Post on 24-Jun-2020
December 2015
Medicaid and CHIP Payment and Access Commission
About MACPAC The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). The U.S. Comptroller General appoints MACPAC’s 17 commissioners, who come from diverse regions across the United States and bring broad expertise and a wide range of perspectives on Medicaid and CHIP.
MACPAC serves as an independent source of information on Medicaid and CHIP, publishing issue briefs and data reports throughout the year to support policy analysis and program accountability. The Commission’s authorizing statute, 42 USC 1396, outlines a number of areas for analysis, including:
• payment;• eligibility; • enrollment and retention;• coverage;• access to care;• quality of care; and• the programs’ interaction with Medicare and the health care system generally.
MACPAC’s authorizing statute also requires the Commission to submit reports to Congress by March 15 and June 15 of each year. In carrying out its work, the Commission holds public meetings and regularly consults with state officials, congressional and executive branch staff, beneficiaries, health care providers, researchers, and policy experts.
December 2015
MACStats: Medicaid and CHIP Data Book
Medicaid and CHIP Payment and Access Commission
MACStats: Medicaid and CHIP Data Book v
Commission Members and Terms
Commission Members and TermsDiane Rowland, ScD, Chair Washington, DC
Marsha Gold, ScD, Vice Chair Washington, DC
Term Expires December 2015Donna Checkett, MPA, MSW Phoenix, AZ
Patricia Gabow, MD Denver, CO
Mark Hoyt, FSA, MAAA Phoenix, AZ
Patricia Riley, MS Brunswick, ME
Diane Rowland, ScD Washington, DC
Steven Waldren, MD, MS Leawood, KS
Term Expires December 2016
Sharon Carte, MHS South Charleston, WV
Andrea Cohen, JD New York, NY
Herman Gray, MD, MBA Detroit, MI
Norma Martínez Rogers, PhD, RN, FAAN San Antonio, TX
Sara Rosenbaum, JD Washington, DC
Term Expires December 2017Gustavo Cruz, DMD, MPH New York, NY
Marsha Gold, ScD Washington, DC
Charles Milligan, JD, MPH Albuquerque, NM
Sheldon Retchin, MD, MSPH Columbus, OH
Peter Szilagyi, MD, MPH Los Angeles, CA
December 2015vi
Commission StaffAnne L. Schwartz, PhD, Executive Director
Office of the Executive DirectorAnnie Andrianasolo, MBA, Executive Assistant
Kathryn Ceja, Director of Communications
Laura Beth Pelner, Communications/Graphic Design Specialist
Policy DirectorsAmy Bernstein, ScD, MHSA Policy Director and Contracting Officer
Moira Forbes, MBA, Policy Director
April Grady, MPAff, Policy Director
Mary Ellen Stahlman, MHSA, Policy and Congressional Affairs Director
Principal AnalystsMartha Heberlein, MA
Joanne Jee, MPH
Chris Peterson, MPP
Anna Sommers, PhD, MS, MPAff
James Teisl, MPH
Kristal Vardaman, MSPH
Senior AnalystsVeronica Daher, JD
Benjamin Finder, MPH
Sarah Melecki, MPAff
Robert Nelb, MPH
Chris Park, MS
Katie Weider, MPH
AnalystsKacey Buderi, MPA Kayla Holgash, MPH
Operations and ManagementRicardo Villeta, MBA, Deputy Director of Operations, Finance, and Management
James Boissonnault, MA, Chief Information Officer
Benjamin Granata, Finance/Budget Specialist
Allissa Jones, Administrative Assistant
Ken Pezzella, Chief Financial Officer
Eileen Wilkie, Administrative Officer
Commission Staff
MACStats: Medicaid and CHIP Data Book vii
Table of Contents
Table of ContentsCommission Members and Terms ...................................................................................................................... v
Commission Staff ............................................................................................................................................... vi
Introduction ......................................................................................................................................................... xi
SECTION 1: Overview—Key Statistics ........................................................................................................ 1
Key Points ........................................................................................................................................... 2
EXHIBIT 1: Medicaid and CHIP Enrollment as a Percentage of the U.S. Population, 2014 (millions) ................................................................................................................. 3
EXHIBIT 2: Characteristics of Non-Institutionalized Individuals by Age and Source of Health Coverage, 2014 .................................................................................................... 4
EXHIBIT 3: National Health Expenditures by Type and Payer, 2013 ............................................... 9
EXHIBIT 4: Major Health Programs and Other Components of the Federal Budget as a Share of Federal Outlays, FYs 1965–2014 .................................................................. 12
EXHIBIT 5: Medicaid as a Share of State Budgets Including and Excluding Federal Funds by State, SFY 2013 ............................................................................................................ 14
EXHIBIT 6: Federal Medical Assistance Percentages (FMAPs) and Enhanced FMAPs (E-FMAPs) by State, FYs 2012–2016 ........................................................................... 17
SECTION 2: Trends ............................................................................................................................. 21
Key Points ......................................................................................................................................... 22
EXHIBIT 7: Medicaid Beneficiaries (Persons Served) by Eligibility Group, FYs 1975–2012 (thousands) ........................................................................................ 23
EXHIBIT 8: Medicaid Enrollment and Spending, FYs 1966–2014 ................................................. 25
EXHIBIT 9: Annual Growth in Medicaid Enrollment and Spending, FYs 1975–2014 ................... 26
EXHIBIT 10: Medicaid Enrollment and Total Spending Levels and Annual Growth, FYs 1966–2014 ............................................................................................................. 27
EXHIBIT 11: Full-Benefit Medicaid and CHIP Enrollment, Selected Months, 2013–2015 ............. 29
EXHIBIT 12: Historical and Projected National Health Expenditures by Payer for Selected Years, 1970–2024 .......................................................................................... 32
EXHIBIT 13: Medicaid as a Share of State Budgets Including and Excluding Federal Funds, SFYs 1987–2013 ........................................................................................................... 34
SECTION 3: Program Enrollment and Spending ....................................................................................... 37
Key Points ......................................................................................................................................... 38
Medicaid Overall
EXHIBIT 14: Medicaid Enrollment by State, Eligibility Group, and Dually Eligible Status, FY 2012 (thousands) .................................................................................................... 39
December 2015viii
Table of Contents
EXHIBIT 15: Medicaid Full-Year Equivalent Enrollment by State and Eligibility Group, FY 2012 (thousands) .................................................................................................... 42
EXHIBIT 16: Medicaid Spending by State, Category, and Source of Funds, FY 2014 (millions) .... 45
Medicaid Benefits
EXHIBIT 17: Total Medicaid Benefit Spending by State and Category, FY 2014 (millions) ..... 48
EXHIBIT 18: Distribution of Medicaid Benefit Spending by Eligibility Group and Service Category, FY 2012 ...................................................................................... 51
EXHIBIT 19: Medicaid Benefit Spending Per Full-Year Equivalent (FYE) Enrollee by Eligibility Group and Service Category, FY 2012 ................................................... 52
EXHIBIT 20: Distribution of Medicaid Enrollment and Benefit Spending by Users and Non-Users of Long-Term Services and Supports, FY 2012 .................................. 53
EXHIBIT 21: Medicaid Spending by State, Eligibility Group, and Dually Eligible Status, FY 2012 (millions) ................................................................................................... 54
EXHIBIT 22: Medicaid Benefit Spending Per Full-Year Equivalent (FYE) Enrollee by State and Eligibility Group, FY 2012 ................................................................................ 56
EXHIBIT 23: Medicaid Supplemental Payments to Hospital Providers by State, FY 2014 (millions) ................................................................................................... 59
EXHIBIT 24: Medicaid Supplemental Payments to Non-Hospital Providers by State, FY 2014 (millions) ................................................................................................... 61
EXHIBIT 25: Medicaid Gross Spending for Drugs by Delivery System and Brand or Generic Status, FY 2014 (millions) ...................................................................................... 64
EXHIBIT 26: Medicaid Drug Prescriptions by Delivery System and Brand or Generic Status, FY 2014 (thousands) .............................................................................................. 67
EXHIBIT 27: Medicaid Gross Spending and Rebates for Drugs by Delivery System, FY 2014 (millions) ................................................................................................... 69
Medicaid Managed Care
EXHIBIT 28: Percentage of Medicaid Enrollees in Managed Care by State, July 1, 2013 ....... 72
EXHIBIT 29: Percentage of Medicaid Enrollees in Managed Care by State and Eligibility Group, FY 2012 ......................................................................................................... 75
Medicaid Program Administration
EXHIBIT 30: Total Medicaid Administrative Spending by State and Category, FY 2014 (millions) .................................................................................................... 78
CHIP
EXHIBIT 31: Child Enrollment in CHIP and Medicaid by State, FY 2014 .................................. 81
EXHIBIT 32: CHIP Spending by State, FY 2014 (millions) ......................................................... 83
EXHIBIT 33: Federal CHIP Allotments, FY 2015 (millions) ........................................................ 86
MACStats: Medicaid and CHIP Data Book ix
Table of Contents
SECTION 4: Medicaid and CHIP Eligibility ....................................................................................... 89
Key Points .................................................................................................................................. 90
EXHIBIT 34: Medicaid and CHIP Income Eligibility Levels as a Percentage of the FPL for Children and Pregnant Women by State, September 2015 .................................. 91
EXHIBIT 35: Medicaid Income Eligibility Levels as a Percentage of the FPL for Non-Aged, Non-Disabled, Non-Pregnant Adults by State, September 2015 .......................... 94
EXHIBIT 36: Medicaid Income Eligibility Levels as a Percentage of the FPL for Individuals Age 65 and Older and Persons with Disabilities by State, 2015 .......................... 97
EXHIBIT 37: Income as a Percentage of the FPL for Various Family Sizes, 2015 ................ 100
SECTION 5: Beneficiary Health, Service Use, and Access to Care .................................................. 103
Key Points ................................................................................................................................ 104
EXHIBIT 38: Coverage, Demographic, and Health Characteristics of Non-Institutionalized Individuals Age 0–18 by Primary Source of Health Coverage, 2014 ................. 105
EXHIBIT 39: Use of Care among Non-Institutionalized Individuals Age 0–18 by Primary Source of Health Coverage, 2014, Data from National Health Interview Survey ........... 108
EXHIBIT 40: Use of Care among Non-Institutionalized Individuals Age 0–18 by Primary Source of Health Coverage, 2013, Data from Medical Expenditures Panel Survey ....... 110
EXHIBIT 41: Measures of Access to Care among Non-Institutionalized Individuals Age 0–18 by Primary Source of Health Coverage, 2014 ............................................ 112
EXHIBIT 42: Coverage, Demographic, and Health Characteristics of Non-Institutionalized Individuals Age 19–64 by Primary Source of Health Coverage, 2014 ............... 114
EXHIBIT 43: Use of Care among Non-Institutionalized Individuals Age 19–64 by Primary Source of Health Coverage, 2014, Data from National Health Interview Survey ........... 118
EXHIBIT 44: Use of Care among Non-Institutionalized Individuals Age 19–64 by Primary Source of Health Coverage, 2013, Data from Medical Expenditures Panel Survey ....... 121
EXHIBIT 45: Measures of Access to Care among Non-Institutionalized Individuals Age 19–64 by Primary Source of Health Coverage, 2014 .......................................... 123
SECTION 6: Technical Guide to MACStats ..................................................................................... 125
Interpreting Medicaid and CHIP Enrollment and Spending Numbers ...................................... 127
Understanding Data on Health and Other Characteristics of Medicaid and CHIP Populations ... 128
Methodology for Adjusting Benefit Spending Data .................................................................... 130
EXHIBIT 46: Medicaid Benefit Spending in MSIS and CMS-64 Data by State, FY 2012 (millions) ... 132
EXHIBIT 47: Service Categories Used to Adjust FY 2012 Medicaid Benefit Spending in the MSIS to Match CMS-64 Totals ...................................................................... 134
Understanding Managed Care Enrollment and Spending Data ................................................. 136
Endnotes ................................................................................................................................ 137
MACStats: Medicaid and CHIP Data Book xi
Introduction
IntroductionThe Medicaid and CHIP Payment and Access Commission is pleased to introduce the inaugural edition of the MACStats: Medicaid and CHIP Data Book.
In past years MACPAC has published Medicaid and State Children’s Health Insurance Program (CHIP) data in our semi-annual reports to Congress. This section, known as MACStats, has provided a comprehensive resource for a broad range of data on Medicaid and CHIP, which often can be difficult to find. Now MACPAC is making Medicaid and CHIP information even more accessible. Instead of publishing MACStats in two parts, we will publish tables and figures on the MACPAC website as soon as new data become available. At the end of each year, MACPAC will compile the most current Medicaid and CHIP program statistics in a stand-alone data book.
The December 2015 data book presents the most current data available on Medicaid and CHIP. Divided into six sections, it includes an overview with key statistics on Medicaid and CHIP; trends in Medicaid; Medicaid and CHIP enrollment and spending with information on benefits, managed care, and program administration; Medicaid and CHIP eligibility; and measures of beneficiary health, use of services, and access to care.
The data describe two programs that provide a safety net for low-income populations who otherwise would not have access to coverage and that cover services other payers often do not cover. The data book also provides a picture of these programs in context. For example, Medicaid and CHIP combined accounted for a smaller share of total health care spending than Medicare in fiscal year 2014, despite covering more people.
The final section of the data book contains a technical guide that describes the data sources used in MACStats, the methods that MACPAC uses to analyze these data, and guidance in interpreting how specific data—such as those on enrollment and spending—may differ from each other or from those published elsewhere.
We would like to thank the many individuals at the Centers for Medicare & Medicaid Services and our contractors—Social & Scientific Systems, and Acumen, LLC—who provided their insights and assistance. We would also like to thank Paula Gordon and GKV Communications, who provided valuable support in copyediting, formatting, and producing this data book.
SECTION 1
Overview— Key Statistics
December 20152
Section 1: Overview—Key Statistics
Section 1: Overview—Key Statistics
Key Points• In 2014, more than one-quarter of the U.S. population was enrolled in Medicaid or CHIP for
at least part of the year. The estimated number of people ever enrolled in Medicaid was 78.6 million in fiscal year (FY) 2014 (including 1 million individuals in the territories); for CHIP, the figure was 8.3 million (Exhibit 1).
• Nearly half of all individuals enrolled in Medicaid in 2014 had family incomes below the federal poverty level. People enrolled in Medicaid or CHIP were more likely to be Hispanic or black than those enrolled in other types of coverage, and they were more likely to be in fair or poor health than either privately insured or uninsured individuals (Exhibit 2).
• Medicaid and CHIP together accounted for 15.9 percent of national health expenditures in calendar year 2013; Medicare accounted for 20.1 percent; and private insurance accounted for 32.9 percent (Exhibit 3).
• The share of the federal budget devoted to Medicaid and Medicare has grown steadily since the programs were enacted in 1965, but Medicaid continues to account for a smaller share (8.6 percent in FY 2014) than Medicare (14.4 percent) (Exhibit 4).
• Medicaid spending as a share of state budgets varies depending on whether federal funds are included. Looking only at the state-funded portion of state budgets (that is, the portion states must finance on their own through taxes and other means), Medicaid’s share was 15.1 percent in state fiscal year (SFY) 2013. After including federal funds in state budgets, a typical practice in other data sources, Medicaid’s share was 24.5 percent in SFY 2013 (Exhibit 5).
MACStats: Medicaid and CHIP Data Book 3
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Popu
latio
nEv
er d
urin
g FY
201
4Po
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n tim
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014
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ates
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ail t
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htt
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EXH
IBIT
1.
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(mill
ions
)
December 20154
Section 1: Overview—Key Statistics
MAC
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pani
c17
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.5*
24.3
*14
.3*
35.5
43.6
*
Whi
te, n
on-H
ispa
nic
63.4
*78
.2*
72.3
*41
.544
.3*
54.2
*68
.4*
36.6
39.5
Blac
k, n
on-H
ispa
nic
12.8
*10
.0*
9.6*
22.7
13.2
*15
.1*
9.9*
23.0
9.7*
Oth
er n
on-w
hite
, non
-His
pani
c6.
44.
1*6.
9*6.
06.
16.
4*7.
4*4.
87.
2
EXH
IBIT
2.
Char
acte
ristic
s of
Non
-Inst
itutio
naliz
ed In
divi
dual
s by
Age
and
Sou
rce
of H
ealth
Cov
erag
e, 2
014
MACStats: Medicaid and CHIP Data Book 5
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
2.
(con
tinue
d)
Char
acte
ristic
Sele
cted
cov
erag
e so
urce
s at
tim
e of
inte
rvie
w, a
ge 1
9-64
1Se
lect
ed c
over
age
sour
ces
at
time
of in
terv
iew
, age
65
and
olde
r1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
co
vera
ge s
ourc
es)5
100.
0%3.
4%66
.7%
11.7
%16
.2%
100.
0%93
.3%
49.0
%7.
8%
Cove
rage
Leng
th o
f tim
e w
ith a
ny c
over
age
durin
g ye
ar
Full
year
78.0
*96
.7*
93.8
*83
.3–
98.3
99.1
99.3
*98
.3
Part
yea
r9.
6*3.
3*6.
2*16
.720
.2*
1.1
0.9
0.7*
1.7
No
cove
rage
dur
ing
year
12.5
*–
––
79.8
*0.
6*–
––
Mul
tiple
cov
erag
e so
urce
s at
tim
e of
inte
rvie
w
Yes,
any
Med
icar
e an
d M
edic
aid/
CHIP
co
mbi
natio
n61.
1*31
.6*
0.1*
9.1
–7.
0*7.
5*0.
9*89
.4
Yes,
any
priv
ate
and
Med
icai
d/CH
IP
com
bina
tion
0.3*
–0.
4*2.
2–
––
††
Yes,
any
oth
er c
ombi
natio
n1.
1*20
.6*
1.4*
0.5
–51
.2*
54.6
*91
.0*
†
No
97.5
*47
.8*
98.2
*88
.210
0.0
41.7
*37
.9*
8.0*
10.2
Dem
ogra
phic
s
Age
0–18
––
––
––
––
–
19–
6410
0.0
100.
010
0.0
100.
010
0.0
––
––
65 o
r old
er–
––
––
100.
010
0.0
100.
010
0.0
Gen
der
Mal
e49
.0*
48.1
*49
.3*
37.7
54.9
*44
.4*
43.8
*44
.4*
36.4
Fem
ale
51.0
*51
.9*
50.7
*62
.345
.1*
55.6
*56
.2*
55.6
*63
.6
Race
His
pani
c16
.9*
9.1*
11.6
*23
.135
.3*
7.7*
7.2*
3.6*
24.1
Whi
te, n
on-H
ispa
nic
63.5
*67
.8*
71.0
*47
.145
.278
.9*
80.1
*87
.1*
48.0
Blac
k, n
on-H
ispa
nic
12.7
*19
.8*
10.1
*22
.813
.7*
8.7*
8.5*
6.1*
18.3
Oth
er n
on-w
hite
, non
-His
pani
c6.
93.
3*7.
36.
95.
8*4.
6*4.
2*3.
2*9.
5
December 20156
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Char
acte
ristic
Sele
cted
cov
erag
e so
urce
s at
tim
e of
inte
rvie
w, a
ll ag
es1
Sele
cted
cov
erag
e so
urce
s at
tim
e of
inte
rvie
w, a
ge 0
-181
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
lPr
ivat
e2M
edic
aid/
CHIP
3U
nins
ured
4
Educ
atio
n7
Less
than
hig
h sc
hool
12.8
%*
18.6
%*
6.4%
*30
.1%
26.2
%*
––
––
Hig
h sc
hool
dip
lom
a/G
ED26
.8*
31.9
*22
.8*
34.6
35.4
––
––
Som
e co
llege
30.4
*25
.132
.0*
25.9
28.0
*–
––
–Co
llege
or g
radu
ate
degr
ee29
.9*
24.3
*38
.8*
9.4
10.4
––
––
Mar
ital s
tatu
s7
Mar
ried
55.1
*54
.6*
62.1
*32
.540
.5*
––
––
Wid
owed
5.9
23.0
*4.
5*6.
41.
7*–
––
–Di
vorc
ed o
r sep
arat
ed10
.6*
13.5
*8.
6*16
.912
.0*
––
––
Livi
ng w
ith p
artn
er7.
5*2.
4*6.
2*10
.214
.7*
––
––
Nev
er m
arrie
d20
.9*
6.5*
18.6
*34
.031
.1*
––
––
Fam
ily in
com
eLe
ss th
an 1
38 p
erce
nt F
PL23
.4*
20.3
*7.
6*66
.143
.6*
32.8
%*
7.1%
*68
.2%
42.7
%*
Has
inco
me
in ra
nges
bel
owLe
ss th
an 1
00 p
erce
nt F
PL15
.3*
11.3
*4.
1*47
.728
.3*
22.5
*3.
7*49
.126
.1*
100–
199
perc
ent F
PL20
.0*
24.7
*12
.3*
33.8
34.7
23.0
*12
.9*
35.1
37.3
200–
399
perc
ent F
PL29
.4*
33.2
*33
.3*
14.3
27.4
*28
.1*
38.1
*13
.329
.5*
400
perc
ent F
PL o
r hig
her
35.3
*30
.8*
50.4
*4.
19.
7*26
.4*
45.3
*2.
57.
0*O
ther
dem
ogra
phic
cha
ract
eris
tics
Citiz
en o
f Uni
ted
Stat
es92
.998
.2*
95.6
*93
.374
.4*
97.3
98.6
*97
.584
.4*
Pare
nt o
f a d
epen
dent
chi
ld7
29.7
*2.
2*31
.6*
36.9
35.3
––
––
Curr
ently
wor
king
761
.8*
14.1
*73
.2*
35.5
65.4
*–
––
–Ve
tera
n79.
0*20
.9*
7.8*
3.1
3.0
––
––
Rece
ives
SSI
or S
SDI
4.0*
12.8
1.1*
13.2
0.7*
1.6*
0.5*
3.6
0.5*
Hea
lthCu
rren
t hea
lth s
tatu
sEx
celle
nt o
r ver
y go
od66
.5*
41.2
*73
.2*
59.5
59.2
84.2
*89
.8*
76.7
78.9
Goo
d23
.7*
32.2
*21
.0*
25.2
30.3
*14
.1*
9.3*
20.5
19.4
Fair
or p
oor
9.8*
26.7
*5.
8*15
.310
.4*
1.7*
0.9*
2.9
1.7*
EXH
IBIT
2.
(con
tinue
d)
MACStats: Medicaid and CHIP Data Book 7
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
2.
(con
tinue
d)
Char
acte
ristic
Sele
cted
cov
erag
e so
urce
s at
tim
e of
inte
rvie
w, a
ge 1
9-64
1Se
lect
ed c
over
age
sour
ces
at
time
of in
terv
iew
, age
65
and
olde
r1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Educ
atio
n7
Less
than
hig
h sc
hool
11.6
%*
24.2
%*
5.4%
*27
.7%
25.9
%18
.0%
*17
.8%
*12
.2%
*45
.4%
Hig
h sc
hool
dip
lom
a/G
ED25
.9*
36.4
21.4
*35
.935
.530
.9*
31.3
*30
.7*
26.0
Som
e co
llege
31.8
*29
.233
.2*
27.6
28.2
24.3
*24
.5*
25.3
*14
.8Co
llege
or g
radu
ate
degr
ee30
.7*
10.2
40.1
*8.
710
.3*
26.8
*26
.5*
31.8
*13
.8M
arita
l sta
tus7
Mar
ried
54.6
*39
.1*
62.1
*32
.940
.4*
57.3
*57
.0*
62.0
*30
.2W
idow
ed1.
4*6.
2*1.
1*2.
31.
5*25
.0*
25.5
*23
.9*
32.3
Divo
rced
or s
epar
ated
10.4
*26
.9*
8.5*
15.9
11.9
*11
.6*
11.4
*9.
2*23
.4Li
ving
with
par
tner
8.8*
6.1*
7.0*
11.5
14.8
*1.
81.
91.
62.
3N
ever
mar
ried
24.8
*21
.8*
21.3
*37
.431
.3*
4.3*
4.1*
3.2*
11.8
Fam
ily in
com
eLe
ss th
an 1
38 p
erce
nt F
PL21
.3*
46.4
*7.
7*63
.843
.7*
16.3
*16
.1*
7.8*
61.9
Has
inco
me
in ra
nges
bel
owLe
ss th
an 1
00 p
erce
nt F
PL13
.9*
30.1
*4.
4*46
.928
.5*
8.5*
8.2*
2.8*
41.6
100–
199
perc
ent F
PL18
.1*
35.1
*11
.1*
31.8
34.3
*22
.7*
23.0
*17
.6*
35.7
200–
399
perc
ent F
PL28
.7*
23.0
*31
.3*
15.8
27.2
*34
.4*
34.9
*36
.0*
14.1
400
perc
ent F
PL o
r hig
her
39.2
*11
.7*
53.2
*5.
510
.0*
34.4
*33
.9*
43.6
*8.
6O
ther
dem
ogra
phic
cha
ract
eris
tics
Citiz
en o
f Uni
ted
Stat
es90
.2*
98.4
*94
.1*
88.5
73.4
*97
.1*
98.1
*99
.0*
88.3
Pare
nt o
f a d
epen
dent
chi
ld7
36.6
*12
.6*
37.0
*42
.635
.7*
0.7
0.6
0.5
1.0
Curr
ently
wor
king
772
.6*
10.4
*82
.2*
40.4
65.9
*16
.4*
14.7
*21
.3*
5.0
Vete
ran7
5.8*
9.4*
5.2*
2.3
3.0*
22.7
*22
.7*
22.9
*7.
8Re
ceiv
es S
SI o
r SSD
I5.
0*71
.5*
1.4*
23.2
0.8*
3.8*
3.7*
0.8*
31.7
Hea
lthCu
rren
t hea
lth s
tatu
sEx
celle
nt o
r ver
y go
od64
.3*
14.5
*71
.5*
42.4
56.7
*44
.9*
45.0
*51
.6*
22.4
Goo
d25
.4*
25.8
*22
.9*
30.5
31.9
33.3
33.2
32.3
31.7
Fair
or p
oor
10.3
*59
.7*
5.6*
27.2
11.5
*21
.7*
21.7
*16
.1*
45.9
December 20158
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
2.
(con
tinue
d)
Not
es: F
PL is
fede
ral p
over
ty le
vel.
SSDI
is S
ocia
l Sec
urity
Dis
abili
ty In
sura
nce.
SSI
is S
uppl
emen
tal S
ecur
ity In
com
e. P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
exhi
bit
excl
ude
indi
vidu
als
with
mis
sing
and
unk
now
n va
lues
. Sta
ndar
d er
rors
are
ava
ilabl
e on
line
in d
ownl
oada
ble
Exce
l file
s at
https://w
ww.m
acpac.go
v/pu
blication/
characteristic
s-of-non
-institu
tionalized-individu
als-by-sou
rce-of-health
-insurance/
. Due
to d
iffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t sur
vey
data
sou
rces
will
var
y. F
or e
xam
ple,
the
Nat
iona
l Hea
lth In
terv
iew
Sur
vey
(NH
IS) i
s kn
own
to p
rodu
ce h
ighe
r est
imat
es o
f ser
vice
use
than
the
Med
ical
Exp
endi
ture
s Pa
nel S
urve
y (M
EPS)
. For
pur
pose
s of
com
parin
g gr
oups
of i
ndiv
idua
ls (a
s in
this
ex
hibi
t), t
he N
HIS
pro
vide
s th
e m
ost r
ecen
t inf
orm
atio
n av
aila
ble.
For
oth
er p
urpo
ses,
suc
h as
mea
surin
g le
vels
of u
se re
lativ
e to
a p
artic
ular
ben
chm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
*Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
–Da
sh in
dica
tes
zero
; 0.0
% in
dica
tes
an a
mou
nt le
ss th
an 0
.05%
that
roun
ds to
zer
o.1
Tota
l inc
lude
s al
l non
-inst
itutio
naliz
ed in
divi
dual
s, re
gard
less
of c
over
age
sour
ce. I
n th
is e
xhib
it, th
e su
m o
f val
ues
acro
ss h
ealth
insu
ranc
e co
vera
ge ty
pes
may
not
add
to
100
per
cent
for e
ach
age
grou
p be
caus
e in
divi
dual
s m
ay h
ave
mul
tiple
sou
rces
of c
over
age
and
beca
use
not a
ll ty
pes
of c
over
age
are
disp
laye
d. O
ther
MAC
Stat
s ex
hibi
ts
appl
y a
hier
arch
y to
ass
ign
indi
vidu
als
with
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
, and
may
ther
efor
e ha
ve d
iffer
ent r
esul
ts th
an th
ose
show
n he
re. C
over
age
sour
ce
is d
efin
ed a
s of
the
time
of th
e su
rvey
inte
rvie
w. S
ince
an
indi
vidu
al m
ay h
ave
mul
tiple
cov
erag
e so
urce
s or
cha
nges
ove
r tim
e, re
spon
ses
to s
urve
y qu
estio
ns m
ay re
flect
ch
arac
teris
tics
or e
xper
ienc
es a
ssoc
iate
d w
ith a
cov
erag
e so
urce
oth
er th
an th
e on
e as
sign
ed in
this
exh
ibit.
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
.4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te-s
pons
ored
or o
ther
gov
ernm
ent-s
pons
ored
hea
lth
plan
, or m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce,
such
as
acci
dent
s or
den
tal c
are.
5 Co
mpo
nent
s m
ay n
ot s
um to
100
per
cent
bec
ause
indi
vidu
als
may
hav
e m
ultip
le s
ourc
es o
f cov
erag
e an
d be
caus
e no
t all
type
s of
cov
erag
e ar
e di
spla
yed.
6 N
HIS
and
oth
er s
urve
y da
ta u
nder
estim
ate
the
num
ber o
f ind
ivid
uals
dua
lly e
nrol
led
in M
edic
are
and
Med
icai
d, in
par
t bec
ause
mos
t sur
veys
do
not c
ount
thos
e w
hose
onl
y M
edic
aid
bene
fit is
pay
men
t of M
edic
are
prem
ium
s an
d co
st s
harin
g as
hav
ing
Med
icai
d co
vera
ge.
7 In
form
atio
n is
lim
ited
to th
ose
age
19 o
r old
er.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
MACStats: Medicaid and CHIP Data Book 9
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
3.
Nat
iona
l Hea
lth E
xpen
ditu
res
by T
ype
and
Paye
r, 20
13
Type
of e
xpen
ditu
re
Paye
r am
ount
(mill
ions
)
Tota
lM
edic
aid
CHIP
Med
icar
ePr
ivat
e in
sura
nce
Oth
er
heal
th
insu
ranc
e1
Oth
er
third
par
ty
paye
rs2
Out
of
pock
et
Tota
l$2
,919
,137
$449
,389
$13,
493
$585
,701
$961
,741
$92,
570
$476
,818
$339
,422
Hos
pita
l car
e93
6,86
716
3,53
43,
478
242,
670
348,
021
50,9
5595
,559
32,6
50
Phys
icia
n an
d cl
inic
al s
ervi
ces
586,
675
50,1
233,
534
130,
302
267,
601
20,5
9459
,170
55,3
50
Dent
al s
ervi
ces
110,
970
7,50
61,
497
475
52,6
241,
204
542
47,1
23
Oth
er p
rofe
ssio
nal s
ervi
ces3
80,2
475,
011
254
18,0
4529
,306
–7,
039
20,5
92
Hom
e he
alth
car
e79
,772
29,1
0333
34,3
816,
336
1,07
92,
412
6,42
8
Oth
er n
on-d
urab
le m
edic
al p
rodu
cts4
55,8
92–
–2,
667
––
253
,223
Pres
crip
tion
drug
s27
1,09
621
,173
1,41
574
,647
117,
937
7,50
02,
513
45,9
11
Dura
ble
med
ical
equ
ipm
ent5
42,9
874,
904
132
7,69
24,
977
–62
524
,656
Nur
sing
car
e fa
cilit
ies
and
cont
inui
ng c
are
retir
emen
t com
mun
ities
615
5,82
946
,867
1134
,555
12,5
804,
475
11,5
1945
,822
Oth
er h
ealth
, res
iden
tial,
and
pers
onal
car
e se
rvic
es7
148,
230
82,5
6095
45,
108
6,61
13,
514
41,8
157,
668
Adm
inis
trat
ion8
210,
588
38,6
072,
185
35,1
5711
5,74
93,
248
15,6
41–
Publ
ic h
ealth
act
ivity
75,3
88–
––
––
75,3
88–
Inve
stm
ent
164,
594
––
––
–16
4,59
4–
December 201510
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Type
of e
xpen
ditu
re
Shar
e of
tota
l
Tota
lM
edic
aid
CHIP
Med
icar
ePr
ivat
e in
sura
nce
Oth
er
heal
th
insu
ranc
e1
Oth
er
third
par
ty
paye
rs2
Out
of
pock
et
Tota
l10
0.0%
15.4
%0.
5%20
.1%
32.9
%3.
2%16
.3%
11.6
%
Hos
pita
l car
e10
0.0
17.5
0.4
25.9
37.1
5.4
10.2
3.5
Phys
icia
n an
d cl
inic
al s
ervi
ces
100.
08.
50.
622
.245
.63.
510
.19.
4
Dent
al s
ervi
ces
100.
06.
81.
30.
447
.41.
10.
542
.5
Oth
er p
rofe
ssio
nal s
ervi
ces3
100.
06.
20.
322
.536
.5–
8.8
25.7
Hom
e he
alth
car
e10
0.0
36.5
0.0
43.1
7.9
1.4
3.0
8.1
Oth
er n
on-d
urab
le m
edic
al p
rodu
cts4
100.
0–
–4.
8–
–0.
095
.2
Pres
crip
tion
drug
s10
0.0
7.8
0.5
27.5
43.5
2.8
0.9
16.9
Dura
ble
med
ical
equ
ipm
ent5
100.
011
.40.
317
.911
.6–
1.5
57.4
Nur
sing
car
e fa
cilit
ies
and
cont
inui
ng c
are
retir
emen
t com
mun
ities
610
0.0
30.1
0.0
22.2
8.1
2.9
7.4
29.4
Oth
er h
ealth
, res
iden
tial,
and
pers
onal
car
e se
rvic
es7
100.
055
.70.
63.
44.
52.
428
.25.
2
Adm
inis
trat
ion8
100.
018
.31.
016
.755
.01.
57.
4–
Publ
ic h
ealth
act
ivity
100.
0–
––
––
100.
0–
Inve
stm
ent
100.
0–
––
––
100.
0–
Not
es: F
igur
es fo
r nur
sing
car
e fa
cilit
ies
and
cont
inui
ng re
tirem
ent c
omm
uniti
es a
nd o
ther
hea
lth, r
esid
entia
l, an
d pe
rson
al c
are
refle
ct n
ew d
ata
and
met
hods
as
of 2
011.
In
prio
r rel
ease
s, M
edic
aid
acco
unte
d fo
r abo
ut 4
0 pe
rcen
t of n
ursi
ng h
ome
expe
nditu
res
and
abou
t thr
ee-q
uart
ers
of o
ther
per
sona
l hea
lth c
are
expe
nditu
res.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
EXH
IBIT
3.
(con
tinue
d)
MACStats: Medicaid and CHIP Data Book 11
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
1 U
.S. D
epar
tmen
t of D
efen
se a
nd U
.S. D
epar
tmen
t of V
eter
ans
Affa
irs.
2 In
clud
es a
ll ot
her p
ublic
and
priv
ate
prog
ram
s an
d ex
pend
iture
s ex
cept
for o
ut-o
f-poc
ket a
mou
nts.
3 Th
e ot
her p
rofe
ssio
nal s
ervi
ces
cate
gory
incl
udes
ser
vice
s pr
ovid
ed in
est
ablis
hmen
ts o
pera
ted
by h
ealth
pra
ctiti
oner
s ot
her t
han
phys
icia
ns a
nd d
entis
ts, i
nclu
ding
thos
e pr
ovid
ed b
y pr
ivat
e-du
ty n
urse
s, c
hiro
prac
tors
, pod
iatr
ists
, opt
omet
rists
, and
phy
sica
l, oc
cupa
tiona
l, an
d sp
eech
ther
apis
ts, a
mon
g ot
hers
.4
The
othe
r non
-dur
able
med
ical
pro
duct
s ca
tego
ry in
clud
es th
e re
tail
sale
s of
non
-pre
scrip
tion
drug
s an
d m
edic
al s
undr
ies.
5 Th
e du
rabl
e m
edic
al e
quip
men
t cat
egor
y in
clud
es re
tail
sale
s of
item
s su
ch a
s co
ntac
t len
ses,
eye
glas
ses,
and
oth
er o
phth
alm
ic p
rodu
cts,
sur
gica
l and
ort
hope
dic
prod
ucts
, he
arin
g ai
ds, w
heel
chai
rs, a
nd m
edic
al e
quip
men
t ren
tals
.6
The
nurs
ing
care
faci
litie
s an
d co
ntin
uing
car
e re
tirem
ent c
omm
uniti
es c
ateg
ory
incl
udes
nur
sing
and
reha
bilit
ativ
e se
rvic
es p
rovi
ded
in fr
eest
andi
ng n
ursi
ng h
ome
faci
litie
s th
at a
re g
ener
ally
pro
vide
d fo
r an
exte
nded
per
iod
of ti
me
by re
gist
ered
or l
icen
sed
prac
tical
nur
ses
and
othe
r sta
ff.
7 Th
e ot
her h
ealth
, res
iden
tial,
and
pers
onal
car
e ca
tego
ry in
clud
es s
pend
ing
for M
edic
aid
hom
e an
d co
mm
unity
-bas
ed w
aive
rs, c
are
prov
ided
in re
side
ntia
l fac
ilitie
s fo
r pe
ople
with
inte
llect
ual d
isab
ilitie
s or
men
tal h
ealth
and
sub
stan
ce a
buse
dis
orde
rs, a
mbu
lanc
e se
rvic
es, s
choo
l hea
lth, a
nd w
orks
ite h
ealth
car
e.8
The
adm
inis
trat
ion
cate
gory
incl
udes
the
adm
inis
trat
ive
cost
of h
ealth
car
e pr
ogra
ms
(e.g
., M
edic
are
and
Med
icai
d) a
nd th
e ne
t cos
t of p
rivat
e he
alth
insu
ranc
e (a
dmin
istr
ativ
e co
sts,
as
wel
l as
addi
tions
to re
serv
es, r
ate
cred
its a
nd d
ivid
ends
, pre
miu
m ta
xes,
and
pla
n pr
ofits
or l
osse
s).
Sour
ces:
Off
ice
of th
e Ac
tuar
y (O
ACT)
, Cen
ters
for M
edic
are
& M
edic
aid
Serv
ices
, 201
4, N
atio
nal h
ealth
exp
endi
ture
s by
type
of s
ervi
ce a
nd s
ourc
e of
fund
s: C
alen
dar y
ears
196
0–20
13, B
altim
ore,
MD:
OAC
T, ht
tps:
//w
ww
.cm
s.go
v/Re
sear
ch-S
tatis
tics-
Data
-and
-Sys
tem
s/St
atis
tics-
Tren
ds-a
nd-R
epor
ts/N
atio
nalH
ealth
Expe
ndDa
ta/D
ownl
oads
/NH
E201
3.zi
p. O
ACT,
2014
, Nat
iona
l hea
lth e
xpen
ditu
re a
ccou
nts:
Met
hodo
logy
pap
er, 2
013,
htt
p://
ww
w.c
ms.
gov/
Rese
arch
-Sta
tistic
s-Da
ta-a
nd-S
yste
ms/
Stat
istic
s-Tr
ends
-and
-Rep
orts
/N
atio
nalH
ealth
Expe
ndDa
ta/D
ownl
oads
/dsm
-13.
pdf.
EXH
IBIT
3.
(con
tinue
d)
December 201512
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
Fiscal year
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Medicaid
Medicare
Social Security
Exchangesubsidies
CHIP
Other mandatory programs
Discretionary, defense
Discretionary, non-defense
Net interest
EXHIBIT 4. Major Health Programs and Other Components of the Federal Budget as a Share of Federal Outlays, FYs 1965–2014
MACStats: Medicaid and CHIP Data Book 13
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Fisc
al y
ear
Man
dato
ry p
rogr
ams
Disc
retio
nary
pro
gram
s
Net
inte
rest
Med
icai
dCH
IPM
edic
are
Exch
ange
su
bsid
ies
Soci
al
Secu
rity
Oth
erDe
fens
eN
on-
defe
nse
1965
0.2%
––
–14
.4%
12.3
%43
.2%
22.6
%7.
3%19
701.
4–
3.0%
–15
.211
.641
.919
.67.
319
752.
1–
3.7
–19
.120
.626
.421
.27.
019
802.
4–
5.2
–19
.816
.922
.824
.08.
919
852.
4–
6.8
–19
.713
.526
.717
.213
.719
903.
3–
7.6
–19
.714
.724
.016
.014
.719
914.
0–
7.7
–20
.113
.224
.116
.114
.719
924.
9–
8.4
–20
.613
.021
.916
.714
.419
935.
4–
9.1
–21
.411
.720
.717
.514
.119
945.
6–
9.7
–21
.712
.119
.317
.713
.919
955.
9–
10.4
–22
.010
.518
.017
.915
.319
965.
9–
11.0
–22
.211
.317
.017
.115
.419
976.
0–
11.7
–22
.610
.317
.017
.215
.219
986.
10.
0%11
.5–
22.8
11.6
16.4
17.1
14.6
1999
6.3
0.0
11.0
–22
.712
.716
.217
.413
.520
006.
60.
110
.9–
22.7
13.0
16.5
17.9
12.5
2001
6.9
0.2
11.5
–23
.012
.416
.418
.411
.120
027.
30.
211
.3–
22.5
13.7
17.4
19.1
8.5
2003
7.4
0.2
11.4
–21
.813
.918
.719
.47.
120
047.
70.
211
.6–
21.4
13.1
19.8
19.2
7.0
2005
7.4
0.2
11.9
–21
.012
.920
.019
.27.
420
066.
80.
212
.2–
20.5
13.4
19.6
18.7
8.5
2007
7.0
0.2
13.6
–21
.311
.020
.118
.18.
720
086.
80.
212
.9–
20.5
13.0
20.5
17.5
8.5
2009
7.1
0.2
12.1
–19
.320
.818
.716
.55.
320
107.
90.
212
.9–
20.3
14.1
19.9
19.0
5.7
2011
7.6
0.2
13.3
–20
.114
.919
.418
.06.
420
127.
10.
313
.2–
21.7
15.2
19.0
17.4
6.2
2013
7.7
0.3
14.2
–23
.413
.218
.116
.76.
420
148.
60.
314
.40.
4%24
.112
.117
.016
.66.
5
Not
es: F
Y is
fisc
al y
ear.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
Off
ice
of M
anag
emen
t and
Bud
get (
OM
B), F
isca
l yea
r 201
6 hi
stor
ical
tabl
es: B
udge
t of t
he U
.S. g
over
nmen
t, Ta
bles
6.1
, 8.5
, and
8.7
, W
ashi
ngto
n, D
C: O
MB,
htt
p://
ww
w.g
po.g
ov/f
dsys
/sea
rch/
page
deta
ils.a
ctio
n?gr
anul
eId=
&pac
kage
Id=B
UDG
ET-2
016-
TAB.
EXH
IBIT
4.
