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.

This statistic presents the total Medicaid spending in the United States in the federal fiscal year 2022, listed by state. In that fiscal year, New Jersey's total Medicaid expenditure was approximately **** billion U.S. dollars. Medicaid spending in the U.S. Medicaid spending varies widely between states. California expended almost ***** billion U.S. dollars in 2022 while Wyoming spent some *** billion U.S. dollars in the same year. Medicaid is a health program that targets families and individuals earning a low-income in the United States. Each state is able to determine the eligibility of individuals to enter the program. Children are among the largest group enrolled in Medicaid, however, almost ** percent of Medicaid spending is targeted towards individuals that are disabled. About ** percent of Medicaid expenditures are used for acute care and some ** percent used for long-term care. Medicaid since the ACA The establishment of the Affordable Care Act increased state and federal spending dedicated to Medicaid. In 1990, the federal government spent **** billion U.S. dollars and the state government spent **** billion U.S. dollars on Medicaid. Since then, federal and state spending increased to *** billion U.S. dollars and *** billion U.S. dollars, respectively, in 2019. Expenditures on this health insurance are expected to continue its trend, increasing to over ************ U.S. dollars by 2027. Medicaid is the largest public health insurance program in the United States and covers roughly ** million citizens in the country.

In 2022, Medicaid expenditure totaled around 805 billion U.S. dollars, the highest in the provided time interval. The federal government paid approximately 70 percent of total Medicaid expenditures in 2022, with states picking up the other 30 percent. Medicaid’s high-cost enrollees Spending on aged enrollees and individuals with disabilities accounted for more than half of the total Medicaid expenditure in 2021. One reason why this share is so high is that these groups require greater health care, and often the services are more costly. Spending on long-term care services, which includes nursing facilities and home health care, totaled approximately 154 billion U.S. dollars in 2022. Overall, long-term care services accounted for around 20 percent of all Medicaid expenditure in 2022. The basics of Medicaid funding Medicaid is a joint federal and state health care plan, and the costs of administering the program are split between the two. States report their Medicaid costs to the federal government on a quarterly basis, and the federal government matches those costs based on a formula. This formula is designed so that the federal government pays a larger share of costs in poorer states, but in general, state costs are matched by the federal government at a 50 percent rate. California was the state with the highest Medicaid costs in 2022.

Total Medicaid spending surpassed 804 billion U.S. dollars in 2022. The state of California had the highest expenditure throughout the year, followed by New York and Texas.

Federal government helps poorer states Both the federal and state governments fund the Medicaid health care program, but at least 50 percent of the costs incurred by states are matched by the federal government. The exact percentage varies by state because the matching rate was designed so that poorer states receive a larger share of program costs from the federal government. The states of Wyoming, South Dakota, North Dakota, spent the least on Medicaid costs in 2021.

Funding share of states set to increase Under the Affordable Care Act, states have the choice to expand their Medicaid programs to cover nearly all low-income Americans under age 65. For states that implemented the expansion, the federal government paid 100 percent of the state costs for all newly eligible adults from 2014 to 2016. The new matching rate has slowly declined since and reached 90 percent in 2020, which means states have to pick up ten percent of the bill. Governors are concerned about the rise in costs, and state expenditure is projected to increase by 50 percent between 2020 and 2027.

This data package contains the information of Medicare and Medicaid healthcare spending and healthcare cost and percentages by state.

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In fiscal year 2021, Medicaid spent 8,651 U.S. dollars per full-year equivalent enrollee. However, spending per enrollee varied by state with North Dakota spending the most per enrollee at 12,434 U.S. dollars, while in South Carolina each Medicaid enrollee cost 5,191 U.S. dollars. This statistic illustrates Medicaid benefit spending per full-year equivalent (FYE) enrollee in the United States in FY 2021, by state.

In FY 2021, Medicaid expenditure on disabled persons was estimated to have totaled 220 billion U.S. dollars, which was more than any other enrollment group. Disabled individuals also had the highest per enrollee Medicaid costs during the year.

The high costs of health care Federal and state governments together spent an estimated 640 billion U.S. dollars on the Medicaid health insurance program in 2019. Despite having the smallest shares of Medicaid enrollees, the elderly and disabled groups combined to account for more than half of all Medicaid expenditure in 2019. These two groups have a significantly higher per enrollee expenditure because they have greater long-term needs – Medicaid expenditure on acute care and long-term care benefits combined for approximately 260 billion U.S. dollars in 2017.

Which eligibility group has the most enrollees? Elderly individuals can qualify for Medicaid through several pathways, but an income-based methodology is primarily used to determine eligibility for most adults, pregnant women, and children. Children accounted for 37.5 percent of Medicaid enrollees in 2019, which was the largest share of all enrollment groups. Around 28 million children are enrolled in Medicaid programs across the United States, and the number of enrollees is projected to top 30 million in the coming years.

