The criteria for assigning statesa level of overall data quality concernare: Low overall level of data quality concern: the states data was assessed as low data quality concern across all four domains. For FY 2021, nearly all states expect enrollment increases to put upward pressure on total Medicaid expenditure growth, with additional upward pressure coming from spending on long-term services and supports and provider rate changes. MACPAC Releases 2021 Edition of MACStats: Medicaid and CHIP Data Book Geographic Variation in US Health Spending by Type of Insurance * Puerto Rico and Virgin Islands do not submit PI data and therefore were not assessed for enrollment benchmarking. For example, while the national unemployment rate in August 2020 was 8.4% (a decline from its initial peak of 14.7% in April 2020 at the start of the pandemic), there was considerable state variation in unemployment with state rates ranging from 4.0% (Nebraska) to 13.2% (Nevada). On October 2, 2020 the PHE was extended from October 23, 2020 to January 21, 2021, leaving the enhanced FMAP in place through March 2021. For example, despite spending 2,041 dollars per Medicare enrollee in New Jersey, the median length of hospitalization is 4 days and the ratio of deaths in hospitals is 3.57 percent. One notable exception is how we ensured each beneficiary was enrolled in Medicaid (and not CHIP) in the month in which a fee-for-service claim occurred. State revenues, however, remain strong and are projected to continue to grow in FY 2023 but at a slower rate than in recent years. After relatively flat enrollment growth in FY 2020 (0.04%), states responding to the survey expect Medicaid enrollment to jump in FY 2021 (8.2%) attributed to the FFCRAs MOE requirements and to the economic downturn that started late in FY 2020. Some of these factors include, for example, differences in: In addition, an array of factors beyond T-MSIS data quality and completeness may impact state performance on the data usability assessments, some of which may be outside of the control of Medicaid agencies, for example, differences in: The following estimates do notadjust for these differences (Table1). Following the end of the MOE, states will have 12 months to initiate redeterminations for all current enrollees. States reported that the state (nonfederal) share of Medicaid spending grew by 9.9% in FY 2022 but projected a sharper growth rate of 16.3% in FY 2023 based on the assumption that the fiscal relief would expire by midFY 2023, shifting the state and federal spending shares even though total Medicaid spending growth is expected to slow. Characteristics of Non-Institutionalized Individuals by Age and Source of Health Coverage EXHIBIT 3. In addition, the US presidential election in November could have major implications for Medicaid, with a sharp contrast in goals for Medicaid and the ACA between President Trump and former Vice President Biden. States will likely face pressure to contain growth in state spending after the enhanced FMAP ends. The rate of total spending growth continued to increase in FY 2022, with almost all states reporting enrollment growth as the most significant upward pressure. The insured share of the population is projected to have been 92.3 percent in 2022 (an historic high) related to high Medicaid enrollment and gains in Marketplace enrollment and remain at that rate through 2023. Official websites use .govA Medicaid is a countercyclical program. Similarly, declining enrollment driven by a strong economy was the primary driver identified by states for slow total Medicaid spending growth in FY 2019. Reports & Evaluations | Medicaid Most responding state Medicaid agencies had assumed that the fiscal relief and continuous enrollment requirement would end by December 31, 2022 (including one-third of states that anticipated the continuous enrollment requirement would end October 31, 2022). The June 2012 Supreme Court ruling on the ACA effectively made the Medicaid expansion optional for states; as of October 2022,39 states(including DC) had adopted the expansion, including Missouri and Oklahoma, which adopted the expansion through ballot measures and implemented in state fiscal year 2022. Medicaid spending grew 9.2% to $734.0billion in 2021, or 17percent of total NHE. Spending details During fiscal year 2012, combined federal and state spending for Medicaid totaled about $415.15 billion, or about $6,833 per enrollee. Improving state economic conditions as well as federal fiscal relief mitigated the need for the widespread state spending cuts that occurred in prior recessions. Share sensitive information only on official, secure websites. are based on the National Health Expenditures and are estimates of spending for health care in the U.S. over the next decade. The elderly were the smallest population group, nearly 15 percent of the population, and accounted for approximately 34 percent of all spending in 2014. For FY 2022 and FY 2023, annual rates of growth for Medicaid spending were calculated as weighted averages across all states. The data quality assessments aresimilar to the approaches used in the 2020Scorecard, but are now drawn from data quality analyses in the DQ Atlas. Virginia (49.2%) Percentage increase in Medicaid spending (FY10-FY18) Medicaid spending growth by state. Sign up to get the latest information about your choice of CMS topics. Out of pocket spending grew 10.4% to $433.2billion in 2021, or 10percent of total NHE. These CMS-64 data were also used for historic Medicaid spending and include all 50 states and DC. This FMAP increase does not apply to the ACA expansion group, for which