(con
tinue
d)
December 201514
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Stat
e
Tota
l bud
get (
incl
udin
g al
l sta
te a
nd fe
dera
l fun
ds)
Stat
e-fu
nded
bud
get (
no fe
dera
l fun
ds)
Dolla
rs
(mill
ions
)
Tota
l spe
ndin
g as
a s
hare
of
tota
l bud
get1
Dolla
rs
(mill
ions
)
Stat
e-fu
nded
spe
ndin
g as
a s
hare
of
sta
te-f
unde
d bu
dget
1
Med
icai
d
Elem
enta
ry
and
seco
ndar
y ed
ucat
ion
Hig
her
educ
atio
nM
edic
aid
Elem
enta
ry
and
seco
ndar
y ed
ucat
ion
Hig
her
educ
atio
nTo
tal
$1,6
89,5
42
24.5
%19
.8%
10.3
%$1
,186
,805
15
.1%
23.9
%13
.0%
Alab
ama
24,5
20
22.8
20.4
19.9
15,0
38
11.7
26.9
24.6
Alas
ka11
,838
12
.213
.79.
29,
108
6.7
15.4
10.6
Ariz
ona
28,2
97
29.8
18.6
14.3
16,2
89
16.4
25.4
20.3
Arka
nsas
21,4
45
21.0
15.6
15.4
15,3
63
8.7
18.4
21.5
Calif
orni
a21
1,43
2 25
.121
.46.
614
1,00
1 17
.527
.66.
5Co
lora
do29
,035
22
.026
.08.
321
,612
16
.632
.19.
1Co
nnec
ticut
27,8
52
21.8
14.1
10.6
25,2
39
24.0
13.7
10.3
Dela
war
e9,
162
17.2
24.3
4.6
7,37
9 9.
627
.34.
8Di
stric
t of C
olum
bia2
––
––
––
––
Flor
ida
63,9
71
31.8
19.3
8.5
39,6
99
21.4
25.8
13.6
Geo
rgia
42,4
44
21.3
24.1
19.0
29,3
98
10.6
26.8
27.2
Haw
aii
11,5
84
14.4
15.5
10.9
9,67
2 8.
215
.612
.9Id
aho
6,69
1 28
.024
.28.
14,
043
15.7
34.1
13.4
Illin
ois
65,2
87
23.8
13.3
3.7
49,8
15
15.9
13.2
4.3
Indi
ana
28,1
71
31.2
30.8
6.1
17,8
14
15.9
42.8
9.6
Iow
a19
,531
19
.816
.426
.013
,804
12
.620
.033
.2Ka
nsas
13,9
69
18.5
26.8
18.2
10,0
79
11.5
32.4
19.1
Kent
ucky
25,6
73
21.9
19.6
26.7
17,6
72
9.6
23.6
33.4
Loui
sian
a27
,317
25
.119
.310
.317
,076
12
.524
.715
.5M
aine
7,67
9 32
.716
.93.
65,
116
19.4
21.4
5.4
Mar
ylan
d36
,255
21
.019
.214
.527
,071
13
.822
.118
.2M
assa
chus
etts
57,5
41
18.7
11.2
10.1
42,0
11
9.0
12.9
13.8
Mic
higa
n47
,398
26
.427
.24.
229
,974
14
.437
.26.
2M
inne
sota
33,0
74
24.3
29.2
4.7
24,6
39
16.3
36.2
6.3
Mis
siss
ippi
18,5
12
26.1
16.4
16.1
10,7
57
11.2
21.7
26.2
EXH
IBIT
5.
Med
icai
d as
a S
hare
of S
tate
Bud
gets
Incl
udin
g an
d Ex
clud
ing
Fede
ral F
unds
by
Stat
e, S
FY 2
013
MACStats: Medicaid and CHIP Data Book 15
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
5.
(con
tinue
d)
Stat
e
Tota
l bud
get (
incl
udin
g al
l sta
te a
nd fe
dera
l fun
ds)
Stat
e-fu
nded
bud
get (
no fe
dera
l fun
ds)
Dolla
rs
(mill
ions
)
Tota
l spe
ndin
g as
a s
hare
of
tota
l bud
get1
Dolla
rs
(mill
ions
)
Stat
e-fu
nded
spe
ndin
g as
a s
hare
of
sta
te-f
unde
d bu
dget
1
Med
icai
d
Elem
enta
ry
and
seco
ndar
y ed
ucat
ion
Hig
her
educ
atio
nM
edic
aid
Elem
enta
ry
and
seco
ndar
y ed
ucat
ion
Hig
her
educ
atio
nM
isso
uri
$22,
943
35.8
%22
.8%
4.8%
$15,
734
25.2
%27
.2%
7.0%
Mon
tana
6,04
0 17
.915
.510
.13,
925
8.8
19.7
14.2
Neb
rask
a10
,162
17
.914
.623
.37,
148
11.5
16.2
28.3
Nev
ada
8,89
7 22
.722
.38.
55,
979
14.3
26.7
12.7
New
Ham
pshi
re5,
017
25.6
23.4
2.2
3,41
3 19
.928
.53.
3N
ew J
erse
y50
,811
20
.424
.97.
938
,770
12
.430
.410
.3N
ew M
exic
o14
,696
25
.019
.519
.38,
897
12.6
27.6
24.5
New
Yor
k13
3,09
7 29
.119
.37.
694
,523
16
.323
.510
.4N
orth
Car
olin
a43
,105
30
.024
.812
.430
,414
14
.830
.517
.5N
orth
Dak
ota
5,71
2 13
.715
.019
.04,
176
8.6
17.2
23.2
Ohi
o58
,268
29
.217
.04.
345
,621
28
.317
.35.
5O
klah
oma
21,4
30
23.0
16.2
22.7
14,5
07
13.7
19.4
30.0
Ore
gon
25,8
03
21.4
14.3
1.1
18,3
52
11.1
17.0
1.2
Penn
sylv
ania
85,3
78
26.9
14.9
2.1
61,4
33
17.2
16.8
2.9
Rhod
e Is
land
7,86
6 24
.814
.913
.05,
346
17.8
17.9
19.1
Sout
h Ca
rolin
a22
,208
22
.017
.619
.514
,408
9.
520
.925
.8So
uth
Dako
ta4,
098
19.9
14.1
22.3
2,60
4 12
.115
.632
.0Te
nnes
see
30,4
91
30.8
17.8
13.9
17,9
59
18.3
23.7
22.5
Texa
s93
,244
31
.727
.415
.762
,360
19
.333
.119
.6U
tah
12,6
79
17.2
23.6
11.5
9,23
3 8.
127
.815
.6Ve
rmon
t4,
965
28.3
32.0
1.8
3,27
0 19
.244
.92.
8Vi
rgin
ia45
,737
16
.715
.115
.336
,191
10
.716
.315
.9W
ashi
ngto
n33
,996
11
.923
.414
.325
,896
7.
927
.418
.6W
est V
irgin
ia22
,320
13
.510
.513
.718
,245
4.
711
.015
.2W
isco
nsin
42,7
69
17.2
16.2
14.3
31,9
54
9.1
19.3
13.6
Wyo
min
g9,
132
6.6
10.9
4.8
6,77
8 4.
414
.36.
4
December 201516
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
5.
(con
tinue
d)
Not
es: S
FY is
sta
te fi
scal
yea
r. To
tal b
udge
t inc
lude
s fe
dera
l and
all
othe
r fun
ds. S
tate
-fund
ed b
udge
t inc
lude
s st
ate
gene
ral f
unds
, oth
er s
tate
fund
s, a
nd b
onds
. Med
icai
d,
elem
enta
ry a
nd s
econ
dary
edu
catio
n, a
nd h
ighe
r edu
catio
n re
pres
ent t
he la
rges
t tot
al b
udge
t sha
res
amon
g fu
nctio
ns b
roke
n ou
t sep
arat
ely
by th
e N
atio
nal A
ssoc
iatio
n of
St
ate
Budg
et O
ffic
ers
(NAS
BO).
Func
tions
not
sho
wn
here
are
tran
spor
tatio
n, c
orre
ctio
ns, p
ublic
ass
ista
nce,
and
all
othe
r. M
edic
aid
spen
ding
am
ount
s ex
clud
e ad
min
istr
ativ
e co
sts
but i
nclu
de M
edic
are
Part
D p
hase
d-do
wn
stat
e co
ntrib
utio
n (a
lso
refe
rred
to a
s cl
awba
ck) p
aym
ents
. 1
Tota
l and
sta
te-fu
nded
bud
get s
hare
s sh
ould
be
view
ed w
ith c
autio
n be
caus
e th
ey re
flect
var
ying
sta
te p
ract
ices
. For
exa
mpl
e, C
onne
ctic
ut re
port
s al
l of i
ts M
edic
aid
spen
ding
as
stat
e-fu
nded
spe
ndin
g du
e to
the
dire
ct d
epos
it of
fede
ral f
unds
into
the
stat
e tr
easu
ry. I
n ad
ditio
n, s
ome
func
tions
—pa
rtic
ular
ly e
lem
enta
ry a
nd s
econ
dary
ed
ucat
ion—
may
be
part
ially
fund
ed o
utsi
de o
f the
sta
te b
udge
t by
loca
l gov
ernm
ents
.
2 N
ASBO
doe
s no
t col
lect
info
rmat
ion
for t
he D
istr
ict o
f Col
umbi
a.
Sour
ce: N
atio
nal A
ssoc
iatio
n of
Sta
te B
udge
t Off
icer
s (N
ASBO
), 20
14, S
tate
exp
endi
ture
repo
rt: E
xam
inin
g fis
cal 2
012–
2014
sta
te s
pend
ing,
Was
hing
ton,
DC:
NAS
BO, h
ttps
://
ww
w.n
asbo
.org
/site
s/de
faul
t/fil
es/S
tate
%20
Expe
nditu
re%
20Re
port
%20
%28
Fisc
al%
2020
12-2
014%
29S.
pdf.
MACStats: Medicaid and CHIP Data Book 17
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Stat
eFM
APs
for M
edic
aid
E-FM
APs
for C
HIP
FY
201
2FY
201
3FY
201
41FY
201
51FY
201
61FY
201
2FY
201
3FY
201
4FY
201
5FY
201
62
Alab
ama
68.6
2%68
.53%
68.1
2%68
.99%
69.8
7%78
.03%
77.9
7%77
.68%
78.2
9%10
0.00
%
Alas
ka50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Ariz
ona
67.3
065
.68
67.2
368
.46
68.9
277
.11
75.9
877
.06
77.9
210
0.00
Arka
nsas
70.7
170
.17
70.1
070
.88
70.0
079
.50
79.1
279
.07
79.6
210
0.00
Calif
orni
a50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Colo
rado
50.0
050
.00
50.0
051
.01
50.7
265
.00
65.0
065
.00
65.7
188
.50
Conn
ectic
ut50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Dela
war
e54
.17
55.6
755
.31
53.6
354
.83
67.9
268
.97
68.7
267
.54
91.3
8
Dist
rict o
f Col
umbi
a70
.00
70.0
070
.00
70.0
070
.00
79.0
079
.00
79.0
079
.00
100.
00
Flor
ida
56.0
458
.08
58.7
959
.72
60.6
769
.23
70.6
671
.15
71.8
095
.47
Geo
rgia
66.1
665
.56
65.9
366
.94
67.5
576
.31
75.8
976
.15
76.8
610
0.00
Haw
aii
50.4
851
.86
51.8
552
.23
53.9
865
.34
66.3
066
.30
66.5
690
.79
Idah
o70
.23
71.0
071
.64
71.7
571
.24
79.1
679
.70
80.1
580
.23
100.
00
Illin
ois
50.0
050
.00
50.0
050
.76
50.8
965
.00
65.0
065
.00
65.5
388
.62
Indi
ana
66.9
667
.16
66.9
266
.52
66.6
076
.87
77.0
176
.84
76.5
699
.62
Iow
a60
.71
59.5
957
.93
55.5
454
.91
72.5
071
.71
70.5
568
.88
91.4
4
Kans
as56
.91
56.5
156
.91
56.6
355
.96
69.8
469
.56
69.8
469
.64
92.1
7
Kent
ucky
71.1
870
.55
69.8
369
.94
70.3
279
.83
79.3
978
.88
78.9
610
0.00
Loui
sian
a369
.78
65.5
162
.11
62.0
562
.21
72.7
672
.87
72.6
973
.44
96.5
5
Mai
ne63
.27
62.5
761
.55
61.8
862
.67
74.2
973
.80
73.0
973
.32
96.8
7
Mar
ylan
d50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Mas
sach
uset
ts50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Mic
higa
n66
.14
66.3
966
.32
65.5
465
.60
76.3
076
.47
76.4
275
.88
98.9
2
Min
neso
ta50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Mis
siss
ippi
74.1
873
.43
73.0
573
.58
74.1
781
.93
81.4
081
.14
81.5
110
0.00
Mis
sour
i63
.45
61.3
762
.03
63.4
563
.28
74.4
272
.96
73.4
274
.42
97.3
0
Mon
tana
66.1
166
.00
66.3
365
.90
65.2
476
.28
76.2
076
.43
76.1
398
.67
Neb
rask
a56
.64
55.7
654
.74
53.2
751
.16
69.6
569
.03
68.3
267
.29
88.8
1
EXH
IBIT
6.
Fede
ral M
edic
al A
ssis
tanc
e Pe
rcen
tage
s (F
MAP
s) a
nd E
nhan
ced
FMAP
s (E
-FM
APs)
by
Stat
e, F
Ys 2
012–
2016
December 201518
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
Stat
eFM
APs
for M
edic
aid
E-FM
APs
for C
HIP
FY
201
2FY
201
3FY
201
41FY
201
51FY
201
61FY
201
2FY
201
3FY
201
4FY
201
5FY
201
62
Nev
ada
56.2
0%59
.74%
63.1
0%64
.36%
64.9
3%69
.34%
71.8
2%74
.17%
75.0
5%98
.45%
New
Ham
pshi
re50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
New
Jer
sey
50.0
050
.00
50.0
050
.00
50.0
065
.00
65.0
065
.00
65.0
088
.00
New
Mex
ico
69.3
669
.07
69.2
069
.65
70.3
778
.55
78.3
578
.44
78.7
610
0.00
New
Yor
k50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Nor
th C
arol
ina
65.2
865
.51
65.7
865
.88
66.2
475
.70
75.8
676
.05
76.1
299
.37
Nor
th D
akot
a55
.40
52.2
750
.00
50.0
050
.00
68.7
866
.59
65.0
065
.00
88.0
0
Ohi
o64
.15
63.5
863
.02
62.6
462
.47
74.9
174
.51
74.1
173
.85
96.7
3
Okl
ahom
a63
.88
64.0
064
.02
62.3
060
.99
74.7
274
.80
74.8
173
.61
95.6
9
Ore
gon
62.9
162
.44
63.1
464
.06
64.3
874
.04
73.7
174
.20
74.8
498
.07
Penn
sylv
ania
55.0
754
.28
53.5
251
.82
52.0
168
.55
68.0
067
.46
66.2
789
.41
Rhod
e Is
land
52.1
251
.26
50.1
150
.00
50.4
266
.48
65.8
865
.08
65.0
088
.29
Sout
h Ca
rolin
a70
.24
70.4
370
.57
70.6
471
.08
79.1
779
.30
79.4
079
.45
100.
00
Sout
h Da
kota
59.1
356
.19
53.5
451
.64
51.6
171
.39
69.3
367
.48
66.1
589
.13
Tenn
esse
e66
.36
66.1
365
.29
64.9
965
.05
76.4
576
.29
75.7
075
.49
98.5
4
Texa
s58
.22
59.3
058
.69
58.0
557
.13
70.7
571
.51
71.0
870
.64
92.9
9
Uta
h70
.99
69.6
170
.34
70.5
670
.24
79.6
978
.73
79.2
479
.39
100.
00
Verm
ont
57.5
856
.04
55.1
154
.01
53.9
070
.31
69.2
368
.58
67.8
190
.73
Virg
inia
50.0
050
.00
50.0
050
.00
50.0
065
.00
65.0
065
.00
65.0
088
.00
Was
hing
ton
50.0
050
.00
50.0
050
.03
50.0
065
.00
65.0
065
.00
65.0
288
.00
Wes
t Virg
inia
72.6
272
.04
71.0
971
.35
71.4
280
.83
80.4
379
.76
79.9
510
0.00
Wis
cons
in60
.53
59.7
459
.06
58.2
758
.23
72.3
771
.82
71.3
470
.79
93.7
6
Wyo
min
g50
.00
50.0
050
.00
50.0
050
.00
65.0
065
.00
65.0
065
.00
88.0
0
Amer
ican
Sam
oa55
.00
55.0
055
.00
55.0
055
.00
68.5
068
.50
68.5
068
.50
91.5
0
Gua
m55
.00
55.0
055
.00
55.0
055
.00
68.5
068
.50
68.5
068
.50
91.5
0
N. M
aria
na Is
land
s55
.00
55.0
055
.00
55.0
055
.00
68.5
068
.50
68.5
068
.50
91.5
0
Puer
to R
ico
55.0
055
.00
55.0
055
.00
55.0
068
.50
68.5
068
.50
68.5
091
.50
Virg
in Is
land
s55
.00
55.0
055
.00
55.0
055
.00
68.5
068
.50
68.5
068
.50
91.5
0
EXH
IBIT
6.
(con
tinue
d)
MACStats: Medicaid and CHIP Data Book 19
Section 1: Overview—Key Statistics
MAC
Stat
sSe
ctio
n 1
EXH
IBIT
6.
(con
tinue
d)
Not
es: F
MAP
is fe
dera
l med
ical
ass
ista
nce
perc
enta
ge. E
-FM
AP is
enh
ance
d FM
AP. A
CA is
Pat
ient
Pro
tect
ion
and
Affo
rdab
le C
are
Act (
P.L.
111
-148
, as
amen
ded)
. The
fede
ral
gove
rnm
ent’s
sha
re o
f mos
t Med
icai
d se
rvic
e co
sts
is d
eter
min
ed b
y th
e FM
AP, w
ith s
ome
exce
ptio
ns. F
or M
edic
aid
adm
inis
trat
ive
cost
s, th
e fe
dera
l sha
re d
oes
not v
ary
by
stat
e an
d is
gen
eral
ly 5
0 pe
rcen
t. Th
e E-
FMAP
det
erm
ines
the
fede
ral s
hare
of b
oth
serv
ice
and
adm
inis
trat
ive
cost
s fo
r CH
IP, s
ubje
ct to
the
avai
labi
lity
of fu
nds
from
a s
tate
’s
fede
ral a
llotm
ents
for C
HIP
.
FMAP
s fo
r Med
icai
d ar
e ge
nera
lly c
alcu
late
d ba
sed
on a
form
ula
that
com
pare
s ea
ch s
tate
’s p
er c
apita
inco
me
rela
tive
to U
.S. p
er c
apita
inco
me
and
prov
ides
a h
ighe
r fe
dera
l mat
ch fo
r sta
tes
with
low
er p
er c
apita
inco
mes
, sub
ject
to a
sta
tuto
ry m
inim
um (5
0 pe
rcen
t) a
nd m
axim
um (8
3 pe
rcen
t). T
he g
ener
al fo
rmul
a fo
r a g
iven
sta
te is
: FM
AP =
1 —
[(st
ate
per c
apita
inco
me)
2 / (U
.S. p
er c
apita
inco
me)
2 × 0
.45]
.
Med
icai
d ex
cept
ions
to th
is fo
rmul
a in
clud
e th
e Di
stric
t of C
olum
bia
(set
in s
tatu
te a
t 70
perc
ent)
and
the
terr
itorie
s (s
et in
sta
tute
at 5
5 pe
rcen
t). O
ther
Med
icai
d ex
cept
ions
ap
ply
to c
erta
in s
ervi
ces,
pro
vide
rs, o
r situ
atio
ns (e
.g.,
serv
ices
pro
vide
d th
roug
h an
Indi
an H
ealth
Ser
vice
faci
lity
rece
ive
an F
MAP
of 1
00 p
erce
nt).
Enha
nced
FM
APs
for C
HIP
ar
e ca
lcul
ated
by
redu
cing
the
stat
e sh
are
unde
r reg
ular
FM
APs
for M
edic
aid
by 3
0 pe
rcen
t and
add
ing
23 p
erce
ntag
e po
ints
(see
not
e 2)
.1
For c
erta
in n
ewly
elig
ible
indi
vidu
als
unde
r the
Med
icai
d ex
pans
ion
begi
nnin
g in
201
4, th
ere
is a
n in
crea
sed
FMAP
(100
per
cent
in 2
014
thro
ugh
2016
, pha
sing
dow
n to
90
perc
ent i
n 20
20 a
nd s
ubse
quen
t yea
rs).
An in
crea
sed
FMAP
is a
lso
avai
labl
e fo
r cer
tain
sta
tes
that
pre
viou
sly
expa
nded
elig
ibili
ty to
low
-inco
me
pare
nts
and
non-
preg
nant
ad
ults
with
out c
hild
ren
prio
r to
enac
tmen
t of t
he A
CA.
2 Un
der t
he A
CA, b
egin
ning
on
Octo
ber 1
, 201
5, a
nd e
ndin
g on
Sep
tem
ber 3
0, 2
019,
the
enha
nced
FM
AP is
incr
ease
d by
23
perc
enta
ge p
oint
s, n
ot to
exc
eed
100
perc
ent,
for a
ll st
ates
.3
Loui
sian
a re
ceiv
ed a
dis
aste
r-rec
over
y st
ate
FMAP
adj
ustm
ent f
or th
e fo
urth
qua
rter
of F
Y 20
11 a
nd F
Ys 2
012–
2014
.
Sour
ces:
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s, F
eder
al R
egis
ter n
otic
es fo
r var
ious
yea
rs.
SECTION 2
Trends
December 201522
Section 2: Trends
Section 2: Trends
Key Points• Trends in Medicaid spending and enrollment over time, shown in Exhibits 8–10, are
affected by federal and state policy choices as well as economic factors. Recent examples include growth around the recessions of 2001 and 2007–2009, which slowed as economic conditions subsequently improved; the fiscal year (FY) 2006 decrease in Medicaid spending driven by the implementation of Medicare Part D, which shifted dually eligible beneficiaries’ outpatient prescription drug costs from Medicaid to Medicare; and the FY 2014 increase in Medicaid spending driven in part by expanded eligibility under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended).
• Medicaid enrollment trends vary by eligibility group. Children (excluding those eligible on the basis of disability) experienced the largest enrollment increase in absolute numbers between FY 1975 and FY 2012, from 9.6 million to 30.5 million. Individuals qualifying for Medicaid on the basis of disability—the smallest eligibility group in terms of absolute numbers—had the largest percentage increase in enrollment, almost quadrupling over this period (Exhibit 7).
• Medicaid’s share of both state-funded budgets (excluding federal funds) and total state budgets (including federal funds) has grown substantially since state fiscal year (SFY) 1987. In SFYs 2009 and 2010, the program’s share of state-funded budgets remained stable or dropped, while its share of total state budgets continued to increase. This divergence was due to a temporary increase in federal matching rates, which effectively allowed states to maintain their programs with a smaller state contribution (Exhibit 13).
• Between 2013 and 2015, the number of individuals enrolled in full-benefit Medicaid and CHIP grew by more than 14 million, largely due to changes made by the ACA. Enrollment in July 2014 was 14.4 percent higher than average monthly enrollment during July to September 2013, a baseline period that precedes the start of open enrollment for exchange plans and state expansions of Medicaid for adults under the ACA. Between July 2014 and July 2015, enrollment grew by an additional 7.3 percent. Because not all states have chosen to expand Medicaid, state-specific growth rates vary substantially (Exhibit 11).
• Medicaid and CHIP are projected to maintain a steady share of national health expenditures at about 17 percent through 2024, and Medicare’s share is projected to increase from about 20 percent to 22.5 percent (Exhibit 12).
MACStats: Medicaid and CHIP Data Book 23
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Fisc
al y
ear
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Unk
now
n19
7522
,007
9,59
84,
529
2,46
43,
615
1,80
119
7622
,815
9,92
44,
773
2,66
93,
612
1,83
719
7722
,832
9,65
14,
785
2,80
23,
636
1,95
819
7821
,965
9,37
64,
643
2,71
83,
376
1,85
219
7921
,520
9,10
64,
570
2,75
33,
364
1,72
719
8021
,605
9,33
34,
877
2,91
13,
440
1,04
419
8121
,980
9,58
15,
187
3,07
93,
367
766
1982
21,6
039,
563
5,35
62,
891
3,24
055
319
8321
,554
9,53
55,
592
2,92
13,
372
134
1984
21,6
079,
684
5,60
02,
913
3,23
817
219
8521
,814
9,75
75,
518
3,01
23,
061
466
1986
22,5
1510
,029
5,64
73,
182
3,14
051
719
8723
,109
10,1
685,
599
3,38
13,
224
737
1988
22,9
0710
,037
5,50
33,
487
3,15
972
119
8923
,511
10,3
185,
717
3,59
03,
132
754
1990
25,2
5511
,220
6,01
03,
718
3,20
21,
105
1991
27,9
6712
,855
6,70
34,
033
3,34
11,
035
1992
31,1
5015
,200
7,04
04,
487
3,74
967
419
9333
,432
16,2
857,
505
5,01
63,
863
763
1994
35,0
5317
,194
7,58
65,
458
4,03
578
019
9536
,282
17,1
647,
604
5,85
84,
119
1,53
719
9636
,118
16,7
397,
127
6,22
14,
285
1,74
619
9734
,872
15,7
916,
803
6,12
93,
955
2,19
519
9840
,096
18,9
697,
895
6,63
73,
964
2,63
119
9939
,748
18,2
337,
446
6,69
03,
698
3,68
220
0041
,212
18,5
288,
538
6,68
83,
640
3,81
720
0145
,164
20,1
819,
707
7,11
43,
812
4,34
920
0246
,839
21,4
8710
,847
7,18
23,
789
3,53
4
EXH
IBIT
7.
Med
icai
d Be
nefic
iarie
s (P
erso
ns S
erve
d) b
y El
igib
ility
Gro
up, F
Ys 1
975–
2012
(tho
usan
ds)
December 201524
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Fisc
al y
ear
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Unk
now
n20
0350
,716
23,7
4211
,530
7,66
44,
041
3,73
920
0454
,250
25,4
1512
,325
8,12
34,
349
4,03
720
0556
,276
25,9
7912
,431
8,20
54,
395
5,26
620
0656
,264
26,3
5812
,495
8,33
44,
374
4,70
320
0755
,210
26,0
6112
,264
8,42
34,
044
4,41
820
0856
,962
26,4
7912
,739
8,68
54,
147
4,91
220
0960
,880
28,3
4414
,245
9,03
14,
195
5,06
620
1063
,730
30,0
2415
,368
9,34
14,
289
4,70
920
1165
,831
30,1
7516
,069
9,60
94,
331
5,64
620
1265
,584
30,4
6716
,483
9,83
64,
376
4,42
3
Not
es: F
Y is
fisc
al y
ear.
Bene
ficia
ries
(enr
olle
es fo
r who
m p
aym
ents
are
mad
e) a
re s
how
n he
re b
ecau
se th
ey p
rovi
de th
e on
ly h
isto
rical
tim
e se
ries
data
dire
ctly
ava
ilabl
e pr
ior
to F
Y 19
90. M
ost c
urre
nt a
naly
ses
of in
divi
dual
s in
Med
icai
d re
flect
enr
olle
es. F
or a
dditi
onal
dis
cuss
ion,
see
htt
ps://
ww
w.m
acpa
c.go
v/m
acst
ats/
data
-sou
rces
-and
-met
hods
/.
The
incr
ease
in F
Y 19
98 re
flect
s a
chan
ge in
how
Med
icai
d be
nefic
iarie
s ar
e co
unte
d: b
egin
ning
in F
Y 19
98, a
Med
icai
d-el
igib
le p
erso
n w
ho re
ceiv
ed o
nly
cove
rage
for m
anag
ed
care
ben
efits
was
incl
uded
in th
is s
erie
s as
a b
enef
icia
ry. E
xclu
des
Med
icai
d-ex
pans
ion
CHIP
and
the
terr
itorie
s. C
hild
ren
and
adul
ts w
ho q
ualif
y fo
r Med
icai
d on
the
basi
s of
a
disa
bilit
y ar
e in
clud
ed in
the
disa
bled
cat
egor
y. In
add
ition
, alth
ough
dis
abili
ty is
not
a b
asis
of e
ligib
ility
for a
ged
indi
vidu
als,
sta
tes
may
repo
rt s
ome
enro
llees
age
65
and
olde
r in
the
disa
bled
cat
egor
y. U
nlik
e th
e m
ajor
ity o
f MAC
Stat
s, th
is e
xhib
it do
es n
ot re
code
indi
vidu
als
age
65 a
nd o
lder
who
are
repo
rted
as
disa
bled
, due
to la
ck o
f det
ail i
n th
e hi
stor
ical
dat
a. G
ener
ally,
indi
vidu
als
who
se e
ligib
ility
gro
up is
unk
now
n ar
e pe
rson
s w
ho w
ere
enro
lled
in th
e pr
ior y
ear b
ut h
ad a
Med
icai
d cl
aim
pai
d in
the
curr
ent y
ear.
Due
to th
e un
avai
labi
lity
of s
ever
al s
tate
s’ M
edic
aid
Stat
istic
al In
form
atio
n Sy
stem
(MSI
S) A
nnua
l Per
son
Sum
mar
y (A
PS) d
ata
for f
isca
l yea
r FY
2012
, MAC
PAC
calc
ulat
ed
enro
llmen
t fro
m th
e fu
ll M
SIS
data
file
s th
at a
re u
sed
to c
reat
e th
e AP
S fil
es. F
or M
ACPA
C’s
anal
ysis
, Med
icai
d en
rolle
es w
ere
assi
gned
a u
niqu
e na
tiona
l ide
ntifi
catio
n (ID
) nu
mbe
r usi
ng a
n al
gorit
hm th
at in
corp
orat
es s
tate
-spe
cific
ID n
umbe
rs a
nd b
enef
icia
ry c
hara
cter
istic
s su
ch a
s da
te o
f birt
h an
d ge
nder
. The
sta
te a
nd n
atio
nal e
nrol
lmen
t co
unts
sho
wn
here
are
und
uplic
ated
usi
ng th
is n
atio
nal I
D.
Sour
ces:
For
FYs
199
9–20
12: M
ACPA
C, 2
015,
ana
lysi
s of
MSI
S da
ta fo
r FYs
197
5–19
98: C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es, M
edic
are
& M
edic
aid
stat
istic
al s
uppl
emen
t, 20
10 e
ditio
n, T
able
13.
4, h
ttps
://w
ww
.cm
s.go
v/Re
sear
ch-S
tatis
tics-
Data
-and
-Sys
tem
s/St
atis
tics-
Tren
ds-a
nd-R
epor
ts/M
edic
areM
edic
aidS
tatS
upp/
Dow
nloa
ds/2
010_
Sect
ion1
3.pd
f#Ta
ble%
2013
.4.
EXH
IBIT
7.
(con
tinue
d)
MACStats: Medicaid and CHIP Data Book 25
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
$500
$550
$600
$650
$700
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
Fiscal year
Spen
ding
(bill
ions
)
FYE
enro
llmen
t (m
illio
ns)
Spending
FYE enrollment
Notes: FY is fiscal year. FYE is full-year equivalent, which also may be referred to as average monthly payment. All numbers exclude CHIP-financed coverage. Data prior to FY 1977 have been adjusted to the current federal fiscal year basis (October 1 to September 30). The amounts shown in this exhibit may differ from those published elsewhere due to slight differences in the timing of data and the treatment of certain adjustments. Spending consists of federal and state Medicaid expenditures for benefits and administration, excluding the Vaccines for Children program. Enrollment counts are full-year equivalents and, for fiscal years prior to FY 1990, have been estimated from counts of persons served (see https://www.macpac.gov/macstats/data-sources-and-methods/ for a discussion of how enrollees are counted). Enrollment data for FYs 2012–2014 are projected; those for FYs 1999–2014 include estimates for Puerto Rico and the Virgin Islands.
Source: Office of the Actuary (OACT), Centers for Medicare & Medicaid Services, 2015, data compilation provided to MACPAC staff, April 17.
EXHIBIT 8. Medicaid Enrollment and Spending, FYs 1966–2014
December 201526
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
-5%
0%
5%
10%
15%
20%
25%
30%
Spending
FYE enrollment
Fiscal year
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
Notes: FY is fiscal year. FYE is full-year equivalent, which also may be referred to as average monthly enrollment. All numbers exclude CHIP-financed coverage. Data prior to FY 1977 have been adjusted to the current federal fiscal year basis (October 1 to September 30). The amounts shown in this exhibit may differ from those published elsewhere due to slight differences in the timing of data and the treatment of certain adjustments. Spending consists of federal and state Medicaid expenditures for benefits and administration, excluding the Vaccines for Children program. Enrollment counts are full-year equivalents and, for fiscal years prior to FY 1990, have been estimated from counts of persons served (see https://www.macpac.gov/macstats/data-sources-and-methods/ for a discussion of how enrollees are counted). Enrollment data for FYs 2012–2014 are projected; those for FYs 1999–2014 include estimates for Puerto Rico and the Virgin Islands.
Source: Office of the Actuary (OACT), Centers for Medicare & Medicaid Services, 2015, data compilation provided to MACPAC staff, April 17.
EXHIBIT 9. Annual Growth in Medicaid Enrollment and Spending, FYs 1975–2014
MACStats: Medicaid and CHIP Data Book 27
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Fisc
al y
ear
Spen
ding
(b
illio
ns)
FYE
enro
llmen
t (m
illio
ns)
Spen
ding
per
FY
E en
rolle
e
Annu
al g
row
th
Spen
ding
Full-
year
equ
ival
ent
enro
llmen
tSp
endi
ng p
er
FYE
enro
llee
1966
$14.
0$1
98–
––
1967
27.
432
119
7.4%
83.3
%62
.2%
1968
410
.634
352
.442
.96.
719
694
11.5
382
21.2
8.9
11.3
1970
514
.036
515
.921
.3-4
.419
717
16.3
401
28.5
16.9
9.9
1972
816
.548
422
.41.
320
.919
739
17.6
534
17.0
6.2
10.2
1974
1119
.056
715
.18.
36.
319
7513
20.2
651
21.8
6.1
14.8
1976
1520
.772
013
.62.
710
.619
7717
20.7
830
15.3
0.1
15.3
1978
1920
.095
911
.2-3
.815
.619
7922
19.6
1,11
514
.0-2
.016
.319
8025
19.6
1,28
515
.70.
415
.219
8130
20.0
1,49
318
.21.
716
.219
8232
19.6
1,62
06.
7-1
.78.
519
8335
19.6
1,77
99.
6-0
.29.
819
8437
19.8
1,88
37.
11.
25.
819
8541
19.8
2,08
010
.50.
010
.519
8645
20.5
2,17
67.
93.
24.
619
8749
21.0
2,33
910
.42.
67.
519
8854
20.8
2,59
810
.1-0
.911
.019
8961
21.4
2,87
113
.42.
610
.519
9073
22.9
3,17
718
.97.
410
.719
9192
26.3
3,49
526
.014
.610
.019
9211
828
.94,
092
28.6
9.8
17.1
EXH
IBIT
10.
Med
icai
d En
rollm
ent a
nd T
otal
Spe
ndin
g Le
vels
and
Ann
ual G
row
th, F
Ys 1
966–
2014
December 201528
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
EXH
IBIT
10.
(co
ntin
ued)
Fisc
al y
ear
Spen
ding
(b
illio
ns)
FYE
enro
llmen
t (m
illio
ns)
Spen
ding
per
FY
E en
rolle
e
Annu
al g
row
th
Spen
ding
Full-
year
equ
ival
ent
enro
llmen
tSp
endi
ng p
er
FYE
enro
llee
1993
$131
31.2
$4,1
9010
.7%
8.1%
2.4%
1994
142
32.4
4,37
18.
33.
94.
319
9515
733
.44,
710
10.9
2.9
7.7
1996
160
33.2
4,81
51.
8-0
.42.
219
9716
733
.05,
054
4.3
-0.6
5.0
1998
175
32.5
5,39
34.
9-1
.76.
719
9918
832
.15,
878
7.7
-1.2
9.0
2000
203
34.5
5,88
87.
97.
70.
220
0122
536
.96,
099
10.6
6.7
3.6
2002
254
40.5
6,28
613
.29.
83.
120
0327
343
.56,
272
7.2
7.4
-0.2
2004
291
45.2
6,44
96.
83.
92.
820
0531
046
.36,
690
6.4
2.6
3.7
2006
307
46.7
6,58
7-0
.80.
7-1
.520
0732
346
.46,
968
5.2
-0.5
5.8
2008
343
47.7
7,18
85.
92.
73.
120
0936
950
.97,
256
7.7
6.7
1.0
2010
388
54.6
7,11
15.
27.
3-2
.020
1141
256
.57,
290
6.1
3.5
2.5
2012
416
58.0
7,17
71.
12.
7-1
.520
1343
258
.97,
342
3.9
1.6
2.3
2014
473
64.8
7,29
49.
310
.0-0
.7
Not
es: F
Y is
fisc
al y
ear.
FYE
is fu
ll-ye
ar e
quiv
alen
t, w
hich
may
als
o be
refe
rred
to a
s av
erag
e m
onth
ly e
nrol
lmen
t. Al
l num
bers
exc
lude
CH
IP-fi
nanc
ed c
over
age.
Dat
a pr
ior t
o FY
197
7 ha
ve b
een
adju
sted
to th
e cu
rren
t fed
eral
fisc
al y
ear b
asis
(Oct
ober
1 th
roug
h Se
ptem
ber 3
0). T
he a
mou
nts
show
n in
this
exh
ibit
may
diff
er fr
om th
ose
publ
ishe
d el
sew
here
due
to s
light
diff
eren
ces
in th
e tim
ing
of d
ata
and
the
trea
tmen
t of c
erta
in a
djus
tmen
ts. S
pend
ing
cons
ists
of f
eder
al a
nd s
tate
Med
icai
d ex
pend
iture
s fo
r ben
efits
an
d ad
min
istr
atio
n, e
xclu
ding
the
Vacc
ines
for C
hild
ren
prog
ram
. Enr
ollm
ent c
ount
s ar
e fu
ll-ye
ar e
quiv
alen
ts a
nd, f
or fi
scal
yea
rs p
rior t
o FY
199
0, h
ave
been
est
imat
ed fr
om
coun
ts o
f per
sons
ser
ved
(see
htt
ps:/
/ww
w.m
acpa
c.go
v/m
acst
ats/
data
-sou
rces
-and
-met
hods
/ for
a d
iscu
ssio
n of
how
enr
olle
es a
re c
ount
ed).
Enro
llmen
t dat
a fo
r FYs
20
12–
2014
are
pro
ject
ed; t
hose
for F
Ys 1
999–
2014
incl
ude
estim
ates
for P
uert
o Ri
co a
nd th
e Vi
rgin
Isla
nds.
Sour
ce: O
ffic
e of
the
Actu
ary
(OAC
T), C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es, 2
015,
dat
a co
mpi
latio
n pr
ovid
ed to
MAC
PAC
staf
f, Ap
ril 1
7.
MACStats: Medicaid and CHIP Data Book 29
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Stat
e
Num
ber o
f ind
ivid
uals
enr
olle
dAn
nual
and
cum
ulat
ive
grow
th
July
–Se
ptem
ber
2013
ave
rage
July
201
4 J
uly
2015
July
–Se
ptem
ber
2013
ave
rage
to
Jul
y 20
14Ju
ly 2
014
to
Jul
y 20
15
July
–Se
ptem
ber
2013
ave
rage
to
Jul
y 20
15To
tal
57,
794,
096 1
67,
147,
446
72,
046,
111
14.4
%2
7.3%
22.9
%2
Alab
ama
799
,176
3 8
68,1
74
878
,270
8.
61.
29.
9Al
aska
122
,334
1
25,2
54
122
,406
2.
4-2
.30.
1Ar
izon
a 1
,201
,770
1
,463
,723
1
,595
,617
21
.89.
032
.8Ar
kans
as 5
56,8
51
784
,335
8
23,7
41
40.9
5.0
47.9
Calif
orni
a 9
,157
,000
1
0,90
0,00
0 4 1
2,64
8,63
7 19
.016
.038
.1Co
lora
do 7
83,4
20
1,1
06,1
34
1,2
65,5
37
41.2
14.4
61.5
Conn
ectic
ut –
7
49,1
59
753
,927
–
0.
6 –
De
law
are
223
,324
2
33,7
06
241
,749
4.
63.
48.
3Di
stric
t of C
olum
bia5
235
,786
2
50,4
46
255
,660
6.
22.
18.
4Fl
orid
a 3
,104
,996
3
,343
,988
6 3
,558
,092
67.
76.
414
.6G
eorg
ia 1
,535
,090
1
,739
,141
1
,731
,306
13
.3-0
.512
.8H
awai
i 2
88,3
57
318
,838
3
32,0
27
10.6
4.1
15.1
Idah
o 2
38,1
50
283
,129
2
77,2
13
18.9
-2.1
16.4
Illin
ois
2,6
26,9
43 7
3,0
21,1
95
3,1
20,5
81
15.0
3.3
18.8
Indi
ana8
1,1
20,6
74
1,2
11,1
25
1,3
27,9
09
8.1
9.6
18.5
Iow
a 4
93,5
15
565
,593
5
99,3
05
14.6
6.0
21.4
Kans
as 3
78,1
60
401
,980
3
97,1
44
6.3
-1.2
5.0
Kent
ucky
606
,805
1
,048
,285
1
,119
,198
72
.86.
884
.4Lo
uisi
ana
1,0
19,7
87
1,0
37,1
36
1,0
75,6
52
1.7
3.7
5.5
Mai
ne –
2
96,2
06
280
,241
–
-5
.4 –
M
aryl
and
856
,297
1
,151
,270
1
,167
,003
34
.41.
436
.3M
assa
chus
etts
1,2
96,3
59
1,4
76,1
84 9
1,6
39,2
59
13.9
11.0
26.5
Mic
higa
n 1
,912
,009
2
,218
,845
2
,284
,761
16
.03.
019
.5M
inne
sota
873
,040
10 1
,068
,305
1
,006
,444
22
.4-5
.815
.3M
issi
ssip
pi 6
37,2
29
693
,425
7
02,3
27
8.8
1.3
10.2
Mis
sour
i 8
46,0
84
812
,785
9
32,0
26
-3.9
14.7
10.2
Mon
tana
148
,974
1
63,5
51
176
,714
9.
88.
018
.6
EXH
IBIT
11.
Ful
l-Ben
efit
Med
icai
d an
d CH
IP E
nrol
lmen
t, Se
lect
ed M
onth
s, 2
013–
2015
December 201530
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Stat
e
Num
ber o
f ind
ivid
uals
enr
olle
dAn
nual
and
cum
ulat
ive
grow
th
July
–Se
ptem
ber
2013
ave
rage
July
201
4 J
uly
2015
July
–Se
ptem
ber
2013
ave
rage
to
Jul
y 20
14Ju
ly 2
014
to
Jul
y 20
15
July
–Se
ptem
ber
2013
ave
rage
to
Jul
y 20
15N
ebra
ska
244
,600
2
38,6
09
232
,088
-2
.4%
-2.7
%-5
.1%
Nev
ada
332
,560
5 5
27,9
29 5
566
,017
58
.77.
270
.2N
ew H
amps
hire
127
,082
1
37,9
34
181
,182
8.
531
.442
.6N
ew J
erse
y 1
,283
,851
1
,562
,483
1
,749
,110
21
.711
.936
.2N
ew M
exic
o 4
57,6
78
705
,128
7
17,1
89
54.1
1.7
56.7
New
Yor
k 5
,678
,417
6
,143
,909
6
,452
,876
8.
25.
013
.6N
orth
Car
olin
a 1
,595
,952
1
,737
,117
1
,911
,334
8.
