mmpc - National Indian Health Board

Findings
Findings
Payments for AIAN Medicaid Recipients
The total amount of Medicaid funds paid in 2006 for 550,000 IHS AIAN Medicaid enrollees living in the service
delivery Areas of IHS and tribally operated facilities for paid personal health care services was $ 2.05 billion
(Table 2). The personal health care services included Medical (including physician, clinic, outpatient, laboratory
and imaging, pharmacy), Behavioral Health and Dental Care services. An additional $15 million was paid by
other third-party payers (mainly private insurance) to cover payments for the claims filed with Medicaid. Of
those IHS AIAN Medicaid enrollees 496,000 were recipients of Medicaid paid services during the year.
Findings are presented here for the CHSDA counties of the IHS service delivery areas. The numbers of IHS AIAN
with Medicaid coverage in the separate states of each IHS service delivery area are not large enough to give
statistically reliable findings (the numbers and payments for AIAN in the counties of the IHS service delivery
areas of the states in the analytical subgroups are presented in Attachments F to I). One of the main reasons why
state numbers of IHS AIAN are not large enough is that not all states report IHS claims separate from other
claims (see American Indian and Alaska Native Medicaid Program and Policy Statistics: Summary Report 2009)
and when they do they do not capture all claims for IHS AIAN.
Recipients with Fee-for-Service Medical Services
Age, Sex, Disability & Morbidity Do Not Explain Differences in Payments
If left unadjusted for any determinants, the mean total payment for IHS AIAN recipients with FFS medical care
who are less than 65 years of age is only slightly higher than Whites ($5,104 compared to $4,960, or $144
difference), but much higher than Other AIAN ($3,670, or $1,436 difference) (Figure 1). The minimal actuarial
adjustment for age and sex differences increases the difference in payments between IHS AIAN and Whites
($7,052 compared to $6,369, or about $600) but not with Other AIAN ($7,052 compared to $5,567, or about
$1500). This effect is expected because the IHS AIAN have a younger age distribution than that of Whites and
therefore lower expected payments, but a similar age distribution to that of Other AIAN and therefore similar
expected payments. The mean adjusted payment increases for all three groups with the age adjustment because
payments for older more costly recipients are given equal weight with less costly younger recipients which
constitute the vast majority of the recipients in all three groups. This is how the statistical adjustment controls
for the differences in age distributions across the three groups.
Adjusting payments further for disability status, either because of Medicaid eligibility as a disabled enrollee, or
as a Medicare-Medicaid ‘Dual’ enrollee under age 65, increases the adjusted means and the differences in means
for all three groups (Figure 1). The mean total payment for IHS AIAN is much higher for Whites ($9,999
compared to $7,884, or a $2,115 difference) and for Other AIAN ($7,319, or a $2,680 difference). Again the
adjusted mean rises for all groups because the higher payments for the smaller groups of Disabled are given
equal weight with less costly but higher proportions of non-disabled recipients during the statistical
adjustment.
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