In fiscal year 2022, Medicaid spent 8,813 U.S. dollars per full-year equivalent enrollee. However, spending per enrollee varied by state with North Dakota spending the most per enrollee at 13,001 U.S. dollars, while in South Carolina each Medicaid enrollee cost 5,199 U.S. dollars. This statistic illustrates Medicaid benefit spending per full-year equivalent (FYE) enrollee in the United States in FY 2022, by state.

2023 saw the largest expenditures on Medicaid in U.S. history. At that time about 894 billion U.S. dollars were expended on the Medicaid public health insurance program that aims to provide affordable health care options to low income residents and people with disabilities. Medicaid was signed into law in 1965. By 1975 around 13 billion U.S. dollars were spent on the program. Groups covered by Medicaid There are several components of the Medicaid health insurance program. The Children’s Health Insurance Program (CHIP) was started in 1997 to provide health coverage to families and children that could not afford care. As of 2021, children represented the largest distribution of Medicaid enrollees. Despite having the largest proportion of enrollees, those that were enrolled in Medicaid as children had the lowest spending per enrollee. As of 2021, disabled Medicaid enrollees had the highest spending per enrollee. Medicaid expenditures Currently, Medicaid accounts for 19 percent of all health care expenditure in the United States. Expenditures on Medicaid programs vary among the U.S. states and depend heavily on whether Medicaid expansion was accepted after the Affordable Care Act was enacted. California and New York are the top states with the highest Medicaid expenditures. It is projected that Medicaid expenditure will continue to increase at both the state and federal levels.

In the fiscal year 2023, Medicaid expenditure in California amounted to a total of about 124 billion U.S. dollars, of which 81.3 billion U.S. dollars were federal-funded and approximately 43 billion U.S. dollars were state-funded. California had, as expected, the highest spending and also the largest number of people enrolled in Medicaid in the United States. The Federal Medical Assistance Percentage (FMAP) varies by state depending on the state's per capita income compared to the national average.

The United States has the highest expenditure on health care per capita globally. However, the U.S. has an unique way of paying for their health care where a majority of the expenditure falls upon private insurances. In FY 2024, around one ***** of all health expenditure is paid by private insurance. Public insurance programs Medicare and Medicaid accounted for ** and ** percent, respectively, of health expenditure during that same year. U.S. health care system Globally health spending has been increasing among most countries. However, the U.S. has the highest public and private per capita health expenditure among all countries globally, followed by Switzerland. As of 2020, annual health care costs per capita in the United States totaled to over ** thousand U.S. dollars, a significant amount considering the average U.S. personal income is around ** thousand dollars. Out of pocket costs in the U.S. Aside from overall high health care costs for U.S. residents, the total out-of-pocket costs for health care have been on the rise. In recent years, the average per capita out-of-pocket health care payments have exceeded *** thousand dollars. Physician services, dental services and prescription drugs account for the largest proportion of out-of-pocket expenditures for U.S. residents.

The CMS Program Statistics - Medicare Part D tables provide use and Part D drug costs by type of Part D plan (stand-alone prescription drug plan and Medicare Advantage prescription drug plan). For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data. Below is the list of tables: MDCR UTLZN D 1. Medicare Part D Utilization: Average Annual Prescription Drug Fills by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Generic Dispensing Rate, Yearly Trend MDCR UTLZN D 2. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 3. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 4. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan and Demographic Characteristics MDCR UTLZN D 5. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan and Demographic Characteristics MDCR UTLZN D 6. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan, by Area of Residence MDCR UTLZN D 7. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan, by Area of Residence MDCR UTLZN D 8. Medicare Part D Utilization: Number of Part D Utilizers and Average Annual Prescription Drug Fills by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 9. Medicare Part D Utilization: Number of Part D Utilizers and Drug Costs by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 10. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Events (Fills) and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Demographic Characteristics MDCR UTLZN D 11. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Area of Residence

More than one in four hospitalizations for those with both Medicare and full Medicaid coverage was potentially avoidable, according to findings reported in Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations, published in Volume 4, Issue 1 of the Medicare and Medicaid Research Review. Using data from 2007 to 2009, the study examined potentially avoidable hospitalizations rates by setting, state, and medical condition, and the average cost of these events. Beneficiaries in institutions were much more likely to have these events - 16 percent of beneficiaries in the study population were in an institution, yet comprised 45 percent of all potentially avoidable hospitalizations. The range in rates per 1,000 person years across the states was considerable from a low of 59 (Utah) to a high of 197 (Mississippi), a more than a threefold difference. Five conditions were responsible for nearly 80 percent of potentially avoidable hospitalizations. From 2007 to 2009, the national and state rates were fairly consistent.