810
.019
.8N
orth
Dak
ota
69,
980 11
79,
076
88,
719
13.0
12.2
26.8
Ohi
o 2
,341
,481
2
,708
,484
2
,988
,934
15
.710
.427
.7O
klah
oma
790
,051
8
03,5
77
821
,867
1.
72.
34.
0O
rego
n 6
26,3
56
997
,762
1
,028
,349
59
.33.
164
.2Pe
nnsy
lvan
ia 2
,386
,046
2
,417
,392
2
,635
,481
1.
39.
010
.5Rh
ode
Isla
nd 1
90,8
33
259
,183
12 2
76,0
28
35.8
6.5
44.6
Sout
h Ca
rolin
a 8
89,7
44
868
,487
9
99,4
38
-2.4
15.1
12.3
Sout
h Da
kota
115
,501
1
16,1
74
118
,715
0.
62.
22.
8Te
nnes
see
1,2
44,5
16
1,3
52,2
43
1,5
04,9
52
8.7
11.3
20.9
Texa
s8 4
,441
,605
4
,575
,968
4
,634
,046
3.
01.
34.
3U
tah8
294
,029
3
01,3
11
302
,560
2.
50.
42.
9Ve
rmon
t 1
61,0
81
208
,699
1
85,2
42
29.6
-11.
215
.0Vi
rgin
ia 9
35,4
34
937
,493
9
62,1
83
0.2
2.6
2.9
Was
hing
ton
1,1
17,5
76
1,5
42,7
89
1,7
21,6
45
38.0
11.6
54.1
Wes
t Virg
inia
354
,544
5
19,6
72
542
,077
46
.64.
352
.9W
isco
nsin
985
,531
13 1
,006
,257
13 1
,048
,817
2.
14.
26.
4W
yom
ing
67,
518
67,
858
64,
516
0.5
-4.9
-4.5
Not
es: E
nrol
lmen
t exc
lude
s in
divi
dual
s w
ith li
mite
d be
nefit
s, s
uch
as th
ose
who
onl
y re
ceiv
e M
edic
aid
cove
rage
of M
edic
are
prem
ium
s an
d co
st s
harin
g, fa
mily
pla
nnin
g se
rvic
es, o
r em
erge
ncy
cove
rage
due
to n
on-c
itize
n st
atus
(sta
te-s
peci
fic e
xcep
tions
are
not
ed b
elow
). Th
e Ju
ly–
Sept
embe
r 201
3 pe
riod
show
n he
re s
erve
s as
a p
re-A
ffor
dabl
e Ca
re A
ct b
asel
ine,
repr
esen
ting
the
num
ber o
f peo
ple
cove
red
by M
edic
aid
and
CHIP
prio
r to
the
star
t of o
pen
enro
llmen
t for
exc
hang
e pl
ans
in O
ctob
er 2
013
and
the
stat
e ex
pans
ions
of M
edic
aid
for a
dults
that
beg
an in
Jan
uary
201
4 an
d be
yond
. Som
e da
ta a
re p
relim
inar
y or
est
imat
ed, a
nd a
ll da
ta a
re s
ubje
ct to
cha
nge
as s
tate
s m
ay re
vise
th
eir s
ubm
issi
ons
at a
ny ti
me.
See
sou
rce
docu
men
ts b
elow
for f
ull d
etai
ls.
EXH
IBIT
11.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 31
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
– D
ash
indi
cate
s th
at s
tate
did
not
repo
rt d
ata.
1 Ex
clud
es tw
o st
ates
not
repo
rtin
g da
ta.
2 Pe
rcen
tage
cal
cula
ted
base
d on
sta
tes
repo
rtin
g da
ta fo
r bot
h pe
riods
.3
Data
are
for S
epte
mbe
r 201
3 on
ly.
4 In
clud
es a
pplic
ants
like
ly e
ligib
le fo
r Med
icai
d or
CH
IP, b
ut w
hose
app
licat
ions
wer
e st
ill p
endi
ng v
erifi
catio
n.5
Incl
udes
lim
ited-
bene
fit in
divi
dual
s w
ho a
re d
ually
elig
ible
for M
edic
are
and
Med
icai
d, a
nd in
divi
dual
s en
rolle
d in
the
loca
lly fu
nded
DC
Hea
lth A
llian
ce.
6 Ex
clud
es S
uppl
emen
tal S
ecur
ity In
com
e be
nefic
iarie
s en
rolle
d in
Med
icai
d.7
Incl
udes
retr
oact
ive
enro
llmen
t.8
Incl
udes
lim
ited-
bene
fit in
divi
dual
s w
ho a
re d
ually
elig
ible
for M
edic
are
and
Med
icai
d.
9 Ex
clud
es in
divi
dual
s re
ceiv
ing
tem
pora
ry tr
ansi
tiona
l cov
erag
e.10
M
ay in
clud
e du
plic
ates
.11
Da
ta a
re fo
r Jul
y 20
13 o
nly.
12 In
clud
es o
nly
enro
llmen
ts b
ased
on
dete
rmin
atio
ns th
roug
h ne
w M
odifi
ed A
djus
ted
Gro
ss In
com
e (M
AGI)
syst
em.
13 Ex
clud
es re
troa
ctiv
e en
rollm
ent.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
Cen
ters
for M
edic
are
& M
edic
aid
Serv
ices
(CM
S), 2
015,
Med
icai
d &
CHIP
Jun
e an
d Ju
ly 2
015
appl
icat
ion,
elig
ibili
ty, a
nd e
nrol
lmen
t dat
a,
http
://w
ww
.med
icai
d.go
v/m
edic
aid-
chip
-pro
gram
-info
rmat
ion/
prog
ram
-info
rmat
ion/
dow
nloa
ds/j
une-
and-
july
-201
5-en
rollm
ent-d
ata.
zip
and
CMS,
201
4, M
edic
aid
& CH
IP A
ugus
t an
d Se
ptem
ber 2
014
appl
icat
ion,
elig
ibili
ty, a
nd e
nrol
lmen
t dat
a, h
ttp:
//w
ww
.med
icai
d.go
v/m
edic
aid-
chip
-pro
gram
-info
rmat
ion/
prog
ram
-info
rmat
ion/
dow
nloa
ds/a
ugus
t-and
-se
ptem
ber-2
014-
enro
llmen
t-dat
a.zi
p.
EXH
IBIT
11.
(co
ntin
ued)
December 201532
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Cale
ndar
ye
ar
Paye
r am
ount
(bill
ions
) and
sha
re o
f tot
al
Tota
l (b
illio
ns)
Med
icai
d an
d CH
IPM
edic
are
Priv
ate
insu
ranc
eO
ther
hea
lth
insu
ranc
e1O
ther
third
pa
rty
paye
rs2
Out
of p
ocke
t
His
toric
al
1970
$75
$57.
1%$8
10.2
%$1
520
.6%
$34.
4%$1
824
.2%
$25
33.4
%
1975
134
1310
.116
12.2
3022
.86
4.5
3022
.537
28.0
1980
256
2610
.237
14.6
6927
.010
3.8
5521
.658
22.8
1985
445
419.
272
16.2
131
29.5
153.
489
20.1
9621
.6
1990
724
7410
.211
015
.223
432
.321
3.0
146
20.2
139
19.1
1995
1,02
714
514
.118
417
.932
731
.827
2.6
198
19.3
146
14.2
2000
1,37
820
314
.822
516
.346
033
.433
2.4
255
18.5
201
14.6
2005
2,03
531
715
.634
016
.770
334
.657
2.8
351
17.2
267
13.1
2010
2,60
440
915
.752
020
.086
233
.184
3.2
422
16.2
306
11.8
2011
2,70
541
915
.554
520
.189
933
.289
3.3
436
16.1
317
11.7
2012
2,81
743
615
.556
720
.193
633
.290
3.2
459
16.3
329
11.7
2013
2,91
946
315
.958
620
.196
232
.993
3.2
477
16.3
339
11.6
Proj
ecte
d
2014
$3,0
80$5
1716
.8%
$617
20.0
%$1
,020
33.1
%$9
63.
1%$4
8615
.8%
$344
11.2
%
2015
3,24
456
017
.364
619
.91,
085
33.5
993.
150
215
.535
110
.8
2016
3,40
358
517
.268
520
.11,
140
33.5
105
3.1
527
15.5
361
10.6
2017
3,58
761
617
.272
820
.31,
198
33.4
112
3.1
557
15.5
376
10.5
2018
3,78
565
017
.277
520
.51,
258
33.2
118
3.1
590
15.6
393
10.4
2019
4,02
068
817
.183
820
.81,
329
33.1
125
3.1
625
15.5
415
10.3
2020
4,27
472
917
.090
621
.21,
406
32.9
133
3.1
662
15.5
438
10.2
2021
4,54
377
117
.097
721
.51,
488
32.8
142
3.1
701
15.4
463
10.2
EXH
IBIT
12.
His
toric
al a
nd P
roje
cted
Nat
iona
l Hea
lth E
xpen
ditu
res
by P
ayer
for S
elec
ted
Year
s, 1
970–
2024
MACStats: Medicaid and CHIP Data Book 33
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
Cale
ndar
ye
ar
Paye
r am
ount
(bill
ions
) and
sha
re o
f tot
al
Tota
l (b
illio
ns)
Med
icai
d an
d CH
IPM
edic
are
Priv
ate
insu
ranc
eO
ther
hea
lth
insu
ranc
e1O
ther
third
pa
rty
paye
rs2
Out
of p
ocke
t
2022
$4,8
25$8
1616
.9%
$1,0
5421
.8%
$1,5
7232
.6%
$152
3.1%
$742
15.4
%$4
8910
.1%
2023
5,11
986
416
.91,
135
22.2
1,65
832
.416
13.
278
515
.351
510
.1
2024
5,42
591
516
.91,
221
22.5
1,74
632
.217
13.
282
915
.354
310
.0
Not
es: C
ompo
nent
s m
ay n
ot s
um to
tota
l due
to ro
undi
ng. H
isto
rical
dat
a w
ere
rele
ased
in 2
014;
pro
ject
ed d
ata
wer
e re
leas
ed in
201
5.1
U.S
. Dep
artm
ent o
f Def
ense
and
U.S
. Dep
artm
ent o
f Vet
eran
s Af
fairs
.2
Incl
udes
all
othe
r pub
lic a
nd p
rivat
e pr
ogra
ms
and
expe
nditu
res
exce
pt fo
r out
-of-p
ocke
t am
ount
s.
Sour
ces:
For
his
toric
al d
ata:
MAC
PAC,
201
5, a
naly
sis
of O
ffic
e of
the
Actu
ary
(OAC
T), C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es, 2
014,
Nat
iona
l hea
lth e
xpen
ditu
res
by ty
pe o
f se
rvic
e an
d so
urce
of f
unds
: Cal
enda
r yea
rs 1
960–
2013
, as
of D
ecem
ber 2
014,
htt
ps:/
/ww
w.c
ms.
gov/
Rese
arch
-Sta
tistic
s-Da
ta-a
nd-S
yste
ms/
Stat
istic
s-Tr
ends
-and
-Rep
orts
/N
atio
nalH
ealth
Expe
ndDa
ta/D
ownl
oads
/NH
E201
3.zi
p. F
or p
roje
cted
dat
a: M
ACPA
C, 2
015,
ana
lysi
s of
OAC
T, 20
15, N
atio
nal h
ealth
exp
endi
ture
(NH
E) a
mou
nts
by ty
pe o
f ex
pend
iture
and
sou
rce
of fu
nds:
Cal
enda
r yea
rs 1
960–
2024
in p
roje
ctio
ns fo
rmat
, as
of J
uly
2015
, htt
ps:/
/ww
w.c
ms.
gov/
Rese
arch
-Sta
tistic
s-Da
ta-a
nd-S
yste
ms/
Stat
istic
s-Tr
ends
-an
d-Re
port
s/N
atio
nalH
ealth
Expe
ndDa
ta/D
ownl
oads
/nhe
60-2
4.zi
p; a
nd a
naly
sis
of O
ACT,
2015
, Tab
le 1
7: H
ealth
and
insu
ranc
e en
rollm
ent a
nd e
nrol
lmen
t gro
wth
rate
s, c
alen
dar
year
s 20
08–2
024,
htt
ps:/
/ww
w.c
ms.
gov/
Rese
arch
-Sta
tistic
s-Da
ta-a
nd-S
yste
ms/
Stat
istic
s-Tr
ends
-and
-Rep
orts
/Nat
iona
lHea
lthEx
pend
Data
/Dow
nloa
ds/P
roj2
014t
able
s.zi
p.
EXH
IBIT
12.
(co
ntin
ued)
December 201534
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
0%
5%
10%
15%
20%
25%
Including state general funds only (no federal funds)
10.2%11.3%
14.2%
18.8%
19.8% 20.0%19.5% 19.7%
22.0% 22.3%
20.9%21.9%
23.8%24.5%
8.1%9.0%
10.5%
13.3%
14.4% 14.6% 14.4%15.2%
17.2% 17.1% 16.6%16.3% 16.5%
18.9%
5.7%6.3%
7.9%
10.9%11.6% 11.5% 11.4% 11.7%
13.1%13.5%
12.8%12.3%
13.3%
15.1%
Including all federal and state funds
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
Fiscal year
Including all state funds (no federal funds)
EXHIBIT 13. Medicaid as a Share of State Budgets Including and Excluding Federal Funds, SFYs 1987–2013
MACStats: Medicaid and CHIP Data Book 35
Section 2: Trends
MAC
Stat
sSe
ctio
n 2
EXHIBIT 13. (continued)
State fiscal yearIncluding all federal
and state funds
Including state general funds only (no federal funds)
Including all state funds (no federal funds)
1987 10.2% 8.1% 5.7%1988 10.8 8.7 6.11989 11.3 9.0 6.31990 12.5 9.5 6.91991 14.2 10.5 7.91992 17.8 12.1 10.01993 18.8 13.3 10.91994 19.7 14.2 11.31995 19.8 14.4 11.61996 19.9 14.7 11.71997 20.0 14.6 11.51998 19.6 14.8 11.61999 19.5 14.4 11.42000 19.1 15.0 11.02001 19.7 15.2 11.72002 20.7 15.8 12.22003 22.0 17.2 13.12004 22.1 16.9 12.92005 22.3 17.1 13.52006 21.4 17.4 13.32007 20.9 16.6 12.82008 20.5 16.0 12.52009 21.9 16.3 12.32010 22.2 14.8 11.62011 23.8 16.5 13.32012 23.6 19.2 14.52013 24.5 18.9 15.1
Notes: SFY is state fiscal year. Amounts shown here reflect the most recent information available in cases where data for a given year were published and then updated in a subsequent report.
The all federal and state funds category reflects amounts from any source. The state general funds category reflects amounts from revenues raised through income, sales, and other broad-based state taxes. The all state funds category reflects amounts from any non-federal source; these include state general funds, other state funds (amounts from revenue sources that are restricted by law for particular government functions or activities, which for Medicaid includes provider taxes and local funds), and bonds (expenditures from the sale of bonds, generally for capital projects).
Source: MACPAC, 2015, analysis of state expenditure reports from the National Association of State Budget Officers, http://www.nasbo.org/publications-data/state-expenditure-report/archives.
SECTION 3
Program Enrollment and Spending
December 201538
Section 3: Program Enrollment and Spending
Section 3: Program Enrollment and Spending
Key Points• Total Medicaid spending was $498.3 billion in fiscal year (FY) 2014, an 8 percent increase
from the prior year (Exhibit 16). Total CHIP spending decreased by about 1 percent, to $13.0 billion (Exhibit 32).
• The share of Medicaid benefit spending on capitation payments for managed care reached about 38 percent of all Medicaid benefit spending in FY 2014, an increase of 6 percentage points over the prior year (Exhibit 17).
• Individuals eligible on the basis of disability and those age 65 and older account for about a quarter of Medicaid enrollees, but about two-thirds of program spending (Exhibits 14 and 21). Many of these individuals are users of long-term services and supports (LTSS). This group accounts for only about 6 percent of Medicaid enrollees, but nearly half of all Medicaid spending (Exhibit 20).
• A large share of Medicaid spending for enrollees eligible on the basis of disability and enrollees age 65 and older is for LTSS, while more than half of spending for children and adults eligible on a basis other than disability is for capitation payments to managed care plans (Exhibit 18).
• Medicaid benefit spending per enrollee varies substantially across states (Exhibit 22). This variation may reflect several factors, including the underlying costs of delivering health care services in specific geographic areas, the breadth of benefit packages offered by states, and the health status and other characteristics of enrollees.
• Almost half (47 percent) of Medicaid gross spending for drugs occurred under managed care in FY 2014 (Exhibit 25). Drug rebates reduced gross drug spending by about 47 percent in FY 2014 (Exhibit 27).
• Disproportionate share hospital (DSH), upper payment limit (UPL), and other types of supplemental payments accounted for more than 40 percent of fee-for-service payments to hospitals in FY 2014 (Exhibit 23).
MACStats: Medicaid and CHIP Data Book 39
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
Basi
s of
elig
ibili
ty1
Dual
ly e
ligib
le s
tatu
s2
All d
ually
elig
ible
en
rolle
esDu
ally
elig
ible
with
fu
ll be
nefit
sDu
ally
elig
ible
with
lim
ited
bene
fits
Child
Adul
tDi
sabl
edAg
edTo
tal
Age
65+
Tota
lAg
e 65
+To
tal
Age
65+
Tota
l68
,680
31,8
8019
,934
10,2
036,
664
10,6
226,
181
7,84
04,
564
2,78
21,
616
Alab
ama
1,10
455
819
822
811
921
811
896
5012
168
Alas
ka13
975
3518
1016
915
81
0Ar
izon
a31,
713
783
646
170
114
183
106
143
7840
28Ar
kans
as69
535
411
215
672
133
7071
4262
28Ca
lifor
nia
12,0
054,
363
5,44
71,
083
1,11
21,
394
977
1,34
994
345
33Co
lora
do82
646
318
112
162
9957
7243
2714
Conn
ectic
ut82
332
530
479
115
165
111
8448
8263
Dela
war
e25
510
011
127
1629
1513
716
8Di
stric
t of C
olum
bia
225
7991
3719
2515
2415
00
Flor
ida
4,14
52,
078
896
636
536
776
503
390
270
386
233
Geo
rgia
31,
640
932
230
309
169
289
166
143
8214
684
Haw
aii
296
121
115
3327
3826
3423
53
Idah
o27
917
043
4520
4119
2712
147
Illin
ois
3,00
51,
603
834
328
239
387
219
344
193
4326
Indi
ana
1,22
866
825
420
799
185
8811
760
6827
Iow
a62
228
320
787
4590
4471
3319
12Ka
nsas
430
251
6080
3973
3648
2525
11Ke
ntuc
ky92
644
514
423
899
318
9723
356
8641
Loui
sian
a1,
311
670
278
243
121
211
119
115
6396
56M
aine
446
131
113
134
6810
663
6028
4635
Mar
ylan
d1,
098
510
357
148
8213
575
8648
4927
Mas
sach
uset
ts1,
549
386
646
356
161
266
137
244
116
2221
Mic
higa
n2,
297
1,16
758
838
915
330
514
025
611
649
25M
inne
sota
1,14
546
344
314
099
153
8013
771
169
Mis
siss
ippi
781
401
116
172
9116
691
8549
8142
EXH
IBIT
14.
Med
icai
d En
rollm
ent b
y St
ate,
Elig
ibili
ty G
roup
, and
Dua
lly E
ligib
le S
tatu
s, F
Y 20
12 (t
hous
ands
)
December 201540
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
14.
(co
ntin
ued)
Stat
eTo
tal
Basi
s of
elig
ibili
ty1
Dual
ly e
ligib
le s
tatu
s2
All d
ually
elig
ible
en
rolle
esDu
ally
elig
ible
with
fu
ll be
nefit
sDu
ally
elig
ible
with
lim
ited
bene
fits
Child
Adul
tDi
sabl
edAg
edTo
tal
Age
65+
Tota
lAg
e 65
+To
tal
Age
65+
Mis
sour
i1,
135
575
241
222
9719
291
180
8413
8M
onta
na13
677
2125
1326
1317
99
5N
ebra
ska
264
149
5042
2445
2340
205
3N
evad
a40
524
179
5233
5432
2516
3016
New
Ham
pshi
re16
896
2332
1736
1623
1013
6N
ew J
erse
y1,
184
624
203
196
162
239
150
209
129
3021
New
Mex
ico
652
354
178
7446
7645
4225
3420
New
Yor
k5,
865
2,09
62,
395
706
669
872
589
741
492
131
97N
orth
Car
olin
a1,
976
1,02
840
735
119
234
718
826
414
183
46N
orth
Dak
ota
8747
1812
916
913
73
2O
hio
2,47
41,
130
775
370
198
370
183
247
128
123
55O
klah
oma
931
491
244
128
6812
666
102
5324
13O
rego
n75
136
621
110
966
115
6471
4045
23Pe
nnsy
lvan
ia2,
562
1,10
750
069
925
645
724
537
419
582
49Rh
ode
Isla
nd18
580
4040
2439
2233
186
4So
uth
Caro
lina
1,04
452
625
717
288
167
8814
274
2514
Sout
h Da
kota
134
7724
2013
2213
148
84
Tenn
esse
e1,
545
794
323
278
150
288
148
157
8013
168
Texa
s34,
641
2,97
955
765
445
168
644
341
227
327
417
0U
tah
388
225
9847
1938
1733
155
3Ve
rmon
t20
569
8726
2338
2229
168
6Vi
rgin
ia1,
093
580
208
190
115
199
109
130
7569
34W
ashi
ngto
n1,
408
795
286
222
105
189
102
135
7854
24W
est V
irgin
ia43
920
864
124
4489
4452
2638
18W
isco
nsin
1,26
449
345
217
414
521
312
519
011
023
15W
yom
ing
8958
1312
612
67
45
2
MACStats: Medicaid and CHIP Data Book 41
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Not
es: F
Y is
fisc
al y
ear.
Enro
llmen
t num
bers
gen
eral
ly in
clud
e in
divi
dual
s ev
er e
nrol
led
in M
edic
aid-
finan
ced
cove
rage
dur
ing
the
year
, eve
n if
for a
sin
gle
mon
th; h
owev
er, i
n th
e ev
ent i
ndiv
idua
ls w
ere
also
enr
olle
d in
CH
IP-fi
nanc
ed M
edic
aid
cove
rage
(i.e
., M
edic
aid-
expa
nsio
n CH
IP) d
urin
g th
e ye
ar, t
hey
are
excl
uded
if th
eir m
ost r
ecen
t enr
ollm
ent
mon
th w
as in
Med
icai
d-ex
pans
ion
CHIP
. Num
bers
exc
lude
indi
vidu
als
enro
lled
only
in M
edic
aid-
expa
nsio
n CH
IP d
urin
g th
e ye
ar a
nd e
nrol
lees
in th
e te
rrito
ries.
Due
to th
e un
avai
labi
lity
of s
ever
al s
tate
s’ M
edic
aid
Stat
istic
al In
form
atio
n Sy
stem
(MSI
S) A
nnua
l Per
son
Sum
mar
y (A
PS) d
ata
for F
Y 20
12, t
he s
ourc
e us
ed in
prio
r edi
tions
of
this
tabl
e, M
ACPA
C ca
lcul
ated
enr
ollm
ent f
rom
the
full
MSI
S da
ta fi
les
that
are
use
d to
cre
ate
the
APS
files
. For
MAC
PAC’
s an
alys
is, M
edic
aid
enro
llees
wer
e as
sign
ed a
uni
que
natio
nal i
dent
ifica
tion
(ID) n
umbe
r usi
ng a
n al
gorit
hm th
at in
corp
orat
es s
tate
-spe
cific
ID n
umbe
rs a
nd b
enef
icia
ry c
hara
cter
istic
s su
ch a
s da
te o
f birt
h an
d ge
nder
. The
sta
te
and
natio
nal e
nrol
lmen
t cou
nts
show
n he
re a
re u
ndup
licat
ed u
sing
this
nat
iona
l ID.
Cat
egor
ies
may
not
sum
to to
tal f
or e
ach
stat
e du
e to
roun
ding
. In
addi
tion,
the
sum
of t
he
stat
e to
tals
exc
eeds
the
natio
nal t
otal
bec
ause
indi
vidu
als
may
be
enro
lled
in m
ore
than
one
sta
te d
urin
g th
e ye
ar.
1 Ch
ildre
n an
d ad
ults
und
er a
ge 6
5 w
ho q
ualif
y fo
r Med
icai
d on
the
basi
s of
dis
abili
ty a
re in
clud
ed in
the
disa
bled
cat
egor
y. A
bout
737
,000
enr
olle
es a
ge 6
5 an
d ol
der a
re
iden
tifie
d in
the
data
as
disa
bled
; giv
en th
at d
isab
ility
is n
ot a
n el
igib
ility
pat
hway
for i
ndiv
idua
ls a
ge 6
5 an
d ol
der,
MAC
PAC
reco
des
thes
e en
rolle
es a
s ag
ed.
2 Du
ally
elig
ible
enr
olle
es a
re c
over
ed b
y bo
th M
edic
aid
and
Med
icar
e; th
ose
with
lim
ited
bene
fits
rece
ive
only
Med
icai
d as
sist
ance
with
Med
icar
e pr
emiu
ms
and
cost
sha
ring.
3 St
ate
had
a ch
ange
in to
tal e
nrol
lmen
t of 1
0 pe
rcen
t or m
ore
over
the
prio
r yea
r. Th
ese
data
may
refle
ct d
ata
anom
alie
s in
the
subm
issi
on o
f MSI
S da
ta a
nd m
ay b
e up
date
d in
futu
re M
SIS
subm
issi
ons
by s
tate
s. M
SIS
data
ano
mal
ies
have
bee
n co
mpi
led
and
repo
rted
by
Mat
hem
atic
a Po
licy
Rese
arch
; the
dat
a an
omal
ies
repo
rt m
ay b
e fo
und
at:
http
://w
ww
.cm
s.go
v/Re
sear
ch-S
tatis
tics-
Data
-and
-Sys
tem
s/Co
mpu
ter-D
ata-
and-
Syst
ems/
Med
icai
dDat
aSou
rces
Gen
Info
/dow
nloa
ds/a
nom
alie
s1.p
df.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
MSI
S da
ta a
s of
Sep
tem
ber 2
014.
EXH
IBIT
14.
(co
ntin
ued)
December 201542
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Stat
e
Tota
lCh
ildAd
ult
Disa
bled
Aged
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1
Tota
l56
,995
50,0
1927
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26,7
0414
,707
10,5
919,
347
8,29
35,
913
4,43
0Al
abam
a94
371
847
347
315
338
207
160
109
46Al
aska
110
110
6161
2424
1616
98
Ariz
ona2
1,38
51,
277
642
630
486
429
156
144
101
75Ar
kans
as59
447
230
730
083
2314
011
063
38Ca
lifor
nia
9,47
56,
900
3,56
33,
358
3,89
31,
579
1,00
899
81,
012
965
Colo
rado
651
625
368
368
129
127
100
8954
42Co
nnec
ticut
695
623
283
283
238
237
7256
102
47De
law
are
209
180
8483
8673
2518
146
Dist
rict o
f Col
umbi
a315
715
755
5561
6127
2714
13Fl
orid
a3,
248
2,80
11,
672
1,66
454
544
656
242
746
926
4G
eorg
ia2
1,24
31,
087
682
682
139
109
272
220
150
77H
awai
i24
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610
690
9030
2824
21Id
aho
223
211
139
139
2626
4135
1711
Illin
ois
2,67
22,
532
1,44
71,
447
711
610
302
287
212
188
Indi
ana
1,00
794
756
556
517
717
718
114
684
59Io
wa
499
446
232
230
147
113
8175
3828
Kans
as34
932
720
720
738
3772
5933
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ntuc
ky77
069
237
137
192
9221
717
789
52Lo
uisi
ana
1,11
494
256
556
521
713
422
218
511
058
Mai
ne2
371
326
112
112
9796
100
9060
28M
aryl
and
915
848
430
429
277
253
136
118
7247
Mas
sach
uset
ts1,
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125
124
242
238
427
927
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7M
ichi
gan
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976
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350
330
130
108
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neso
ta88
985
037
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231
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912
373
64M
issi
ssip
pi65
555
333
233
183
5515
812
283
45
EXH
IBIT
15.
Med
icai
d Fu
ll-Ye
ar E
quiv
alen
t Enr
ollm
ent b
y St
ate
and
Elig
ibili
ty G
roup
, FY
2012
(tho
usan
ds)
MACStats: Medicaid and CHIP Data Book 43
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Stat
e
Tota
lCh
ildAd
ult
Disa
bled
Aged
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
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enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1
Mis
sour
i93
183
448
548
518
093
187
182
8074
Mon
tana
108
100
6262
1313
2218
117
Neb
rask
a20
820
412
212
230
3037
3519
17N
evad
a30
628
018
518
548
4744
3328
15N
ew H
amps
hire
137
126
8080
1515
2821
149
New
Jer
sey
971
943
533
533
118
117
178
170
142
124
New
Mex
ico
557
478
307
307
143
9467
5440
23N
ew Y
ork
4,95
14,
668
1,76
51,
731
1,92
11,
802
666
634
600
501
Nor
th C
arol
ina
1,62
01,
470
873
873
263
187
314
281
169
128
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th D
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a65
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108
6O
hio
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329
269
168
120
Okl
ahom
a72
364
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339
315
599
115
105
5948
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gon
618
552
293
286
168
149
9980
5737
Penn
sylv
ania
2,14
51,
953
919
918
379
261
627
596
220
178
Rhod
e Is
land
162
155
6969
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Sout
h Ca
rolin
a85
374
242
542
319
510
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514
578
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uth
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ta10
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063
6315
1518
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nnes
see
1,32
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252
252
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197
132
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xas
4,07
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606
394
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h28
127
616
516
559
5941
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rmon
t16
816
058
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15Vi
rgin
ia89
880
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548
514
211
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013
910
171
Was
hing
ton
1,15
81,
029
676
675
197
116
194
168
9070
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t Virg
inia
355
323
166
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4040
111
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nsin
1,06
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041
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736
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616
115
312
611
3W
yom
ing
6863
4544
87
109
53
EXH
IBIT
15.
(co
ntin
ued)
December 201544
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
15.
(co
ntin
ued)
Not
es: F
Y is
fisc
al y
ear.
Full-
year
equ
ival
ent (
FYE)
may
als
o be
refe
rred
to a
s av
erag
e m
onth
ly e
nrol
lmen
t. En
rollm
ent n
umbe
rs g
ener
ally
incl
ude
indi
vidu
als
ever
enr
olle
d in
M
edic
aid-
finan
ced
cove
rage
dur
ing
the
year
, eve
n if
for a
sin
gle
mon
th; h
owev
er, i
n th
e ev
ent i
ndiv
idua
ls w
ere
also
enr
olle
d in
CH
IP-fi
nanc
ed M
edic
aid
cove
rage
(i.e
., M
edic
aid-
expa
nsio
n CH
IP) d
urin
g th
e ye
ar, t
hey
are
excl
uded
if th
eir m
ost r
ecen
t enr
ollm
ent m
onth
was
in M
edic
aid-
expa
nsio
n CH
IP. N
umbe
rs e
xclu
de in
divi
dual
s en
rolle
d on
ly in
M
edic
aid-
expa
nsio
n CH
IP d
urin
g th
e ye
ar a
nd e
nrol
lees
in th
e te
rrito
ries.
Chi
ldre
n an
d ad
ults
und
er a
ge 6
5 w
ho q
ualif
y fo
r Med
icai
d on
the
basi
s of
dis
abili
ty a
re in
clud
ed in
the
disa
bled
cat
egor
y. A
bout
737
,000
enr
olle
es a
ge 6
5 an
d ol
der a
re id
entif
ied
in th
e da
ta a
s di
sabl
ed; g
iven
that
dis
abili
ty is
not
an
elig
ibili
ty p
athw
ay fo
r ind
ivid
uals
age
65
and
olde
r, M
ACPA
C re
code
s th
ese
enro
llees
as
aged
.
Due
to th
e un
avai
labi
lity
of s
ever
al s
tate
s’ M
edic
aid
Stat
istic
al In
form
atio
n Sy
stem
(MSI
S) A
nnua
l Per
son
Sum
mar
y (A
PS) d
ata
for f
isca
l yea
r FY
2012
, MAC
PAC
calc
ulat
ed
enro
llmen
t fro
m th
e fu
ll M
SIS
data
file
s th
at a
re u
sed
to c
reat
e th
e AP
S fil
es. C
ateg
orie
s m
ay n
ot s
um to
tota
l for
eac
h st
ate
due
to ro
undi
ng. I
n ad
ditio
n, th
e su
m o
f the
sta
te
tota
ls e
xcee
ds th
e na
tiona
l tot
al b
ecau
se in
divi
dual
s m
ay b
e en
rolle
d in
mor
e th
an o
ne s
tate
dur
ing
the
year
.1
In th
is e
xhib
it, fu
ll be
nefit
enr
olle
es c
olum
ns e
xclu
des
enro
llees
repo
rted
by
stat
es in
the
MSI
S as
rece
ivin
g co
vera
ge o
f onl
y fa
mily
pla
nnin
g se
rvic
es, a
ssis
tanc
e w
ith
Med
icar
e pr
emiu
ms
and
cost
sha
ring,
or e
mer
genc
y se
rvic
es.
2 St
ate
had
a ch
ange
in F
YE e
nrol
lees
of 1
0 pe
rcen
t or m
ore
over
the
prio
r yea
r. Th
ese
data
may
refle
ct a
nom
alie
s in
the
MSI
S da
ta a
nd m
ay b
e up
date
d in
futu
re M
SIS
subm
issi
ons
by s
tate
s. M
SIS
data
ano
mal
ies
have
bee
n co
mpi
led
and
repo
rted
by
Mat
hem
atic
a Po
licy
Rese
arch
; the
dat
a an
omal
ies
repo
rt m
ay b
e fo
und
at: h
ttp:
//w
ww
.cm
s.go
v/Re
sear
ch-S
tatis
tics-
Data
-and
-Sys
tem
s/Co
mpu
ter-D
ata-
and-
Syst
ems/
Med
icai
dDat
aSou
rces
Gen
Info
/dow
nloa
ds/a
nom
alie
s1.p
df.
3 Th
e Di
stric
t of C
olum
bia
had
a sl
ight
incr
ease
in to
tal e
nrol
lees
but
a la
rge
decr
ease
in to
tal e
nrol
led
mon
ths,
thus
cre
atin
g a
decr
ease
in F
YE e
nrol
lees
and
num
ber o
f m
onth
s pe
r enr
olle
e of
10
perc
ent o
r mor
e ov
er th
e pr
ior y
ear.
Thes
e da
ta m
ay re
flect
ano
mal
ies
in th
e M
SIS
data
and
may
be
upda
ted
in fu
ture
MSI
S su
bmis
sion
s. M
SIS
data
an
omal
ies
have
bee
n co
mpi
led
and
repo
rted
by
Mat
hem
atic
a Po
licy
Rese
arch
; the
dat
a an
omal
ies
repo
rt m
ay b
e fo
und
at: h
ttp:
//w
ww
.cm
s.go
v/Re
sear
ch-S
tatis
tics-
Data
-and
-Sy
stem
s/Co
mpu
ter-D
ata-
and-
Syst
ems/
Med
icai
dDat
aSou
rces
Gen
Info
/dow
nloa
ds/a
nom
alie
s1.p
df.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
MSI
S da
ta a
s of
Dec
embe
r 201
4.
MACStats: Medicaid and CHIP Data Book 45
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Stat
e1
Bene
fits
Stat
e pr
ogra
m a
dmin
istr
atio
nTo
tal M
edic
aid
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Alab
ama
$5,2
13$3
,599
$1,6
14$2
12$1
36$7
6$5
,425
$3,7
35$1
,690
Alas
ka1,
412
832
580
134
8550
1,54
791
763
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izon
a9,
185
6,56
52,
620
268
195
739,
453
6,76
02,
693
Arka
nsas
4,84
03,
615
1,22
531
421
110
45,
154
3,82
61,
328
Calif
orni
a63
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35,7
5627
,628
4,86
42,
724
2,14
068
,248
38,4
8029
,769
Colo
rado
5,91
93,
335
2,58
434
622
412
26,
265
3,55
92,
706
Conn
ectic
ut6,
821
3,87
92,
942
347
215
132
7,16
84,
094
3,07
4De
law
are
1,69
21,
004
688
113
8033
1,80
51,
084
721
Dist
rict o
f Col
umbi
a2,
368
1,72
164
715
710
057
2,52
41,
821
704
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ida
20,3
0312
,151
8,15
274
747
127
621
,050
12,6
238,
428
Geo
rgia
9,39
76,
347
3,05
046
131
215
09,
858
6,65
93,
199
Haw
aii
1,95
01,
125
824
100
7624
2,05
01,
201
848
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o1,
586
1,13
744
810
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301,
692
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447
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inoi
s16
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8,94
07,
676
1,10
666
943
817
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9,60
98,
114
Indi
ana
9,09
46,
145
2,94
950
632
418
29,
600
6,46
93,
131
Iow
a3,
922
2,46
01,
462
189
137
514,
110
2,59
71,
513
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as2,
728
1,56
21,
165
205
136
692,
933
1,69
91,
234
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ucky
7,79
35,
935
1,85
822
315
766
8,01
66,
092
1,92
4Lo
uisi
ana
7,05
64,
408
2,64
728
217
710
57,
338
4,58
62,
752
Mai
ne2,
365
1,47
189
516
311
747
2,52
91,
587
941
Mar
ylan
d9,
210
5,25
53,
955
415
268
147
9,62
65,
523
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2M
assa
chus
etts
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517,
321
6,92
970
242
228
014
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7,74
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209
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higa
n13
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9,27
04,
233
645
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206
14,1
489,
709
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9M
inne
sota
9,91
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481
4,43
759
537
022
510
,513
5,85
14,
663
Mis
siss
ippi
4,86
53,
585
1,28
015
110
249
5,01
63,
687
1,33
0M
isso
uri
8,82
95,
545
3,28
441
027
113
99,
239
5,81
63,
423
Mon
tana
1,07
272
934
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1,14
578
136
3N
ebra
ska
1,77
297
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evad
a2,
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110
942
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New
Ham
pshi
re1,
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678
645
9866
321,
421
744
677
New
Jer
sey
12,4
707,
099
5,37
172
440
831
613
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7,50
75,
687
New
Mex
ico
4,16
93,
140
1,02
918
012
159
4,34
93,
261
1,08
8
EXH
IBIT
16.
Med
icai
d Sp
endi
ng b
y St
ate,
Cat
egor
y, an
d So
urce
of F
unds
, FY
2014
(mill
ions
)
December 201546
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Stat
e1
Bene
fits
Stat
e pr
ogra
m a
dmin
istr
atio
nTo
tal M
edic
aid
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
New
Yor
k$5
1,80
6$2
7,62
2$2
4,18
4$1
,792
$1,0
74$7
19$5
3,59
9$2
8,69
6$2
4,90
3N
orth
Car
olin
a11
,993
7,94
54,
047
663
440
222
12,6
558,
386
4,26
9N
orth
Dak
ota
402
206
195
4932
1745
123
921
2O
hio
19,4
3913
,068
6,37
178
450
228
220
,223
13,5
706,
653
Okl
ahom
a4,
666
3,03
81,
629
259
178
814,
925
3,21
51,
710
Ore
gon
6,78
44,
952
1,83
250
728
122
67,
291
5,23
32,
058
Penn
sylv
ania
23,4
6212
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10,7
5795
360
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e Is
land
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71,
410
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712
988
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566
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069
Sout
h Ca
rolin
a5,
321
3,77
11,
550
276
185
905,
597
3,95
61,
640
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h Da
kota
778
455
323
6342
2184
149
734
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nnes
see
9,20
56,
064
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216
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654
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63,
308
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s31
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9012
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1,44
688
456
232
,831
19,6
7413
,157
Uta
h2,
064
1,45
960
617
012
446
2,23
51,
583
652
Verm
ont
1,52
690
162
544
395
1,57
094
063
0Vi
rgin
ia7,
547
3,84
33,
704
433
299
134
7,98
04,
142
3,83
8W
ashi
ngto
n10
,250
6,43
43,
816
596
361
235
10,8
466,
794
4,05
1W
est V
irgin
ia3,
331
2,45
487
715
710
552
3,48
82,
559
929
Wis
cons
in7,
396
4,44
82,
949
387
241
146
7,78
34,
689
3,09
4W
yom
ing
539
276
263
5537
1859
531
328
1Su
btot
al (s
tate
s)$4
67,6
39$2
82,5
00$1
85,1
39$2
4,33
7$1
5,13
6$9
,201
$491
,976
$297
,636
$194
,340
Amer
ican
Sam
oa25
1411
10
026
1511
Gua
m74
4232
53
178
4533
Nor
ther
n M
aria
na Is
land
s34
1914
10
034
2014
Puer
to R
ico
1,84
21,
139
703
8762
261,
929
1,20
172
8Vi
rgin
Isla
nds
7140
319
81
8047
32Su
btot
al (s
tate
s an
d te
rrito
ries)
$469
,683
$283
,754
$185
,929
$24,
440
$15,
209
$9,2
30$4
94,1
23$2
98,9
64$1
95,1
59St
ate
Med
icai
d Fr
aud
Cont
rol U
nits
(M
FCU
s)–
––
285
214
7128
521
471
Med
icai
d su
rvey
and
cer
tific
atio
n of
nur
sing
and
inte
rmed
iate
car
e fa
cilit
ies
––
–29
322
073
293
220
73
Vacc
ines
for C
hild
ren
(VFC
) pro
gram
––
––
––
3,55
73,
557
–To
tal
$469
,683
$283
,754
$185
,929
$25,
018
$15,
643
$9,3
75$4
98,2
582
$302
,954
2$1
95,3
04
EXH
IBIT
16.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 47
Section 3: Program Enrollment and Spending—Medicaid Overall
MAC
Stat
sSe
ctio
n 3
Not
es: F
Y is
fisc
al y
ear.
Tota
l fed
eral
spe
ndin
g sh
own
here
($30
2,95
4 m
illio
n) w
ill d
iffer
from
tota
l fed
eral
out
lays
sho
wn
in F
Y 20
16 b
udge
t doc
umen
ts d
ue to
slig
ht d
iffer
ence
s in
the
timin
g of
dat
a fo
r the
sta
tes
and
the
trea
tmen
t of c
erta
in a
djus
tmen
ts. F
eder
al s
pend
ing
in th
e te
rrito
ries
is c
appe
d; h
owev
er, t
errit
orie
s re
port
thei
r tot
al s
pend
ing
rega
rdle
ss o
f whe
ther
they
hav
e re
ache
d th
eir c
aps.
As
a re
sult,
fede
ral s
pend
ing
show
n he
re m
ay e
xcee
d th
e am
ount
s ac
tual
ly p
aid
to th
e te
rrito
ries.
Sta
te s
hare
s fo
r MFC
Us
and
surv
ey a
nd c
ertif
icat
ion
are
MAC
PAC
estim
ates
bas
ed o
n 75
per
cent
fede
ral m
atch
. Sta
te-le
vel e
stim
ates
for t
hese
item
s ar
e av
aila
ble
but a
re n
ot s
how
n he
re. T
he
VFC
prog
ram
is a
utho
rized
in th
e M
edic
aid
stat
ute
but i
s op
erat
ed a
s a
sepa
rate
pro
gram
; 100
per
cent
fede
ral f
undi
ng fi
nanc
es th
e pu
rcha
se o
f vac
cine
s fo
r chi
ldre
n w
ho
are
enro
lled
in M
edic
aid,
uni
nsur
ed, o
r priv
atel
y in
sure
d w
ithou
t vac
cine
cov
erag
e. S
pend
ing
on a
dmin
istr
atio
n is
onl
y fo
r sta
te p
rogr
ams;
fede
ral o
vers
ight
spe
ndin
g is
not
in
clud
ed.