The Medicaid by Drug dataset presents information on spending for covered outpatient drugs prescribed to beneficiaries enrolled in Medicaid by physicians and other healthcare professionals. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. Units refer to the drug unit in the lowest dispensable amount. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications. Drug spending metrics for Medicaid represent the total amount reimbursed by both Medicaid and non-Medicaid entities to pharmacies for the drug. Medicaid drug spending contains both the Federal and State reimbursement and is inclusive of any applicable dispensing fees. In addition, this total is not reduced or affected by Medicaid rebates paid to the states.

This dataset reports summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs. These state expenditures are tracked through the automated Medicaid Budget and Expenditure System/State Children's Health Insurance Program Budget and Expenditure System (MBES/CBES). For more information, visit https://medicaid.gov/medicaid/finance/state-expenditure-reporting/expenditure-reports/index.html.

In 2022, Medicare and Medicaid national health expenditures reached 944 billion U.S. dollars and 805 billion U.S. dollars, respectively. The largest expense category for both healthcare care programs was hospital care. Long-term care solutions Medicaid’s second-largest expense category was other health care, which includes programs that provide alternatives to long-term institutional services. The use of home- and community-based services can substantially reduce expenditures for enrollees who would otherwise have to receive care in an institutional setting, such as a nursing home. In recent decades, there has been a significant shift in the distribution of Medicaid’s long-term care services expenditures. Medicaid’s federal-state partnership Medicare is a health insurance program solely funded by the federal government, whereas Medicaid plays an important role in both federal and state budgets. The federal government establishes certain parameters for all states to follow, but states can decide who gets coverage and what gets covered in its version of Medicaid. In 2021, California was the state with the highest Medicaid expenditure.

CMS has released several information products that provide spending information for prescription drugs in the Medicare and Medicaid programs. The CMS Drug Spending Dashboards are online interactive tools that provide spending information for certain prescription drugs in the Medicare and Medicaid programs. CMS selected drugs for inclusion in the dashboards based on three criteria 1) drugs with high spending on a per user basis (Medicare Program) and drugs with high spending on a per prescription fill basis (Medicaid Program) 2) drugs with high total program spending and 3) drugs with high costs increases in recent years. The dashboard tools display relevant spending, utilization, and trend data and also include consumer-friendly information on the drug product descriptions, manufacturer(s), and uses. In addition to the Dashboards, CMS has released Medicare spending and utilization data for all Part B and Part D drugs. These summary data files were the basis for the Medicare Drug Spending Dashboard and include annual data for the most recent five years.

In 2022, health spending in the United States reached approximately 4.6 trillion U.S. dollars, and private insurance accounted for around 29 percent of that figure. However, public health insurance, which includes the Medicare and Medicaid programs, combined for a share of around 39 percent. The rising costs of health care coverage U.S. national health expenditure continues to increase and is projected to exceed four trillion U.S. dollars in 2021. Hospital care and physician services have been the leading spending categories for several years and combined for more than half of all health spending in 2021. In the same year, federal and state governments made up 61 percent of national health expenditures, with the federal government’s share accounting for 27 percent. The differences between Medicare and Medicaid Medicare and Medicaid were both signed into U.S. law by President Johnson in 1965. Medicare is a health insurance program solely funded by the federal government. The plan was primarily created for all Americans aged 65 and older, regardless of their income. Medicaid is administered at a state level in accordance with some core federal requirements, but both fund the program. The plan provides health care to millions of Americans, and some states have expanded the Medicaid program to cover nearly all low-income adults under the age of 65.

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Context

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarize counts of enrollees who are dually-eligible for both Medicare and Medicaid program, including those in Medicare Savings Programs. “Duals” represent 20 percent of all Medicare beneficiaries, yet they account for 34 percent of all spending by the program, according to the Commonwealth Fund . As a representation of this high-needs, high-cost population, these data offer a view of regions ripe for more intensive care coordination that can address complex social and clinical needs. In addition to the high cost savings opportunity to deliver upstream clinical interventions, this population represents the county-by-county volume of patients who are eligible for both state level (Medicaid) and federal level (Medicare) reimbursements and potential funding streams to address unmet social needs across various programs, waivers, and other projects. The dataset includes eligibility type and enrollment by quarter, at both the state and county level. These data represent monthly snapshots submitted by states to the CMS, which are inherently lower than ever-enrolled counts (which include persons enrolled at any time during a calendar year.) For more information on dually eligible beneficiaries

Querying BigQuery tables

You can use the BigQuery Python client library to query tables in this dataset in Kernels. Note that methods available in Kernels are limited to querying data. Tables are at bigquery-public-data.sdoh_cms_dual_eligible_enrollment.