In 2023, just four in ten Medicaid/CHIP enrollees were White, non-Hispanic. In comparison, roughly three-quarters of Medicare beneficiaries were White. The Affordable Care Act (ACA) Medicaid expansion in 2014, has helped reduce racial disparities in access to healthcare in the United States. Medicaid eligibility Medicaid provides health coverage to certain low-income individuals, families, children, pregnant women, the elderly, and persons with disabilities. Each state has its own Medicaid eligibility criteria in accordance with federal guidelines. As a result, Medicaid eligibility and benefits differ widely from state to state. Medicaid expansion provision under the Affordable Care Act (ACA) allows states to provide coverage for low-income adults by expanding eligibility for Medicaid to 138 percent of the federal poverty line (FPL). Medicaid coverage gap Uninsured individuals who live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA) are referred to as being in the Medicaid coverage gap. As of January 2021, 12 states have not adopted the Medicaid expansion provision under the Affordable Care Act (ACA). More than two million uninsured adults fall into this coverage gap, and among them, more than 60 percent are people of color.

NADAC (National Average Drug Acquisition Cost) 2024

  Description

National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.

  Dataset Details

Publisher: Centers for Medicare & Medicaid Services Last Modified: 2024-12-23 Contact: Medicaid.gov (Medicaid.gov@cms.hhs.gov)

  Source

Original data can be found at: https://healthdata.gov/d/3tha-57c6

  Usage

You can load this dataset using: from datasets import… See the full description on the dataset page: https://huggingface.co/datasets/HHS-Official/nadac-national-average-drug-acquisition-cost-2024.

ER visit rate for children with Medicaid, per 1,000 people with Medicaid (Approximate). The rate of visits due to Asthma and Diabetes are also calculated. Data are for 2013. The number of children with medicaid comes from the 2010-2014 5 year average ACS.

ER visit rate for children with Medicaid, per 1,000 people with Medicaid (Approximate). The rate of visits due to Asthma and Diabetes are also calculated. Data are for 2013. The number of children with medicaid comes from the 2010-2014 5 year average ACS.

Drugs that have been reported under the Medicaid Drug Rebate Program along with an indication of whether or not the required Average Manufacturer Price (AMP) was reported for each drug. All drugs are identified in the file by the 11-digit National Drug Code, product name, labeler name, and reported (R) or not reported (NR).

Counties baseline characteristics by log transformed county-level median household income.

Median annual per beneficiary spending in 2012 by race-ethnicity among autistic adults.

Association of SARS-COV-2 outcomes as of December 6, 2020 with county-level median household income quartiles.

In 2023, some 47.6 percent of Medicaid and CHIP enrollees were aged between 18 and 64 years, while adults aged 65 years accounted for only eight percent of enrollees. Medicaid program is funded jointly by the federal and the state governments, it provided coverage to nearly 19.5 percent of the U.S. population in 2022. Medicaid vs CHIPMedicaid and the Children’s Health Insurance Program (CHIP) both provide health insurance coverage for children from low-income families. Children who are not eligible for Medicaid but who would otherwise be unable to obtain insurance through a family plan are covered by CHIP. More than five million children were enrolled in CHIP in the U.S. in 2023. Medicaid and CHIP funding rateThe Federal Medical Assistance Percentages (FMAPs) are used to calculate the amount of federal matching funds for State Medicare and CHIP programs. To encourage states to expand coverage for uninsured children the federal matching rates for CHIP are generally 15 points higher than the Medicaid rate. However, unlike permanent federal funding for Medicaid, CHIP federal funding is capped and due to expire in FY 2027.

NOTE: HAART, highly-active antiretroviral therapy; DOT, directly observed therapy; QALE, quality-adjusted life expectancy.* Complete response considered to be a sustained reduction in viral load of 2.0 log10 copies/ml; partial response considered to be a sustained reduction of 0.75 log10 copies/ml; non-response associated with a reduction of 0.25 log10 copies/ml [32].† Non-elective Caesarean at term and Caesarean section with premature delivery were not associated with reduced risk of mother-to-child HIV transmission [59].‡ Base-case probability of prematurity approximates that seen in a cohort of HIV-infected New York Medicaid recipients; upper bound based on rates of premature delivery seen in a subgroup of women receiving methadone maintenance therapy [58].§ In base case, risk of antiretroviral toxicity in infants was assumed to be negligible, consistent with available data [6], [62], [65]. Risk of severe toxicity used in sensitivity analysis based on upper bound confidence limit for mitochondrial toxicity in a French cohort study [63], [64]. Risk of moderate toxicity based on best estimate of plausible upper bound.∥ Base-case estimates and ranges for viral loads greater than 1000 copies/ml derived based on outcomes among individuals receiving peripartum zidovudine in a prospective multi-centre study of HIV in pregnancy [5].¶ QALY and lifetime cost estimates presented in table based on the use of a 3% discount rate. Base-case quality-adjustment for HIV-uninfected individuals 45 years of age and older performed using community-derived utility estimates, as described in [78], while upper bound estimates are not quality-adjusted.** Quality-adjusted survival in HIV-infected infants was estimated based on the assumption that 2/3 of person-time with HIV infection would be symptom-free, while 1/3 of person-time with HIV would include HIV-attributable symptoms. Acquired immune deficiency syndrome was assumed to be present in the last two years of life. Death due to HIV in infected children has declined markedly in both the U.S. and Europe with the advent of HAART, making estimation of survival in HIV-infected children difficult due to small numbers of events [35], [37]. Survival in HIV-infected children was assumed to approximate that seen in the youngest adults treated with HAART [36]. Lower bound survival estimates for HIV were generated using community-derived utility weights for life with HIV infection [34], while upper bound estimates were generated using more favorable survival estimates, and without quality-adjustment [79].†† Based on in-hospital mortality in 15% of premature infants (including third-trimester still-births), with a risk of moderate to severe cognitive impairment in 10–30% [68], [70], [76]. Reduction in quality-adjusted survival estimated based on health utility weight of 0.67 predicted for an individual with moderate cognitive and sensory impairment and impaired self-care ability using the Health Utilities Index Mark II [69].‡‡ Based on intravenous zidovudine during 12 hour labor, and average dose of 1 ml zidovudine syrup (10 mg/ml) administered to neonate qid for 6 weeks postpartum [6].§§ Estimated based on weighted average healthcare costs associated with prematurity in infants born from 28 to 36 weeks of gestation in the state of California [75], with future costs occurring due to developmental delay in 15–30% of surviving infants [68], [74], [76], [80].