– D
ash
indi
cate
s ze
ro; $
0 in
dica
tes
an a
mou
nt le
ss th
an $
0.5
mill
ion
that
roun
ds to
zer
o.
1 N
ot a
ll st
ates
hav
e ce
rtifi
ed th
eir C
MS-
64 F
MR
subm
issi
ons
as o
f Feb
ruar
y 25
, 201
5. C
alifo
rnia
’s a
nd C
olor
ado’
s se
cond
, thi
rd, a
nd fo
urth
qua
rter
sub
mis
sion
s ar
e no
t ce
rtifi
ed; N
orth
Dak
ota’
s th
ird a
nd fo
urth
qua
rter
sub
mis
sion
s ar
e no
t cer
tifie
d; S
outh
Car
olin
a’s
seco
nd q
uart
er s
ubm
issi
on is
not
cer
tifie
d; R
hode
Isla
nd’s
four
th q
uart
er
subm
issi
on is
not
cer
tifie
d. F
igur
es p
rese
nted
in th
is e
xhib
it m
ay c
hang
e if
stat
es re
vise
thei
r exp
endi
ture
dat
a af
ter t
his
date
.2
Amou
nts
exce
ed th
e su
m o
f ben
efits
and
sta
te p
rogr
am a
dmin
istr
atio
n co
lum
ns d
ue to
the
incl
usio
n of
the
VFC
prog
ram
.
Sour
ces:
For
sta
te a
nd te
rrito
ry s
pend
ing:
MAC
PAC,
201
5, a
naly
sis
of C
MS-
64 F
MR
net e
xpen
ditu
re d
ata
as o
f Feb
ruar
y 25
, 201
5. F
or a
ll ot
her s
pend
ing
(MCF
Us,
sur
vey
and
cert
ifica
tion,
VFC
): Ce
nter
s fo
r Med
icar
e &
Med
icai
d Se
rvic
es, 2
015,
Fis
cal y
ear 2
016
just
ifica
tion
of e
stim
ates
for A
ppro
pria
tions
Com
mitt
ees,
Bal
timor
e, M
D, h
ttp:
//w
ww
.cm
s.go
v/Ab
out-C
MS/
Agen
cy-In
form
atio
n/Pe
rfor
man
ceBu
dget
/Dow
nloa
ds/F
Y201
6-CJ
-Fin
al.p
df.
EXH
IBIT
16.
(co
ntin
ued)
December 201548
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
17.
Tot
al M
edic
aid
Bene
fit S
pend
ing
by S
tate
and
Cat
egor
y, FY
201
4 (m
illio
ns)
Stat
e1
Tota
l sp
endi
ng
on b
enef
its
Fee
for s
ervi
ceM
anag
ed
care
and
pr
emiu
m
assi
stan
ce
Med
icar
e pr
emiu
ms
and
coin
sura
nce
Colle
ctio
nsH
ospi
tal
Phys
icia
nDe
ntal
Oth
er
prac
titio
nerCl
inic
and
he
alth
ce
nter
Oth
er a
cute
Drug
sIn
stitu
tiona
l LT
SS
Hom
e an
d co
mm
unity
-ba
sed
LTSS
Alab
ama
$5,2
13$1
,909
$503
$84
$49
$89
$499
$293
$1,0
03$4
59$9
6$2
58-$
30
Alas
ka1,
412
308
119
7421
208
112
3915
936
30
24-1
5
Ariz
ona
9,18
51,
175
375
514
826
45
725
7,30
022
5-5
4
Arka
nsas
4,84
01,
009
339
7422
4990
318
599
848
952
929
9-5
6
Calif
orni
a63
,384
13,2
741,
446
593
252,
485
5,83
51,
408
5,68
29,
010
21,8
382,
257
-469
Colo
rado
5,91
91,
910
493
146
–15
425
028
071
01,
064
843
109
-41
Conn
ectic
ut6,
821
1,97
239
617
111
626
447
146
71,
613
1,38
00
380
-411
Dela
war
e1,
692
5413
341
5864
106
3710
81,
218
35-3
4
Dist
rict o
f Col
umbi
a2,
368
379
4624
314
911
779
372
408
769
37-1
3
Flor
ida
20,3
034,
942
1,33
018
442
184
1,44
641
71,
836
1,22
47,
459
1,36
1-1
23
Geo
rgia
9,39
72,
139
431
3932
1571
427
71,
380
932
3,19
433
4-8
9
Haw
aii
1,95
011
43
360
374
310
106
1,62
853
-45
Idah
o1,
586
434
111
-018
2218
462
272
299
165
41-2
3
Illin
ois
16,6
166,
722
892
183
109
288
1,18
941
42,
508
1,73
32,
286
401
-110
Indi
ana
9,09
41,
906
320
184
1139
435
746
32,
358
1,05
91,
907
172
-36
Iow
a3,
922
802
196
5423
7936
812
694
174
555
914
4-1
16
Kans
as2
2,72
814
621
03
546
-182
139
2,24
085
-37
Kent
ucky
7,79
345
857
34
113
386
361,
148
735
4,76
919
8-1
15
Loui
sian
a7,
056
2,21
232
882
–89
314
234
1,33
483
51,
659
271
-303
Mai
ne2,
365
510
102
2743
233
384
7542
843
93
213
-92
Mar
ylan
d9,
210
1,21
012
812
525
5793
629
11,
338
1,10
33,
892
267
-162
Mas
sach
uset
ts14
,251
2,25
738
722
723
332
1,00
233
91,
901
2,36
85,
339
427
-352
Mic
higa
n13
,503
1,48
644
071
923
051
328
82,
034
799
7,31
539
7-7
9
Min
esso
ta9,
918
642
237
3619
263
647
118
1,00
32,
387
4,55
417
7-1
38
Mis
siss
ippi
4,86
51,
661
198
423
9537
514
71,
096
315
763
207
-19
Mis
sour
i8,
829
2,88
142
1412
445
819
648
1,38
91,
298
1,05
532
0-9
5
Mon
tana
1,07
230
256
2819
2019
041
193
175
2536
-13
Neb
rask
a1,
772
186
3334
35
6759
421
340
566
103
-45
Nev
ada
2,28
151
412
633
1632
202
9827
518
769
712
0-1
9
New
Ham
pshi
re2
1,32
316
338
217
514
5-9
404
301
243
27-2
1
MACStats: Medicaid and CHIP Data Book 49
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
e1
Tota
l sp
endi
ng
on b
enef
its
Fee
for s
ervi
ceM
anag
ed
care
and
pr
emiu
m
assi
stan
ce
Med
icar
e pr
emiu
ms
and
coin
sura
nce
Colle
ctio
nsH
ospi
tal
Phys
icia
nDe
ntal
Oth
er
prac
titio
nerCl
inic
and
he
alth
ce
nter
Oth
er a
cute
Drug
sIn
stitu
tiona
l LT
SS
Hom
e an
d co
mm
unity
-ba
sed
LTSS
New
Jer
sey
$12,
470
$1,7
76$7
1$8
$3$1
96$8
38$1
9$2
,967
$1,0
57$5
,307
$333
-$10
4
New
Mex
ico2
4,16
936
035
1138
2841
-14
3432
13,
236
91-1
3
New
Yor
k251
,806
7,70
738
876
216
1,26
35,
101
-1,4
899,
661
6,11
723
,861
1,30
2-2
,398
Nor
th C
arol
ina
11,9
933,
471
730
318
320
247
1,04
661
01,
377
860
2,69
742
1-1
05
Nor
th D
akot
a40
263
266
56
2610
163
928
6-7
Ohi
o19
,439
2,45
938
753
2611
81,
539
772,
859
2,60
39,
078
385
-143
Okl
ahom
a4,
666
1,67
349
111
643
389
359
297
770
526
157
146
-300
Ore
gon
6,78
451
431
223
7854
065
411
1,23
53,
762
169
-47
Penn
sylv
ania
23,4
621,
822
105
282
103
346
144,
896
3,53
012
,203
574
-161
Rhod
e Is
land
2,43
736
516
101
2956
73
239
21,
177
43-1
4
Sout
h Ca
rolin
a5,
321
1,08
915
994
2224
132
56
812
488
2,14
017
8-2
32
Sout
h Da
kota
778
193
6415
291
5732
165
136
228
-7
Tenn
esse
e9,
205
856
5314
21
4023
548
525
968
46,
163
346
-58
Texa
s31
,385
5,47
11,
690
8523
738
4,54
234
63,
692
2,44
512
,634
1,02
3-8
17
Uta
h2,
064
303
7619
311
9363
275
238
975
37-3
0
Verm
ont2
1,52
644
20
01
1,42
8-7
412
08
-06
-9
Virg
inia
7,54
799
220
212
833
501,
006
441,
246
1,32
62,
356
228
-64
Was
hing
ton
10,2
501,
080
193
155
2953
638
059
910
1,71
05,
022
331
-154
Wes
t Virg
inia
3,33
162
219
940
1847
261
156
747
586
552
121
-18
Wis
cons
in7,
396
779
130
4423
312
676
321
956
899
3,03
332
2-9
9
Wyo
min
g53
911
746
1413
3628
1813
312
82
14-8
Subt
otal
$467
,639
$85,
432
$13,
960
$3,9
55$1
,912
$10,
209
$38,
235
$8,0
34$6
5,68
7$5
5,79
5$1
77,2
77$1
5,08
4-$
7,94
1Am
eric
an S
amoa
2523
––
––
10
––
––
–
Gua
m74
159
20
127
171
0–
1–
N. M
aria
na Is
land
s34
22–
1–
33
2–
10
1–
Puer
to R
ico
1,84
2–
––
––
30–
––
1,81
1–
1
Virg
in Is
land
s71
444
11
3-2
65
0–
8-0
Tota
l$4
69,6
83$8
5,53
7$1
3,97
3$3
,960
$1,9
13$1
0,21
6$3
8,29
4$8
,059
$65,
692
$55,
796
$179
,089
$15,
094
-$7,
940
Perc
ent o
f tot
al,
excl
usiv
e of
co
llect
ions
–17
.9%
2.9%
0.8%
0.4%
2.1%
8.0%
1.7%
13.8
%11
.7%
37.5
%3.
2%–
EXH
IBIT
17.
(co
ntin
ued)
December 201550
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Not
es: L
TSS
is lo
ng-te
rm s
ervi
ces
and
supp
orts
. Inc
lude
s fe
dera
l and
sta
te fu
nds.
Ser
vice
cat
egor
y de
finiti
ons
and
spen
ding
am
ount
s sh
own
here
may
diff
er fr
om o
ther
CM
S da
ta s
ourc
es, s
uch
as th
e M
edic
aid
Stat
istic
al In
form
atio
n Sy
stem
(MSI
S). T
he s
peci
fic s
ervi
ces
incl
uded
in e
ach
cate
gory
hav
e ch
ange
d ov
er ti
me
and
ther
efor
e m
ay n
ot b
e di
rect
ly c
ompa
rabl
e to
ear
lier e
ditio
ns o
f MAC
Stat
s. C
olle
ctio
ns in
clud
e th
ird-p
arty
liab
ility
, est
ate,
and
oth
er re
cove
ries.
– D
ash
indi
cate
s ze
ro; $
0 or
-$0
indi
cate
s an
am
ount
bet
wee
n $0
.5 a
nd -$
0.5
mill
ion
that
roun
ds to
zer
o.
Addi
tiona
l det
ail o
n ca
tego
ries:
• Hos
pita
l inc
lude
s in
patie
nt, o
utpa
tient
, crit
ical
acc
ess
hosp
ital,
and
emer
genc
y ho
spita
l ser
vice
s, a
s w
ell a
s re
late
d di
spro
port
iona
te s
hare
hos
pita
l (DS
H) p
aym
ents
. • P
hysi
cian
incl
udes
phy
sici
an a
nd s
urgi
cal s
ervi
ces,
bot
h re
gula
r pay
men
ts a
nd th
ose
asso
ciat
ed w
ith th
e pr
imar
y ca
re p
hysi
cian
pay
men
t inc
reas
e.• C
linic
and
hea
lth c
ente
r inc
lude
s no
n-ho
spita
l out
patie
nt c
linic
, rur
al h
ealth
clin
ic, f
eder
ally
qua
lifie
d he
alth
cen
ter,
and
free
stan
ding
birt
h ce
nter
.• O
ther
acu
te in
clud
es la
b or
X-ra
y; s
teril
izat
ions
; abo
rtio
ns; E
arly
and
Per
iodi
c Sc
reen
ing,
Dia
gnos
tic, a
nd T
reat
men
t (EP
SDT)
scr
eeni
ngs;
em
erge
ncy
serv
ices
for u
naut
horiz
ed
alie
ns; n
on-e
mer
genc
y tr
ansp
orta
tion;
phy
sica
l, oc
cupa
tiona
l, sp
eech
, and
hea
ring
ther
apy;
pro
sthe
tics,
den
ture
s, a
nd e
yegl
asse
s; p
reve
ntiv
e se
rvic
es w
ith U
.S. P
reve
ntiv
e Se
rvic
es T
ask
Forc
e (U
SPST
F) G
rade
A o
r B a
nd A
dvis
ory
Com
mitt
ee o
n Im
mun
izat
ion
Prac
tices
(ACI
P) v
acci
nes;
oth
er d
iagn
ostic
scr
eeni
ng a
nd p
reve
ntiv
e se
rvic
es;
scho
ol-b
ased
ser
vice
s; h
ealth
hom
e w
ith c
hron
ic c
ondi
tions
; tob
acco
ces
satio
n fo
r pre
gnan
t wom
en; p
rivat
e du
ty n
ursi
ng; c
ase
man
agem
ent (
excl
udin
g pr
imar
y ca
re c
ase
man
agem
ent)
; reh
abili
tativ
e se
rvic
es; h
ospi
ce; a
nd o
ther
car
e no
t oth
erw
ise
cate
goriz
ed.
• Dru
gs a
re n
et o
f reb
ates
.• I
nstit
utio
nal L
TSS
incl
udes
nur
sing
faci
lity,
inte
rmed
iate
car
e fa
cilit
y fo
r ind
ivid
uals
with
inte
llect
ual d
isab
ilitie
s, a
nd m
enta
l hea
lth fa
cilit
y.• H
ome
and
com
mun
ity-b
ased
LTS
S in
clud
es h
ome
heal
th, w
aive
r and
sta
te p
lan
serv
ices
, and
per
sona
l car
e.• M
anag
ed c
are
and
prem
ium
ass
ista
nce
incl
udes
com
preh
ensi
ve a
nd li
mite
d-be
nefit
man
aged
car
e pl
ans,
prim
ary
care
cas
e m
anag
emen
t (PC
CM),
empl
oyer
-spo
nsor
ed
prem
ium
ass
ista
nce
prog
ram
s, a
nd P
rogr
ams
of A
ll-in
clus
ive
Care
for t
he E
lder
ly (P
ACE)
. Com
preh
ensi
ve p
lans
acc
ount
for a
bout
90
perc
ent o
f spe
ndin
g in
the
man
aged
ca
re c
ateg
ory.
Man
aged
car
e al
so in
clud
es re
bate
s fo
r dru
gs p
rovi
ded
by m
anag
ed c
are
plan
s, a
nd m
anag
ed c
are
paym
ents
ass
ocia
ted
with
the
prim
ary
care
phy
sici
an
paym
ent i
ncre
ase,
Com
mun
ity F
irst C
hoic
e op
tion,
and
pre
vent
ive
serv
ices
with
USP
STF
Gra
de A
or B
, and
ACI
P va
ccin
es.
1 N
ot a
ll st
ates
had
cer
tifie
d th
eir C
MS-
64 F
MR
subm
issi
ons
as o
f Feb
ruar
y 25
, 201
5. C
alifo
rnia
’s a
nd C
olor
ado’
s se
cond
, thi
rd, a
nd fo
urth
qua
rter
sub
mis
sion
s ar
e no
t ce
rtifi
ed; N
orth
Dak
ota’
s th
ird a
nd fo
urth
qua
rter
sub
mis
sion
s ar
e no
t cer
tifie
d; S
outh
Car
olin
a’s
seco
nd q
uart
er s
ubm
issi
on is
not
cer
tifie
d; R
hode
Isla
nd’s
four
th q
uart
er
subm
issi
on is
not
cer
tifie
d. F
igur
es p
rese
nted
in th
is e
xhib
it m
ay c
hang
e if
stat
es re
vise
thei
r exp
endi
ture
dat
a af
ter t
his
date
.2
Stat
e re
port
s ne
gativ
e fe
e-fo
r-ser
vice
(FFS
) dru
g sp
endi
ng a
fter
the
appl
icat
ion
of d
rug
reba
tes.
The
neg
ativ
e ne
t am
ount
may
refle
ct a
shi
ft o
f som
e FF
S dr
ug s
pend
ing
into
M
edic
aid
man
aged
car
e or
the
stat
e no
t sep
arat
ely
repo
rtin
g th
e FF
S an
d m
anag
ed c
are
drug
reba
tes.
Ver
mon
t sho
ws
nega
tive
drug
spe
ndin
g be
caus
e it
repo
rts
mos
t of i
ts
bene
fit s
pend
ing
unde
r oth
er c
are
serv
ices
in it
s CM
S-64
sub
mis
sion
.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
CM
S-64
FM
R ne
t exp
endi
ture
dat
a as
of F
ebru
ary
25, 2
015.
EXH
IBIT
17.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 51
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
All enrollees$389.5 billion
Child$72.4 billion
Adult$59.5 billion
Disabled$166.8 billion
Aged$90.7 billion
Medicare premiums
LTSS institutional
LTSS non-institutional
Managed care
Drugs
Non-hospital acute
Inpatient and outpatient hospital
17.5%
17.3%
19.5%
14.0%
5.8%
0.4%
47.0%
19.0%
1.3%1.7%*
27.7%
2.6%3.4%
3.1% 3.0%
0.5%0.3%0.3%
15.0%
3.5%
14.4%
3.3%
7.8%
8.6%
24.9%15.7%
15.0%
3.5%
14.4%
3.3%
7.8%
8.6%
24.9%15.7%
14.2% 23.2%
16.9%
30.0%
14.2%
22.2%
23.2%
13.6%
16.9%
50.0% 52.4%
Notes: FY is fiscal year. LTSS is long-term services and supports. Includes federal and state funds. Excludes spending for administration, the territories, and Medicaid-expansion CHIP enrollees. Children and adults under age 65 who qualify for Medicaid on the basis of disability are included in the disabled category. About 737,000 enrollees age 65 and older are identified in the data as disabled; given that disability is not an eligibility pathway for individuals age 65 and older, MACPAC recodes these enrollees as aged. Amounts are fee for service unless otherwise noted. Benefit spending from Medicaid Statistical Information System (MSIS) data has been adjusted to reflect CMS-64 totals. Due to changes in both methods and data, figures shown here are not directly comparable to earlier years. With regard to methods, spending totals now exclude disproportionate share hospital (DSH) payments and certain incentive and uncompensated care pool payments made under Section 1115 waiver expenditure authority, which were previously included. In addition, due to the unavailability of several states’ MSIS Annual Person Summary (APS) data for FY 2012, the source used in prior editions of this exhibit, MACPAC calculated spending and enrollment from the full MSIS data files that are used to create the APS files. See https://www.macpac.gov/macstats/data-sources-and-methods/ for additional information.
* Values less than 0.1 percent are not shown.
Sources: MACPAC, 2015, analysis of MSIS data as of December 2014 and analysis of CMS-64 FMR net expenditure data from CMS as of June 2015.
EXHIBIT 18. Distribution of Medicaid Benefit Spending by Eligibility Group and Service Category, FY 2012
December 201552
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
s
Medicare premiums
LTSS institutional
LTSS non-institutional
Managed care
Drugs
Non-hospital acute
Inpatient and outpatienthospital
All enrollees$6,833
Child$2,679
Adult$4,044
Disabled$17,848
Aged$15,346
$1,027
$177
$2,047 $2,119
$969
$1,183
$237
$1,194 $508 $1,121$3,486
$2,575
$609
$3,959
$4,135
$2,502
$582 $1,326
$7,210
$2,590
$2,079
$60
$1,196
$885
$667 $635
$83 $123
$1,339
$36 $21
$46 $11
* $14
Notes: FY is fiscal year. LTSS is long-term services and supports. Includes federal and state funds. Excludes spending for administration, the territories, and Medicaid-expansion CHIP enrollees. Children and adults under age 65 who qualify for Medicaid on the basis of disability are included in the disabled category. About 737,000 enrollees age 65 and older are identified in the data as disabled; given that disability is not an eligibility pathway for individuals age 65 and older, MACPAC recodes these enrollees as aged. Amounts are fee for service unless otherwise noted, and they reflect all enrollees, including those with limited benefits. Benefit spending from Medicaid Statistical Information System (MSIS) data has been adjusted to reflect CMS-64 totals. Due to changes in both methods and data, figures shown here are not directly comparable to earlier years. With regard to methods, spending totals now exclude disproportionate share hospital (DSH) and certain incentive and uncompensated care pool payments made under Section 1115 waiver expenditure authority, which were previously included. In addition, due to the unavailability of several states’ MSIS Annual Person Summary (APS) data for FY 2012, the source used in prior editions of this exhibit, MACPAC calculated spending and enrollment from the full MSIS data files that are used to create the APS files. See https://www.macpac.gov/macstats/data-sources-and-methods/ for additional information.
* Values less than $1 are not shown.
Sources: MACPAC, 2015, analysis of MSIS data as of December 2014 and analysis of CMS-64 FMR net expenditure data from CMS as of June 2015.
EXHIBIT 19. Medicaid Benefit Spending Per Full-Year Equivalent (FYE) Enrollee by Eligibility Group and Service Category, FY 2012
Sect
ion
3
MACStats: Medicaid and CHIP Data Book 53
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
All enrollees69.2 million
Benefit spending for LTSS and all other services
$389.5 billion
43.4% of spending ($169.2 billion)is for LTSS users
6.2% of enrollees(4.3 million) are
LTSS users
Not using LTSS
Using LTSS: Non-institutional only, no services under HCBS waiver1
Using LTSS: Non-institutional only,with some services under HCBS waiver1
Using LTSS: Institutional only
Using LTSS: Both institutional andnon-institutional
93.8%
56.6%
8.3%
18.8%
2.9%2.9%
13.4%
2.1%1.9%1.9%
Notes: FY is fiscal year. LTSS is long-term services and supports. HCBS is home and community-based services. Includes federal and state funds. Excludes administrative spending and spending and enrollees in the territories and in Medicaid-expansion CHIP. Benefit spending from Medicaid Statistical Information System (MSIS) data has been adjusted to reflect CMS-64 totals, and enrollment counts are unduplicated using unique national identification numbers. Due to changes in both methods and data, figures shown here are not directly comparable to earlier years. With regard to methods, spending totals now exclude disproportionate share hospital (DSH) payments and certain incentive and uncompensated care pool payments made under Section 1115 waiver expenditure authority, which were previously included. In addition, due to the unavailability of several states’ MSIS Annual Person Summary (APS) data for FY 2012, the source used in prior editions of this exhibit, MACPAC calculated spending and enrollment from the full MSIS data files that are used to create the APS files. See https://www.macpac.gov/macstats/data-sources-and-methods/ for additional information.
LTSS users are defined here as enrollees using at least one LTSS service during the year under a fee-for-service arrangement. (The data do not allow a breakout of LTSS services delivered through managed care.) For example, an enrollee with a short stay in a nursing facility for rehabilitation following a hospital discharge and an enrollee with permanent residence in a nursing facility would both be counted as LTSS users. More refined definitions that take these and other factors into account would produce different results and will be considered in future Commission work.1 All states have HCBS waiver programs that provide a range of LTSS for targeted populations of non-institutionalized enrollees who require institutional levels of care. Based on a comparison with CMS-372 data (a state-reported source containing aggregate spending and enrollment for HCBS waivers), the number of HCBS waiver enrollees may be underreported in the MSIS.
Source: MACPAC, 2015, analysis of MSIS data as of December 2014 and CMS-64 FMR net expenditure data from CMS as of June 2015.
EXHIBIT 20. Distribution of Medicaid Enrollment and Benefit Spending by Users and Non-Users of Long-Term Services and Supports, FY 2012
December 201554
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
s
Stat
eTo
tal
Basi
s of
elig
ibilt
y1
Dual
ly e
ligib
le s
tatu
s2
All d
ually
elig
ible
en
rolle
esDu
ally
elig
ible
with
full
bene
fits
Dual
ly e
ligib
le w
ith
limite
d be
nefit
sCh
ildAd
ult
Disa
bled
Aged
Tota
lAg
e 65
+To
tal
Age
65+
Tota
lAg
e 65
+To
tal
$389
,456
18.6
%15
.3%
42.8
%23
.3%
$144
,690
59.1
%$1
38,1
7459
.4%
$6,5
1553
.1%
Alab
ama
4,56
923
.810
.441
.024
.81,
643
67.6
1,41
969
.622
454
.7Al
aska
1,33
126
.916
.038
.219
.039
254
.739
154
.71
70.6
Ariz
ona
7,51
622
.732
.131
.613
.61,
590
57.4
1,53
057
.160
63.6
Arka
nsas
4,09
324
.75.
346
.823
.31,
486
62.0
1,34
464
.514
238
.1Ca
lifor
nia
45,5
0417
.016
.439
.826
.816
,181
68.2
15,6
8468
.249
768
.4Co
lora
do4,
534
21.2
14.8
42.3
21.7
1,51
061
.41,
472
61.8
3945
.0Co
nnec
ticut
6,28
116
.823
.331
.528
.42,
863
59.0
2,71
058
.715
364
.2De
law
are
1,47
219
.732
.832
.115
.439
555
.336
356
.132
46.6
Dist
rict o
f Col
umbi
a2,
050
11.3
19.8
48.3
20.6
548
62.2
547
62.3
227
.4Fl
orid
a16
,602
18.3
13.4
41.3
27.0
6,58
464
.15,
833
65.5
751
53.4
Geo
rgia
8,11
023
.611
.743
.521
.32,
562
65.7
2,26
267
.730
050
.1H
awai
i1,
465
15.0
26.6
31.3
27.1
534
71.7
524
71.9
1062
.4Id
aho
1,42
819
.011
.550
.019
.553
250
.150
450
.627
41.2
Illin
ois
12,9
4923
.016
.940
.219
.94,
062
55.6
3,98
855
.774
48.8
Indi
ana
7,48
717
.813
.645
.423
.22,
939
56.5
2,71
958
.222
035
.1Io
wa
3,43
917
.211
.448
.423
.01,
550
50.7
1,51
350
.637
56.8
Kans
as2,
593
22.3
8.8
43.5
25.3
1,03
061
.498
862
.342
39.2
Kent
ucky
5,49
323
.411
.546
.918
.23,
413
29.0
3,29
528
.511
843
.9Lo
uisi
ana
6,62
519
.711
.950
.218
.22,
092
56.1
1,92
556
.316
753
.0M
aine
2,37
212
.312
.647
.128
.01,
197
54.6
1,09
353
.110
470
.2M
aryl
and
7,65
019
.119
.442
.019
.52,
299
58.8
2,17
359
.412
648
.9M
assa
chus
etts
11,9
9412
.313
.347
.426
.95,
353
56.7
5,31
256
.441
95.8
Mic
higa
n12
,184
19.2
15.6
45.9
19.3
3,72
758
.83,
526
58.4
201
65.0
Min
neso
ta8,
846
16.0
22.8
40.8
20.5
3,45
850
.43,
430
50.4
2850
.6M
issi
ssip
pi4,
255
20.7
10.8
43.7
24.8
1,61
764
.91,
421
67.6
196
45.3
Mis
sour
i7,
971
22.3
9.0
49.4
19.3
2,72
851
.72,
703
51.8
2549
.1M
onta
na95
524
.411
.239
.125
.237
664
.235
465
.221
48.8
Neb
rask
a1,
680
18.5
11.2
45.5
24.7
731
52.3
722
52.4
1048
.8N
evad
a1,
653
28.1
12.7
43.6
15.6
394
59.9
337
61.9
5748
.0N
ew H
amps
hire
1,14
522
.66.
439
.931
.159
257
.556
757
.824
48.9
New
Jer
sey
9,14
616
.08.
346
.329
.44,
440
56.9
4,39
756
.843
67.3
EXH
IBIT
21.
Med
icai
d Sp
endi
ng b
y St
ate,
Elig
ibili
ty G
roup
, and
Dua
lly E
ligib
le S
tatu
s, F
Y 20
12 (m
illio
ns)
Sect
ion
3
MACStats: Medicaid and CHIP Data Book 55
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
Basi
s of
elig
ibilt
y1
Dual
ly e
ligib
le s
tatu
s2
All d
ually
elig
ible
en
rolle
esDu
ally
elig
ible
with
full
bene
fits
Dual
ly e
ligib
le w
ith
limite
d be
nefit
sCh
ildAd
ult
Disa
bled
Aged
Tota
lAg
e 65
+To
tal
Age
65+
Tota
lAg
e 65
+N
ew M
exic
o$3
,374
39.3
%26
.4%
31.0
%3.
3%$3
4630
.1%
$297
25.8
%$5
055
.8%
New
Yor
k49
,668
10.4
20.4
40.5
28.8
21,6
5862
.121
,370
62.0
288
71.4
Nor
th C
arol
ina
11,9
7223
.615
.044
.616
.83,
480
57.3
3,34
057
.714
047
.1N
orth
Dak
ota
743
16.5
8.8
43.1
31.5
412
56.1
407
56.2
545
.9O
hio
15,8
0815
.617
.543
.223
.75,
953
57.0
5,65
157
.730
242
.3O
klah
oma
4,60
628
.915
.539
.516
.11,
306
53.1
1,27
453
.232
50.9
Ore
gon
4,51
817
.123
.537
.621
.81,
518
63.0
1,43
863
.980
46.6
Penn
sylv
ania
19,2
3216
.57.
152
.823
.67,
147
61.1
7,02
361
.212
455
.6Rh
ode
Isla
nd1,
727
17.0
14.6
44.6
23.8
728
54.3
719
54.3
1049
.1So
uth
Caro
lina
4,39
120
.616
.542
.020
.91,
547
59.4
1,51
959
.528
55.1
Sout
h Da
kota
749
23.9
11.7
43.1
21.3
279
56.2
262
56.7
1848
.2Te
nnes
see
7,52
023
.416
.340
.020
.42,
667
56.3
2,45
857
.620
942
.0Te
xas
24,3
7532
.77.
540
.419
.57,
226
64.1
6,48
064
.374
662
.6U
tah
1,87
028
.017
.344
.410
.347
739
.146
939
.18
37.8
Verm
ont
1,31
13
33
33
33
33
3
Virg
inia
6,69
221
.011
.146
.121
.82,
422
54.7
2,30
155
.412
141
.4W
ashi
ngto
n7,
168
23.2
14.6
42.5
19.8
2,24
761
.42,
135
62.4
113
41.4
Wes
t Virg
inia
2,71
415
.88.
949
.825
.51,
097
62.2
1,03
363
.164
46.6
Wis
cons
in7,
096
11.6
16.5
42.6
29.3
3,52
157
.83,
487
57.9
3455
.4W
yom
ing
528
19.6
9.0
44.9
26.6
264
52.9
247
53.6
1742
.1
Not
es: F
Y is
fisc
al y
ear.
Incl
udes
fede
ral a
nd s
tate
fund
s. E
xclu
des
spen
ding
for a
dmin
istra
tion,
the
terri
torie
s, a
nd M
edic
aid-
expa
nsio
n CH
IP e
nrol
lees
. Ben
efit
spen
ding
from
M
edic
aid
Stat
istic
al In
form
atio
n Sy
stem
(MSI
S) d
ata
has
been
adj
uste
d to
refle
ct C
MS-
64 to
tals
. Due
to c
hang
es in
bot
h m
etho
ds a
nd d
ata,
figu
res
show
n he
re a
re n
ot d
irect
ly
com
para
ble
to e
arlie
r yea
rs. W
ith re
gard
to m
etho
ds, s
pend
ing
tota
ls e
xclu
de d
ispr
opor
tiona
te s
hare
hos
pita
l (DS
H) p
aym
ents
and
cer
tain
ince
ntiv
e an
d un
com
pens
ated
car
e po
ol
paym
ents
mad
e un
der S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y, w
hich
wer
e pr
evio
usly
incl
uded
. In
addi
tion,
due
to th
e un
avai
labi
lity
of s
ever
al s
tate
s’ M
SIS
Annu
al P
erso
n Su
mm
ary
(APS
) dat
a fo
r FY
2012
, the
sou
rce
used
in p
rior e
ditio
ns o
f thi
s ex
hibi
t, M
ACPA
C ca
lcul
ated
enr
ollm
ent f
rom
the
full
MSI
S da
ta fi
les
that
are
use
d to
cre
ate
the
APS
files
. See
htt
ps:/
/ww
w.m
acpa
c.go
v/m
acst
ats/
data
-sou
rces
-and
-met
hods
/ for
add
ition
al in
form
atio
n.1
Child
ren
and
adul
ts u
nder
age
65
who
qua
lify
for M
edic
aid
on th
e ba
sis
of d
isab
ility
are
incl
uded
in th
e di
sabl
ed c
ateg
ory.
Abo
ut 7
37,0
00 e
nrol
lees
age
65
and
olde
r are
id
entif
ied
in th
e da
ta a
s di
sabl
ed; g
iven
that
dis
abili
ty is
not
an
elig
ibili
ty p
athw
ay fo
r ind
ivid
uals
age
65
and
olde
r, M
ACPA
C re
code
s th
ese
enro
llees
as
aged
.2
Dual
ly e
ligib
le e
nrol
lees
are
cov
ered
by
both
Med
icai
d an
d M
edic
are;
thos
e w
ith li
mite
d be
nefit
s re
ceiv
e on
ly M
edic
aid
assi
stan
ce w
ith M
edic
are
prem
ium
s an
d co
st s
harin
g.3
Due
to la
rge
diff
eren
ces
in th
e w
ay s
pend
ing
is re
port
ed b
y Ve
rmon
t in
CMS-
64 a
nd M
SIS
data
, MAC
PAC’
s ad
just
men
t met
hodo
logy
is a
pplie
d on
ly to
tota
l Med
icai
d sp
endi
ng.
Sour
ces:
MAC
PAC,
201
5, a
naly
sis
of M
SIS
data
as
of D
ecem
ber 2
014
and
anal
ysis
of C
MS-
64 F
MR
net e
xpen
ditu
re d
ata
as o
f Jun
e 20
15.
EXH
IBIT
21.
(co
ntin
ued)
December 201556
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
s
Stat
e
Tota
lCh
ildAd
ult
Disa
bled
Aged
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1
Tota
l$6
,833
$7,4
82$2
,679
$2,6
96$4
,044
$4,9
60$1
7,84
8$1
9,66
0$1
5,34
6$1
9,56
3
Alab
ama
4,84
75,
679
2,29
72,
297
3,11
35,
579
9,02
711
,032
10,3
9921
,805
Alas
ka12
,047
12,0
865,
829
5,82
98,
752
8,74
631
,583
31,8
3129
,066
30,0
90
Ariz
ona2
5,42
95,
597
2,65
72,
676
4,97
15,
261
15,2
9015
,776
10,0
4012
,608
Arka
nsas
6,88
98,
187
3,28
83,
325
2,60
06,
213
13,6
4916
,530
15,0
1123
,527
Calif
orni
a4,
803
6,14
12,
174
2,27
11,
918
3,25
817
,963
17,9
2312
,052
12,1
41
Colo
rado
6,96
77,
073
2,61
42,
597
5,16
64,
884
19,2
6321
,210
18,3
3823
,121
Conn
ectic
ut9,
042
9,83
93,
721
3,72
16,
155
6,15
727
,324
34,5
3717
,595
36,2
52
Dela
war
e7,
035
7,85
13,
466
3,50
25,
583
6,26
518
,770
25,1
1716
,280
33,1
87
Dist
rict o
f Col
umbi
a313
,039
13,0
034,
170
4,17
06,
612
6,50
436
,725
36,7
5231
,271
31,4
29
Flor
ida
5,11
15,
453
1,81
61,
797
4,07
73,
935
12,1
9615
,161
9,56
015
,336
Geo
rgia
26,
524
7,08
22,
806
2,80
66,
809
7,73
712
,936
15,3
1511
,507
20,5
35
Haw
aii
5,87
65,
925
2,06
62,
066
4,32
94,
326
15,5
6116
,179
16,7
7918
,494
Idah
o6,
412
6,63
01,
959
1,95
76,
202
6,06
717
,570
20,2
2116
,267
23,8
93
Illin
ois
4,84
65,
008
2,05
82,
058
3,07
93,
300
17,2
3117
,999
12,1
5013
,432
Indi
ana
7,43
47,
674
2,36
22,
362
5,75
55,
755
18,7
1422
,334
20,7
8727
,999
Iow
a6,
897
7,40
72,
548
2,55
22,
657
2,61
920
,603
22,0
2920
,643
27,4
02
Kans
as7,
420
7,77
32,
794
2,79
36,
062
5,87
115
,724
18,6
0519
,968
27,6
57
Kent
ucky
7,13
87,
739
3,45
53,
452
6,81
26,
733
11,8
8014
,130
11,2
8918
,412
Loui
sian
a5,
949
6,70
72,
310
2,31
03,
628
4,83
914
,978
17,5
2111
,003
19,3
24
Mai
ne2
6,40
16,
941
2,59
62,
599
3,07
73,
096
11,1
2712
,042
10,9
8021
,285
Mar
ylan
d8,
361
8,62
83,
399
3,38
85,
352
5,06
123
,576
26,6
9420
,766
30,1
15
Mas
sach
uset
ts11
,105
11,7
525,
892
6,08
53,
784
4,03
920
,419
20,4
8325
,148
29,5
94
Mic
higa
n6,
462
6,75
32,
383
2,39
74,
500
5,24
815
,981
16,7
3118
,104
20,5
09
Min
neso
ta9,
950
10,2
983,
780
3,79
26,
431
6,77
327
,956
29,1
1624
,943
28,0
31
Mis
siss
ippi
6,49
97,
101
2,65
22,
650
5,58
25,
979
11,7
8414
,375
12,7
4621
,672
EXH
IBIT
22.
Med
icai
d Be
nefit
Spe
ndin
g Pe
r Ful
l-Yea
r Equ
ival
ent (
FYE)
Enr
olle
e by
Sta
te a
nd E
ligib
ility
Gro
up, F
Y 20
12
Sect
ion
3
MACStats: Medicaid and CHIP Data Book 57
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
22.
(co
ntin
ued)
Stat
e
Tota
lCh
ildAd
ult
Disa
bled
Aged
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1Al
l en
rolle
esFu
ll be
nefit
en
rolle
es1
All
enro
llees
Full
bene
fit
enro
llees
1
Mis
sour
i$8
,558
$9,3
11$3
,664
$3,6
64$3
,977
$5,8
91$2
1,11
1$2
1,50
2$1
9,29
7$2
0,70
9
Mon
tana
8,84
09,
318
3,77
83,
778
7,94
28,
020
17,3
5520
,184
21,3
1532
,143
Neb
rask
a8,
082
8,17
32,
545
2,54
36,
321
6,20
220
,638
21,5
6222
,114
24,6
29
Nev
ada
5,41
05,
595
2,50
92,
497
4,36
04,
065
16,2
8720
,602
9,17
715
,553
New
Ham
pshi
re8,
374
8,91
33,
224
3,22
44,
972
4,97
216
,477
20,7
5925
,399
36,7
98
New
Jer
sey
9,41
59,
590
2,74
12,
740
6,45
66,
198
23,7
8524
,821
18,9
1421
,434
New
Mex
ico
6,05
56,
631
4,31
34,
310
6,24
67,
916
15,6
7918
,911
2,75
03,
586
New
Yor
k10
,031
10,3
982,
919
2,94
25,
262
5,29
030
,190
31,4
6623
,868
27,8
74
Nor
th C
arol
ina
7,39
17,
911
3,23
83,
236
6,81
58,
552
16,9
8418
,685
11,9
0015
,161
Nor
th D
akot
a11
,469
11,8
343,
451
3,45
15,
975
5,97
330
,085
32,9
9931
,016
37,6
10
Ohi
o7,
508
7,97
22,
457
2,45
94,
597
4,94
120
,742
24,7
3122
,264
30,0
81
Okl
ahom
a6,
370
6,88
63,
389
3,38
94,
600
5,94
815
,765
17,0
8012
,481
15,0
13
Ore
gon
7,31
47,
948
2,64
22,
693
6,31
96,
834
17,0
8220
,596
17,2
0225
,870
Penn
sylv
ania
8,96
79,
672
3,45
93,
457
3,61
34,
546
16,1
8816
,900
20,5
9125
,039
Rhod
e Is
land
10,6
8910
,978
4,25
64,
254
7,67
77,
726
20,6
2521
,321
18,3
5721
,304
Sout
h Ca
rolin
a5,
148
5,63
02,
131
2,13
33,
706
5,09
211
,908
12,5
6111
,747
13,6
69
Sout
h Da
kota
6,96
97,
292
2,83
02,
830
5,89
55,
865
17,7
8021
,147
14,3
1620
,969
Tenn
esse
e5,
690
6,05
62,
561
2,56
04,
863
4,86
611
,976
14,6
1911
,601
20,1
53
Texa
s5,
985
6,30
73,
056
3,04
54,
610
5,95
715
,248
17,4
1011
,138
15,8
45
Uta
h6,
657
6,66
83,
164
3,15
65,
464
5,18
420
,246
21,2
9712
,491
14,3
72
Verm
ont
7,81
64
44
44
44
44
Virg
inia
7,45
27,
998
2,88
92,
886
5,25
55,
996
18,1
6621
,431
14,4
6419
,733
Was
hing
ton
6,19
06,
547
2,45
52,
442
5,29
16,
669
15,7
1417
,574
15,6
9819
,568
Wes
t Virg
inia
7,64
28,
200
2,58
72,
587
6,01
06,
006
12,2
2214
,050
18,0
4128
,587
Wis
cons
in6,
680
7,26
21,
994
2,02
83,
255
3,66
718
,731
19,5
2516
,421
18,1
30
Wyo
min
g7,
713
8,02
42,
312
2,32
65,
820
6,21
122
,712
26,1
8327
,131
41,8
18
December 201558
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Not
es: F
Y is
fisc
al y
ear.
Full
year
equ
ival
ent (
FYE)
may
als
o be
refe
rred
to a
s av
erag
e m
onth
ly e
nrol
lmen
t. In
clud
es fe
dera
l and
sta
te fu
nds.
Exc
lude
s sp
endi
ng fo
r ad
min
istr
atio
n, th
e te
rrito
ries,
and
Med
icai
d-ex
pans
ion
CHIP
enr
olle
es. C
hild
ren
and
adul
ts u
nder
age
65
who
qua
lify
for M
edic
aid
on th
e ba
sis
of d
isab
ility
are
incl
uded
in
the
disa
bled
cat
egor
y. A
bout
737
,000
enr
olle
es a
ge 6
5 an
d ol
der a
re id
entif
ied
in th
e da
ta a
s di
sabl
ed; g
iven
that
dis
abili
ty is
not
an
elig
ibili
ty p
athw
ay fo
r ind
ivid
uals
age
65
and
olde
r, M
ACPA
C re
code
s th
ese
enro
llees
as
aged
. Ben
efit
spen
ding
from
Med
icai
d St
atis
tical
Info
rmat
ion
Syst
em (M
SIS)
dat
a ha
s be
en a
djus
ted
to re
flect
CM
S-64
tota
ls.