the federal government already pays 90% of costs. Other large states, New York, Texas, Florida, and Pennsylvania, also were among the states with the highest total personal health care spending. On the other . Enrollment declined in FY 2018 (-2.1%) and FY 2019 (-1.7%) and was relatively flat in FY 2020 (0.04%). Medicaid Spending: A Brief History - PMC - National Center for Total Medicaid spending was nearly $604 billion in FY 2019 with 64.4% paid by the federal government and 35.6% financed by states. [4] Monthly beneficiary payments are all monthly payments reported in the TAF Other claims file (OT) which would be claims with claim type = 2: Medicaid or Medicaid-Expansion Capitated Payment. Medicaid spending growth is expected to have accelerated to 10.4% in 2021, associated with rapid gains in enrollment. This chart collection explores recently released National Health Expenditure (NHE) data from the Centers for Medicare and Medicaid Services (CMS). Across all reporting states, states were anticipating that total Medicaid spending growth would accelerate to 8.4% in FY 2021 compared to growth of 6.3% in FY 2020. Even larger enrollment declines are expected in the future as Medicaid renewals resume over a period of time. U.S. Healthcare System Spending to Outpace Economic Growth - AARP Effective January 1, 2014, the ACA expanded Medicaid eligibility to millions of non-elderly adults with income at or below 138% of the federal poverty level (FPL) $18,754 per year for an individual in 2022. The Summary Data Files, which include the data in the Dashboards as well as additional spending and use data for the most recent five years . For this reason,data quality assessments across four domains and an overall assessment of data quality are included to evaluate the usability of each states data to produce the per capita expenditure estimates. website belongs to an official government organization in the United States. This methodology largely aligns with methods that CMSs Office of the Actuary employs to estimate national-level Medicaid spending per enrollee. MBES expenditure data (reported by states on Form CMS-64) are at the state level and do not include expenditures at the enrollee or at the eligibility group levels; therefore, CMS used T-MSIS data to classify enrollees, allocate expenditures into eligibility groups, and construct the denominator (number of enrollee years) for each eligibility group. Further, about three-quarters of states noted that utilization was a factor for Medicaid spending: slightly more than half of these states identified utilization as an upward pressure on projected spending while the remaining states indicated utilization was expected to be a downward pressure (likely due to pandemic-related utilization reductions). Note: Some states report significant capitation dollars as service tracking claims that might distort the distribution of per capita expenditure across eligibility groups. Elizabeth Williams and by sponsor (businesses, households and govern. The program is administered by states but funded by both the federal government and the states . All reporting states responded that the MOE was an upward or significant upward pressure on enrollment and nearly all reporting states noted that the economy was an upward or significant upward pressure on enrollment. State Medicaid agencies reported enrollment changes as the most significant factor driving changes in total Medicaid spending. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone . Many factors have likely contributed to Medicaid enrollment growth during the pandemic, including the MOE continuous enrollment requirement, which kept people enrolled in the program irrespective of changes in income and haltedchurn, as well as other economic factors. Medicare Part D Spending by Drug Data Dictionary. The volume of state reported claims data was greater than or equal to 10 percent of the national median for inpatient, other services, and prescription drug claims, as shown in the fourth column of Table 2. About two-thirds of reporting states said the fiscal relief is also being used to mitigate provider rate and/or benefit cuts. At the same time, over three-quarters of states identified the unwinding of the PHE and MOE requirements as the most significant downward pressure in FY 2023. These provisions have driven Medicaid enrollment to record highs and contributed to declines in the uninsured rate. Secure .gov websites use HTTPSA To view the version of the Medicaid and CHIP Scorecard that was published in October 2020, please visit the archived Scorecard page. In addition, we allocated CMS-64 drug rebates expenditures across eligibility groups using the overall distribution of TAF expenditures rather than the specific distribution of TAF prescription drug expenditures. Published by. As a share of GDP, West Virginia ranked the highest (28.7 percent) and Washington state the lowest (11.7 percent) in 2020. For FY 2022 and FY 2023, 49 states reported Medicaid expenditure growth rates. $ 358 B 9 % Key Takeaways Health spending as a share of a states GDP shows the importance of the health care sector in a states economy. Medicaid spending has also increased, though KFF estimates show the fiscal relief from the enhanced FMAP met or exceeded the state costs of the additional enrollment through federal fiscal year (FFY) 2022 in every state. CMS Office of the Actuary Releases 2021-2030 Projections of National Recent Trends in Medicaid Spending and Use of Drugs With US Food and Home | Data.Medicaid.gov Centers for Medicare & Medicaid Services Data

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