Over ** million Americans were estimated to be enrolled in the Medicaid program as of 2023. That is a significant increase from around ** million ten years earlier. Medicaid is basically a joint federal and state health program that provides medical coverage to low-income individuals and families. Currently, Medicaid is responsible for ** percent of the nation’s health care bill, making it the third-largest payer behind private insurances and Medicare. From the beginning to ObamacareMedicaid was implemented in 1965 and since then has become the largest source of medical services for Americans with low income and limited resources. The program has become particularly prominent since the introduction of President Obama’s health reform – the Patient Protection and Affordable Care Act - in 2010. Medicaid was largely impacted by this reform, for states now had the opportunity to expand Medicaid eligibility to larger parts of the uninsured population. Thus, the percentage of uninsured in the United States decreased from over ** percent in 2010 to *** percent in 2022. Who is enrolled in Medicaid?Medicaid enrollment is divided mainly into four groups of beneficiaries: children, adults under 65 years of age, seniors aged 65 years or older, and disabled people. Children are the largest group, with a share of approximately ** percent of enrollees. However, their share of Medicaid expenditures is relatively small, with around ** percent. Compared to that, disabled people, accounting for **** percent of total enrollment, were responsible for **** percent of total expenditures. Around half of total Medicaid spending goes to managed care and health plans.

Analysis of ‘Medicare Beneficiary Enrollment and Demographics, Washington State and Counties, 2007-2018’ provided by Analyst-2 (analyst-2.ai), based on source dataset retrieved from https://catalog.data.gov/dataset/6a298eb9-488f-48b0-a832-f47ef9edf3e9 on 26 January 2022.

--- Dataset description provided by original source is as follows ---

(Source: CMS Medicare Geographic Variation Public Use File, February 2021)

--- Original source retains full ownership of the source dataset ---

Abstract

Stanford has a 20% sample of CMS data. These data are hosted on our secure servers and can only be accessed after completing a reuse application with CMS. You can explore these data using our CMS Public files which have no restrictions.

Documentation

**A checklist for the steps in gaining access to the CMS RIF 20% sample can be found here: **CMS RIF 20% Sample Access Checklist

**ResDAC has full and current **CMS File Availability and Documentation

The Stanford Center for Population Health Sciences has purchased a 20% sample (linked) of all records from for the files as listed below. Where available, we have purchased all data from 2006 – 2018, though for some files all years are not available. We have the following files and years. N/A indicates that we have not purchased these files.

Medicare Claims Inpatient: N/A Outpatient: 2006-2018 SNF: N/A Hospice: 2006-2018 Home Health: 2006-2018 Carrier: 2006-2018 DMERC: 2006-2018

Part D Event with actual Prescriber/Pharmacy identifiersDrug Characteristics: 2006-2018 Prescriber Characteristics File: N/A Formulary File: 2010-2018 Plan Characteristics Files: 2006-2018

MEDPAR All (SS/LS/SNF): 2006-2018

Enrollment/Summary FilesMaster Beneficiary Summary File: All years. Base Beneficiary Summary File A/B/C/D: 2006-2018 Chronic Conditions: 2006-2018 Cost & Utilization: 2006-2018 Other Chronic or Potentially Disabling Conditions: 2006-2018 National Death Index: N/A EDB User View: Current Vital Status File: Current

MiscellaneousMDPPAS: 2008-2018

Between 2012/2013 and 2018, the number of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) increased steadily from 220 to 561. The figures have fluctuated since then with a total of 483 ACOs participating in the MSSP by 2022. The ACOs collectively care for around 10.9 million beneficiaries in 2023, which is roughly one in six Medicare enrollees. ACOs are groups of doctors, hospitals, and other health care providers, who voluntarily collaborate to achieve coordinated enhanced quality of care, reduced costs, and improved health outcomes of a designated patient population. ACOs were introduced as part of the Affordable Care Act to shift the U.S. health system from volume-based care (fee-for-service) to value-based care (alternative payment models). Most ACOs receive payment through Medicare or Medicaid, but an increasing number also contract with commercial (or private) payers.

Medicare is an important public health insurance scheme for U.S. adults aged 65 years and over. As of 2023, an estimated 18.9 percent of the U.S. population was covered by Medicare, an increase from the previous year. As of 2021, California, Florida, and Texas had the largest number of adults aged 65 years and older. The Medicare program Medicare has two primary parts: Medicare Part A covers hospital care and Medicare Part B covers medical and preventative services. Both parts of Medicare are available to those aged 65 years and older under certain conditions. Medicare premiums are variable and depend on the enrollee’s income. Despite a majority of the Medicare enrollees being above the federal poverty line, there are still several programs in place to help cover the costs of healthcare for the elderly. Opinions on elderly care in the U.S. It is estimated that about 23 percent of Medicare enrollees are in fair/poor health. But there are lots of questions about who should pay for or help with elderly care long-term. In a recent survey of U.S. adults, about half of the respondents said that health insurance companies should pay for elderly care. However, a majority of adults also supported a long-term government sponsored health plan like Medicaid. The issue is still hotly debated and politicized in the United States.

This statistic shows personal health care expenditure by source of funds in the United States, comparing the years 1990 and 2018. In 1990, some 70 billion U.S. dollars of personal health care expenditure was funded by the Medicaid program.