Due
to c
hang
es in
bot
h m
etho
ds a
nd d
ata,
figu
res
show
n he
re a
re n
ot d
irect
ly c
ompa
rabl
e to
ear
lier y
ears
. With
rega
rd to
met
hods
, spe
ndin
g to
tals
exc
lude
dis
prop
ortio
nate
sh
are
hosp
ital (
DSH
) pay
men
ts a
nd c
erta
in in
cent
ive
and
unco
mpe
nsat
ed c
are
pool
pay
men
ts m
ade
unde
r Sec
tion
1115
wai
ver e
xpen
ditu
re a
utho
rity,
whi
ch w
ere
prev
ious
ly
incl
uded
. In
addi
tion,
due
to th
e un
avai
labi
lity
of s
ever
al s
tate
s’ M
SIS
Annu
al P
erso
n Su
mm
ary
(APS
) dat
a fo
r FY
2012
, the
sou
rces
use
d in
prio
r edi
tions
of t
his
exhi
bit,
MAC
PAC
calc
ulat
ed s
pend
ing
and
enro
llmen
t fro
m th
e fu
ll M
SIS
data
file
s th
at a
re u
sed
to c
reat
e th
e AP
S fil
es. S
ee h
ttps
://w
ww
.mac
pac.
gov/
mac
stat
s/da
ta-s
ourc
es-a
nd-
met
hods
/ for
add
ition
al in
form
atio
n.1
In th
is ta
ble,
the
full
bene
fit c
olum
ns e
xclu
de e
nrol
lees
repo
rted
by
stat
es in
the
MSI
S as
rece
ivin
g co
vera
ge o
f onl
y fa
mily
pla
nnin
g se
rvic
es, a
ssis
tanc
e w
ith M
edic
are
prem
ium
s an
d co
st s
harin
g, o
r em
erge
ncy
serv
ices
.2
Stat
e ha
d a
chan
ge in
FYE
enr
olle
es o
f 10
perc
ent o
r mor
e ov
er th
e pr
ior y
ear.
Thes
e da
ta m
ay re
flect
ano
mal
ies
in th
e M
SIS
data
and
may
be
upda
ted
in fu
ture
MSI
S su
bmis
sion
s by
sta
tes.
MSI
S da
ta a
nom
alie
s ha
ve b
een
com
pile
d an
d re
port
ed b
y M
athe
mat
ica
Polic
y Re
sear
ch; t
he d
ata
anom
alie
s re
port
may
be
foun
d at
: htt
p://
ww
w.c
ms.
gov/
Rese
arch
-Sta
tistic
s-Da
ta-a
nd-S
yste
ms/
Com
pute
r-Dat
a-an
d-Sy
stem
s/M
edic
aidD
ataS
ourc
esG
enIn
fo/d
ownl
oads
/ano
mal
ies1
.3
The
Dist
rict o
f Col
umbi
a ha
d a
slig
ht in
crea
se in
tota
l enr
olle
es b
ut a
larg
e de
crea
se in
tota
l enr
olle
d m
onth
s, th
us c
reat
ing
a de
crea
se in
FYE
enr
olle
es a
nd n
umbe
r of
mon
ths
per e
nrol
lee
of 1
0 pe
rcen
t or m
ore
over
the
prio
r yea
r. Th
ese
data
may
refle
ct a
nom
alie
s in
the
MSI
S da
ta a
nd m
ay b
e up
date
d in
futu
re M
SIS
subm
issi
ons.
MSI
S da
ta
anom
alie
s ha
ve b
een
com
pile
d an
d re
port
ed b
y M
athe
mat
ica
Polic
y Re
sear
ch; t
he d
ata
anom
alie
s re
port
may
be
foun
d at
: htt
p://
ww
w.c
ms.
gov/
Rese
arch
-Sta
tistic
s-Da
ta-a
nd-
Syst
ems/
Com
pute
r-Dat
a-an
d-Sy
stem
s/M
edic
aidD
ataS
ourc
esG
enIn
fo/d
ownl
oads
/ano
mal
ies1
.4
Due
to la
rge
diff
eren
ces
in th
e w
ay s
pend
ing
is re
port
ed b
y Ve
rmon
t in
CMS-
64 a
nd M
SIS
data
, MAC
PAC’
s ad
just
men
t met
hodo
logy
is a
pplie
d on
ly to
tota
l Med
icai
d sp
endi
ng.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
MSI
S da
ta a
s of
Dec
embe
r 201
4 an
d CM
S-64
FM
R ne
t exp
endi
ture
dat
a as
of J
une
2015
.
EXH
IBIT
22.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 59
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
s
Stat
e1
Inpa
tient
and
out
patie
nt h
ospi
tals
2
Tota
l Med
icai
d pa
ymen
tsDS
H p
aym
ents
Non
-DSH
sup
plem
enta
l pa
ymen
tsSe
ctio
n 11
15 w
aive
r au
thor
ity p
aym
ents
Supp
lem
enta
l pa
ymen
ts a
s %
of t
otal
Tota
l$8
9,26
0.4
$15,
204.
2$1
3,66
9.7
$10,
545.
644
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ama
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rado
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ticut
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Sect
ion
3
EXH
IBIT
23.
Med
icai
d Su
pple
men
tal P
aym
ents
to H
ospi
tal P
rovi
ders
by
Stat
e, F
Y 20
14 (m
illio
ns)
December 201560
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
e1
Inpa
tient
and
out
patie
nt h
ospi
tals
2
Tota
l Med
icai
d pa
ymen
tsDS
H p
aym
ents
Non
-DSH
sup
plem
enta
l pa
ymen
tsSe
ctio
n 11
15 w
aive
r au
thor
ity p
aym
ents
Supp
lem
enta
l pa
ymen
ts a
s %
of t
otal
Okl
ahom
a$1
,673
.0$4
0.3
$590
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37.7
%O
rego
n51
3.7
12.2
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3–
29.3
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sylv
ania
1,82
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966
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ode
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nd36
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313
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h Ca
rolin
a1,
089.
444
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uth
Dako
ta19
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nnes
see3,
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xas3,
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769.
41,
409.
232
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571.
377
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tah
302.
830
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ont
44.2
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––
84.8
Virg
inia
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216
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301.
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hing
ton
1,07
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est V
irgin
ia62
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55.5
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cons
in77
8.5
50.8
22.3
–9.
4W
yom
ing
116.
60.
517
.2–
15.2
Not
es: F
Y is
fisc
al y
ear.
DSH
is d
ispr
opor
tiona
te s
hare
hos
pita
l. In
clud
es fe
dera
l and
sta
te fu
nds.
Exc
lude
s pa
ymen
ts m
ade
unde
r man
aged
car
e ar
rang
emen
ts. A
ll am
ount
s in
this
tabl
e ar
e as
repo
rted
by
stat
es in
CM
S-64
dat
a du
ring
the
fisca
l yea
r to
obta
in fe
dera
l mat
chin
g fu
nds;
am
ount
s in
clud
e ex
pend
iture
s fo
r the
cur
rent
fisc
al y
ear a
nd
adju
stm
ents
to e
xpen
ditu
res
for p
rior f
isca
l yea
rs th
at m
ay b
e po
sitiv
e or
neg
ativ
e. A
mou
nts
repo
rted
by
stat
es fo
r any
giv
en c
ateg
ory
(e.g
., in
patie
nt h
ospi
tal)
som
etim
es
show
sub
stan
tial a
nnua
l flu
ctua
tions
. CM
S on
ly b
egan
to re
quire
sep
arat
e re
port
ing
of n
on-D
SH s
uppl
emen
tal p
aym
ents
in F
Y 20
10 a
nd is
con
tinui
ng to
wor
k w
ith s
tate
s to
st
anda
rdiz
e th
is re
port
ing.
As
a re
sult,
the
info
rmat
ion
pres
ente
d m
ay n
ot re
flect
a c
onsi
sten
t cla
ssifi
catio
n of
sup
plem
enta
l pay
men
t spe
ndin
g ac
ross
sta
tes.
Rep
ortin
g is
ex
pect
ed to
impr
ove
over
tim
e.
– D
ash
indi
cate
s ze
ro; $
0.0
indi
cate
s an
am
ount
less
than
$0.
05 m
illio
n th
at ro
unds
to z
ero.
1 N
ot a
ll st
ates
had
cer
tifie
d th
eir C
MS-
64 F
inan
cial
Man
agem
ent R
epor
t (FM
R) s
ubm
issi
ons
as o
f Feb
ruar
y 25
, 201
5. C
alifo
rnia
’s a
nd C
olor
ado’
s se
cond
, thi
rd, a
nd fo
urth
qu
arte
r sub
mis
sion
s ar
e no
t cer
tifie
d; N
orth
Dak
ota’
s th
ird a
nd fo
urth
qua
rter
sub
mis
sion
s ar
e no
t cer
tifie
d; S
outh
Car
olin
a’s
seco
nd q
uart
er s
ubm
issi
on is
not
cer
tifie
d; R
hode
Is
land
’s a
nd W
ashi
ngto
n’s
four
th q
uart
er s
ubm
issi
ons
are
not c
ertif
ied.
Fig
ures
pre
sent
ed in
this
tabl
e m
ay c
hang
e if
stat
es re
vise
thei
r exp
endi
ture
dat
a af
ter t
his
date
.2
Incl
udes
inpa
tient
, out
patie
nt, c
ritic
al a
cces
s ho
spita
l, and
em
erge
ncy
hosp
ital c
ateg
orie
s in
the
CMS-
64 d
ata.
The
CM
S-64
inst
ruct
ions
to s
tate
s no
te th
at D
SH p
aym
ents
are
thos
e m
ade
in a
ccor
danc
e w
ith S
ectio
n 19
23 o
f the
Soc
ial S
ecur
ity A
ct. N
on-D
SH s
uppl
emen
tal p
aym
ents
are
des
crib
ed in
the
CMS-
64 in
stru
ctio
ns to
sta
tes
as th
ose
mad
e in
add
ition
to
the
stan
dard
fee
sche
dule
or o
ther
sta
ndar
d pa
ymen
t for
a g
iven
ser
vice
. The
y in
clud
e pa
ymen
ts m
ade
unde
r ins
titut
iona
l upp
er p
aym
ent l
imit
rule
s an
d pa
ymen
ts to
hos
pita
ls
for g
radu
ate
med
ical
edu
catio
n. S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y pa
ymen
ts in
clud
e th
ose
mad
e un
der u
ncom
pens
ated
car
e po
ols,
del
iver
y sy
stem
refo
rm in
cent
ive
paym
ents
(DSR
IP),
and
othe
r non
-DSH
sup
plem
enta
l pay
men
ts th
at h
ave
been
aut
horiz
ed u
nder
Sec
tion
1115
wai
vers
. Bec
ause
the
maj
ority
of D
SRIP
pay
men
ts g
o to
hos
pita
ls,
DSRI
P pa
ymen
ts th
at w
ere
repo
rted
as
othe
r car
e se
rvic
es o
n th
e CM
S-64
wer
e in
clud
ed in
the
Sect
ion
1115
wai
ver e
xpen
ditu
re c
ateg
ory
and
the
tota
l hos
pita
l pay
men
t cat
egor
y.3
Stat
e m
ade
supp
lem
enta
l pay
men
ts th
roug
h an
unc
ompe
nsat
ed c
are
pool
und
er S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y.4
Stat
e m
ade
supp
lem
enta
l pay
men
ts th
roug
h a
DSRI
P un
der S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y.5
Stat
e m
ade
othe
r sup
plem
enta
l pay
men
ts, i
nclu
ding
gra
duat
e m
edic
al e
duca
tion,
und
er S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
CM
S-64
FM
R ne
t exp
endi
ture
dat
a as
of F
ebru
ary
25, 2
015
and
CMS-
64 S
ched
ule
C w
aive
r rep
ort d
ata
as o
f Aug
ust 1
8, 2
015.
EXH
IBIT
23.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 61
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
e1
Men
tal h
ealth
faci
litie
s2N
ursi
ng fa
cilit
ies
and
ICFs
/ID3
Phys
icia
ns a
nd o
ther
pra
ctiti
oner
s4
Tota
l M
edic
aid
paym
ents
Supp
lem
enta
l pa
ymen
ts
Supp
lem
enta
l pa
ymen
ts a
s
% o
f tot
al
Tota
l M
edic
aid
paym
ents
Supp
lem
enta
l pa
ymen
ts
Supp
lem
enta
l pa
ymen
ts a
s
% o
f tot
al
Tota
l M
edic
aid
paym
ents
Supp
lem
enta
l pa
ymen
ts
Supp
lem
enta
l pa
ymen
ts a
s
% o
f tot
alTo
tal
$5,4
62.6
$3,1
11.2
57.0
%$6
0,22
4.4
$2,9
97.4
5.0%
$15,
370.
4$1
,554
.410
.1%
Alab
ama
72.2
0.2
0.2
931.
1–
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5.7
––
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ka31
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7.2
––
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izon
a30
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.241
.13.
89.
239
.7–
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kans
as15
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0.5
845.
1–
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9.2
35.0
9.7
Calif
orni
a539
0.2
0.6
0.2
5,29
1.8
261.
14.
91,
468.
247
8.8
32.6
Colo
rado
5.0
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704.
798
.213
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2.9
5.9
1.2
Conn
ectic
ut22
0.2
105.
647
.91,
393.
2–
–51
1.6
––
Dela
war
e6.
05.
895
.930
.8–
–13
.4–
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stric
t of C
olum
bia
24.9
5.9
23.8
346.
9–
–47
.38.
117
.1Fl
orid
a12
7.4
95.9
75.3
1,70
8.6
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0.3
1,36
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168.
012
.3G
eorg
ia38
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341.
393
.87.
046
2.2
39.2
8.5
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aii
––
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aho
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––
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ois
196.
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––
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ana
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632
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00.
0Ka
nsas
27.1
25.5
94.2
54.5
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23.7
18.0
76.0
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ucky
40.3
37.4
93.0
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0.0
58.4
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sian
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aryl
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inne
sota
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siss
ippi
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5–
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isso
uri
235.
220
7.2
88.1
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tana
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ebra
ska
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evad
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73.
22.
3N
ew H
amps
hire
28.4
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2–
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.6–
–
EXH
IBIT
24.
Med
icai
d Su
pple
men
tal P
aym
ents
to N
on-H
ospi
tal P
rovi
ders
by
Stat
e, F
Y 20
14 (m
illio
ns)
December 201562
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
e1
Men
tal h
ealth
faci
litie
s2N
ursi
ng fa
cilit
ies
and
ICFs
/ID3
Phys
icia
ns a
nd o
ther
pra
ctiti
oner
s4
Tota
l M
edic
aid
paym
ents
Supp
lem
enta
l pa
ymen
ts
Supp
lem
enta
l pa
ymen
ts a
s
% o
f tot
al
Tota
l M
edic
aid
paym
ents
Supp
lem
enta
l pa
ymen
ts
Supp
lem
enta
l pa
ymen
ts a
s
% o
f tot
al
Tota
l M
edic
aid
paym
ents
Supp
lem
enta
l pa
ymen
ts
Supp
lem
enta
l pa
ymen
ts a
s
% o
f tot
alN
ew J
erse
y$4
64.0
$357
.477
.0%
$2,5
03.1
––
$72.
5–
–N
ew M
exic
o1.
7–
–32
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–71
.8$6
.38.
7%N
ew Y
ork
1,00
0.0
545.
554
.68,
660.
8$4
77.3
5.5%
603.
637
.56.
2N
orth
Car
olin
a15
8.2
157.
899
.71,
218.
4–
–75
5.3
51.7
6.8
Nor
th D
akot
a5.
40.
59.
115
7.3
0.7
0.4
28.0
––
Ohi
o9-4
6.6
93.4
-200
.42,
905.
6–
–41
1.8
––
Okl
ahom
a97
.03.
33.
467
3.1
––
531.
8–
–O
rego
n25
.320
.079
.038
6.2
––
51.7
––
Penn
sylv
ania
372.
931
2.4
83.8
4,52
3.3
725.
216
.010
6.6
––
Rhod
e Is
land
4.5
––
234.
1–
–17
.1–
–So
uth
Caro
lina
104.
249
.147
.170
7.9
21.2
3.0
178.
536
.820
.6So
uth
Dako
ta4.
20.
817
.916
0.9
1.7
1.0
66.0
––
Tenn
esse
e37
.2–
–22
1.6
––
53.2
––
Texa
s713
3.5
117.
187
.73,
558.
239
.71.
11,
914.
955
.32.
9U
tah
23.1
0.9
4.0
252.
114
.25.
679
.813
.016
.3Ve
rmon
t–
––
119.
80.
10.
12.
10.
02.
1Vi
rgin
ia14
5.4
9.4
6.5
1,10
0.7
3.0
0.3
235.
337
.516
.0W
ashi
ngto
n15
9.6
130.
681
.875
0.0
––
220.
783
.838
.0W
est V
irgin
ia11
2.7
18.9
16.8
634.
4–
–21
2.9
28.3
13.3
Wis
cons
in15
.9–
–93
9.8
38.4
4.1
151.
3–
–W
yom
ing
15.0
––
118.
430
.525
.855
.3–
–
Not
es: F
Y is
fisc
al y
ear.
ICF/
ID is
inte
rmed
iate
car
e fa
cilit
y fo
r per
sons
with
inte
llect
ual d
isab
ilitie
s. In
clud
es fe
dera
l and
sta
te fu
nds.
Exc
lude
s pa
ymen
ts m
ade
unde
r man
aged
ca
re a
rran
gem
ents
. All
amou
nts
in th
is ta
ble
are
as re
port
ed b
y st
ates
in C
MS-
64 d
ata
durin
g th
e fis
cal y
ear t
o ob
tain
fede
ral m
atch
ing
fund
s; a
mou
nts
incl
ude
expe
nditu
res
for t
he c
urre
nt fi
scal
yea
r and
adj
ustm
ents
to e
xpen
ditu
res
for p
rior f
isca
l yea
rs th
at m
ay b
e po
sitiv
e or
neg
ativ
e. A
mou
nts
repo
rted
by
stat
es fo
r any
giv
en c
ateg
ory
(e.g
., nu
rsin
g fa
cilit
y) s
omet
imes
sho
w s
ubst
antia
l ann
ual f
luct
uatio
ns.
– D
ash
indi
cate
s ze
ro; $
0.0
indi
cate
s an
am
ount
less
than
$0.
05 m
illio
n th
at ro
unds
to z
ero.
1 N
ot a
ll st
ates
had
cer
tifie
d th
eir C
MS-
64 F
inan
cial
Man
agem
ent R
epor
t (FM
R) s
ubm
issi
ons
as o
f Feb
ruar
y 25
, 201
5. C
alifo
rnia
’s a
nd C
olor
ado’
s se
cond
, thi
rd, a
nd fo
urth
qu
arte
r sub
mis
sion
s ar
e no
t cer
tifie
d; N
orth
Dak
ota’
s th
ird a
nd fo
urth
qua
rter
sub
mis
sion
s ar
e no
t cer
tifie
d; S
outh
Car
olin
a’s
seco
nd q
uart
er s
ubm
issi
on is
not
cer
tifie
d; R
hode
Is
land
’s a
nd W
ashi
ngto
n’s
four
th q
uart
er s
ubm
issi
ons
are
not c
ertif
ied.
Fig
ures
pre
sent
ed in
this
tabl
e m
ay c
hang
e if
stat
es re
vise
thei
r exp
endi
ture
dat
a af
ter t
his
date
.
EXH
IBIT
24.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 63
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
2 In
clud
es in
patie
nt p
sych
iatr
ic s
ervi
ces
for i
ndiv
idua
ls u
nder
age
21
and
inpa
tient
hos
pita
l or n
ursi
ng fa
cilit
y se
rvic
es fo
r ind
ivid
uals
age
65
and
olde
r in
an in
stitu
tion
for
men
tal d
isea
ses.
Sup
plem
enta
l pay
men
ts in
clud
e DS
H p
aym
ents
mad
e in
acc
orda
nce
with
Sec
tion
1923
of t
he S
ocia
l Sec
urity
Act
as
wel
l as
unco
mpe
nsat
ed c
are
pool
and
ot
her n
on-D
SH s
uppl
emen
tal p
aym
ents
mad
e un
der S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y. S
tate
s ar
e no
t ins
truc
ted
to b
reak
out
non
-DSH
sup
plem
enta
l pay
men
ts fo
r m
enta
l hea
lth fa
cilit
ies.
3 In
clud
es n
ursi
ng fa
cilit
ies
and
inte
rmed
iate
car
e fa
cilit
ies
for p
erso
ns w
ith in
telle
ctua
l dis
abili
ties
(ICF/
ID).
Supp
lem
enta
l pay
men
ts in
clud
e th
ose
paym
ents
that
are
m
ade
in a
dditi
on to
the
stan
dard
fee
sche
dule
or o
ther
sta
ndar
d pa
ymen
ts fo
r a g
iven
ser
vice
, inc
ludi
ng p
aym
ents
mad
e un
der i
nstit
utio
nal u
pper
pay
men
t lim
it ru
les
and
unco
mpe
nsat
ed c
are
pool
s m
ade
unde
r Sec
tion
1115
wai
ver e
xpen
ditu
re a
utho
rity.
4
Incl
udes
the
phys
icia
n an
d ot
her p
ract
ition
er c
ateg
orie
s in
CM
S-64
dat
a; e
xclu
des
addi
tiona
l cat
egor
ies
(e.g
., de
ntal
, nur
se-m
idw
ife, n
urse
pra
ctiti
oner
) for
whi
ch s
tate
s ar
e no
t ins
truc
ted
to b
reak
out
sup
plem
enta
l pay
men
ts. S
uppl
emen
tal p
aym
ents
incl
ude
thos
e pa
ymen
ts th
at a
re m
ade
in a
dditi
on to
the
stan
dard
fee
sche
dule
pay
men
t as
wel
l as
unc
ompe
nsat
ed c
are
pool
pay
men
ts m
ade
unde
r Sec
tion
1115
wai
ver e
xpen
ditu
re a
utho
rity.
Unl
ike
for i
nstit
utio
nal p
rovi
ders
, the
re is
not
a re
gula
tory
upp
er p
aym
ent l
imit
for p
hysi
cian
s an
d ot
her p
ract
ition
ers.
5 St
ate
mad
e no
n-DS
H p
aym
ents
to m
enta
l hea
lth fa
cilit
ies
thro
ugh
an u
ncom
pens
ated
car
e po
ol o
r mad
e ot
her n
on-D
SH s
uppl
emen
tal p
aym
ents
und
er S
ectio
n 11
15 w
aive
r ex
pend
iture
aut
horit
y.6
Stat
e m
ade
paym
ents
to n
ursi
ng fa
cilit
ies
thro
ugh
an u
ncom
pens
ated
car
e po
ol u
nder
Sec
tion
1115
wai
ver e
xpen
ditu
re a
utho
rity.
7 St
ate
mad
e pa
ymen
ts to
phy
sici
ans
and
othe
r pra
ctiti
oner
s th
roug
h an
unc
ompe
nsat
ed c
are
pool
und
er S
ectio
n 11
15 w
aive
r exp
endi
ture
aut
horit
y.8
Mas
sach
uset
ts a
nd M
ichi
gan
repo
rted
sup
plem
enta
l pay
men
ts th
at w
ere
grea
ter t
han
the
tota
l pay
men
ts, c
reat
ing
a pe
rcen
tage
abo
ve 1
00 p
erce
nt.
9 O
hio
repo
rted
neg
ativ
e no
n-DS
H p
aym
ents
to m
enta
l hea
lth fa
cilit
ies
that
wer
e gr
eate
r tha
n th
e DS
H p
aym
ents
, cre
atin
g a
nega
tive
tota
l pay
men
t and
a n
egat
ive
perc
enta
ge.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
CM
S-64
FM
R ne
t exp
endi
ture
dat
a as
of F
ebru
ary
25, 2
015
and
CMS-
64 S
ched
ule
C w
aive
r rep
ort d
ata
as o
f Aug
ust 1
8, 2
015.
EXH
IBIT
24.
(co
ntin
ued)
December 201564
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
Fee
for s
ervi
ceM
anag
ed c
are
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
l$4
2,74
7.6
76.4
%23
.2%
0.5%
$22,
607.
579
.5%
20.4
%0.
2%$2
0,14
0.1
72.9
%26
.3%
0.8%
Alab
ama
596.
275
.824
.10.
159
6.2
75.8
24.1
0.1
––
––
Alas
ka75
.672
.727
.00.
375
.672
.727
.00.
3–
––
–
Ariz
ona
721.
568
.031
.70.
211
.283
.416
.10.
471
0.3
67.8
32.0
0.2
Arka
nsas
363.
672
.427
.50.
136
3.6
72.4
27.5
0.1
––
––
Calif
orni
a4,
737.
378
.421
.60.
03,
414.
984
.915
.10.
01,
322.
461
.838
.20.
0
Colo
rado
549.
973
.426
.20.
454
9.9
73.4
26.2
0.4
––
––
Conn
ectic
ut86
7.6
81.7
18.2
0.1
867.
681
.718
.20.
1–
––
–
Dela
war
e21
7.5
83.1
16.9
0.0
189.
382
.018
.00.
028
.290
.29.
80.
0
Dist
rict o
f Col
umbi
a14
3.8
75.1
24.9
0.0
72.3
81.1
18.9
0.0
71.5
69.0
31.0
0.0
Flor
ida
2,34
0.8
79.2
20.7
0.1
1,40
0.1
82.7
17.3
0.1
940.
774
.125
.80.
1
Geo
rgia
987.
374
.525
.50.
061
5.4
80.7
19.3
0.0
371.
964
.235
.80.
0
Haw
aii4
411.
847
.220
.632
.21.
076
.623
.30.
141
0.8
47.1
20.6
32.2
Idah
o17
1.7
76.5
23.4
0.1
171.
776
.523
.40.
1–
––
–
Illin
ois
1,20
6.2
72.7
27.2
0.0
936.
173
.226
.80.
027
0.1
71.3
28.7
0.0
Indi
ana
1,08
9.9
80.6
18.2
1.2
1,07
7.0
80.4
18.4
1.2
12.9
96.0
3.4
0.5
Iow
a34
9.2
77.2
22.8
0.0
349.
177
.222
.80.
00.
195
.24.
80.
0
Kans
as44
3.2
77.8
22.2
0.1
1.5
82.8
17.0
0.2
441.
777
.822
.20.
1
Kent
ucky
742.
970
.029
.80.
277
.074
.524
.70.
966
5.9
69.5
30.4
0.1
Loui
sian
a76
5.3
73.4
26.4
0.1
483.
974
.025
.90.
128
1.4
72.6
27.3
0.1
Mai
ne22
4.6
82.8
17.2
0.0
224.
682
.817
.20.
0–
––
–
Mar
ylan
d81
0.4
82.1
17.9
0.0
428.
987
.712
.30.
038
1.5
75.7
24.3
0.0
Mas
sach
uset
ts97
9.9
73.5
26.3
0.2
472.
972
.327
.50.
250
7.1
74.6
25.1
0.3
Mic
higa
n1,
285.
577
.222
.70.
177
8.3
82.7
17.3
0.1
507.
368
.831
.00.
1
Min
neso
ta84
5.4
72.2
27.6
0.2
261.
973
.526
.30.
258
3.4
71.6
28.2
0.2
Mis
siss
ippi
459.
369
.430
.60.
026
1.4
75.5
24.5
0.0
198.
061
.438
.60.
0
Mis
sour
i1,
139.
774
.425
.30.
31,
139.
774
.425
.30.
3–
––
–
Mon
tana
105.
980
.319
.60.
110
5.9
80.3
19.6
0.1
––
––
Neb
rask
a19
3.9
79.0
20.9
0.0
183.
178
.521
.50.
010
.887
.312
.40.
2
EXH
IBIT
25.
Med
icai
d G
ross
Spe
ndin
g fo
r Dru
gs b
y De
liver
y Sy
stem
and
Bra
nd o
r Gen
eric
Sta
tus,
FY
2014
(mill
ions
)
MACStats: Medicaid and CHIP Data Book 65
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
Fee
for s
ervi
ceM
anag
ed c
are
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Nev
ada
$263
.579
.3%
20.5
%0.
2%$2
04.5
81.5
%18
.3%
0.2%
$59.
071
.5%
28.2
%0.
3%
New
Ham
pshi
re11
4.8
79.3
20.5
0.3
41.6
82.8
16.7
0.5
73.1
77.2
22.6
0.2
New
Jer
sey
892.
976
.823
.20.
076
.078
.521
.50.
081
6.9
76.6
23.4
0.0
New
Mex
ico
219.
569
.930
.00.
211
.271
.228
.80.
020
8.3
69.8
30.0
0.2
New
Yor
k4,
848.
379
.620
.40.
072
2.6
85.0
15.0
0.0
4,12
5.8
78.6
21.4
0.0
Nor
th C
arol
ina
1,52
5.2
78.8
21.1
0.1
1,52
5.2
78.8
21.1
0.1
––
––
Nor
th D
akot
a51
.873
.626
.30.
043
.872
.427
.60.
08.
080
.319
.70.
0
Ohi
o1,
803.
873
.126
.00.
954
1.9
76.3
23.2
0.5
1,26
1.8
71.8
27.2
1.0
Okl
ahom
a50
4.5
75.0
25.0
0.1
504.
575
.025
.00.
1–
––
–
Ore
gon
438.
671
.928
.10.
014
7.5
68.6
31.4
0.0
291.
273
.526
.40.
0
Penn
sylv
ania
1,91
3.8
76.5
23.4
0.1
67.8
76.7
23.1
0.2
1,84
6.1
76.5
23.5
0.1
Rhod
e Is
land
10.1
86.0
14.0
0.1
10.1
86.0
14.0
0.1
––
––
Sout
h Ca
rolin
a46
1.3
73.6
26.3
0.1
141.
580
.319
.50.
231
9.8
70.6
29.3
0.1
Sout
h Da
kota
66.4
76.5
23.5
0.0
66.4
76.5
23.5
0.0
––
––
Tenn
esse
e89
5.7
80.0
19.9
0.2
850.
079
.320
.60.
145
.791
.77.
11.
2
Texa
s2,
797.
979
.420
.60.
073
4.8
82.7
17.3
0.0
2,06
3.2
78.2
21.8
0.0
Uta
h20
2.0
77.2
22.8
0.0
115.
879
.720
.30.
086
.273
.926
.10.
0
Verm
ont
156.
676
.923
.10.
115
6.6
76.9
23.1
0.1
––
––
Virg
inia
584
3.0
61.6
37.5
1.0
148.
373
.025
.41.
669
4.7
59.1
40.0
0.8
Was
hing
ton
550.
275
.624
.30.
112
0.4
72.7
27.1
0.2
429.
876
.323
.50.
1
Wes
t Virg
inia
455.
178
.421
.50.
136
6.5
79.6
20.3
0.1
88.6
73.5
26.3
0.2
Wis
cons
in86
1.3
78.4
21.6
0.1
855.
478
.421
.50.
15.
967
.532
.20.
2
Wyo
min
g44
.979
.420
.50.
144
.979
.420
.50.
1–
––
–
Not
es: F
Y is
fisc
al y
ear.
Amou
nts
incl
ude
fede
ral a
nd s
tate
fund
s. G
ross
spe
ndin
g re
flect
s ex
pend
iture
s pr
ior t
o th
e ap
plic
atio
n of
man
ufac
ture
r reb
ates
. Dru
g ex
pend
iture
s in
this
exh
ibit
use
info
rmat
ion
from
the
stat
e dr
ug u
tiliz
atio
n da
ta th
at s
tate
s su
bmit
to C
MS
for r
ebat
e pu
rpos
es a
nd a
re d
iffer
ent f
rom
the
CMS-
64 F
inan
cial
Man
agem
ent
Repo
rt (F
MR)
and
Med
icai
d St
atis
tical
Info
rmat
ion
Syst
em (M
SIS)
dat
a th
at s
erve
as
our u
sual
sou
rces
of e
xpen
ditu
re d
ata.
Spe
ndin
g sh
own
in th
e dr
ug u
tiliz
atio
n da
ta m
ay
diff
er fr
om th
ese
othe
r sou
rces
due
to d
iffer
ence
s in
tim
ing
and
run-
out o
f dat
a us
ed. I
n ad
ditio
n, th
e dr
ug u
tiliz
atio
n da
ta m
ay in
clud
e ph
ysic
ian-
adm
inis
tere
d dr
ugs
for w
hich
re
bate
s ar
e av
aila
ble;
thes
e dr
ugs
are
typi
cally
repo
rted
und
er th
e ph
ysic
ian
serv
ices
cat
egor
y in
stea
d of
the
outp
atie
nt p
resc
riptio
n dr
ug c
ateg
ory
in o
ther
dat
a. T
he s
tate
dru
g ut
iliza
tion
data
pro
vide
bot
h fe
e-fo
r-ser
vice
and
man
aged
car
e dr
ug u
tiliz
atio
n an
d sp
endi
ng in
form
atio
n at
the
natio
nal d
rug
code
(NDC
) lev
el. T
o as
sign
bra
nd a
nd g
ener
ic
stat
us, w
e lin
ked
the
quar
terly
sta
te d
rug
utili
zatio
n da
ta to
the
quar
terly
Med
icai
d dr
ug p
rodu
ct d
ata
from
CM
S us
ing
the
NDC
cod
e. B
rand
and
gen
eric
sta
tus
was
ass
igne
d
EXH
IBIT
25.
(co
ntin
ued)
December 201566
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
usin
g th
e dr
ug c
ateg
ory
indi
cato
r fro
m th
e dr
ug p
rodu
ct fi
le. T
he s
tate
dru
g ut
iliza
tion
data
are
ava
ilabl
e at
htt
p://
ww
w.m
edic
aid.
gov/
med
icai
d-ch
ip-p
rogr
am-in
form
atio
n/by
-topi
cs/b
enef
its/p
resc
riptio
n-dr
ugs/
med
icai
d-dr
ug-p
rogr
ams-
data
-and
-reso
urce
s.ht
ml a
nd th
e dr
ug p
rodu
ct d
ata
are
avai
labl
e at
htt
p://
ww
w.m
edic
aid.
gov/
med
icai
d-ch
ip-
prog
ram
-info
rmat
ion/
by-to
pics
/ben
efits
/pre
scrip
tion-
drug
s/m
edic
aid-
drug
-reba
te-p
rogr
am-d
ata.
htm
l. Th
e di
ffer
ent b
rand
and
gen
eric
pro
port
ions
und
er fe
e fo
r ser
vice
and
m
anag
ed c
are
may
refle
ct d
iffer
ence
s in
the
popu
latio
ns a
nd s
peci
fic d
rugs
cov
ered
und
er e
ach
deliv
ery
syst
em (e
.g.,
beha
vior
al h
ealth
dru
gs c
arve
d ou
t of m
anag
ed c
are)
as
wel
l as
diff
eren
ces
in h
ow th
e st
ate
and
part
icip
atin
g he
alth
pla
ns m
anag
ed th
e dr
ug b
enef
it.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 Fo
r thi
s ex
hibi
t, br
and
drug
s w
ere
defin
ed a
s si
ngle
sou
rce
drug
s an
d in
nova
tor,
mul
tiple
sou
rce
drug
s as
indi
cate
d in
that
qua
rter
’s M
edic
aid
drug
pro
duct
dat
a.2
For t
his
exhi
bit,
gene
ric d
rugs
wer
e de
fined
as
non-
inno
vato
r, m
ultip
le s
ourc
e dr
ugs
as in
dica
ted
in th
at q
uart
er’s
Med
icai
d dr
ug p
rodu
ct fi
le.
3 Fo
r thi
s ex
hibi
t, un
know
n dr
ugs
wer
e th
ose
drug
s w
hose
NDC
did
not
hav
e a
mat
ch in
that
qua
rter
’s M
edic
aid
drug
pro
duct
file
.4
Haw
aii r
epor
ts a
larg
e am
ount
of s
pend
ing
in m
anag
ed c
are
unde
r an
unid
entif
iabl
e N
DC c
ode
and
drug
nam
e, w
hich
acc
ount
s fo
r the
hig
h pe
rcen
tage
of s
pend
ing
on d
rugs
in
the
unkn
own
cate
gory
.5
Virg
inia
dat
a w
ere
corr
ecte
d fo
r an
appa
rent
err
or in
fee-
for-s
ervi
ce s
pend
ing
in th
e se
cond
qua
rter
of 2
014.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
Med
icai
d dr
ug p
rodu
ct d
ata
and
stat
e dr
ug re
bate
util
izat
ion
data
as
of O
ctob
er 2
015.
EXH
IBIT
25.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 67
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
Fee
for s
ervi
ceM
anag
ed c
are
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
l58
8,62
418
.9%
80.7
%0.
4%26
1,95
621
.5%
78.0
%0.
5%32
6,66
816
.8%
82.8
%0.
3%Al
abam
a7,
662
21.9
77.9
0.2
7,66
221
.977
.90.
2–
––
–Al
aska
961
21.6
77.7
0.7
961
21.6
77.7
0.7
––
––
Ariz
ona
13,8
0413
.686
.00.
410
315
.384
.00.
713
,701
13.6
86.0
0.4
Arka
nsas
5,06
720
.179
.50.
45,
067
20.1
79.5
0.4
––
––
Calif
orni
a61
,811
18.4
81.5
0.0
26,1
4826
.073
.90.
135
,663
12.9
87.1
0.0
Colo
rado
6,47
318
.781
.10.
26,
473
18.7
81.1
0.2
––
––
Conn
ectic
ut7,
971
26.4
73.3
0.3
7,97
126
.473
.30.
3–
––
–De
law
are
2,42
123
.476
.50.
12,
256
22.6
77.3
0.1
165
33.9
65.9
0.2
Dist
rict o
f Col
umbi
a2,
356
17.6
82.4
0.1
936
20.6
79.3
0.0
1,42
015
.684
.30.
1Fl
orid
a27
,697
19.6
80.2
0.1
13,5
4323
.076
.90.
114
,154
16.5
83.4
0.1
Geo
rgia
16,6
6118
.281
.80.
08,
068
19.4
80.6
0.0
8,59
316
.983
.00.
0H
awai
i2,
699
14.5
83.3
2.2
107.
891
.90.
32,
689
14.5
83.3
2.2
Idah
o2,
201
20.5
79.4
0.1
2,20
120
.579
.40.
1–
––
–Ill
inoi
s19
,805
17.2
82.8
0.0
15,2
2117
.682
.40.
04,
584
16.1
83.9
0.0
Indi
ana
12,0
1121
.877
.11.
111
,858
21.7
77.2
1.1
153
30.1
69.2
0.7
Iow
a5,
616
20.6
79.4
0.0
5,61
620
.679
.40.
00
81.0
19.0
0.0
Kans
as5,
651
21.6
78.3
0.1
1523
.876
.00.
25,
636
21.6
78.3
0.1
Kent
ucky
15,6
3515
.284
.30.
51,
375
14.0
83.7
2.2
14,2
6115
.384
.40.
3Lo
uisi
ana
10,5
1021
.278
.60.
25,
957
24.0
75.8
0.2
4,55
317
.682
.20.
2M
aine
2,96
224
.775
.30.
02,
962
24.7
75.3
0.0
––
––
Mar
ylan
d12
,359
19.0
81.0
0.0
3,69
125
.174
.90.
08,
668
16.4
83.6
0.0
Mas
sach
uset
ts13
,186
16.8
81.3
1.9
6,68
415
.582
.02.
56,
502
18.0
80.6
1.3
Mic
higa
n22
,319
16.7
82.7
0.5
8,07
622
.377
.30.
414
,243
13.6
85.8
0.6
Min
neso
ta11
,571
16.7
82.9
0.4
3,03
518
.681
.00.
48,
537
16.0
83.5
0.4
Mis
siss
ippi
5,69
220
.879
.10.
02,
878
27.0
73.0
0.0
2,81
414
.585
.40.
0M
isso
uri
11,6
8421
.378
.40.
211
,684
21.3
78.4
0.2
––
––
Mon
tana
1,13
622
.077
.80.
21,
136
22.0
77.8
0.2
––
––
Neb
rask
a2,
663
18.2
81.7
0.1
2,54
017
.782
.20.
112
326
.872
.20.
9N
evad
a3,
756
18.9
79.9
1.1
2,42
622
.176
.61.
31,
330
13.2
85.9
0.9
New
Ham
pshi
re1,
523
21.5
77.5
1.0
540
20.8
76.9
2.4
983
21.9
77.8
0.3
New
Jer
sey
12,8
1517
.982
.00.
01,
103
19.6
80.4
0.0
11,7
1217
.882
.20.
0N
ew M
exic
o4,
251
15.4
84.3
0.3
161
20.0
79.9
0.2
4,09
015
.384
.40.
3N
ew Y
ork
67,5
8217
.682
.40.
010
,372
16.6
83.4
0.0
57,2
0917
.882
.20.
0
EXH
IBIT
26.
Med
icai
d Dr
ug P
resc
riptio
ns b
y De
liver
y Sy
stem
and
Bra
nd o
r Gen
eric
Sta
tus,
FY
2014
(tho
usan
ds)
December 201568
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
Fee
for s
ervi
ceM
anag
ed c
are
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Tota
lBr
and1
Gen
eric
2U
nkno
wn3
Nor
th C
arol
ina
16,9
3926
.4%
73.4
%0.
2%16
,939
26.4
%73
.4%
0.2%
––
––
Nor
th D
akot
a70
519
.880
.10.
159
920
.279
.70.
110
617
.2%
82.7
%0.
1%O
hio
30,0
0717
.080
.12.
98,
345
17.4
77.6
5.1
21,6
6216
.981
.12.
0O
klah
oma
6,27
418
.981
.00.
16,
274
18.9
81.0
0.1
––
––
Ore
gon
7,66
614
.985
.00.
02,
035
14.0
86.0
0.0
5,63
115
.384
.70.
0Pe
nnsy
lvan
ia25
,494
18.3
81.5
0.2
1,85
413
.986
.00.
123
,641
18.6
81.2
0.2
Rhod
e Is
land
384
21.6
78.2
0.1
384
21.6
78.2
0.1
––
––
Sout
h Ca
rolin
a6,
908
19.3
80.3
0.3
1,72
523
.775
.60.
75,
183
17.9
81.9
0.2
Sout
h Da
kota
821
21.9
78.1
0.0
821
21.9
78.1
0.0
––
––
Tenn
esse
e13
,159
18.2
81.4
0.3
12,6
9417
.981
.90.
246
627
.867
.94.
3Te
xas
35,1
5022
.977
.00.
06,
152
28.7
71.2
0.0
28,9
9821
.778
.30.
0U
tah
3,01
119
.780
.30.
01,
347
21.1
78.9
0.0
1,66
518
.681
.40.
0Ve
rmon
t1,
365
28.0
71.8
0.1
1,36
528
.071
.80.
1–
––
–Vi
rgin
ia10
,317
17.9
79.7
2.4
2,66
517
.774
.67.
67,
652
17.9
81.5
0.6
Was
hing
ton
10,3
8114
.584
.90.
52,
452
14.4
84.7
0.9
7,92
914
.685
.00.
4W
est V
irgin
ia7,
852
19.9
80.0
0.1
6,00
119
.880
.10.
11,
851
20.2
79.6
0.2
Wis
cons
in11
,153
21.9
77.9
0.2
11,0
5322
.077
.80.
110
111
.487
.21.
4W
yom
ing
526
21.0
79.0
0.1
526
21.0
79.0
0.1
––
––
Not
es: F
Y is
fisc
al y
ear.