This statistic illustrates the health spending distribution of state and local government in the United States from 2013 to 2022. In 2022, 36 percent of state and local government health spending in the U.S. was spent on Medicaid. Health spending distributionHealth spending by the state and local government in the United States is divided among four major categories. As of 2021, 36 percent of spending was dedicated to Medicaid, 33 percent to private insurance premiums, 29 percent to other health programs, and three percent to Medicare payroll tax for state and local workers. In 1960, the majority of spending on prescription medications came from the consumer’s pocket, today out-of-pocket spending for prescriptions has decreased to about 13 percent. Among OECD countries, the United States spends the largest portion of its gross domestic product on health care expenditures, totaling nearly 17 percent in 2022. In comparison, the United Kingdom spent about 11.3 percent of the nation’s GDP on health care. High income countries spend over 6,100 U.S. dollars per capita compared to the world average of around 1,177 U.S. dollars per person. Health care spending in the United States has steadily risen over the last decades. In 1970, 355 U.S. dollars was expended on health care per capita in the United States; by 2021, this figure had risen to 12,591 U.S. dollars per capita. The increase in health care expenditure in the country may lie in parallel with the increase in premiums. Spending for hospitals, physicians, specialists, and dentists are significantly higher than other high income countries. Health care provider prices are especially high in the U.S. due to greater access to medical technologies as well as the obesity epidemic in the country.

In fiscal year 2023, the Children’s Health Insurance Program (CHIP) spent a total of about 23.2 billion U.S. dollars, of which 17.2 billion U.S. dollars were federal-funded and 5.9 billion U.S. dollars were state-funded. California had, as expected the highest spending and also the largest number of children enrolled in CHIP/Medicaid. The federal government matches spending for both Medicaid and CHIP, but has a higher match rate for CHIP than traditional Medicaid. The Federal Medical Assistance Percentage (FMAP) varies by state depending on the state's per capita income compared to the national average. This statistic illustrates CHIP spending in the United States in FY 2023, by state and state & federal share.

Healthcare premiums under the Affordable Care Act (ACA) have fallen for all consumers nationally in 2023 when compared with the previous two years. This is due to a system of tax credits provided by the American Rescue Plan and the Inflation Reduction Act passed by the United States Congress. After these tax credits, the average person with ACA coverage pays an average monthly premium of *** U.S. dollars, down from *** U.S. dollars in 2021. A report from the U.S. Centers for Medicare & Medicaid Services estimates that due to the tax credits, consumers nationally on average save over *** U.S. dollars per year in premiums. The ACA created a federally run healthcare exchange which is used by ** states as of 2023. States can also decide to run their own exchange - due to politics or practicality - of which there are ** plus the District of Columbia.

In 2023, approximately ******** percent of the Hispanic population in the United States did not have health insurance, a historical low since 2010. In 2023, the national average was *** percent. White Americans had a below-average rate of just *** percent, whereas *** percent of Black Americans had no health insurance.Impact of the Affordable Care ActThe Affordable Care Act (ACA), also known as Obamacare, was enacted in March 2010, which expanded the Medicaid program, made affordable health insurance available to more people and aimed to lower health care costs by supporting innovative medical care delivery methods. Though it was enacted in 2010, the full effects of it weren’t seen until 2013, when government-run insurance marketplaces such as HealthCare.gov were opened. The number of Americans without health insurance fell significantly between 2010 and 2015, but began to rise again after 2016. What caused the change?The Tax Cuts and Jobs Act of 2017 has played a role in decreasing the number of Americans with health insurance, because the individual mandate was repealed. The aim of the individual mandate (part of the ACA) was to ensure that all Americans had health coverage and thus spread the costs over the young, old, sick and healthy by imposing a large tax fine on those without coverage.