Personal health care expenditure in the United States

Health care facilities in the U.S. are mostly considered part of the private sector. The United States' total health care expenditures were over 3.6 trillion U.S. dollars in 2018. Globally, the U.S. spent the most on health care per capita as well as, as a percentage of its GDP. It has been ranked as one of the least efficient health care systems in the world. Health care expenditure includes a variety of services and products such as hospital care, physician and clinical services, dental, home health care, and nursing care facilities.

Personal health care expenditure in the United States has skyrocketed from 1990 to 2018. Funds for health care are still primarily derived from private health insurance and governmental health plans. A slowing growth in out-of-pocket payments can indicate higher cost-sharing and increased enrollment in consumer-directed health plans. In 1990, private health insurance funded some 205 billion U.S. dollars of health care services and increased to over one trillion U.S. dollars by 2017. Health care expenditure through private insurance has grown to over 35 percent of total personal health costs. The percentage of U.S. citizens covered by Medicare has increased from the 1990s until today. Medicare is a national social insurance program through the U.S. federal government which guarantees health insurance for citizens over the age of 64. Medicare expenditure totaled 697 billion U.S. dollars in 2018.

Provide the first national description across the US of variations in healthcare measures in 2018 among Medicaid beneficiaries with schizophrenia. Adult beneficiaries with ≥2 diagnoses for schizophrenia, and continuous enrollment with consistent geographical data in all of 2018 were identified from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) data for 45 of 50 states. Antipsychotic (AP) utilization rates, including long-acting injectable APs (LAIs), quality metrics, and all-cause healthcare resource utilization and costs for claims submitted to Medicaid were reported nationally and by state. Pearson correlation evaluated associations between LAI utilization and total healthcare costs at state and county levels. Across the US 688,437 patients with schizophrenia were identified. The AP utilization rate was 51% (state range: 24–77%), while the LAI utilization rate was 13% (range: 4–26%). The proportion of patients adherent to any AP was 56% (range: 19–73%). Within 30 days post-discharge from an inpatient admission, 22% (range: 8–58%) of patients had an outpatient visit, and 12% (range: 4–48%) had a readmission. The proportion of patients with ≥1 inpatient admission and ≥1 emergency room visit was 34% (range: 19–82%) and 45% (range: 20–70%). Per-patient-per-year total healthcare costs averaged $32,920 (range: $717–$93,972). At the county level, a weak negative correlation was observed between LAI utilization and total healthcare costs. This study included Medicaid beneficiaries enrolled with pharmacy and medical benefits, including beneficiaries dually eligible for Medicare; results cannot be generalized to the overall schizophrenia population or those with other payer coverage. In 2018, half of beneficiaries with schizophrenia did not submit any claims for APs to Medicaid, nearly half had an emergency room visit, and one-third had an inpatient admission. Moreover, healthcare measures varied considerably across states. These findings may indicate unmet treatment needs for Medicaid beneficiaries with schizophrenia. Schizophrenia is a severe mental disorder that poses a large health, social, and cost burden to patients and society. While treatment with antipsychotic medications can reduce the number of relapses and hospitalizations, many patients do not adhere to treatment, which can lead to poor symptom control and further use of healthcare services. Interestingly, these measures of schizophrenia care seem to vary across US states. Therefore, we ran the first study to describe the regional differences in antipsychotic use, measures of quality of care, healthcare use, and healthcare costs among Medicaid-insured patients across the US in 2018. Our results showed that only half of patients used antipsychotics in 2018 (with a range of 24–77% across states) and the proportion of patients adherent to antipsychotic treatment was low (range of 19–73%). Additionally, nearly half of all patients had an emergency room visit (range of 20–70%), and one-third had an inpatient admission (range of 19–82%). These findings highlight large variations in antipsychotic use, performance measures, and healthcare use, possibly due to regional differences in unmet needs in schizophrenia care for Medicaid-insured patients in the US. Since use of inpatient and emergency room services was consistently high in specific states or regions, and yearly healthcare costs per patient varied from $717–$93,972 (mean = $32,920), there may be a particularly high burden in certain areas of the country where patients with schizophrenia may potentially be experiencing multiple relapses. Further research is needed to identify policies that may help narrow these regional differences.

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.

The percentage of Americans covered by the Medicaid public health insurance plan increased from **** percent in 2020 to around **** percent in 2023. However, the percentage of those insured through Medicaid remains lower than the peak of **** percent in 2015. The expansion of Medicaid The Affordable Care Act (ACA) provided the option for states to expand Medicaid eligibility to people whose income was below a particular threshold. The ACA’s major coverage expansion came into force in 2014, and the number of individuals estimated to be enrolled in Medicaid has since surpassed ** million. More than ** million children were enrolled in the program in 2018, representing ** percent of overall Medicaid enrollment. State Medicaid coverage Initially, the ACA mandated that all state Medicaid programs would have to be extended to provide medical coverage to nearly all low-income groups. However, the Supreme Court rejected that part of the act in 2012, leaving the door open for states to make their own decision on whether they expand their plans. As of September 2021, ** states plus the District of Columbia have adopted the Medicaid expansion.