Drug
util
izat
ion
in th
is e
xhib
it re
flect
s th
e nu
mbe
r of p
resc
riptio
ns re
port
ed in
the
stat
e dr
ug u
tiliz
atio
n da
ta th
at s
tate
s su
bmit
to C
MS
for r
ebat
e pu
rpos
es a
nd a
re d
iffer
ent f
rom
the
Med
icai
d St
atis
tical
Info
rmat
ion
Syst
em (M
SIS)
dat
a th
at s
erve
as
our u
sual
sou
rce
of u
tiliz
atio
n da
ta. U
tiliz
atio
n sh
own
in th
e dr
ug
utili
zatio
n da
ta m
ay d
iffer
from
oth
er s
ourc
es d
ue to
diff
eren
ces
in ti
min
g an
d ru
n-ou
t of d
ata
used
. In
addi
tion,
the
drug
util
izat
ion
data
may
incl
ude
phys
icia
n-ad
min
iste
red
drug
s fo
r whi
ch re
bate
s ar
e av
aila
ble;
thes
e dr
ugs
are
typi
cally
repo
rted
und
er th
e ph
ysic
ian
serv
ices
cat
egor
y in
stea
d of
the
outp
atie
nt p
resc
riptio
n dr
ug c
ateg
ory
in o
ther
da
ta. T
he s
tate
dru
g ut
iliza
tion
data
pro
vide
bot
h fe
e-fo
r-ser
vice
and
man
aged
car
e dr
ug u
tiliz
atio
n an
d sp
endi
ng in
form
atio
n at
the
natio
nal d
rug
code
(NDC
) lev
el. T
o as
sign
br
and
and
gene
ric s
tatu
s, w
e lin
ked
the
quar
terly
sta
te d
rug
utili
zatio
n da
ta to
the
quar
terly
Med
icai
d dr
ug p
rodu
ct d
ata
from
CM
S us
ing
the
NDC
cod
e. B
rand
and
gen
eric
st
atus
was
ass
igne
d us
ing
the
drug
cat
egor
y in
dica
tor f
rom
the
drug
pro
duct
file
. The
sta
te d
rug
utili
zatio
n da
ta a
re a
vaila
ble
at h
ttp:
//w
ww
.med
icai
d.go
v/m
edic
aid-
chip
-pr
ogra
m-in
form
atio
n/by
-topi
cs/b
enef
its/p
resc
riptio
n-dr
ugs/
med
icai
d-dr
ug-p
rogr
ams-
data
-and
-reso
urce
s.ht
ml a
nd th
e dr
ug p
rodu
ct d
ata
are
avai
labl
e at
htt
p://
ww
w.m
edic
aid.
gov/
med
icai
d-ch
ip-p
rogr
am-in
form
atio
n/by
-topi
cs/b
enef
its/p
resc
riptio
n-dr
ugs/
med
icai
d-dr
ug-re
bate
-pro
gram
-dat
a.ht
ml.
The
diff
eren
t bra
nd a
nd g
ener
ic p
ropo
rtio
ns u
nder
fe
e fo
r ser
vice
and
man
aged
car
e m
ay re
flect
diff
eren
ces
in th
e po
pula
tions
and
spe
cific
dru
gs c
over
ed u
nder
eac
h de
liver
y sy
stem
(e.g
., be
havi
oral
hea
lth d
rugs
car
ved
out o
f m
anag
ed c
are)
as
wel
l as
diff
eren
ces
in h
ow th
e st
ate
and
part
icip
atin
g he
alth
pla
ns m
anag
ed th
e dr
ug b
enef
it.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 Fo
r thi
s ex
hibi
t, br
and
drug
s w
ere
defin
ed a
s si
ngle
sou
rce
drug
s an
d in
nova
tor,
mul
tiple
sou
rce
drug
s as
indi
cate
d in
that
qua
rter
’s M
edic
aid
drug
pro
duct
dat
a.2
For t
his
exhi
bit,
gene
ric d
rugs
wer
e de
fined
as
non-
inno
vato
r, m
ultip
le s
ourc
e dr
ugs
as in
dica
ted
in th
at q
uart
er’s
Med
icai
d dr
ug p
rodu
ct fi
le.
3 Fo
r thi
s ex
hibi
t, un
know
n dr
ugs
wer
e th
ose
drug
s w
hose
NDC
did
not
hav
e a
mat
ch in
that
qua
rter
’s M
edic
aid
drug
pro
duct
file
.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
Med
icai
d dr
ug p
rodu
ct d
ata
and
stat
e dr
ug re
bate
util
izat
ion
data
as
of O
ctob
er 2
015.
EXH
IBIT
26.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 69
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
Stat
eG
ross
spe
ndin
gRe
bate
sTo
tal
Fee
for s
ervi
ceM
anag
ed c
are
Tota
lFe
e fo
r ser
vice
Man
aged
car
eTo
tal
$42,
747.
6$2
2,60
7.5
$20,
140.
1-$
19,9
44.1
-$13
,323
.3-$
6,62
0.7
Alab
ama
596.
259
6.2
–-2
76.0
-276
.0–
Alas
ka75
.675
.6–
-33.
0-3
3.0
–
Ariz
ona
721.
511
.271
0.3
-305
.3-5
.4-2
99.9
Arka
nsas
363.
636
3.6
–-1
37.2
-137
.2–
Calif
orni
a4,
737.
33,
414.
91,
322.
4-2
,246
.2-1
,545
.2-7
01.0
Colo
rado
549.
954
9.9
–-2
24.7
-224
.7–
Conn
ectic
ut86
7.6
867.
6–
-388
.2-3
88.2
–
Dela
war
e21
7.5
189.
328
.2-1
22.5
-116
.6-5
.9
Dist
rict o
f Col
umbi
a14
3.8
72.3
71.5
-66.
1-3
9.3
-26.
8
Flor
ida
2,34
0.8
1,40
0.1
940.
7-1
,109
.9-8
21.5
-288
.4
Geo
rgia
987.
361
5.4
371.
9-4
39.1
-321
.7-1
17.4
Haw
aii1
411.
81.
041
0.8
-54.
8-0
.3-5
4.5
Idah
o17
1.7
171.
7–
-92.
3-9
2.3
–
Illin
ois
1,20
6.2
936.
127
0.1
-493
.4-4
20.6
-72.
7
Indi
ana
1,08
9.9
1,07
7.0
12.9
-497
.0-4
93.7
-3.3
Iow
a34
9.2
349.
10.
1-1
90.4
-190
.4-0
.0
Kans
as2
443.
21.
544
1.7
-163
.7-1
.9-1
61.8
Kent
ucky
742.
977
.066
5.9
-260
.5-3
6.5
-224
.0
Loui
sian
a376
5.3
483.
928
1.4
-340
.2-3
31.5
-8.7
Mai
ne22
4.6
224.
6–
-136
.4-1
36.4
–
Mar
ylan
d81
0.4
428.
938
1.5
-331
.8-1
90.7
-141
.1
Mas
sach
uset
ts97
9.9
472.
950
7.1
-401
.7-2
10.0
-191
.7
Mic
higa
n1,
285.
577
8.3
507.
3-7
32.4
-459
.8-2
72.7
Min
neso
ta84
5.4
261.
958
3.4
-492
.8-1
31.1
-361
.7
Mis
siss
ippi
459.
326
1.4
198.
0-1
75.5
-113
.8-6
1.7
Mis
sour
i1,
139.
71,
139.
7–
-473
.5-4
55.2
-18.
4
Mon
tana
105.
910
5.9
–-5
6.0
-56.
0–
EXH
IBIT
27.
Med
icai
d G
ross
Spe
ndin
g an
d Re
bate
s fo
r Dru
gs b
y De
liver
y Sy
stem
, FY
2014
(mill
ions
)
December 201570
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
27.
(co
ntin
ued)
Stat
eG
ross
spe
ndin
gRe
bate
sTo
tal
Fee
for s
ervi
ceM
anag
ed c
are
Tota
lFe
e fo
r ser
vice
Man
aged
car
eN
ebra
ska4
$193
.9$1
83.1
$10.
8-$
113.
8-$
113.
8–
Nev
ada
263.
520
4.5
59.0
-110
.2-9
1.8
-$18
.4
New
Ham
pshi
re2,
311
4.8
41.6
73.1
-41.
8-4
1.8
–
New
Jer
sey2
892.
976
.081
6.9
-471
.8-6
7.3
-404
.5
New
Mex
ico2
219.
511
.220
8.3
-155
.9-2
6.5
-129
.4
New
Yor
k34,
848.
372
2.6
4,12
5.8
-2,1
94.5
-2,1
94.5
–
Nor
th C
arol
ina
1,52
5.2
1,52
5.2
–-8
34.5
-834
.5–
Nor
th D
akot
a251
.843
.88.
0-1
1.9
-11.
9–
Ohi
o1,
803.
854
1.9
1,26
1.8
-796
.8-3
57.8
-439
.1
Okl
ahom
a50
4.5
504.
5–
-237
.0-2
37.0
–
Ore
gon
438.
614
7.5
291.
2-2
17.6
-85.
5-1
32.1
Penn
sylv
ania
21,
913.
867
.81,
846.
1-8
85.8
-57.
6-8
28.2
Rhod
e Is
land
510
.110
.1–
-58.
9-1
3.9
-45.
0
Sout
h Ca
rolin
a246
1.3
141.
531
9.8
-210
.9-1
24.4
-86.
5
Sout
h Da
kota
66.4
66.4
–-2
6.9
-26.
9–
Tenn
esse
e489
5.7
850.
045
.7-3
93.6
-393
.6–
Texa
s2,
797.
973
4.8
2,06
3.2
-1,5
25.0
-425
.1-1
,099
.9
Uta
h20
2.0
115.
886
.2-9
8.0
-56.
7-4
1.3
Verm
ont
156.
615
6.6
–-7
7.7
-77.
7–
Virg
inia
684
3.0
148.
369
4.7
-301
.4-8
0.3
-221
.2
Was
hing
ton
550.
212
0.4
429.
8-2
17.5
-97.
5-1
20.0
Wes
t Virg
inia
455.
136
6.5
88.6
-220
.7-1
79.0
-41.
7
Wis
cons
in86
1.3
855.
45.
9-4
76.2
-474
.4-1
.8
Wyo
min
g44
.944
.9–
-24.
9-2
4.9
–
Not
es: F
Y is
fisc
al y
ear.
Amou
nts
incl
ude
fede
ral a
nd s
tate
fund
s. G
ross
spe
ndin
g re
flect
s ex
pend
iture
s pr
ior t
o th
e ap
plic
atio
n of
man
ufac
ture
r reb
ates
. The
gro
ss d
rug
expe
nditu
res
in th
is e
xhib
it us
e in
form
atio
n fr
om th
e st
ate
drug
util
izat
ion
data
that
sta
tes
subm
it to
CM
S fo
r reb
ate
purp
oses
and
are
diff
eren
t fro
m th
e CM
S-64
Fin
anci
al
Man
agem
ent R
epor
t (FM
R) a
nd M
edic
aid
Stat
istic
al In
form
atio
n Sy
stem
(MSI
S) d
ata
that
ser
ve a
s ou
r usu
al s
ourc
es o
f exp
endi
ture
dat
a. S
pend
ing
show
n in
the
drug
ut
iliza
tion
data
may
diff
er fr
om th
ese
othe
r sou
rces
due
to d
iffer
ence
s in
tim
ing
and
run-
out o
f dat
a us
ed. I
n ad
ditio
n, th
e dr
ug re
bate
dat
a m
ay in
clud
e ph
ysic
ian-
adm
inis
tere
d
MACStats: Medicaid and CHIP Data Book 71
Section 3: Program Enrollment and Spending—Medicaid Benefits
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
27.
(co
ntin
ued)
drug
s fo
r whi
ch re
bate
s ar
e av
aila
ble;
the
spen
ding
for t
hese
dru
gs a
re ty
pica
lly re
port
ed u
nder
the
phys
icia
n se
rvic
es c
ateg
ory
inst
ead
of th
e ou
tpat
ient
pre
scrip
tion
drug
ca
tego
ry in
oth
er d
ata.
The
sta
te d
rug
utili
zatio
n da
ta p
rovi
de b
oth
fee-
for-s
ervi
ce a
nd m
anag
ed c
are
drug
util
izat
ion
and
spen
ding
info
rmat
ion
at th
e na
tiona
l dru
g co
de (N
DC)
leve
l, w
hich
is n
ot a
vaila
ble
in C
MS-
64 d
ata.
The
sta
te d
rug
utili
zatio
n da
ta a
re a
vaila
ble
at h
ttp:
//w
ww
.med
icai
d.go
v/m
edic
aid-
chip
-pro
gram
-info
rmat
ion/
by-to
pics
/ben
efits
/pr
escr
iptio
n-dr
ugs/
med
icai
d-dr
ug-p
rogr
ams-
data
-and
-reso
urce
s.ht
ml.
The
drug
reba
te in
form
atio
n co
mes
from
the
CMS-
64 a
nd d
oes
allo
w s
tate
s to
sep
arat
ely
iden
tify
fee-
for-s
ervi
ce a
nd m
anag
ed c
are
drug
reba
tes.
The
reba
te to
tals
sho
wn
here
incl
ude
fede
ral r
ebat
es, s
tate
sup
plem
enta
l reb
ates
, and
the
reba
te in
crea
ses
attr
ibut
able
to th
e Af
ford
able
Car
e Ac
t.
Due
to th
e tim
e it
take
s to
col
lect
the
drug
util
izat
ion
info
rmat
ion
and
invo
ice
drug
man
ufac
ture
rs fo
r the
reba
te, t
he re
bate
s co
llect
ed in
any
par
ticul
ar q
uart
er a
re g
ener
ally
at
trib
utab
le to
dru
gs p
urch
ased
in p
rior q
uart
ers;
thus
, the
gro
ss s
pend
ing
and
reba
te d
olla
rs fo
r a g
iven
tim
e pe
riod
are
not n
eces
saril
y al
igne
d. C
hang
es in
cov
ered
po
pula
tions
or b
enef
it de
sign
(e.g
., m
anag
ed c
are
expa
nsio
n or
pha
rmac
y ca
rve-
in) c
an c
reat
e di
stor
tions
in th
e da
ta, b
ecau
se c
hang
es w
ill b
e re
flect
ed in
gro
ss s
pend
ing
befo
re th
ey a
re re
flect
ed in
reba
tes
colle
cted
.
– D
ash
indi
cate
s ze
ro; -
$0.0
indi
cate
s an
am
ount
bet
wee
n ze
ro a
nd -$
0.5
mill
ion
that
roun
ds to
zer
o.1
Haw
aii s
how
s w
ide
quar
terly
var
iatio
ns in
thei
r man
aged
car
e dr
ug s
pend
ing;
this
is d
ue in
par
t due
to th
e st
ate’
s pr
actic
e of
repo
rtin
g a
larg
e am
ount
of s
pend
ing
unde
r an
unid
entif
iabl
e N
DC c
ode
and
drug
nam
e.2
Stat
e re
cent
ly im
plem
ente
d or
exp
ande
d m
anag
ed c
are.
Thi
s ch
ange
cre
ates
a la
rge
diff
eren
ce b
etw
een
gros
s sp
endi
ng a
nd re
bate
col
lect
ions
for f
ee-fo
r-ser
vice
and
m
anag
ed c
are,
resu
lting
in a
nom
alou
s re
bate
per
cent
ages
at t
he d
eliv
ery
syst
em le
vel.
3 St
ate
repo
rts
little
or n
o m
anag
ed c
are
reba
tes
in C
MS-
64 d
ata.
The
reba
tes
for t
hese
man
aged
car
e ex
pend
iture
s ap
pear
s to
be
repo
rted
with
the
fee-
for-s
ervi
ce re
bate
s.4
Stat
e ge
nera
lly c
arve
s ou
t pre
scrip
tion
drug
s fr
om th
e m
anag
ed c
are
prog
ram
. Sta
te m
anag
ed c
are
spen
ding
may
refle
ct p
hysi
cian
-adm
inis
tere
d dr
ugs;
how
ever
, reb
ates
for
thes
e m
anag
ed c
are
expe
nditu
res
are
not r
epor
ted
sepa
rate
ly in
the
CMS-
64 d
ata
and
appe
ar to
be
repo
rted
with
the
fee-
for-s
ervi
ce re
bate
s.5
Rhod
e Is
land
has
not
repo
rted
any
man
aged
car
e dr
ug u
tiliz
atio
n si
nce
the
seco
nd q
uart
er o
f FY
2013
.6
Virg
inia
dat
a w
ere
corr
ecte
d fo
r an
appa
rent
err
or in
fee-
for-s
ervi
ce s
pend
ing
in th
e se
cond
qua
rter
of F
Y 20
14.
Sour
ces:
MAC
PAC,
201
5, a
naly
sis
of M
edic
aid
stat
e dr
ug re
bate
util
izat
ion
data
as
of O
ctob
er 2
015
and
CMS-
64 F
MR
net e
xpen
ditu
re d
ata
as o
f Feb
ruar
y 25
, 201
5.
December 201572
Section 3: Program Enrollment and Spending—Medicaid Managed Care
MAC
Stat
sSe
ctio
n 3
Stat
e
Tota
l Med
icai
d en
rolle
es
(tho
usan
ds)
Perc
enta
ge o
f enr
olle
es in
man
aged
car
e
Com
preh
ensi
ve
man
aged
car
e1
Lim
ited-
bene
fit p
lans
PCCM
MLT
SSBH
O (P
IHP
and/
or P
AHP)
Dent
alTr
ansp
orta
tion
Oth
erTo
tal
60,5
1255
.3%
0.3%
15.9
%10
.8%
11.7
%1.
9%13
.2%
Alab
ama
960
0.0
––
––
2.4
57.1
Alas
ka14
5–
––
––
––
Ariz
ona
1,27
184
.4–
––
––
–
Arka
nsas
614
0.0
––
–75
.3–
71.6
Calif
orni
a8,
469
67.2
––
7.8
–0.
0–
Colo
rado
740
10.6
–94
.9–
–2.
948
.0
Conn
ectic
ut62
2–
––
––
––
Dela
war
e21
684
.4–
––
––
–
Dist
rict o
f Col
umbi
a25
362
.4–
––
20.3
––
Flor
ida
3,38
444
.80.
617
.338
.9–
0.2
17.4
Geo
rgia
1,81
463
.3–
––
––
–
Haw
aii
307
93.9
––
––
––
Idah
o225
5–
–0.
094
.594
.60.
385
.6
Illin
ois
2,93
19.
6–
––
––
63.8
Indi
ana
1,12
664
.9–
––
––
3.1
Iow
a43
47.
0–
96.9
–93
.2–
47.6
Kans
as39
982
.5–
––
––
–
Kent
ucky
847
84.6
––
––
––
Loui
sian
a1,
257
34.1
–82
.5–
––
41.1
Mai
ne26
2–
––
––
–68
.0
Mar
ylan
d1,
089
79.4
––
––
––
Mas
sach
uset
ts1,
410
31.6
–4.
8–
––
25.6
Mic
higa
n1,
816
71.1
–88
.223
.7–
––
Min
neso
ta90
270
.2–
––
––
–
Mis
siss
ippi
689
22.5
––
––
––
EXH
IBIT
28.
Per
cent
age
of M
edic
aid
Enro
llees
in M
anag
ed C
are
by S
tate
, Jul
y 1,
201
3
MACStats: Medicaid and CHIP Data Book 73
Section 3: Program Enrollment and Spending—Medicaid Managed Care
MAC
Stat
sSe
ctio
n 3
Stat
e
Tota
l Med
icai
d en
rolle
es
(tho
usan
ds)
Perc
enta
ge o
f enr
olle
es in
man
aged
car
e
Com
preh
ensi
ve
man
aged
car
e1
Lim
ited-
bene
fit p
lans
PCCM
MLT
SSBH
O (P
IHP
and/
or P
AHP)
Dent
alTr
ansp
orta
tion
Oth
erM
isso
uri
868
47.9
%–
––
49.4
%–
–
Mon
tana
119
––
––
––
65.5
%
Neb
rask
a324
475
.7–
86.9
%–
––
–
Nev
ada
329
54.9
––
–54
.9–
–
New
Ham
pshi
re2
146
0.0
––
––
––
New
Jer
sey
1,20
187
.9–
––
84.5
––
New
Mex
ico
555
74.5
–67
.6–
––
–
New
Yor
k5,
353
73.6
1.9%
––
––
–
Nor
th C
arol
ina
1,58
90.
0–
76.2
––
–96
.2
Nor
th D
akot
a77
0.1
–0.
4–
––
54.8
Ohi
o2,
390
69.8
––
––
––
Okl
ahom
a73
60.
0–
––
93.7
–10
0.0
Ore
gon4
695
78.8
–3.
586
.7%
––
0.1
Penn
sylv
ania
3,44
747
.2–
53.8
–14
.3–
–
Rhod
e Is
land
197
71.3
––
32.5
––
0.8
Sout
h Ca
rolin
a1,
002
45.9
––
–10
0.0
–17
.9
Sout
h Da
kota
122
––
––
––
74.8
Tenn
esse
e41,
216
100.
0–
–60
.7–
88.7
%–
Texa
s3,
879
77.3
–12
.363
.848
.60.
3–
Uta
h326
670
.1–
98.0
–81
.4–
–
Verm
ont
182
56.5
––
––
––
Virg
inia
938
67.8
––
––
––
Was
hing
ton
1,17
367
.3–
65.3
–2.
2–
0.7
Wes
t Virg
inia
330
51.6
––
––
–1.
2
Wis
cons
in1,
179
59.5
3.2
0.1
––
––
Wyo
min
g66
0.0
––
––
––
EXH
IBIT
28.
(co
ntin
ued)
December 201574
Section 3: Program Enrollment and Spending—Medicaid Managed Care
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
28.
(co
ntin
ued)
Not
es: P
CCM
is p
rimar
y ca
re c
ase
man
agem
ent.
MLT
SS is
man
aged
long
-term
ser
vice
s an
d su
ppor
ts. B
HO
is b
ehav
iora
l hea
lth o
rgan
izat
ion.
PIH
P is
pre
paid
inpa
tient
hea
lth
plan
. PAH
P is
pre
paid
am
bula
tory
hea
lth p
lan.
Exc
lude
s th
e te
rrito
ries.
Thi
s ex
hibi
t inc
lude
s M
edic
aid-
expa
nsio
n CH
IP e
nrol
lees
. Med
icai
d be
nefic
iarie
s m
ay b
e en
rolle
d co
ncur
rent
ly in
mor
e th
an o
ne ty
pe o
f man
aged
car
e pr
ogra
m (e
.g.,
a co
mpr
ehen
sive
pla
n an
d a
BHO
), so
the
sum
of e
nrol
lmen
t in
each
pro
gram
type
as
a pe
rcen
tage
of t
otal
M
edic
aid
enro
llmen
t may
be
grea
ter t
han
100
perc
ent.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 In
clud
es c
ompr
ehen
sive
man
aged
car
e an
d Pr
ogra
ms
of A
ll-In
clus
ive
Care
for t
he E
lder
ly (P
ACE)
.2
Stat
e op
erat
ed a
Med
icai
d m
anag
ed c
are
prog
ram
in 2
013
but t
he p
rogr
am e
ither
end
ed b
efor
e Ju
ly 1
, 201
3 or
beg
an a
fter
that
dat
e. Id
aho
had
a BH
O p
rogr
am a
nd N
ew
Ham
pshi
re h
ad a
com
preh
ensi
ve m
anag
ed c
are
prog
ram
in 2
013,
but
bot
h ha
d ze
ro e
nrol
lmen
t on
July
1, 2
013.
3 Th
e to
tal f
or B
HO
pla
ns p
ublis
hed
by C
MS
was
gre
ater
than
the
tota
l num
ber o
f Med
icai
d en
rolle
es d
ue to
the
stat
e ha
ving
two
beha
vior
al h
ealth
pro
gram
s th
at a
llow
ed fo
r co
ncur
rent
enr
ollm
ent.
The
valu
e sh
own
here
use
s th
e en
rollm
ent t
otal
from
the
larg
est o
f the
two
type
s of
BH
O p
rogr
ams.
4 Th
e to
tal f
or c
ompr
ehen
sive
man
aged
car
e pl
ans
publ
ishe
d by
CM
S w
as g
reat
er th
an th
e to
tal n
umbe
r of M
edic
aid
enro
llees
due
to a
n ap
pare
nt c
lass
ifica
tion
erro
r; so
me
plan
s th
at a
ppea
r to
be li
mite
d-be
nefit
pla
ns (d
enta
l, BH
O, o
r oth
er m
anag
ed c
are)
wer
e cl
assi
fied
as c
ompr
ehen
sive
man
aged
car
e. T
he v
alue
s sh
own
here
use
pla
n-le
vel
info
rmat
ion
in th
e CM
S re
port
to s
epar
ate
enro
llmen
t in
the
limite
d pl
ans
from
the
com
preh
ensi
ve m
anag
ed c
are
tota
l and
cat
egor
ize
enro
llmen
t in
thos
e lim
ited-
bene
fit p
lans
as
BH
O, d
enta
l, or
oth
er m
anag
ed c
are.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
CM
S, 2
015,
Med
icai
d m
anag
ed c
are
enro
llmen
t and
pro
gram
cha
ract
eris
tics,
201
3, h
ttp:
//w
ww
.med
icai
d.go
v/m
edic
aid-
chip
-pro
gram
-in
form
atio
n/by
-topi
cs/d
ata-
and-
syst
ems/
med
icai
d-m
anag
ed-c
are/
dow
nloa
ds/2
013-
med
icai
d-m
anag
ed-c
are-
enro
llmen
t-rep
ort.p
df.
MACStats: Medicaid and CHIP Data Book 75
Section 3: Program Enrollment and Spending—Medicaid Managed Care
MAC
Stat
sSe
ctio
n 3
Stat
e
Tota
l M
edic
aid
enro
llees
(th
ousa
nds)
Perc
enta
ge o
f enr
olle
es in
man
aged
car
eCo
mpr
ehen
sive
man
aged
car
e1Li
mite
d-be
nefit
pla
nsPC
CM
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Tota
l68
,680
52.5
%66
.2%
50.1
%37
.3%
17.0
%48
.0%
56.3
%35
.6%
52.0
%39
.0%
15.9
%22
.0%
10.8
%14
.9%
3.5%
Alab
ama
1,10
43.
0–
0.0
6.9
14.6
––
––
–61
.993
.222
.251
.51.
5
Alas
ka13
9–
––
––
––
––
––
––
––
Ariz
ona
1,71
379
.188
.177
.365
.647
.288
.494
.384
.189
.670
.3–
––
––
Arka
nsas
695
0.0
–0.
00.
00.
278
.798
.146
.975
.141
.263
.890
.728
.056
.13.
8
Calif
orni
a12
,005
47.8
72.1
28.8
62.4
30.6
68.8
93.8
36.9
99.8
96.6
––
––
–
Colo
rado
826
12.1
12.9
11.5
10.4
10.3
95.1
99.2
95.5
89.1
75.2
3.9
3.4
3.1
6.3
5.1
Conn
ectic
ut82
348
.881
.944
.40.
70.
0–
––
––
––
––
–
Dela
war
e25
584
.893
.987
.066
.243
.989
.498
.890
.274
.749
.33.
03.
03.
33.
20.
6
Dist
rict o
f Co
lum
bia
225
71.4
89.6
89.7
22.3
2.9
36.7
20.6
26.2
79.0
71.9
––
––
–
Flor
ida
4,14
540
.053
.537
.027
.97.
127
.041
.011
.323
.72.
725
.135
.214
.325
.93.
5
Geo
rgia
1,64
063
.189
.285
.02.
80.
082
.693
.577
.073
.147
.9–
––
––
Haw
aii
296
98.0
99.7
99.0
95.6
89.4
1.2
2.1
0.0
3.3
0.2
––
––
–
Idah
o27
9–
––
––
94.8
100.
097
.485
.666
.786
.294
.283
.677
.145
.3
Illin
ois
3,00
5–
––
––
10.6
12.2
9.4
9.8
4.4
65.3
77.9
72.6
29.4
4.9
Indi
ana
1,22
870
.692
.289
.111
.70.
2–
––
––
3.9
2.2
0.1
15.3
1.8
Iow
a62
21.
62.
61.
10.
10.
279
.499
.147
.992
.774
.956
.371
.070
.04.
51.
0
Kans
as43
059
.282
.078
.91.
70.
692
.510
0.0
96.9
86.5
49.8
7.4
3.9
2.0
24.8
2.3
Kent
ucky
926
84.8
99.1
95.0
72.7
34.6
90.8
99.9
99.7
81.7
58.7
22.5
35.4
25.7
5.7
0.5
Loui
sian
a1,
311
0.0
––
0.0
0.2
75.9
59.1
90.8
96.1
94.2
64.3
91.0
38.5
46.8
10.5
Mai
ne44
6–
––
––
––
––
–98
.297
.197
.999
.298
.8
Mar
ylan
d1,
098
81.3
97.3
86.1
60.1
2.1
––
––
––
––
––
Mas
sach
uset
ts1,
549
45.1
53.4
57.3
27.0
16.0
28.3
38.3
24.7
36.7
0.2
24.1
30.2
24.4
27.8
0.2
Mic
higa
n2,
297
71.4
86.5
69.1
54.3
8.4
93.4
98.7
83.9
95.2
85.7
––
––
–
Min
neso
ta1,
145
76.1
86.4
80.5
40.4
59.2
––
––
––
––
––
Mis
siss
ippi
781
8.2
0.4
0.2
35.5
0.7
87.5
99.8
82.7
79.4
55.2
––
––
–
EXH
IBIT
29.
Per
cent
age
of M
edic
aid
Enro
llees
in M
anag
ed C
are
by S
tate
and
Elig
ibili
ty G
roup
, FY
2012
December 201576
Section 3: Program Enrollment and Spending—Medicaid Managed Care
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
29.
(co
ntin
ued)
Stat
e
Tota
l M
edic
aid
enro
llees
(th
ousa
nds)
Perc
enta
ge o
f enr
olle
es in
man
aged
car
eCo
mpr
ehen
sive
man
aged
car
e1Li
mite
d-be
nefit
pla
nsPC
CM
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Tota
lCh
ildre
nAd
ults
Disa
bled
Aged
Mis
sour
i1,
135
45.2
%67
.8%
49.0
%2.
0%0.
2%–
––
––
––
––
–
Mon
tana
136
––
––
–0.
7%–
0.0%
3.6%
0.1%
74.6
%92
.7%
83.0
%51
.0%
1.6%
Neb
rask
a26
465
.882
.769
.037
.65.
185
.796
.0%
84.7
74.8
43.2
––
––
–
Nev
ada
405
60.3
77.9
71.1
1.8
0.0
87.6
95.6
89.5
71.9
50.0
––
––
–
New
Ham
pshi
re16
80.
00.
0–
––
––
––
––
––
––
New
Jer
sey
1,18
483
.895
.563
.184
.563
.996
.699
.795
.995
.287
.1–
––
––
New
Mex
ico
652
68.1
84.1
63.3
42.9
2.6
68.1
84.1
40.0
67.6
53.9
––
––
–
New
Yor
k5,
865
75.0
87.8
88.4
49.0
14.5
1.0
0.0
0.0
1.3
7.5
0.3
0.3
0.2
0.6
0.0
Nor
th C
arol
ina
1,97
60.
0–
–0.
00.
281
.196
.578
.867
.327
.980
.396
.261
.274
.745
.8
Nor
th D
akot
a87
2.4
4.3
0.1
0.1
0.8
0.4
0.3
0.2
1.5
0.2
54.5
72.6
72.1
1.8
0.0
Ohi
o2,
474
74.3
93.5
80.9
38.7
5.5
––
––
––
––
––
Okl
ahom
a93
10.
0–
–0.
00.
281
.596
.450
.585
.178
.868
.388
.061
.442
.11.
2
Ore
gon
751
77.6
87.8
80.0
63.5
36.6
88.5
96.6
86.4
80.2
63.5
0.5
0.5
0.2
0.8
0.9
Penn
sylv
ania
2,56
262
.278
.561
.257
.47.
487
.797
.677
.893
.049
.816
.620
.916
.215
.61.
1
Rhod
e Is
land
185
59.8
88.2
81.4
16.6
1.0
27.2
59.3
–6.
90.
0–
––
––
Sout
h Ca
rolin
a1,
044
50.7
65.5
49.7
31.8
1.3
90.2
99.8
70.0
94.2
84.0
19.2
23.3
13.8
20.1
8.1
Sout
h Da
kota
134
––
––
––
––
––
73.0
92.0
88.4
29.3
0.7
Tenn
esse
e1,
545
92.0
100.
010
0.0
79.8
55.1
92.0
100.
010
0.0
79.8
54.9
––
––
–
Texa
s4,
641
79.7
94.1
55.9
67.5
34.9
11.7
14.2
7.0
9.9
4.2
18.5
23.5
12.6
13.7
0.3
Uta
h38
822
.926
.918
.217
.215
.190
.098
.870
.392
.482
.227
.631
.021
.228
.818
.6
Verm
ont
205
0.1
––
0.1
0.6
––
––
–68
.086
.978
.639
.33.
3
Virg
inia
1,09
366
.587
.164
.942
.45.
2–
––
––
5.3
5.9
5.2
6.3
0.4
Was
hing
ton
1,40
866
.687
.460
.730
.51.
391
.399
.973
.988
.878
.50.
70.
80.
90.
50.
0
Wes
t Virg
inia
439
53.2
88.3
76.8
1.5
0.0
––
––
–1.
42.
21.
70.
50.
0
Wis
cons
in1,
264
59.5
83.3
72.8
4.5
2.5
84.6
92.8
88.4
93.2
35.0
––
––
–
Wyo
min
g89
––
––
––
––
––
––
––
–
MACStats: Medicaid and CHIP Data Book 77
Section 3: Program Enrollment and Spending—Medicaid Managed Care
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
29.
(co
ntin
ued)
Not
es: F
Y is
fisc
al y
ear.
PCCM
is p
rimar
y ca
re c
ase
man
agem
ent.
Enro
llmen
t num
bers
gen
eral
ly in
clud
e in
divi
dual
s ev
er e
nrol
led
in M
edic
aid-
finan
ced
cove
rage
dur
ing
the
year
, ev
en if
for a
sin
gle
mon
th; h
owev
er, i
n th
e ev
ent i
ndiv
idua
ls w
ere
also
enr
olle
d in
CH
IP-fi
nanc
ed M
edic
aid
cove
rage
(i.e
., M
edic
aid-
expa
nsio
n CH
IP) d
urin
g th
e ye
ar, t
hey
are
excl
uded
if th
eir m
ost r
ecen
t enr
ollm
ent m
onth
was
in M
edic
aid-
expa
nsio
n CH
IP. N
umbe
rs e
xclu
de in
divi
dual
s en
rolle
d on
ly in
Med
icai
d-ex
pans
ion
CHIP
dur
ing
the
year
and
en
rolle
es in
the
terr
itorie
s. C
hild
ren
and
adul
ts u
nder
age
65
who
qua
lify
for M
edic
aid
on th
e ba
sis
of d
isab
ility
are
incl
uded
in th
e di
sabl
ed c
ateg
ory.
Abo
ut 7
37,0
00 e
nrol
lees
age
65
and
old
er a
re id
entif
ied
in th
e da
ta a
s di
sabl
ed; g
iven
that
dis
abili
ty is
not
an
elig
ibili
ty p
athw
ay fo
r ind
ivid
uals
age
65
and
olde
r, M
ACPA
C re
code
s th
ese
enro
llees
as
aged
.
Due
to c
hang
es in
bot
h m
etho
ds a
nd d
ata,
figu
res
show
n he
re a
re n
ot d
irect
ly c
ompa
rabl
e to
ear
lier y
ears
. With
rega
rd to
met
hods
, ind
ivid
uals
are
cou
nted
as
part
icip
atin
g in
m
anag
ed c
are
if th
ey h
ad a
t lea
st o
ne m
onth
indi
catin
g pl
an e
nrol
lmen
t; pr
evio
usly
, ind
ivid
uals
wer
e co
unte
d as
par
ticip
atin
g if
at le
ast o
ne m
anag
ed c
are
paym
ent w
as m
ade
on th
eir b
ehal
f dur
ing
the
fisca
l yea
r. In
add
ition
, due
to th
e un
avai
labi
lity
of a
sta
tes’
MSI
S An
nual
Per
son
Sum
mar
y (A
PS) d
ata
for F
Y 20
12, t
he s
ourc
e us
ed in
prio
r edi
tions
of
this
exh
ibit,
MAC
PAC
calc
ulat
ed s
pend
ing
and
enro
llmen
t fro
m th
e fu
ll M
SIS
data
file
s th
at a
re u
sed
to c
reat
e th
e AP
S fil
es. F
or M
ACPA
C’s
anal
ysis
, Med
icai
d en
rolle
es
wer
e as
sign
ed a
uni
que
natio
nal i
dent
ifica
tion
(ID) n
umbe
r usi
ng a
n al
gorit
hm th
at in
corp
orat
es s
tate
-spe
cific
ID n
umbe
rs a
nd b
enef
icia
ry c
hara
cter
istic
s su
ch a
s da
te o
f bi
rth
and
gend
er. T
he s
tate
and
nat
iona
l enr
ollm
ent c
ount
s sh
own
here
are
und
uplic
ated
usi
ng th
is n
atio
nal I
D. T
he s
um o
f the
sta
te to
tals
exc
eeds
the
natio
nal t
otal
bec
ause
in
divi
dual
s m
ay b
e en
rolle
d in
mor
e th
an o
ne s
tate
dur
ing
the
year
. See
htt
ps:/
/ww
w.m
acpa
c.go
v/m
acst
ats/
data
-sou
rces
-and
-met
hods
/ for
add
ition
al in
form
atio
n. M
edic
aid
enro
llees
may
be
enro
lled
conc
urre
ntly
in m
ore
than
one
type
of m
anag
ed c
are
prog
ram
(e.g
., a
com
preh
ensi
ve p
lan
and
a lim
ited-
bene
fit p
lan)
, so
the
sum
of e
nrol
lmen
t in
each
pro
gram
type
as
a pe
rcen
tage
of t
otal
Med
icai
d en
rollm
ent m
ay b
e gr
eate
r tha
n 10
0 pe
rcen
t.
Figu
res
show
n he
re, w
hich
are
bas
ed o
n M
SIS
data
, may
diff
er fr
om th
ose
that
use
Med
icai
d m
anag
ed c
are
enro
llmen
t rep
ort d
ata.
Rea
sons
for d
iffer
ence
s in
clud
e di
ffer
ing
time
perio
ds, s
tate
repo
rtin
g an
omal
ies,
and
the
trea
tmen
t of M
edic
aid-
expa
nsio
n CH
IP e
nrol
lees
(exc
lude
d he
re b
ut in
clud
ed in
enr
ollm
ent r
epor
t dat
a). A
lthou
gh th
e en
rollm
ent r
epor
t is
a co
mm
only
cite
d so
urce
, it d
oes
not p
rovi
de in
form
atio
n on
the
char
acte
ristic
s of
enr
olle
es in
man
aged
car
e (e
.g.,
elig
ibili
ty g
roup
).
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 In
clud
es c
ompr
ehen
sive
man
aged
car
e pl
ans
and
Prog
ram
s of
All-
Incl
usiv
e Ca
re fo
r the
Eld
erly
(PAC
E).
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
MSI
S da
ta a
s of
Dec
embe
r 201
4.
December 201578
Section 3: Program Enrollment and Spending—Medicaid Program Administration
MAC
Stat
sSe
ctio
n 3
Stat
e1
Tota
l sp
endi
ng o
n ad
min
istr
atio
n
Spen
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cate
gory
Colle
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MIS
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igib
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sy
stem
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EHR
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ntiv
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Oth
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atch
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Oth
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atch
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5
Alab
ama
$212
$35
$19
$26
$10
$122
-$0
Alas
ka13
416
1016
687
–Ar
izon
a26
830
125
458
60-0
Arka
nsas
314
4847
1748
154
–Ca
lifor
nia
4,86
439
987
250
262
3,86
6–
Colo
rado
346
4544
446
207
–Co
nnec
ticut
347
4055
237
222
–De
law
are
113
2723
76
52–
Dist
rict o
f Col
umbi
a15
725
239
595
–Fl
orid
a74
770
4990
4848
9–
Geo
rgia
461
101
7676
320
6-0
Haw
aii
100
1434
192
30–
Idah
o10
723
2417
637
–Ill
inoi
s1,
106
4436
144
7281
0–
Indi
ana
506
8831
5318
316
–Io
wa
189
5972
275
26–
Kans
as20
525
4024
411
2-0
Kent
ucky
223
4313
4623
98–
Loui
sian
a28
235
1340
1118
3–
Mai
ne16
356
1823
858
–M
aryl
and
415
2857
4660
226
–M
assa
chus
etts
702
9114
6634
497
–M
ichi
gan
645
199
4666
1531
9–
Min
neso
ta59
567
9169
836
1–
Mis
siss
ippi
151
316
339
71–
Mis
sour
i41
048
4757
3222
6-0
Mon
tana
727
2610
327
-0N
ebra
ska
136
2632
166
56–
Nev
ada
151
3450
1611
40–
EXH
IBIT
30.
Tot
al M
edic
aid
Adm
inis
trat
ive
Spen
ding
by
Stat
e an
d Ca
tego
ry, F
Y 20
14 (m
illio
ns)
MACStats: Medicaid and CHIP Data Book 79
Section 3: Program Enrollment and Spending—Medicaid Program Administration
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
30.
(co
ntin
ued)
Stat
e1
Tota
l sp
endi
ng o
n ad
min
istr
atio
n
Spen
ding
by
cate
gory
Colle
ctio
nsM
MIS
2El
igib
ility
sy
stem
2
EHR
ince
ntiv
e pr
ogra
m3
Oth
er fu
nctio
ns,
fede
ral m
atch
, ab
ove
50%
4
Oth
er fu
nctio
ns,
fede
ral m
atch
of
50%
5
New
Ham
pshi
re$9
8$1
6$4
2$6
$2$3
1–
New
Jer
sey
724
5519
3229
589
–N
ew M
exic
o18
022
5211
986
–N
ew Y
ork
1,79
219
732
174
861,
304
–N
orth
Car
olin
a66
387
167
7127
311
–N
orth
Dak
ota
4911
55
127
–O
hio
784
108
8892
1348
2–
Okl
ahom
a25
957
1737
2911
9–
Ore
gon
507
2617
278
429
-0Pe
nnsy
lvan
ia95
398
184
7122
577
–Rh
ode
Isla
nd12
923
298
565
-0So
uth
Caro
lina
276
7521
4111
127
-0So
uth
Dako
ta63
62
152
37–
Tenn
esse
e44
961
4552
1427
8-1
Texa
s1,
446
256
5014
725
975
-8U
tah
170
3140
2911
59–
Verm
ont
4416
1112
14
–Vi
rgin
ia43
332
174
5125
151
–W
ashi
ngto
n59
663
2362
2642
1–
Wes
t Virg
inia
157
386
1721
75–
Wis
cons
in38
719
1346
1029
9–
Wyo
min
g55
1312
52
22–
Subt
otal
(sta
tes)
$24,
337
$3,0
65$2
,260
$2,3
86$1
,111
$15,
524
-$9
Amer
ican
Sam
oa1
––
0–
1–
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m5
––
20
3–
Nor
ther
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aria
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land
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871
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98
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tate
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$24,
440
$3,0
75$2
,260
$2,4
23$1
,111
$15,
580
-$9
December 201580
Section 3: Program Enrollment and Spending—Medicaid Program Administration
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
30.
