with non-overlapping C.L.), but was reversed for Whites ($379 and $371 per Recipient per Month
with non-overlapping C.L.) (Table 4). To avoid potentially unadjusted differences between the
groups behind the phenomenon, data for Medicaid Recipients enrolled 12 months is analyzed
separately from those enrolled less than 12 months. For IHS Area-specific values for the numbers of
recipients and Mean Total Payment per Year for Recipients enrolled 12 months and enrolled less
than 12 months see Attachment Tables C.5 and C.6.
Table 4. Mean Medicaid and Third Party payments per Medicaid recipient* divided between those enrolled all 12
months, and those enrolled less than 12 months for the main analysis groups. The 95% Confidence Limits are
also shown.
Analysis Groups Recipients* Mean +/- C.L. Mean +/- C.L. Mean +/- C.L.
Recipients* enrolled 12 months
IHS AIAN 271,509
Other AIAN 83,156
Whites, Non-Hispanic 588,629
Recipients* enrolled Less than 12 months
IHS AIAN 224,120
Other AIAN 70,296
Whites, Non-Hispanic 485,295
Recipients* enrolled 12 months
IHS AIAN 271,509
Other AIAN 83,156
Whites, Non-Hispanic 588,629
Recipients* enrolled Less than 12 months
IHS AIAN 224,120
Other AIAN 70,296
Whites, Non-Hispanic 485,295
Medicaid Third Party Total
$ 5,086 $ 57 $ 42 $ 10 $ 5,128 $ 58
$ 3,721 $ 120 $ 35 $ 5 $ 3,756 $ 120
$ 4,551 $ 31 $ 104 $ 15 $ 4,656 $ 34
$ 2,997 $ 47 $ 17 $ 4 $ 3,014 $ 47
$ 2,050 $ 84 $ 16 $ 3 $ 2,066 $ 85
$ 2,085 $ 19 $ 33 $ 4 $ 2,118 $ 19
$ 424 $ 5 $ 3 $ 1 $ 427 $ 5
$ 310 $ 10 $ 3 $ 0 $ 313 $ 10
$ 379 $ 3 $ 9 $ 1 $ 388 $ 3
$ 505 $ 10 $ 3 $ 1 $ 507 $ 10
$ 410 $ 23 $ 3 $ 1 $ 413 $ 23
$ 371 $ 5 $ 7 $ 1 $ 378 $ 5
9
Annual Payment per Recipient
Monthly Payment per Recipient
*Only enrollees who are recipients of services are included because analyses exclude enrollees with zero dollar Medicaid
payments.