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GAO: Small Share of Medicaid Enrollees Drive Expenditures

A small percentage of Medicaid enrollees consistently account for a large share of all Medicaid expenditures according to a report released by the U.S. Government Accountability Office (GAO). GAO examined fiscal years 2009 to 2011 and found that the most expensive 5 percent of Medicaid-only enrollees (those not also eligible for Medicare) accounted for nearly half of all expenditures. In contrast,  the least expensive 50 percent of Medicaid enrollees accounted for less than 8 percent of expenditures.

GAO also found that nationally, a consistent proportion of people with certain medical conditions and eligibility criteria fell within this 5 percent repeatedly over the three-year period. For example, although representing less than 10 percent of Medicaid-only enrollees, disabled enrollees consistently represented 64 percent of those with the highest expenditures. Further, GAO found that there was wide variation between states, particularly for managed care and premium assistance-related expenditures.

GAO conducted this study in response to a request by the U.S. Senate Committee on Finance. Contact Beth Feldpush, DrPH, senior vice president of policy and advocacy, at bfeldpush@essentialhospitals.org or 202.585.0111 with questions.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.

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