Sample Query

In what counties in Michigan has the number of dual-eligible individuals increased the most from 2015 to 2018? Find the counties in Michigan which have experienced the largest increase of dual enrollment households

duals_Jan_2015 AS ( SELECT Public_Total AS duals_2015, County_Name, FIPS FROM bigquery-public-data.sdoh_cms_dual_eligible_enrollment.dual_eligible_enrollment_by_county_and_program WHERE State_Abbr = "MI" AND Date = '2015-12-01' ),

duals_increase AS ( SELECT d18.FIPS, d18.County_Name, d15.duals_2015, d18.duals_2018, (d18.duals_2018 - d15.duals_2015) AS total_duals_diff FROM duals_Jan_2018 d18 JOIN duals_Jan_2015 d15 ON d18.FIPS = d15.FIPS )

SELECT * FROM duals_increase WHERE total_duals_diff IS NOT NULL ORDER BY total_duals_diff DESC

Notes: 1. CAA 2023 provides a temporary 5.0 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning April 1, 2023 through June 30, 2023. 2. CAA 2023 provides a temporary 2.5 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning July 1, 2023 through September 30, 2023. 3. CAA 2023 provides a temporary 1.5 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning October 1, 2023 through December 31, 2023. 4. States that have reported “0” either have no expenditures for that reporting category or have not yet reported expenditures for that category. 5. This report is a cumulative summary report that includes current and prior period adjustment expenditures that apply to this quarter and does not include Collections or Overpayment Recoveries.

Medicaid expenditure continues to grow and is projected to surpass one trillion U.S. dollars for the first time in 2027. It is estimated that the federal government will continue to pay around 60 percent of total Medicaid costs over the coming years, with states picking up the other 40 percent.

Federal government pays a higher share The Medicaid expenditure forecasts are similar to spending patterns of recent years, with an approximate 60:40 split between the federal government and the states. In 2017, the federal government spent around 370 billion U.S. dollars on Medicaid costs, while states paid nearly 230 billion U.S. dollars. Total Medicaid expenditure increased for eleven consecutive years between 2006 and 2017, and much of the growth is the result of higher enrollment numbers.

How are state costs matched by the federal government? Although the federal government establishes a framework for all states to follow, each state can administer its own Medicaid program differently. The costs of operating the program are shared between the two, with the federal government matching state spending for eligible beneficiaries based on a formula called the federal medical assistance percentage (FMAP). This calculation is designed so that the federal government pays a larger share of costs in poorer states, such as West Virginia and Mississippi. In 2020, the FMAP ranged from a base level of 50 percent up to 77 percent.

This dataset reports summary level expenditure data associated with the new adult group established under the Affordable Care Act. These state expenditures are reported through the federal Medicaid Budget and Expenditure System (MBES). Notes: 1. “VIII GROUP” is also known as the “New Adult Group.” 2. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. VIII Group expenditure information for the states that have not expanded their Medicaid program is noted as “N/A.” 3. States that have reported “0” either have no expenditures for that reporting category or have not yet reported expenditures for that category. 4. MCHIP expenditures are not included in the All Medical Assistance Expenditures.

The Share of Medicaid Enrollees in any Managed Care and in Comprehensive Managed CaAre profiles state-level enrollment statistics (numbers and percentages) of total Medicaid enrollees in any type of managed care as well as those enrolled specifically in comprehensive managed care programs. The report provides managed care enrollment by state with all 50 states, the District of Columbia and the US territories are represented in these data. Note: "n/a" indicates that a state or territory was not able to report data or does not have a managed care program. The “Total Medicaid Enrollees” column represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing. The “Total Medicaid Enrollment in Any Type of Managed Care” column represents an unduplicated count of beneficiaries enrolled in any Medicaid managed care program, including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM entities. The “Medicaid Enrollment in Comprehensive Managed Care” column represents an unduplicated count of Medicaid beneficiaries enrolled in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes beneficiaries who are enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care.

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage to more than 90 million Americans as of early 2023. There is substantial variation in eligibility criteria, application procedures, premiums, and other programmatic characteristics across states and over time. Analyzing changes in Medicaid policies is important for state and federal agencies and other stakeholders, but such analysis requires data on historical programmatic characteristics that are often not available in a form ready for quantitative analysis. Our objective is to fill this gap by synthesizing existing qualitative policy data to create a new data resource that facilitates Medicaid policy research. Our source data were the 50-state surveys of Medicaid and CHIP eligibility, enrollment, and cost-sharing policies conducted near annually by KFF since 2000, which we coded through 2020. These reports are a rich source of point-in-time information but not operationalized for quantitative analysis. Through a review of the measures captured in the KFF surveys, we developed five Medicaid policy domains with 122 measures in total, with each coded by state-quarter—1) eligibility (28 measures), 2) enrollment and renewal processes (39), 3) premiums (16), 4) cost-sharing (26), and 5) managed care (13).