Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Figure 20-3. <strong>Medicaid</strong> Expenditures by Type of Service, 1995 (percentage)
inatient H ospita DSH Paymnents
Drugs > z ome Health
Go_ ~~~~~~~~~Meniai Health
Acute
<strong>Care</strong>
2%
44%
FhyslcanoutpatientgTe
12% .
ICF/MR
care 34%
Oth erAr- _ /
9% Nursing Facility <strong>Care</strong>
Payments to Medicare
and to <strong>Medicaid</strong> HMOs
9%
SOURCE: Kaiser Commission on the Future of <strong>Medicaid</strong> 1997a.
* Includes case management, family planning, dental, EPSDT, vision, and other acute services.
NOTE: Total spending for 1995 was $151.8 billion.
whole. 5 In fact, <strong>Medicaid</strong> in 1994 funded almost half of all nursing home care in the United States
(Levit et al. 1996).
Spending by State
<strong>Medicaid</strong> spending differs dramatically by state (Table 20-1). In 1994, the average annual payment
per recipient of <strong>Medicaid</strong> services ranged from $2,261 in Tennessee and $2,529 in Mississippi to
$10,036 in New Hampshire. 6 Because of the wide variation in states' proportions of their low-income
populations participating in <strong>Medicaid</strong>, average spending per poor person ranged from $969 in
Oklahoma to $4,874 in Connecticut. Finally, on a per capita basis, the highest spending occurs in New
York ($1,164) and the District of Columbia ($1,350), the result of both high per beneficiary spending
and large eligible populations (Liska et al. 1996).
While total state spending is a function of the actual number of <strong>Medicaid</strong> beneficiaries, differences in
service coverage and payment policies also create spending differences across states. The pattern of
<strong>Medicaid</strong> spending among service categories also varies by state. One state may put more money into
long-term care, for example, while another state may emphasize inpatient hospital services.
' The proportion of <strong>Medicaid</strong> dollars spent on long-term care services has fallen, however, from nearly one-half in 1988
to about one-third in 1995 (Liska et al. 1996).
' New Hampshire's spending is about one-third higher than the next highest state ($7,311 in New York). The difference
is New Hampshire's $4,596 per beneficiary in disproportionate share hospital payments. Its use of these payments is almost
triple the next highest state (Liska et al. 1996).
1997 Annual Report to CongrernlChapter 20 420