(co
ntin
ued)
Stat
e1
Tota
l sp
endi
ng o
n ad
min
istr
atio
n
Spen
ding
by
cate
gory
Colle
ctio
nsM
MIS
2El
igib
ility
sy
stem
2
EHR
ince
ntiv
e pr
ogra
m3
Oth
er fu
nctio
ns,
fede
ral m
atch
, ab
ove
50%
4
Oth
er fu
nctio
ns,
fede
ral m
atch
of
50%
5
Med
icai
d Fr
aud
Cont
rol U
nits
6$2
85–
––
$285
––
Med
icai
d su
rvey
and
cer
tific
atio
n of
nu
rsin
g an
d in
term
edia
te c
are
faci
litie
s629
3–
––
293
––
Tota
l$2
5,01
8$3
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90$1
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9Pe
rcen
t of t
otal
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lusi
ve o
f col
lect
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.3%
9.0%
9.7%
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62.3
%–
Not
es: F
Y is
fisc
al y
ear.
MM
IS is
Med
icai
d m
anag
emen
t inf
orm
atio
n sy
stem
. EH
R is
ele
ctro
nic
heal
th re
cord
. Inc
lude
s fe
dera
l and
sta
te fu
nds.
Exc
lude
s ad
min
istr
ativ
e ac
tiviti
es p
erfo
rmed
by
Med
icai
d m
anag
ed c
are
plan
s (w
hich
are
incl
uded
in th
e ca
pita
tion
paym
ents
that
sta
tes
mak
e to
thes
e pl
ans)
and
act
iviti
es th
at a
re e
xclu
sive
ly
fede
ral,
such
as
prog
ram
ove
rsig
ht b
y CM
S st
aff.
Colle
ctio
ns m
ay in
clud
e, fo
r exa
mpl
e, d
onat
ions
mad
e by
hos
pita
ls to
com
pens
ate
for t
he c
ost o
f on-
site
sta
tioni
ng o
f sta
te o
r lo
cal M
edic
aid
agen
cy p
erso
nnel
to d
eter
min
e el
igib
ility
or p
rovi
de o
utre
ach.
For
mor
e in
form
atio
n on
spe
cific
item
s no
ted
in th
is e
xhib
it, s
ee C
MS,
201
0, M
BES
CBES
cat
egor
y of
ser
vice
line
def
initi
ons
for t
he 6
4.10
bas
e fo
rm, h
ttps
://w
ww
.cm
s.go
v/Re
sear
ch-S
tatis
tics-
Data
-and
-Sys
tem
s/Co
mpu
ter-D
ata-
and-
Syst
ems/
Med
icai
dBud
getE
xpen
dSys
tem
/Do
wnl
oads
/CM
S641
0Bas
e.pd
f.
– D
ash
indi
cate
s ze
ro; $
0 or
-$0
indi
cate
s an
am
ount
bet
wee
n $0
.5 a
nd -$
0.5
mill
ion
that
roun
ds to
zer
o.1
Not
all
stat
es h
ad c
ertif
ied
thei
r CM
S-64
Fin
anci
al M
anag
emen
t Rep
ort (
FMR)
sub
mis
sion
s as
of F
ebru
ary
25, 2
015.
Cal
iforn
ia’s
and
Col
orad
o’s
seco
nd, t
hird
, and
four
th
quar
ter s
ubm
issi
ons
are
not c
ertif
ied;
Nor
th D
akot
a’s
third
and
four
th q
uart
er s
ubm
issi
ons
are
not c
ertif
ied;
Sou
th C
arol
ina’
s se
cond
qua
rter
sub
mis
sion
is n
ot c
ertif
ied;
Rho
de
Isla
nd’s
four
th q
uart
er s
ubm
issi
on is
not
cer
tifie
d. F
igur
es p
rese
nted
in th
is ta
ble
may
cha
nge
if st
ates
revi
se th
eir e
xpen
ditu
re d
ata
afte
r thi
s da
te.
2 In
clud
es d
esig
n an
d de
velo
pmen
t of s
yste
ms
(90
perc
ent f
eder
al m
atch
), op
erat
ion
of a
ppro
ved
syst
ems
(75
perc
ent)
, and
oth
er c
osts
(50
perc
ent)
.3
Incl
udes
EH
R in
cent
ive
paym
ents
to p
rovi
ders
(100
per
cent
fede
ral m
atch
) and
adm
inis
trat
ion
of p
aym
ents
(90
perc
ent)
.4
Incl
udes
ski
lled
med
ical
pro
fess
iona
ls, p
read
mis
sion
scr
eeni
ng a
nd re
side
nt re
view
, med
ical
and
util
izat
ion
revi
ew, e
xter
nal i
ndep
ende
nt re
view
, sur
vey
and
cert
ifica
tion,
and
M
FCU
ope
ratio
ns (a
ll at
75
perc
ent f
eder
al m
atch
); tr
ansl
atio
n an
d in
terp
reta
tion
serv
ices
for c
hild
ren
and
plan
ning
act
iviti
es fo
r the
Hea
lth H
ome
bene
fit (b
oth
at m
atch
equ
al to
a
stat
e’s fe
dera
l med
ical
ass
ista
nce
perc
enta
ge);
elig
ibili
ty c
hang
es a
ssoc
iate
d w
ith th
e Te
mpo
rary
Ass
ista
nce
for N
eedy
Fam
ilies
pro
gram
(75
or 9
0 pe
rcen
t); a
dmin
istra
tion
of fa
mily
pl
anni
ng s
ervi
ces
(90
perc
ent)
; and
imm
igra
tion
stat
us v
erifi
catio
n sy
stem
s (1
00 p
erce
nt).
Excl
udes
MM
IS a
nd e
ligib
ility
sys
tem
spe
ndin
g, w
hich
hav
e th
eir o
wn
cate
gorie
s.5
Excl
udes
MM
IS a
nd e
ligib
ility
sys
tem
spe
ndin
g, w
hich
hav
e th
eir o
wn
cate
gorie
s.6
Stat
e-le
vel e
stim
ates
for M
FCU
s an
d su
rvey
and
cer
tific
atio
n ar
e av
aila
ble
but a
re n
ot in
clud
ed in
the
CMS-
64 d
ata
that
MAC
PAC
typi
cally
use
s to
ana
lyze
Med
icai
d sp
endi
ng.
Sour
ces:
For
sta
te a
nd te
rrito
ry s
pend
ing:
MAC
PAC,
201
5, a
naly
sis
of C
MS-
64 F
MR
net e
xpen
ditu
re d
ata
as o
f Feb
ruar
y 25
, 201
5; fo
r MCF
Us
and
surv
ey a
nd c
ertif
icat
ion:
CM
S,
2015
, Fis
cal y
ear 2
016
just
ifica
tion
of e
stim
ates
for A
ppro
pria
tions
Com
mitt
ees,
Bal
timor
e, M
D: C
MS,
htt
p://
ww
w.c
ms.
gov/
Abou
t-CM
S/Ag
ency
-Info
rmat
ion/
Perf
orm
ance
Budg
et/
Dow
nloa
ds/F
Y201
6-CJ
-Fin
al.p
df.
MACStats: Medicaid and CHIP Data Book 81
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
Stat
eTo
tal
CHIP
-fun
ded
cove
rage
Med
icai
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nded
cov
erag
eTo
tal
43,6
89,8
248,
129,
426
36,1
33,2
60Al
abam
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3,24
110
5,49
163
7,75
0Al
aska
96,2
329,
661
86,5
71Ar
izon
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54,3
6195
2,53
2Ar
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0,11
240
6,17
8Ca
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4,34
71,
874,
939
4,60
2,27
0Co
lora
do59
3,44
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146
7,96
9Co
nnec
ticut
352,
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19,9
2733
2,69
9De
law
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119,
594
18,6
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0,94
4Di
stric
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bia
98,2
347,
085
91,1
49Fl
orid
a2,
710,
000
423,
351
2,28
6,64
9G
eorg
ia3
1,47
2,52
423
1,27
01,
241,
254
Haw
aii
174,
062
30,5
0514
3,55
7Id
aho
220,
383
30,6
1518
9,76
8Ill
inoi
s1,
912,
477
295,
844
1,61
6,63
3In
dian
a86
8,55
615
3,52
371
5,03
3Io
wa
404,
006
83,4
1132
0,59
5Ka
nsas
306,
335
73,5
7423
2,76
1Ke
ntuc
ky3
596,
706
61,4
7353
5,23
3Lo
uisi
ana
799,
554
136,
263
663,
291
Mai
ne20
6,63
127
,461
179,
170
Mar
ylan
d65
1,76
813
7,19
251
4,57
6M
assa
chus
etts
467
3,19
012
6,38
454
6,80
6M
ichi
gan
1,27
8,29
710
4,12
71,
174,
170
Min
neso
ta54
2,38
23,
590
538,
792
Mis
siss
ippi
533,
140
80,5
7545
2,56
5M
isso
uri
632,
734
86,8
2854
5,90
6M
onta
na13
9,60
349
,671
89,9
32N
ebra
ska
214,
638
56,4
7615
8,16
2N
evad
a34
3,60
845
,870
297,
738
New
Ham
pshi
re11
0,67
616
,523
94,1
53N
ew J
erse
y92
0,51
521
1,37
170
9,14
4N
ew M
exic
o40
0,96
116
,037
384,
924
New
Yor
k2,
797,
987
604,
566
2,19
3,42
1
EXH
IBIT
31.
Chi
ld E
nrol
lmen
t in
CHIP
and
Med
icai
d by
Sta
te, F
Y 20
14
December 201582
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
31.
(co
ntin
ued)
Stat
eTo
tal
CHIP
-fun
ded
cove
rage
Med
icai
d-fu
nded
cov
erag
eN
orth
Car
olin
a1,
404,
270
236,
893
1,16
7,37
7N
orth
Dak
ota
59,1
085,
032
54,0
76O
hio5
1,38
6,82
413
6,16
91,
250,
655
Okl
ahom
a69
8,69
016
4,83
153
3,85
9O
rego
n354
0,19
410
9,08
543
1,10
9Pe
nnsy
lvan
ia3
1,57
2,27
525
8,45
51,
313,
820
Rhod
e Is
land
120,
825
22,1
3698
,689
Sout
h Ca
rolin
a68
8,15
579
,740
608,
415
Sout
h Da
kota
682
,271
15,8
7066
,401
Tenn
esse
e88
8,30
611
2,82
677
5,48
0Te
xas
4,72
1,45
71,
041,
482
3,67
9,97
5U
tah
380,
762
76,5
3330
4,22
9Ve
rmon
t79
,490
5,95
373
,537
Virg
inia
842,
607
186,
513
656,
094
Was
hing
ton
762,
451
42,6
3771
9,81
4W
est V
irgin
ia1
330,
901
40,8
6429
0,03
7W
isco
nsin
734,
922
183,
115
551,
807
Wyo
min
g64
,686
9,09
555
,591
Not
es: F
Y is
fisc
al y
ear.
Tota
l col
umn
refle
cts
child
ren
ever
enr
olle
d in
CH
IP o
r Med
icai
d du
ring
the
year
, eve
n if
for a
sin
gle
mon
th. M
ost s
tate
s co
unte
d ch
ildre
n w
ho w
ere
enro
lled
in m
ultip
le c
ateg
orie
s du
ring
the
year
(for
exa
mpl
e, in
Med
icai
d-fu
nded
cov
erag
e fo
r the
firs
t hal
f of t
he y
ear b
ut in
CH
IP-fu
nded
cov
erag
e fo
r the
sec
ond
half)
in th
e m
ost r
ecen
t cat
egor
y (s
tate
-spe
cific
exc
eptio
ns to
this
rule
are
not
ed b
elow
). M
edic
aid-
fund
ed c
hild
enr
ollm
ent s
how
n he
re in
clud
es a
ll ch
ildre
n, re
gard
less
of d
isab
ility
sta
tus;
in
oth
er M
ACSt
ats
exhi
bits
that
bre
ak e
nrol
lmen
t out
by
elig
ibili
ty g
roup
, chi
ldre
n qu
alify
ing
on th
e ba
sis
of d
isab
ility
may
be
coun
ted
in th
e di
sabl
ed c
ateg
ory
rath
er th
an th
e ch
ild c
ateg
ory.
Dat
a w
ere
repo
rted
by
indi
vidu
al s
tate
s as
of M
ay 1
3, 2
015,
and
may
be
revi
sed
at a
late
r dat
e.1
Child
ren
who
tran
sitio
ned
betw
een
CHIP
and
Med
icai
d w
ere
repo
rted
in b
oth
prog
ram
s ra
ther
than
the
prog
ram
in w
hich
they
wer
e la
st e
nrol
led.
The
refo
re, e
nrol
lmen
t tot
als
are
artif
icia
lly h
igh.
2 Th
e to
tal r
efle
cts
undu
plic
ated
enr
ollm
ent a
nd is
acc
urat
e; h
owev
er, t
he d
ata
repo
rted
for e
ach
prog
ram
con
tain
dup
licat
es a
nd a
re a
rtifi
cial
ly h
igh.
3 Du
e to
elig
ibili
ty a
nd e
nrol
lmen
t sys
tem
cha
lleng
es, s
ome
CHIP
-fund
ed M
edic
aid
enro
llees
wer
e in
clud
ed in
Med
icai
d en
rollm
ent c
ount
s, ra
ther
than
CH
IP.
4 Du
e to
elig
ibili
ty a
nd e
nrol
lmen
t sys
tem
cha
lleng
es, c
erta
in m
embe
rs w
ho s
houl
d ha
ve b
een
assi
gned
to C
HIP
wer
e as
sign
ed to
Med
icai
d-fu
nded
cov
erag
e be
ginn
ing
in th
e se
cond
qua
rter
of 2
014.
5 Du
e to
elig
ibili
ty a
nd e
nrol
lmen
t sys
tem
cha
lleng
es, c
erta
in m
embe
rs w
ho s
houl
d ha
ve b
een
assi
gned
to C
HIP
wer
e as
sign
ed to
Med
icai
d-fu
nded
cov
erag
e fo
r FY
2014
.6
Due
to th
e ex
clus
ion
of c
erta
in M
edic
aid
enro
llees
in re
port
ing,
dat
a ar
e ar
tific
ially
low
.
Sour
ce: C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es (C
MS)
, 201
5, F
Y 20
14 u
ndup
licat
ed n
umbe
r of c
hild
ren
ever
enr
olle
d in
Med
icai
d an
d CH
IP, h
ttp:
//w
ww
.med
icai
d.go
v/ch
ip/
dow
nloa
ds/f
y-20
14-c
hild
rens
-enr
ollm
ent-r
epor
t.pdf
.
MACStats: Medicaid and CHIP Data Book 83
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
EXH
IBIT
32.
CH
IP S
pend
ing
by S
tate
, FY
2014
(mill
ions
)
Stat
e
Tota
l CH
IP
Bene
fits
Stat
e pr
ogra
m a
dmin
istr
atio
n
Sect
ion
2105
(g)
spen
ding
2M
edic
aid-
expa
nsio
n CH
IPSe
para
te C
HIP
pro
gram
s an
d co
vera
ge o
f pre
gnan
t wom
en1
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Fede
ral
Alab
ama
$181
.6$1
41.1
$40.
5$2
2.6
$17.
5$5
.0$1
52.1
$118
.2$3
3.9
$6.9
$5.4
$1.5
–
Alas
ka30
.019
.510
.528
.918
.810
.1–
––
1.1
0.7
0.4
–
Ariz
ona
85.4
65.8
19.6
50.8
39.2
11.7
32.8
25.2
7.5
1.8
1.4
0.4
–
Arka
nsas
97.0
76.7
20.3
72.9
57.6
15.3
20.6
16.3
4.3
3.5
2.8
0.7
–
Calif
orni
a2,
189.
21,
423.
176
6.1
1,82
9.9
1,18
9.4
640.
527
6.3
179.
696
.683
.154
.029
.1–
Colo
rado
196.
912
8.0
68.9
59.3
38.5
20.8
130.
785
.045
.86.
94.
52.
4–
Conn
ectic
ut30
.639
.2-8
.6–
––
27.5
17.9
9.6
3.1
2.0
1.1
$19.
3
Dela
war
e24
.016
.57.
50.
10.
10.
023
.015
.87.
21.
00.
70.
3–
Dist
rict o
f Col
umbi
a20
.816
.44.
419
.915
.74.
2–
––
0.8
0.7
0.2
–
Flor
ida
646.
546
0.0
186.
612
6.7
90.2
36.6
472.
333
6.0
136.
347
.533
.813
.7–
Geo
rgia
439.
533
4.7
104.
8–
––
408.
831
1.3
97.5
30.7
23.4
7.3
–
Haw
aii
57.0
37.6
19.5
54.6
36.0
18.6
––
–2.
41.
60.
8–
Idah
o67
.454
.013
.427
.221
.85.
435
.628
.57.
14.
63.
70.
9–
Illin
ois
453.
729
4.9
158.
812
2.1
79.1
43.0
287.
418
7.0
100.
344
.228
.815
.4–
Indi
ana
172.
913
2.9
40.1
106.
081
.524
.660
.946
.814
.16.
04.
61.
4–
Iow
a14
5.7
102.
842
.932
.723
.09.
610
2.0
72.0
30.0
11.1
7.8
3.3
–
Kans
as99
.469
.530
.0–
––
89.9
62.8
27.1
9.6
6.7
2.9
–
Kent
ucky
177.
814
0.3
37.6
102.
881
.121
.771
.356
.215
.13.
83.
00.
8–
Loui
sian
a20
2.2
147.
055
.217
1.0
124.
346
.715
.411
.24.
215
.811
.54.
3–
Mai
ne30
.622
.38.
217
.312
.74.
612
.39.
03.
30.
90.
70.
2–
Mar
ylan
d29
4.1
191.
210
2.9
271.
317
6.3
95.0
––
–22
.814
.88.
0–
Mas
sach
uset
ts51
9.4
337.
618
1.8
243.
815
8.5
85.3
223.
714
5.4
78.3
51.9
33.7
18.2
–
Mic
higa
n12
6.6
96.7
29.9
22.3
17.0
5.3
97.8
74.7
23.1
6.6
5.0
1.5
–
Min
neso
ta16
.733
.5-1
6.8
0.1
0.1
0.0
16.4
10.7
5.7
0.2
0.1
0.1
22.6
Mis
siss
ippi
227.
418
4.5
42.9
––
–22
3.2
181.
142
.14.
33.
50.
8–
Mis
sour
i18
1.4
133.
148
.211
3.8
83.6
30.3
50.0
36.7
13.3
17.6
12.9
4.7
–
Mon
tana
97.4
74.5
23.0
26.0
19.9
6.1
65.6
50.1
15.5
5.8
4.5
1.4
–
Neb
rask
a82
.856
.626
.268
.546
.821
.712
.18.
33.
82.
21.
50.
7–
Nev
ada
47.3
35.1
12.2
6.3
4.6
1.6
38.9
28.9
10.1
2.1
1.6
0.5
–
December 201584
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
Stat
e
Tota
l CH
IP
Bene
fits
Stat
e pr
ogra
m a
dmin
istr
atio
n
Sect
ion
2105
(g)
spen
ding
2M
edic
aid-
expa
nsio
n CH
IPSe
para
te C
HIP
pro
gram
s an
d co
vera
ge o
f pre
gnan
t wom
en1
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Tota
lFe
dera
lSt
ate
Fede
ral
New
Ham
pshi
re$1
5.7
$16.
3-$
0.6
$15.
6$1
0.1
$5.4
$0.0
$0.0
$0.0
$0.1
$0.1
$0.1
$6.1
New
Jer
sey
433.
728
1.3
152.
420
8.1
135.
372
.819
5.3
126.
468
.830
.319
.610
.7–
New
Mex
ico
76.6
60.1
16.5
75.2
59.0
16.2
––
–1.
61.
30.
3–
New
Yor
k1,
221.
079
3.7
427.
261
9.9
402.
921
7.0
581.
037
7.8
203.
320
.013
.07.
0–
Nor
th C
arol
ina
423.
232
1.9
101.
418
4.7
140.
444
.222
7.5
173.
054
.511
.08.
42.
6–
Nor
th D
akot
a25
.516
.68.
911
.47.
44.
012
.78.
24.
41.
50.
90.
5–
Ohi
o37
7.3
279.
797
.636
7.0
272.
195
.0–
––
10.3
7.6
2.7
–
Okl
ahom
a18
7.4
140.
247
.217
0.4
127.
542
.910
.98.
22.
76.
04.
51.
5–
Ore
gon
212.
815
7.9
54.9
––
–19
9.5
148.
051
.513
.49.
93.
5–
Penn
sylv
ania
448.
830
2.8
146.
035
.824
.111
.639
7.2
268.
012
9.2
15.8
10.7
5.2
–
Rhod
e Is
land
57.6
37.5
20.1
42.7
27.8
14.9
12.0
7.8
4.2
2.9
1.9
1.0
–
Sout
h Ca
rolin
a14
6.6
116.
230
.413
4.0
106.
427
.6–
––
12.6
9.8
2.8
–
Sout
h Da
kota
22.6
15.2
7.4
16.6
11.1
5.4
5.7
3.8
1.8
0.4
0.3
0.1
–
Tenn
esse
e21
3.5
161.
651
.949
.537
.512
.014
7.4
111.
635
.816
.612
.64.
0–
Texa
s1,
217.
986
5.6
352.
316
5.2
117.
447
.895
7.8
680.
727
7.1
94.8
67.4
27.4
–
Uta
h60
.447
.912
.516
.012
.73.
339
.231
.18.
15.
24.
11.
1–
Verm
ont
9.2
12.7
-3.6
6.7
4.7
2.0
1.9
1.3
0.6
0.6
0.4
0.2
6.3
Virg
inia
309.
920
1.4
108.
513
0.7
84.9
45.7
163.
410
6.2
57.2
15.8
10.3
5.5
–
Was
hing
ton
104.
810
4.7
0.1
17.2
11.2
6.0
82.5
53.7
28.8
5.1
3.3
1.8
36.5
Wes
t Virg
inia
56.5
45.1
11.4
3.2
2.6
0.6
49.3
39.3
10.0
4.0
3.2
0.8
–
Wis
cons
in24
0.9
180.
560
.411
1.4
79.3
32.1
118.
384
.433
.911
.28.
03.
28.
8
Wyo
min
g14
.29.
25.
00.
70.
50.
312
.98.
44.
50.
50.
30.
2–
Subt
otal
$12,
817.
5$9
,033
.0$3
,784
.4$5
,978
.7$4
,108
.0$1
,870
.7$6
,160
.9$4
,352
.7$1
,808
.3$6
78.1
$472
.9$2
05.2
$99.
7
Amer
ican
Sam
oa1.
71.
40.
31.
71.
40.
3–
––
––
––
Gua
m6.
74.
81.
96.
74.
81.
9–
––
––
––
N. M
aria
na Is
land
s1.
10.
90.
11.
10.
90.
1–
––
––
––
Puer
to R
ico
214.
914
9.5
65.4
214.
914
9.5
65.4
––
––
––
–
Virg
in Is
land
s5.
84.
01.
75.
84.
01.
7–
––
––
––
Tota
l$1
3,04
7.6
$9,1
93.7
$3,8
53.9
$6,2
08.9
$4,2
68.7
$1,9
40.1
$6,1
60.9
$4,3
52.7
$1,8
08.3
$678
.1$4
72.9
$205
.2$9
9.7
EXH
IBIT
32.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 85
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
Not
es: F
Y is
fisc
al y
ear.
Com
pone
nts
may
not
add
to to
tal d
ue to
roun
ding
. Fed
eral
CH
IP s
pend
ing
on a
dmin
istr
atio
n is
gen
eral
ly li
mite
d to
10
perc
ent o
f a s
tate
’s to
tal f
eder
al
CHIP
spe
ndin
g fo
r the
yea
r. St
ates
with
a M
edic
aid-
expa
nsio
n CH
IP p
rogr
am m
ay e
lect
to re
ceiv
e re
imbu
rsem
ent f
or a
dmin
istr
ativ
e sp
endi
ng fr
om M
edic
aid
rath
er th
an C
HIP
fu
nds;
Med
icai
d fu
nds
are
not s
how
n in
this
exh
ibit.
1
Thre
e st
ates
(Col
orad
o, N
ew J
erse
y, an
d Rh
ode
Isla
nd) u
se C
HIP
fund
s to
pro
vide
cov
erag
e fo
r pre
gnan
t wom
en.
2 Se
ctio
n 21
05(g
) of t
he S
ocia
l Sec
urity
Act
per
mits
11
qual
ifyin
g st
ates
to u
se C
HIP
fund
s to
pay
the
diff
eren
ce b
etw
een
the
regu
lar M
edic
aid
mat
chin
g ra
te a
nd th
e en
hanc
ed C
HIP
mat
chin
g ra
te fo
r Med
icai
d-en
rolle
d, M
edic
aid-
finan
ced
child
ren
who
se fa
mily
inco
me
exce
eds
133
perc
ent o
f the
fede
ral p
over
ty le
vel.
Alth
ough
thes
e ar
e CH
IP fu
nds,
they
eff
ectiv
ely
redu
ce s
tate
spe
ndin
g on
chi
ldre
n in
Med
icai
d an
d do
not
requ
ire a
sta
te m
atch
with
in th
e CH
IP p
rogr
am. I
n ca
ses
whe
re th
e su
m o
f 210
5(g)
fe
dera
l CH
IP s
pend
ing
(for
Med
icai
d en
rolle
es) a
nd re
gula
r fed
eral
CH
IP s
pend
ing
(for
CH
IP e
nrol
lees
) exc
eeds
tota
l spe
ndin
g fo
r CH
IP e
nrol
lees
, sta
tes
are
show
n in
this
ex
hibi
t as
havi
ng n
egat
ive
stat
e CH
IP s
pend
ing
(Con
nect
icut
, Min
neso
ta, N
ew H
amps
hire
, and
Ver
mon
t).
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
Med
icai
d an
d CH
IP B
udge
t Exp
endi
ture
Sys
tem
(MBE
S/CB
ES) d
ata
from
the
Cent
ers
for M
edic
are
& M
edic
aid
Serv
ices
as
of M
arch
6, 2
015.
EXH
IBIT
32.
(co
ntin
ued)
December 201586
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
Stat
e
FY 2
014
fe
dera
l CH
IP
spen
ding
FY 2
015
allo
tmen
t in
crea
se fa
ctor
Full
year
FY
2015
am
ount
bas
ed o
n re
base
d am
ount
1
Firs
t hal
f FY
201
5 al
lotm
ent2
Seco
nd h
alf
FY 2
015
allo
tmen
t3
FY 2
015
fe
dera
l CH
IP
allo
tmen
ts
AB
C =
A ×
BD
= C
× 86
.5%
E =
2.85
0 bi
llion
×
(D /
colu
mn
D to
tal)
F =
D +
EAl
abam
a$1
41.1
1.
0595
$149
.5
$129
.2
$43.
7 $1
72.9
Al
aska
19.5
1.
0609
20.7
17
.9
6.0
23.9
Ar
izon
a65
.8
1.05
9669
.7
60.3
20
.4
80.7
Ar
kans
as76
.7
1.05
9581
.2
70.2
23
.7
94.0
Ca
lifor
nia
1,42
3.1
1.05
951,
507.
7 1,
303.
7 44
0.4
1,74
4.1
Colo
rado
128.
0 1.
0639
136.
2 11
7.7
39.8
15
7.5
Conn
ectic
ut39
.2
1.05
9541
.6
35.9
12
.1
48.1
De
law
are
16.5
1.
0595
17.5
15
.1
5.1
20.3
Di
stric
t of C
olum
bia
16.4
1.
0921
17.9
15
.5
5.2
20.7
Fl
orid
a46
0.0
1.06
3848
9.3
423.
1 14
2.9
566.
0 G
eorg
ia33
4.7
1.06
0535
4.9
306.
9 10
3.7
410.
6 H
awai
i37
.6
1.06
5240
.0
34.6
11
.7
46.3
Id
aho
54.0
1.
0600
57.2
49
.5
16.7
66
.2
Illin
ois
294.
9 1.
0595
312.
4 27
0.1
91.3
36
1.4
Indi
ana
132.
9 1.
0595
140.
8 12
1.7
41.1
16
2.9
Iow
a10
2.8
1.05
9810
8.9
94.2
31
.8
126.
0 Ka
nsas
69.5
1.
0595
73.6
63
.6
21.5
85
.1
Kent
ucky
140.
3 1.
0595
148.
6 12
8.5
43.4
17
1.9
Loui
sian
a14
7.0
1.05
9515
5.7
134.
6 45
.5
180.
1 M
aine
22.3
1.
0595
23.7
20
.5
6.9
27.4
M
aryl
and
191.
2 1.
0595
202.
5 17
5.1
59.2
23
4.3
Mas
sach
uset
ts33
7.6
1.05
9535
7.7
309.
3 10
4.5
413.
8 M
ichi
gan
96.7
1.
0595
102.
5 88
.6
29.9
11
8.6
Min
esso
ta33
.5
1.06
0935
.6
30.7
10
.4
41.1
M
issi
ssip
pi18
4.5
1.05
9519
5.5
169.
1 57
.1
226.
2 M
isso
uri
133.
1 1.
0595
141.
1 12
2.0
41.2
16
3.2
Mon
tana
74.5
1.
0650
79.3
68
.6
23.2
91
.7
Neb
rask
a56
.6
1.06
4660
.2
52.1
17
.6
69.7
N
evad
a35
.1
1.06
1437
.3
32.2
10
.9
43.1
N
ew H
amps
hire
16.3
1.
0595
17.3
15
.0
5.1
20.0
N
ew J
erse
y28
1.3
1.05
9529
8.1
257.
7 87
.1
344.
8 N
ew M
exic
o60
.1
1.05
9563
.7
55.0
18
.6
73.6
N
ew Y
ork
793.
7 1.
0595
840.
9 72
7.1
245.
7 97
2.8
EXH
IBIT
33.
Fed
eral
CH
IP A
llotm
ents
, FY
2015
(mill
ions
)
MACStats: Medicaid and CHIP Data Book 87
Section 3: Program Enrollment and Spending—CHIP
MAC
Stat
sSe
ctio
n 3
Stat
e
FY 2
014
fe
dera
l CH
IP
spen
ding
FY 2
015
allo
tmen
t in
crea
se fa
ctor
Full
year
FY
2015
am
ount
bas
ed o
n re
base
d am
ount
1
Firs
t hal
f FY
201
5 al
lotm
ent2
Seco
nd h
alf
FY 2
015
allo
tmen
t3
FY 2
015
fe
dera
l CH
IP
allo
tmen
ts
AB
C =
A ×
BD
= C
× 86
.5%
E =
2.85
0 bi
llion
×
(D /
colu
mn
D to
tal)
F =
D +
EN
orth
Car
olin
a$3
21.9
1.
0609
$341
.5
$295
.3
$99.
8 $3
95.0
N
orth
Dak
ota
16.6
1.
0966
18.2
15
.7
5.3
21.0
O
hio
279.
7 1.
0595
296.
3 25
6.2
86.6
34
2.8
Okl
ahom
a14
0.2
1.06
7414
9.6
129.
4 43
.7
173.
1 O
rego
n15
7.9
1.05
9516
7.3
144.
7 48
.9
193.
5 Pe
nnsy
lvan
ia30
2.8
1.05
9532
0.8
277.
4 93
.7
371.
1 Rh
ode
Isla
nd37
.5
1.05
9539
.8
34.4
11
.6
46.0
So
uth
Caro
lina
116.
2 1.
0627
123.
5 10
6.8
36.1
14
2.9
Sout
h Da
kota
15.2
1.
0714
16.3
14
.1
4.8
18.9
Te
nnes
see
161.
6 1.
0595
171.
2 14
8.1
50.0
19
8.1
Texa
s86
5.6
1.06
7492
3.9
798.
8 26
9.9
1,06
8.7
Uta
h47
.9
1.06
7851
.1
44.2
14
.9
59.1
Ve
rmon
t12
.7
1.05
9513
.5
11.6
3.
9 15
.6
Virg
inia
201.
4 1.
0626
214.
0 18
5.1
62.5
24
7.6
Was
hing
ton
104.
7 1.
0649
111.
5 96
.4
32.6
12
9.0
Wes
t Virg
inia
45.1
1.
0595
47.8
41
.3
14.0
55
.2
Wis
cons
in18
0.5
1.05
9519
1.3
165.
4 55
.9
221.
2 W
yom
ing
9.2
1.06
739.
8 8.
5 2.
9 11
.4
Subt
otal
$9
,033
.0
$9,5
86.1
$8
,288
.9
$2,8
00.3
$1
1,08
9.2
Amer
ican
Sam
oa1.
4 1.
0595
1.5
1.3
0.4
1.7
Gua
m4.
8 1.
0595
5.1
4.4
1.5
5.9
N. M
aria
na Is
land
s0.
9 1.
0636
1.0
0.9
0.3
1.2
Puer
to R
ico
149.
5 1.
0595
158.
4 13
7.0
46.3
18
3.2
Virg
in Is
land
s4.
0 1.
0595
4.3
3.7
1.3
5.0
Tota
l $9
,193
.7
$9,7
56.3
$8
,436
.1
$2,8
50.0
$1
1,28
6.1
Not
es: F
Y is
fisc
al y
ear.
For o
dd-n
umbe
red
year
s (e
.g.,
FY 2
015)
, fed
eral
CH
IP a
llotm
ents
are
bas
ed o
n ea
ch s
tate
’s p
rior-y
ear s
pend
ing.
1
Colu
mn
C co
ntai
ns th
e fu
ll ye
ar a
mou
nt b
ased
on
reba
sed
amou
nt d
escr
ibed
in S
ectio
n 21
04(m
)(3)
(C) o
f the
Soc
ial S
ecur
ity A
ct.
2 Th
e fir
st h
alf a
llotm
ent i
s ca
lcul
ated
by
mul
tiply
ing
the
full
year
am
ount
in C
olum
n C
by th
e fir
st h
alf r
atio
des
crib
ed in
Sec
tion
2104
(m)(
3)(D
) of t
he S
ocia
l Sec
urity
Act
, w
hich
is e
qual
to 8
6.46
7879
%.
3 Th
e se
cond
hal
f allo
tmen
t is
calc
ulat
ed b
y m
ultip
lyin
g th
e $2
.850
bill
ion
prov
ided
in s
ectio
n 21
04(a
)(18
)(B)
of t
he S
ocia
l Sec
urity
Act
by
the
ratio
equ
al to
eac
h st
ate’
s pr
opor
tion
of th
e to
tal a
mou
nt a
war
ded
for t
he fi
rst h
alf F
Y 20
15 C
HIP
allo
tmen
ts in
Col
umn
D.
Sour
ce: C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es (C
MS)
, 201
5, e
mai
l to
MAC
PAC
staf
f, Fe
brua
ry 9
.
EXH
IBIT
33.
(co
ntin
ued)
SECTION 4
Medicaid and CHIP Eligibility
December 201590
Section 4: Medicaid and CHIP Eligibility
Section 4: Medicaid and CHIP Eligibility
Key Points• More than half of states are now covering low-income adults, for whom a new Medicaid
eligibility group was added in 2014. Most of these new adults are eligible at incomes up to 138 percent of the federal poverty level (FPL), which amounts to $16,243 for a single individual (Exhibits 35 and 37).
• Beginning in 2014, Medicaid and CHIP eligibility levels for most child and adult populations reflect the application of uniform modified adjusted gross income (MAGI) rules across states. A maintenance of effort provision also prevents states from lowering their existing eligibility levels for children through the end of FY 2019 (Exhibits 34 and 35).
• Eligibility criteria for individuals eligible for Medicaid on the basis of disability and for individuals age 65 and older, who are not subject to MAGI rules, were largely unchanged between 2014 and 2015 (Exhibit 36).
• In the lower 48 states and the District of Columbia, 100 percent of the 2015 FPL is $11,770 for an individual, plus $4,160 for each additional family member (Exhibit 37).
MACStats: Medicaid and CHIP Data Book 91
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
s
Stat
e
Med
icai
d co
vera
ge
CHIP
pro
gram
type
2 (a
s of
May
1, 2
015)
Sepa
rate
CH
IP
cove
rage
Med
icai
d/CH
IP
cove
rage
Infa
nts
unde
r age
1Ag
e 1–
5Ag
e 6–
18Bi
rth
thro
ugh
age
18U
nbor
n ch
ildre
n3
Preg
nant
wom
en
and
deem
ed
new
born
s4M
edic
aid
fund
ed1
CHIP
fu
nded
1M
edic
aid
fund
ed1
CHIP
fu
nded
1M
edic
aid
fund
ed1
CHIP
fu
nded
1
Alab
ama
141%
–14
1%–
141%
107–
141%
Com
bina
tion
312%
–14
1%Al
aska
17
715
9–20
3%17
715
9–20
3%17
712
4–20
3M
edic
aid
expa
nsio
n–
–20
0Ar
izon
a514
7–
141
–13
310
4–13
3Co
mbi
natio
n20
0–
156
Arka
nsas
142
–14
2–
142
107–
142
Com
bina
tion
211
209%
209
Calif
orni
a20
820
8–26
114
214
2–26
113
310
8–26
1Co
mbi
natio
n31
7631
720
8Co
lora
do
142
–14
2–
142
108–
142
Com
bina
tion
260
–19
5/26
0Co
nnec
ticut
19
6–
196
–19
6–
Sepa
rate
318
–25
8De
law
are
212
194–
212
142
–13
311
0–13
3Co
mbi
natio
n21
2–
212
Dist
rict o
f Col
umbi
a31
920
6–31
931
914
6–31
931
911
2–31
9M
edic
aid
expa
nsio
n–
–31
9Fl
orid
a20
619
2–20
614
0–
133
112–
133
Com
bina
tion
2107
–19
1G
eorg
ia
205
–14
9–
133
113–
133
Com
bina
tion
247
–22
0H
awai
i 19
119
1–30
813
913
9–30
813
310
5–30
8M
edic
aid
expa
nsio
n–
–19
1Id
aho
142
–14
2–
133
107–
133
Com
bina
tion
185
–13
3Ill
inoi
s 14
2–
142
–14
210
8–14
2Co
mbi
natio
n31
320
820
8In
dian
a 20
815
7–20
815
814
1–15
815
810
6–15
8Co
mbi
natio
n25
0–
208
Iow
a37
524
0–37
516
7–
167
122–
167
Com
bina
tion
302
–37
5Ka
nsas
16
6–
149
–13
311
3–13
3Co
mbi
natio
n23
9–
166
Kent
ucky
19
5–
142
142–
159
133
109–
159
Com
bina
tion
213
–19
5Lo
uisi
ana
142
142–
212
142
142–
212
142
108–
212
Com
bina
tion
250
209
133
Mai
ne
191
–15
714
0–15
715
713
2–15
7Co
mbi
natio
n20
8–
209
Mar
ylan
d 19
419
4–31
713
813
8–31
713
310
9–31
7M
edic
aid
expa
nsio
n–
–25
9M
assa
chus
etts
200
185–
200
150
133–
150
150
114–
150
Com
bina
tion
300
200
200
Mic
higa
n 19
5–
160
143–
160
160
109–
160
Com
bina
tion
212
195
195
Min
neso
ta8
275
275-
283
275
–27
5–
Com
bina
tion
–27
827
8M
issi
ssip
pi
194
–14
3–
133
107–
133
Com
bina
tion
209
–19
4M
isso
uri
196
–14
814
8–15
014
811
0–15
0Co
mbi
natio
n30
0–
196
Mon
tana
143
–14
3–
133
109–
143
Com
bina
tion
261
–15
7N
ebra
ska
162
162–
213
145
145–
213
133
109–
213
Com
bina
tion
–19
719
4N
evad
a16
0–
160
–13
312
2–13
3Co
mbi
natio
n20
0–
160
New
Ham
pshi
re
196
196–
318
196
196–
318
196
196–
318
Med
icai
d ex
pans
ion
––
196
New
Jer
sey
194
–14
2–
142
107–
142
Com
bina
tion
350
–19
4/20
0N
ew M
exic
o 24
020
0–30
024
020
0–30
019
013
8–24
0M
edic
aid
expa
nsio
n–
–25
0
EXH
IBIT
34.
Med
icai
d an
d CH
IP In
com
e El
igib
ility
Lev
els
as a
Per
cent
age
of th
e FP
L fo
r Chi
ldre
n an
d Pr
egna
nt W
omen
by
Stat
e,
Sept
embe
r 201
5
Sect
ion
4
December 201592
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
sSe
ctio
n 4
EXH
IBIT
34.
(co
ntin
ued)
Stat
e
Med
icai
d co
vera
ge
CHIP
pro
gram
type
2 (a
s of
May
1, 2
015)
Sepa
rate
CH
IP
cove
rage
Med
icai
d/CH
IP
cove
rage
Infa
nts
unde
r age
1Ag
e 1–
5Ag
e 6–
18Bi
rth
thro
ugh
age
18U
nbor
n ch
ildre
n3
Preg
nant
wom
en
and
deem
ed
new
born
s4M
edic
aid
fund
ed1
CHIP
fu
nded
1M
edic
aid
fund
ed1
CHIP
fu
nded
1M
edic
aid
fund
ed1
CHIP
fu
nded
1
New
Yor
k 21
8%19
6–21
8%14
9%–
149%
110–
149%
Com
bina
tion
400%
–21
8%N
orth
Car
olin
a 21
019
4–21
021
014
1–21
0%13
310
7–13
3Co
mbi
natio
n21
19–
196
Nor
th D
akot
a14
7–
147
–13
311
1–13
3Co
mbi
natio
n17
0–
147
Ohi
o15
614
1–20
615
614
1–20
615
610
7–20
6M
edic
aid
expa
nsio
n–
–20
0O
klah
oma
205
169–
205
205
151–
205
205
115–
205
Com
bina
tion
–20
5%13
3O
rego
n 18
513
3–18
513
3–
133
100–
133
Com
bina
tion
300
185
185
Penn
sylv
ania
21
5–
157
–13
311
9–13
3Co
mbi
natio
n31
4–
215
Rhod
e Is
land
190
190–
261
142
142–
261
133
109–
261
Com
bina
tion
–25
319
0/25
3So
uth
Caro
lina
194
194–
208
143
143–
208
133
107–
208
Med
icai
d ex
pans
ion
––
194
Sout
h Da
kota
18
217
7–18
218
217
7–18
218
212
4–18
2Co
mbi
natio
n20
4–
133
Tenn
esse
e1019
5–
142
–13
310
9–13
3Co
mbi
natio
n25
025
019
5Te
xas
198
–14
4–
133
109–
133
Com
bina
tion
201
202
198
Uta
h13
9–
139
–13
310
5–13
3Co
mbi
natio
n20
0–
139
Verm
ont
312
237–
312
312
237–
312
312
237–
312
Med
icai
d ex
pans
ion
––
208
Virg
inia
143
–14
3–
143
109–
143
Com
bina
tion
200
–14
3/20
0W
ashi
ngto
n 21
0–
210
–21
0–
Sepa
rate
312
193
193
Wes
t Virg
inia
15
8–
141
–13
310
8–13
3Co
mbi
natio
n30
0–
158
Wis
cons
in
301
–18
6–
133
101–
151
Com
bina
tion
301
301
301
Wyo
min
g 15
4–
154
–13
311
9–13
3Co
mbi
natio
n20
0–
154
Not
es: F
PL is
fede
ral p
over
ty le
vel.
In 2
015,
100
per
cent
FPL
is $
11,7
70 fo
r an
indi
vidu
al p
lus
$4,1
60 fo
r eac
h ad
ditio
nal f
amily
mem
ber i
n th
e lo
wer
48
stat
es a
nd th
e Di
stric
t of
Col
umbi
a. W
hen
dete
rmin
ing
Med
icai
d an
d CH
IP e
ligib
ility
prio
r to
2014
, sta
tes
had
the
flexi
bilit
y to
dis
rega
rd in
com
e so
urce
s an
d am
ount
s of
thei
r cho
osin
g. B
egin
ning
in
201
4, u
nifo
rm m
odifi
ed a
djus
ted
gros
s in
com
e (M
AGI)
rule
s m
ust b
e us
ed to
det
erm
ine
Med
icai
d an
d CH
IP e
ligib
ility
for m
ost n
on-d
isab
led
child
ren
and
adul
ts u
nder
age
65
, inc
ludi
ng th
e gr
oups
sho
wn
in th
is ta
ble.
As
a re
sult,
sta
tes
are
now
requ
ired
to u
se M
AGI-c
onve
rted
elig
ibili
ty le
vels
that
acc
ount
for t
he c
hang
e in
inco
me-
coun
ting
rule
s.
The
elig
ibili
ty le
vels
sho
wn
in th
is ta
ble
refle
ct th
ese
MAG
I-con
vert
ed le
vels
or a
noth
er M
AGI-b
ased
inco
me
limit
in e
ffec
t in
each
sta
te fo
r the
se g
roup
s as
of S
epte
mbe
r 201
5.
Und
er fe
dera
l reg
ulat
ions
, the
eff
ectiv
e in
com
e lim
its m
ay b
e hi
gher
by
5 pe
rcen
t of t
he F
PL th
an th
ose
show
n on
this
tabl
e to
acc
ount
for a
gen
eral
inco
me
disr
egar
d th
at
appl
ies
to a
n in
divi
dual
’s d
eter
min
atio
n of
elig
ibili
ty fo
r Med
icai
d an
d CH
IP o
vera
ll, ra
ther
than
for p
artic
ular
elig
ibili
ty g
roup
s w
ithin
Med
icai
d or
CH
IP.
Med
icai
d co
vera
ge o
f chi
ldre
n un
der a
ge 1
9 w
ith in
com
es b
elow
sta
tes’
elig
ibili
ty le
vels
in e
ffec
t as
of M
arch
31,
199
7, c
ontin
ues
to b
e fin
ance
d by
Med
icai
d (T
itle
XIX)
fund
ing.
An
y ex
pans
ion
of e
ligib
ility
to u
nins
ured
chi
ldre
n ab
ove
thos
e le
vels
—th
roug
h ex
pans
ions
of M
edic
aid
or th
roug
h se
para
te C
HIP
pro
gram
s—is
gen
eral
ly fi
nanc
ed b
y CH
IP
(Titl
e XX
I) fu
ndin
g. C
HIP
fund
ing
is n
ot p
erm
itted
for c
hild
ren
with
oth
er c
over
age.
Thu
s, w
here
Med
icai
d co
vera
ge in
this
tabl
e sh
ows
over
lapp
ing
elig
ibili
ty le
vels
for M
edic
aid
fund
ing
and
CHIP
fund
ing,
chi
ldre
n w
ith n
o ot
her c
over
age
are
fund
ed b
y CH
IP, w
hile
chi
ldre
n w
ith o
ther
cov
erag
e ar
e fu
nded
by
Med
icai
d. P
regn
ant w
omen
can
rece
ive
Med
icai
d- o
r CH
IP-fu
nded
ser
vice
s th
roug
h re
gula
r sta
te p
lan
elig
ibili
ty p
athw
ays
or th
roug
h Se
ctio
n 11
15 w
aive
rs; i
n ad
ditio
n, th
e un
born
chi
ldre
n of
pre
gnan
t wom
en m
ay
rece
ive
CHIP
-fund
ed c
over
age
unde
r a s
tate
pla
n op
tion.
Dee
med
new
born
s ar
e in
fant
s up
to a
ge 1
who
are
dee
med
elig
ible
for M
edic
aid
or C
HIP
—w
ith n
o se
para
te a
pplic
atio
n or
elig
ibili
ty d
eter
min
atio
n re
quire
d—if
thei
r mot
her w
as e
nrol
led
at th
e tim
e of
thei
r birt
h.
MACStats: Medicaid and CHIP Data Book 93
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
sSe
ctio
n 4
EXH
IBIT
34.
(co
ntin
ued)
1 U
nder
Med
icai
d fu
nded
, the
re is
no
low
er b
ound
for i
ncom
e el
igib
ility
. The
elig
ibili
ty le
vels
list
ed u
nder
Med
icai
d fu
nded
are
the
high
est i
ncom
e le
vels
und
er w
hich
eac
h ag
e gr
oup
of c
hild
ren
is c
over
ed u
nder
the
Med
icai
d st
ate
plan
, whe
re e
ither
all
or ju
st in
sure
d ch
ildre
n ar
e cl
aim
ed w
ith M
edic
aid
fund
ing.
The
elig
ibili
ty le
vels
list
ed u
nder
CH
IP fu
nded
are
the
inco
me
leve
ls to
whi
ch M
edic
aid
has
expa
nded
with
CH
IP fu
ndin
g si
nce
its c
reat
ion
in 1
997.
For
sta
tes
that
hav
e di
ffer
ent C
HIP
-fund
ed e
ligib
ility
leve
ls
for c
hild
ren
age
6 th
roug
h 13
and
age
14
thro
ugh
18, t
his
tabl
e sh
ows
only
the
leve
ls fo
r chi
ldre
n ag
e 6
thro
ugh
13. I
n ad
ditio
n, S
ectio
n 21
05(g
) of t
he S
ocia
l Sec
urity
Act
pe
rmits
11
qual
ifyin
g st
ates
to u
se C
HIP
fund
s to
pay
the
diff
eren
ce b
etw
een
the
regu
lar M
edic
aid
mat
chin
g ra
te a
nd th
e en
hanc
ed C
HIP
mat
chin
g ra
te fo
r Med
icai
d-en
rolle
d,
Med
icai
d-fin
ance
d un
insu
red
child
ren
who
se fa
mily
inco
me
exce
eds
133
perc
ent F
PL (n
ot s
epar
atel
y no
ted
on th
is ta
ble)
.2
Und
er C
HIP
, sta
tes
have
the
optio
n to
use
an
expa
nsio
n of
Med
icai
d, a
sep
arat
e CH
IP p
rogr
am, o
r a c
ombi
natio
n of
bot
h ap
proa
ches
. Nin
e st
ates
(inc
ludi
ng th
e Di
stric
t of
Col
umbi
a) a
re M
edic
aid
expa
nsio
ns a
nd 2
sta
tes
are
sepa
rate
CH
IP o
nly
(Con
nect
icut
and
Was
hing
ton)
. Fo
rty
stat
es a
re c
ombi
natio
n pr
ogra
ms—
and
amon
g th
ose,
11
cons
ider
them
selv
es to
hav
e se
para
te p
rogr
ams
but a
re te
chni
cally
com
bina
tions
due
to th
e tr
ansi
tion
of c
hild
ren
belo
w 1
33 p
erce
nt F
PL fr
om s
epar
ate
CHIP
to M
edic
aid
(Ala
bam
a, A
rizon
a, G
eorg
ia, K
ansa
s, M
issi
ssip
pi, O
rego
n, P
enns
ylva
nia,
Tex
as, U
tah,
Wes
t Virg
inia
, Wyo
min
g).
3 Se
para
te C
HIP
elig
ibili
ty fo
r chi
ldre
n bi
rth
thro
ugh
age
18 g
ener
ally
beg
ins
whe
re M
edic
aid
cove
rage
end
s (a
s sh
own
in th
e pr
evio
us c
olum
ns).
For u
nbor
n ch
ildre
n, th
ere
is
no lo
wer
bou
nd fo
r inc
ome
elig
ibili
ty if
the
mot
her i
s no
t elig
ible
for M
edic
aid.
4 Pr
egna
nt w
omen
can
be
cove
red
with
Med
icai
d or
CH
IP fu
ndin
g. U
nder
CH
IP, c
over
age
can
be th
roug
h a
stat
e pl
an o
ptio
n fo
r tar
gete
d lo
w-in
com
e pr
egna
nt w
omen
or
thro
ugh
cont
inua
tion
of a
n ex
istin
g Se
ctio
n 11
15 w
aive
r. W
hen
two
valu
es a
re s
how
n in
this
col
umn,
the
first
is fo
r Med
icai
d an
d th
e se
cond
is fo
r CH
IP.
5 Al
thou
gh A
rizon
a’s
sepa
rate
CH
IP p
rogr
am u
p to
200
per
cent
FPL
(Kid
sCar
e) h
as b
een
clos
ed to
new
enr
ollm
ent s
ince
Jan
uary
201
0, th
ousa
nds
of c
hild
ren
wer
e ad
ded
to
the
stat
e’s
CHIP
-fund
ed c
over
age
thro
ugh
the
stat
e’s
Kids
Care
II w
aive
r, w
hich
was
in e
ffec
t fro
m M
ay 2
012
until
Jan
uary
201
4.6
Calif
orni
a ha
s a
sepa
rate
CH
IP p
rogr
am in
thre
e co
untie
s on
ly th
at c
over
s ch
ildre
n up
to 3
17 p
erce
nt F
PL.
7 Fl
orid
a’s
sepa
rate
CH
IP p
rogr
am c
over
s ch
ildre
n ag
e 1–
18.
8 In
Min
neso
ta, o
nly
infa
nts
(def
ined
by
the
stat
e as
bei
ng u
nder
age
2) a
re e
ligib
le fo
r the
Med
icai
d-ex
pans
ion
CHIP
pro
gram
.9
Nor
th C
arol
ina’
s se
para
te C
HIP
pro
gram
cov
ers
child
ren
age
6–18
.10
W
hile
Ten
ness
ee c
over
s ch
ildre
n w
ith C
HIP
-fund
ed M
edic
aid,
enr
ollm
ent i
s cu
rren
tly c
appe
d, e
xcep
t for
chi
ldre
n w
ho ro
ll ov
er fr
om tr
aditi
onal
Med
icai
d.
Sour
ces:
MAC
PAC,
201
5, a
naly
sis
of C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es (C
MS)
, 201
4, S
tate
Med
icai
d an
d CH
IP in
com
e el
igib
ility
sta
ndar
ds (F
or M
AGI G
roup
s, ba
sed
on s
tate
de
cisi
ons
as o
f Oct
ober
1, 2
014)
, htt
p://
ww
w.m
edic
aid.
gov/
med
icai
d-ch
ip-p
rogr
am-in
form
atio
n/pr
ogra
m-in
form
atio
n/do
wnl
oads
/med
icai
d-an
d-ch
ip-e
ligib
ility
-leve
ls-ta
ble.
pdf;
MAC
PAC,
201
5, a
naly
sis
of C
MS,
201
5, M
AGI c
onve
rsio
n pl
ans
and
SIPP
-bas
ed M
AGI c
onve
rsio
n re
sults
, htt
p://
ww
w.m
edic
aid.
gov/
med
icai
d-ch
ip-p
rogr
am-in
form
atio
n/by
-sta
te/b
y-st
ate.
htm
l; M
ACPA
C, 2
015,
ana
lysi
s of
CM
S, 2
015,
Med
icai
d st
ate
plan
am
endm
ents
, htt
p://
ww
w.m
edic
aid.
gov/
stat
e-re
sour
ce-c
ente
r/m
edic
aid-
stat
e-pl
an-
amen
dmen
ts/m
edic
aid-
stat
e-pl
an-a
men
dmen
ts.h
tml;
MAC
PAC,
201
5, a
naly
sis
of C
MS,
201
5, C
HIP
sta
te p
lan
amen
dmen
ts, h
ttp:
//w
ww
.med
icai
d.go
v/ch
ip/s
tate
-pro
gram
-in
form
atio
n/ch
ip-s
tate
-pro
gram
-info
rmat
ion.
htm
l; M
ACPA
C, 2
015,
ana
lysi
s of
CM
S, 2
015,
Chi
ldre
n’s
Hea
lth In
sura
nce
Prog
ram
: Pla
n ac
tivity
as
of M
ay 1
, 201
5, h
ttp:
//w
ww
.m
edic
aid.
gov/
chip
/dow
nloa
ds/c
hip-
map
; MAC
PAC,
201
5, a
naly
sis
of s
tate
web
site
s; a
nd M
ACPA
C, 2
015,
ana
lysi
s of
CM
S, 2
015,
em
ail t
o M
ACPA
C st
aff,
Oct
ober
29.
December 201594
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
sSe
ctio
n 4
EXH
IBIT
35.
Med
icai
d In
com
e El
igib
ility
Lev
els
as a
Per
cent
age
of th
e FP
L fo
r Non
-Age
d, N
on-D
isab
led,
Non
-Pre
gnan
t Adu
lts b
y St
ate,
Sep
tem
ber 2
015
Stat
ePa
rent
s an
d ca
reta
ker r
elat
ives
of
dep
ende
nt c
hild
ren1
Addi
tiona
l ind
ivid
uals
age
19–
642
Alab
ama
13%
–Al
aska
143
133%
(143
onl
y fo
r tho
se a
ge 1
9–20
)Ar
izon
a10
613
3Ar
kans
as17
133
Calif
orni
a10
913
3Co
lora
do68
133
Conn
ectic
ut15
013
3De
law
are
8713
3Di
stric
t of C
olum
bia
216
210
(216
onl
y fo
r tho
se a
ge 1
9–20
)Fl
orid
a29
29 o
nly
for t
hose
age
19–
20G
eorg
ia34
–H
awai
i10
513
3Id
aho
243
–4
Illin
ois
133
133
Indi
ana
1913
3Io
wa
5413
3Ka
nsas
33–
Kent
ucky
2313
3Lo
uisi
ana
193
–4
Mai
ne10
015
6 on
ly fo
r tho
se a
ge 1
9–20
4
Mar
ylan
d12
313
3M
assa
chus
etts
133
133
(150
onl
y fo
r tho
se a
ge 1
9–20
)M
ichi
gan
5413
3M
inne
sota
1335
1335
Mis
siss
ippi
23–
Mis
sour
i18
3–
4
Mon
tana
46–
4
Neb
rask
a58
–N
evad
a33
133
MACStats: Medicaid and CHIP Data Book 95
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
sSe
ctio
n 4
Stat
ePa
rent
s an
d ca
reta
ker r
elat
ives
of
dep
ende
nt c
hild
ren1
Addi
tiona
l ind
ivid
uals
age
19–
642
New
Ham
pshi
re68
%13
3%N
ew J
erse
y32
133
New
Mex
ico
4613
3N
ew Y
ork
133
133
Nor
th C
arol
ina
4444
onl
y fo
r tho
se a
ge 1
9–20
Nor
th D
akot
a53
133
Ohi
o90
133
Okl
ahom
a42
3–
4
Ore
gon
4113
3Pe
nnsy
lvan
ia33
133
Rhod
e Is
land
116
133
Sout
h Ca
rolin
a62
–So
uth
Dako
ta57
–Te
nnes
see
104
–Te
xas
15–
Uta
h45
3–
4
Verm
ont
5313
3Vi
rgin
ia49
–W
ashi
ngto
n40
133
Wes
t Virg
inia
1913
3W
isco
nsin
9595
Wyo
min
g56
–
Not
es: F
PL is
fede
ral p
over
ty le
vel.
In 2
015,
100
per
cent
FPL
is $
11,7
70 fo
r an
indi
vidu
al p
lus
$4,1
60 fo
r eac
h ad
ditio
nal f
amily
mem
ber i
n th
e lo
wer
48
stat
es a
nd th
e Di
stric
t of
Col
umbi
a. W
hen
dete
rmin
ing
Med
icai
d an
d CH
IP e
ligib
ility
prio
r to
2014
, sta
tes
had
the
flexi
bilit
y to
dis
rega
rd in
com
e so
urce
s an
d am
ount
s of
thei
r cho
osin
g. B
egin
ning
in
201
4, u
nifo
rm m
odifi
ed a
djus
ted
gros
s in
com
e (M
AGI)
rule
s m
ust b
e us
ed to
det
erm
ine
Med
icai
d an
d CH
IP e
ligib
ility
for m
ost n
on-d
isab
led
child
ren
and
adul
ts u
nder
age
65
, inc
ludi
ng th
e gr
oups
sho
wn
in th
is ta
ble.
As
a re
sult,
sta
tes
are
now
requ
ired
to u
se M
AGI-c
onve
rted
elig
ibili
ty le
vels
that
acc
ount
for t
he c
hang
e in
inco
me-
coun
ting
rule
s.
The
elig
ibili
ty le
vels
sho
wn
in th
is ta
ble
refle
ct th
ese
MAG
I-con
vert
ed le
vels
or a
noth
er M
AGI-b
ased
inco
me
limit
in e
ffec
t in
each
sta
te fo
r the
se g
roup
s as
of S
epte
mbe
r 20
15. U
nder
fede
ral r
egul
atio
ns, t
he e
ffec
tive
inco
me
limits
may
be
high
er b
y 5
perc
enta
ge p
oint
s of
the
FPL
than
thos
e sh
own
on th
is ta
ble
to a
ccou
nt fo
r a g
ener
al in
com
e di
sreg
ard
that
app
lies
to a
n in
divi
dual
’s d
eter
min
atio
n of
elig
ibili
ty fo
r Med
icai
d an
d CH
IP o
vera
ll, ra
ther
than
for p
artic
ular
elig
ibili
ty g
roup
s w
ithin
Med
icai
d or
CH
IP.
EXH
IBIT
35.
(co
ntin
ued)
December 201596
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
s
Stat
es a
re re
quire
d to
pro
vide
Med
icai
d co
vera
ge fo
r par
ents
and
oth
er c
aret
aker
rela
tives
(and
thei
r dep
ende
nt c
hild
ren)
, at a
min
imum
, at t
heir
1988
Aid
to F
amili
es w
ith
Depe
nden
t Chi
ldre
n (A
FDC)
elig
ibili
ty le
vels
. Und
er re
gula
r Med
icai
d st
ate
plan
rule
s, s
tate
s m
ay o
pt to
cov
er a
dditi
onal
par
ents
and
car
etak
er re
lativ
es; c
hild
ren
age
19 o
r 20;
an
d ot
her i
ndiv
idua
ls a
ged
19–
64 w
ho a
re n
ot p
regn
ant,
not e
ligib
le fo
r Med
icar
e, a
nd h
ave
inco
mes
at o
r bel
ow 1
33 p
erce
nt o
f the
fede
ral p
over
ty le
vel.
Stat
es m
ay a
lso
prov
ide
cove
rage
und
er S
ectio
n 11
15 w
aive
rs, w
hich
allo
w th
em to
ope
rate
thei
r Med
icai
d pr
ogra
ms
with
out r
egar
d to
cer
tain
sta
tuto
ry re
quire
men
ts. A
s no
ted
in th
is ta
ble,
the
cove
red
bene
fits
unde
r the
se w
aive
rs m
ay b
e m
ore
limite
d th
an th
ose
prov
ided
und
er re
gula
r sta
te p
lan
rule
s an
d m
ay n
ot b
e av
aila
ble
to a
ll in
divi
dual
s at
the
inco
me
leve
ls s
how
n.1
In s
tate
s th
at u
se d
olla
r am
ount
s ra
ther
than
per
cent
ages
of t
he F
PL to
det
erm
ine
elig
ibili
ty fo
r par
ents
, tho
se a
mou
nts
wer
e co
nver
ted
to a
per
cent
of t
he F
PL fo
r 201
5, a
nd
the
high
est p
erce
ntag
e w
as s
elec
ted
to re
flect
elig
ibili
ty le
vel f
or th
e gr
oup.
2 Re
flect
s st
ate
plan
cov
erag
e un
der S
ectio
n 19
02(a
)(10
)(A)
(i)(V
III) o
f the
Soc
ial S
ecur
ity A
ct fo
r ind
ivid
uals
who
are
age
19–
64, n
ot p
regn
ant,
not e
ligib
le fo
r Med
icar
e, a
nd
have
inco
me
at o
r bel
ow 1
33 p
erce
nt F
PL; s
tate
pla
n co
vera
ge fo
r chi
ldre
n ag
e 19
or 2
0 w
here
indi
cate
d; a
nd S
ectio
n 11
15 w
aive
r cov
erag
e th
at is
not
sub
ject
to th
e lim
itatio
ns
indi
cate
d in
not
e 4.
3 Re
flect
s pa
rent
cov
erag
e un
der t
he M
edic
aid
stat
e pl
an. T
he s
tate
has
som
e ad
ditio
nal c
over
age
abov
e st
ate
plan
elig
ibili
ty s
tand
ards
thro
ugh
a Se
ctio
n 11
15 d
emon
stra
tion
or a
pen
ding
dem
onst
ratio
n pr
opos
al. T
he d
emon
stra
tion
incl
udes
lim
itatio
ns o
n el
igib
ility
or b
enef
its, i
s no
t off
ered
to a
ll re
side
nts
of th
e st
ate,
or i
nclu
des
an e
nrol
lmen
t cap
.4
The
stat
e ha
s a
Sect
ion
1115
dem
onst
ratio
n or
a p
endi
ng d
emon
stra
tion
prop
osal
that
pro
vide
s M
edic
aid
cove
rage
to s
ome
low
-inco
me
adul
ts. T
he d
emon
stra
tion
incl
udes
lim
itatio
ns o
n el
igib
ility
or b
enef
its, i
s no
t off
ered
to a
ll re
side
nts
of th
e st
ate,
or i
nclu
des
an e
nrol
lmen
t cap
.5
Min
neso
ta im
plem
ente
d a
Basi
c H
ealth
Pro
gram
(BH
P) in
Jan
uary
201
5. In
divi
dual
s w
ith in
com
es b
etw
een
133
and
200
perc
ent F
PL w
ho w
ere
prev
ious
ly c
over
ed u
nder
a
Med
icai
d Se
ctio
n 11
15 w
aive
r are
now
cov
ered
und
er th
e BH
P.
Sour
ces:
MAC
PAC,
201
5, a
naly
sis
of C
ente
rs fo
r Med
icar
e &
Med
icai
d Se
rvic
es (C
MS)
, 201
4, S
tate
Med
icai
d an
d CH
IP in
com
e el
igib
ility
sta
ndar
ds (F
or M
AGI G
roup
s, b
ased
on
stat
e de
cisi
ons
as o
f Oct
ober
1, 2
014)
, htt
p://
ww
w.m
edic
aid.
gov/
med
icai
d-ch
ip-p
rogr
am-in
form
atio
n/pr
ogra
m-in
form
atio
n/do
wnl
oads
/med
icai
d-an
d-ch
ip-e
ligib
ility
-leve
ls-ta
ble.
pdf;
MAC
PAC,
201
5, a
naly
sis
of C
MS,
201
5, M
edic
aid
stat
e pl
an a
men
dmen
ts, h
ttp:
//w
ww
.med
icai
d.go
v/st
ate-
reso
urce
-cen
ter/
med
icai
d-st
ate-
plan
-am
endm
ents
/med
icai
d-st
ate-
plan
-am
endm
ents
.htm
l; M
ACPA
C, 2
015,
ana
lysi
s of
sta
te w
ebsi
tes;
and
MAC
PAC,
201
5, a
naly
sis
of C
MS,
201
5, e
mai
l to
MAC
PAC
staf
f, O
ctob
er 2
9, 2
015.
EXH
IBIT
35.
(co
ntin
ued)
Sect
ion
4
MACStats: Medicaid and CHIP Data Book 97
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
s
Stat
eSt
ate
elig
ibili
ty
type
1SS
I rec
ipie
nts
209(
b) e
ligib
ility
Pove
rty
leve
l2M
edic
ally
nee
dy3
Spec
ial i
ncom
e le
vel4
Alab
ama
1634
75%
––
–22
4%Al
aska
SSI c
riter
ia60
5–
––
179
Ariz
ona
1634
75–
100%
–22
4Ar
kans
as16
3475
–80
(age
d on
ly)
11%
224
Calif
orni
a16
3475
–10
061
–Co
lora
do16
3475
––
–22
4Co
nnec
ticut
209(
b)–
62%
–62
224
Dela
war
e16
3475
––
–18
7Di
stric
t of C
olum
bia
1634
75–
100
6422
4Fl
orid
a16
3475
–88
1822
4G
eorg
ia16
3475
––
3222
4H
awai
i20
9(b)
–65
100
42–
Idah
oSS
I crit
eria
75–
––
224
Illin
ois
209(
b)–
100
100
100
–In
dian
a616
3475
–10
0–
224
Iow
a16
3475
––
4922
4Ka
nsas
SSI c
riter
ia75
––
4822
4Ke
ntuc
ky16
3475
––
2222
4Lo
uisi
ana
1634
75–
7510
224
Mai
ne16
3475
–10
032
224
Mar
ylan
d16
3475
––
3622
4
Mas
sach
uset
ts7
1634
75–
100
(age
d)/
133
(dis
able
d)53
224
Mic
higa
n16
3475
–10
042
224
Min
neso
ta20
9(b)
–75
100
7522
4M
issi
ssip
pi16
3475
––
–22
4M
isso
uri
209(
b)–
8585
8513
1M
onta
na16
3475
––
64–
Neb
rask
aSS
I crit
eria
75–
100
40–
Nev
ada
SSI c
riter
ia75
––
–22
4
EXH
IBIT
36.
Med
icai
d In
com
e El
igib
ility
Lev
els
as a
Per
cent
age
of th
e FP
L fo
r Ind
ivid
uals
Age
65
and
Old
er a
nd P
erso
ns w
ith
Disa
bilit
ies
by S
tate
, 201
5
Sect
ion
4
December 201598
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
sSe
ctio
n 4
EXH
IBIT
36.
(co
ntin
ued)
Stat
eSt
ate
elig
ibili
ty
type
1SS
I rec
ipie
nts
209(
b) e
ligib
ility
Pove
rty
leve
l2M
edic
ally
nee
dy3
Spec
ial i
ncom
e le
vel4
New
Ham
pshi
re20
9(b)
–76
%–
60%
224%
New
Jer
sey
1634
75%
–10
0%37
224
New
Mex
ico
1634
75–
––
224
New
Yor
k16
3475
–84
84–
Nor
th C
arol
ina
1634
75–
100
25–
Nor
th D
akot
a20
9(b)
–83
–83
–O
hio
209(
b)–
64–
6422
4O
klah
oma6
SSI c
riter
ia75
–10
0–
224
Ore
gon
SSI c
riter
ia75
––
–22
4Pe
nnsy
lvan
ia16
3475
–10
043
224
Rhod
e Is
land
1634
75–
100
8722
4So
uth
Caro
lina
1634
75–
100
–22
4So
uth
Dako
ta16
3475
––
–22
4Te
nnes
see
1634
75–
––
224
Texa
s16
3475
––
–22
4U
tah
SSI c
riter
ia75
–10
010
022
4Ve
rmon
t16
3475
––
110
224
Virg
inia
209(
b)–
7580
4722
4W
ashi
ngto
n16
3475
––
7522
4W
est V
irgin
ia16
3475
––
2022
4W
isco
nsin
1634
75–
–60
224
Wyo
min
g16
3475
––
–22
4
Not
es: F
PL is
fede
ral p
over
ty le
vel.
SSI i
s Su
pple
men
tal S
ecur
ity In
com
e. In
201
5, 1
00 p
erce
nt F
PL is
$11
,770
for a
n in
divi
dual
and
$4,
160
for e
ach
addi
tiona
l fam
ily m
embe
r in
the
low
er 4
8 st
ates
and
the
Dist
rict o
f Col
umbi
a. E
ligib
ility
leve
ls s
how
n he
re a
pply
to c
ount
able
inco
me;
as
a re
sult,
sta
tes
that
use
opt
iona
l inc
ome
disr
egar
ds to
redu
ce
coun
tabl
e in
com
e ef
fect
ivel
y al
low
a la
rger
num
ber o
f peo
ple
to q
ualif
y at
a g
iven
elig
ibili
ty le
vel (
e.g.
, 100
per
cent
FPL
) rel
ativ
e to
sta
tes
that
do
not.
The
elig
ibili
ty le
vels
list
ed
in th
is e
xhib
it ar
e fo
r ind
ivid
uals
; the
elig
ibili
ty le
vels
for c
oupl
es d
iffer
for c
erta
in c
ateg
orie
s. In
add
ition
, inc
ome
elig
ibili
ty le
vels
for i
ndiv
idua
ls w
ho q
ualif
y ba
sed
on b
lindn
ess
may
be
high
er th
an fo
r ind
ivid
uals
who
qua
lify
base
d on
oth
er d
isab
ilitie
s or
bei
ng a
ge 6
5 or
old
er.
In m
ost s
tate
s, e
nrol
lmen
t in
the
SSI p
rogr
am fo
r ind
ivid
uals
age
65
and
olde
r and
per
sons
with
dis
abili
ties
auto
mat
ical
ly q
ualif
ies
them
for M
edic
aid.
How
ever
, 209
(b) s
tate
s m
ay u
se m
ore
rest
rictiv
e cr
iteria
(rel
ated
to in
com
e an
d as
sets
, dis
abili
ty, o
r bot
h) th
an S
SI w
hen
dete
rmin
ing
Med
icai
d el
igib
ility
. All
stat
es h
ave
the
optio
n of
cov
erin
g ad
ditio
nal p
eopl
e w
ith lo
w in
com
es o
r hig
h m
edic
al e
xpen
ses
thro
ugh
othe
r elig
ibili
ty p
athw
ays,
suc
h as
pov
erty
leve
l, m
edic
ally
nee
dy, a
nd s
peci
al in
com
e le
vel.
MACStats: Medicaid and CHIP Data Book 99
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
sSe
ctio
n 4
– D
ash
indi
cate
s th
at s
tate
doe
s no
t use
this
elig
ibili
ty p
athw
ay.
1 SS
I crit
eria
are
use
d to
det
erm
ine
Med
icai
d el
igib
ility
in b
oth
Sect
ion
1634
and
SSI
-crit
eria
sta
tes.
In S
ectio
n 16
34 s
tate
s, th
e fe
dera
l elig
ibili
ty d
eter
min
atio
n pr
oces
s fo
r SSI
au
tom
atic
ally
qua
lifie
s an
indi
vidu
al fo
r Med
icai
d; in
SSI
-crit
eria
sta
tes,
indi
vidu
als
mus
t sub
mit
info
rmat
ion
to th
e st
ate
for a
sep
arat
e el
igib
ility
det
erm
inat
ion.
Sec
tion
209(
b)
stat
es m
ay u
se e
ligib
ility
crit
eria
(rel
ated
to in
com
e an
d as
sets
, dis
abili
ty, o
r bot
h) m
ore
rest
rictiv
e th
an th
e SS
I pro
gram
but
may
not
use
mor
e re
stric
tive
crite
ria th
an th
ose
in e
ffec
t in
the
stat
e on
Jan
uary
1, 1
972.
If a
Sec
tion
209(
b) s
tate
doe
s no
t hav
e a
sepa
rate
med
ical
ly n
eedy
sta
ndar
d, it
mus
t allo
w in
divi
dual
s w
ith h
ighe
r inc
omes
to s
pend
do
wn
to th
e 20
9(b)
inco
me
leve
l sho
wn
here
by
dedu
ctin
g in
curr
ed m
edic
al e
xpen
ses
from
the
amou
nt o
f inc
ome
that
is c
ount
ed fo
r Med
icai
d el
igib
ility
pur
pose
s.2
Und
er th
e po
vert
y le
vel o
ptio
n, s
tate
s m
ay c
hoos
e to
pro
vide
Med
icai
d co
vera
ge to
per
sons
who
are
age
d or
dis
able
d an
d w
hose
inco
me
is a
bove
the
SSI o
r 209
(b) l
evel
, but
is
at o
r bel
ow th
e FP
L.3
Und
er th
e m
edic
ally
nee
dy o
ptio
n, in
divi
dual
s w
ith h
ighe
r inc
omes
can
spe
nd d
own
to th
e m
edic
ally
nee
dy in
com
e le
vel s
how
n he
re b
y de
duct
ing
incu
rred
med
ical
exp
ense
s fr
om th
e am
ount
of i
ncom
e th
at is
cou
nted
for M
edic
aid
elig
ibili
ty p
urpo
ses.
Fiv
e st
ates
(Con
nect
icut
, Lou
isia
na, M
ichi
gan,
Ver
mon
t, an
d Vi
rgin
ia) h
ave
a m
edic
ally
nee
dy
inco
me
stan
dard
that
var
ies
by lo
catio
n; th
e hi
ghes
t inc
ome
stan
dard
is li
sted
for e
ach
of th
ese
stat
es.
4 U
nder
the
spec
ial i
ncom
e le
vel o
ptio
n, s
tate
s ha
ve th
e op
tion
to p
rovi
de M
edic
aid
bene
fits
to p
eopl
e w
ho re
quire
at l
east
30
days
of n
ursi
ng h
ome
or o
ther
inst
itutio
nal c
are
and
have
inco
mes
up
to 3
00 p
erce
nt o
f the
SSI
ben
efit
rate
(whi
ch w
as a
bout
224
per
cent
FPL
in 2
015)
. The
inco
me
stan
dard
list
ed in
this
col
umn
may
be
for i
nstit
utio
nal
serv
ices
, hom
e an
d co
mm
unity
-bas
ed w
aive
r ser
vice
s, o
r bot
h.5
The
dolla
r am
ount
that
equ
als
the
uppe
r inc
ome
elig
ibili
ty le
vel f
or S
SI d
oes
not v
ary
by s
tate
; how
ever
, the
dol
lar a
mou
nt th
at e
qual
s th
e FP
L is
hig
her i
n Al
aska
, res
ultin
g in
a
low
er p
erce
ntag
e.6
Indi
ana
was
a 2
09(b
) sta
te u
ntil
June
1, 2
014,
at w
hich
poi
nt it
bec
ame
a 16
34 s
tate
; the
sta
te’s
pov
erty
leve
l gro
up a
lso
took
eff
ect o
n Ju
ne 1
, 201
4. O
klah
oma
was
a 2
09(b
) st
ate
until
Oct
ober
1, 2
015,
at w
hich
poi
nt it
bec
ame
an S
SI-c
riter
ia s
tate
.7
Mas
sach
uset
ts p
rovi
des
med
ical
ly n
eedy
cov
erag
e fo
r ind
ivid
uals
age
65
and
olde
r and
thos
e w
ho a
re e
ligib
le o
n th
e ba
sis
of d
isab
ility
, but
the
rule
s fo
r cou
ntin
g in
com
e an
d sp
end-
dow
n ex
pens
es v
ary
for t
hese
gro
ups.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
elig
ibili
ty in
form
atio
n fr
om s
tate
web
site
s an
d M
edic
aid
stat
e pl
ans
as o
f Jul
y 20
15.
EXH
IBIT
36.
(co
ntin
ued)
December 2015100
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
s
Stat
eFP
L
Annu
al a
mou
ntM
onth
ly a
mou
nt
Fam
ily s
ize
Fam
ily s
ize
12
34
Each
ad
ditio
nal
pers
on1
23
4
Each
ad
ditio
nal
pers
on
Low
er 4
8 st
ates
an
d DC
100%
$11,
770
$15,
930
$20,
090
$24,
250
$4,1
60$9
81$1
,328
$1,6
74$2
,021
$347
133
15,6
5421
,187
26,7
2032
,253
5,53
31,
305
1,76
62,
227
2,68
846
1
138
16,2
4321
,983
27,7
2433
,465
5,74
11,
354
1,83
22,
310
2,78
947
8
150
17,6
5523
,895
30,1
3536
,375
6,24
01,
471
1,99
12,
511
3,03
152
0
185
21,7
7529
,471
37,1
6744
,863
7,69
61,
815
2,45
63,
097
3,73
964
1
200
23,5
4031
,860
40,1
8048
,500
8,32
01,
962
2,65
53,
348
4,04
269
3
250
29,4
2539
,825
50,2
2560
,625
10,4
002,
452
3,31
94,
185
5,05
286
7
300
35,3
1047
,790
60,2
7072
,750
12,4
802,
943
3,98
35,
023
6,06
31,
040
400
47,0
8063
,720
80,3
6097
,000
16,6
403,
923
5,31
06,
697
8,08
31,
387
Alas
ka10
0%$1
4,72
0$1
9,92
0$2
5,12
0$3
0,32
0$5
,200
$1,2
27$1
,660
$2,0
93$2
,527
$433
133
19,5
7826
,494
33,4
1040
,326
6,91
61,
631
2,20
82,
784
3,36
057
6
138
20,3
1427
,490
34,6
6641
,842
7,17
61,
693
2,29
12,
889
3,48
759
8
150
22,0
8029
,880
37,6
8045
,480
7,80
01,
840
2,49
03,
140
3,79
065
0
185
27,2
3236
,852
46,4
7256
,092
9,62
02,
269
3,07
13,
873
4,67
480
2
200
29,4
4039
,840
50,2
4060
,640
10,4
002,
453
3,32
04,
187
5,05
386
7
250
36,8
0049
,800
62,8
0075
,800
13,0
003,
067
4,15
05,
233
6,31
71,
083
300
44,1
6059
,760
75,3
6090
,960
15,6
003,
680
4,98
06,
280
7,58
01,
300
400
58,8
8079
,680
100,
480
121,
280
20,8
004,
907
6,64
08,
373
10,1
071,
733
EXH
IBIT
37.
Inc
ome
as a
Per
cent
age
of th
e FP
L fo
r Var
ious
Fam
ily S
izes
, 201
5
Sect
ion
4
MACStats: Medicaid and CHIP Data Book 101
Section 4: Medicaid and CHIP Eligibility
MAC
Stat
s
Stat
eFP
L
Annu
al a
mou
ntM
onth
ly a
mou
nt
Fam
ily s
ize
Fam
ily s
ize
12
34
Each
ad
ditio
nal
pers
on1
23
4
Each
ad
ditio
nal
pers
on
Haw
aii
100%
$13,
550
$18,
330
$23,
110
$27,
890
$4,7
80$1
,129
$1,5
28$1
,926
$2,3
24$3
98
133
18,0
2224
,379
30,7
3637
,094
6,35
71,
502
2,03
22,
561
3,09
153
0
138
18,6
9925
,295
31,8
9238
,488
6,59
61,
558
2,10
82,
658
3,20
755
0
150
20,3
2527
,495
34,6
6541
,835
7,17
01,
694
2,29
12,
889
3,48
659
8
185
25,0
6833
,911
42,7
5451
,597
8,84
32,
089
2,82
63,
563
4,30
073
7
200
27,1
0036
,660
46,2
2055
,780
9,56
02,
258
3,05
53,
852
4,64
879
7
250
33,8
7545
,825
57,7
7569
,725
11,9
502,
823
3,81
94,
815
5,81
099
6
300
40,6
5054
,990
69,3
3083
,670
14,3
403,
388
4,58
35,
778
6,97
31,
195
400
54,2
0073
,320
92,4
4011
1,56
019
,120
4,51
76,
110
7,70
39,
297
1,59
3
Not
es: F
PL is
fede
ral p
over
ty le
vel.
The
FPLs
sho
wn
here
are
bas
ed o
n th
e U
.S. D
epar
tmen
t of H
ealth
and
Hum
an S
ervi
ces
2015
fede
ral p
over
ty g
uide
lines
. The
se d
iffer
slig
htly
fr
om th
e U
.S. C
ensu
s Bu
reau
’s fe
dera
l pov
erty
thre
shol
ds, w
hich
are
use
d m
ainl
y fo
r sta
tistic
al p
urpo
ses.
The
sep
arat
e po
vert
y gu
idel
ines
for A
lask
a an
d H
awai
i ref
lect
Off
ice
of E
cono
mic
Opp
ortu
nity
adm
inis
trat
ive
prac
tice
begi
nnin
g in
the
1966
–19
70 p
erio
d.
Sour
ce: U
.S. D
epar
tmen
t of H
ealth
and
Hum
an S
ervi
ces
(HH
S), 2
015,
Ann
ual u
pdat
e of
the
HH
S po
vert
y gu
idel
ines
, Fed
eral
Reg
iste
r 80,
no.
14
(Jan
uary
22)
: 323
7.
EXH
IBIT
37.
(co
ntin
ued)
Sect
ion
4
SECTION 5
Beneficiary Health, Service Use, and Access to Care
December 2015104
Section 5: Beneficiary Health, Service Use, and Access to Care
Section 5: Beneficiary Health, Service Use, and Access to Care
Key Points• Children whose primary coverage source is Medicaid or CHIP report being in poorer health
than those who have private coverage or are uninsured (Exhibit 38). However, their use of services relative to other groups varies depending on the type of care and data source. For example, both National Health Interview Survey (NHIS) and Medical Expenditures Panel Survey (MEPS) data indicate that children with Medicaid or CHIP are less likely than those with private coverage and more likely than those who are uninsured to have seen a dentist in the last 12 months. However, the percentage of children with Medicaid or CHIP reported as having seen a dentist differs substantially between the NHIS (77.0 percent in 2014) and MEPS (41.5 percent in 2013), with similar differences observed for children who have private coverage or are uninsured (Exhibits 39 and 40).
• As with children, adults age 19–64 whose primary coverage source is Medicaid or CHIP generally report being in poorer health, and comparisons of their service use relative to other groups varies by data source. Those whose primary coverage source is Medicare, who must meet federal disability criteria to receive coverage, report the poorest health and highest service use among adults age 19–64 (Exhibits 42–44).
• Children whose primary coverage source is Medicaid or CHIP report having seen a general doctor or had a well-child checkup at rates similar to those with private coverage. However, they are more likely to have had trouble finding a doctor or delayed care than those with private coverage; reports of unmet need due to cost vary depending on the type of care in question (Exhibit 41). Relative to those with private coverage, adults age 19–64 with Medicaid report having a usual source of care at a similar rate, but are more likely to report having difficulties with access to care. Among adults age 19–64, those whose primary coverage source is Medicare report the highest rates of delayed care and unmet need due to cost (Exhibit 45).
• The measures reported in Exhibits 38–45 should be interpreted with caution due to the limitations of survey data, and the characteristics of the populations examined. For example, the results shown are unadjusted for differences in age, health, income, race, ethnicity, and family and household characteristics that are known to explain some of the differences in access and use observed between individuals with different coverage sources. In addition, Exhibits 38–45 reflect an individual’s primary payer of care because those with multiple coverage sources are assigned to a single source based on a hierarchy. For selected characteristics of individuals without the application of this hierarchy, see Exhibit 2. For information on individuals who are dually eligible for Medicare and Medicaid, see the latest joint data book published by MACPAC and the Medicare Payment Advisory Commission (MedPAC).
MACStats: Medicaid and CHIP Data Book 105
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lPr
ivat
e2M
edic
aid/
CHIP
3U
nins
ured
4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%53
.5%
37.6
%5.
6%Co
vera
geLe
ngth
of t
ime
with
any
cov
erag
e du
ring
the
year
Full
year
90.8
*96
.9*
93.9
–
Part
yea
r6.
1 3.
1*6.
139
.6*
No
cove
rage
dur
ing
year
3.2
–
–60
.4
Dem
ogra
phic
sAg
e0–
530
.9*
28.4
*35
.622
.1*
6–11
31.3
31
.0
31.8
29.5
12
–18
37.8
*40
.6*
32.6
48.4
*G
ende
rM
ale
51.1
51
.1
50.6
54.2
Fe
mal
e48
.9
48.9
49
.445
.8
Race
His
pani
c24
.3*
14.3
*36
.342
.8*
Whi
te, n
on-H
ispa
nic
54.1
*68
.3*
35.6
39.4
Bl
ack,
non
-His
pani
c15
.3*
10.1
*23
.310
.7*
Oth
er n
on-w
hite
, non
-His
pani
c6.
3*
7.3
*4.
87.
1
Pare
nts
pres
ent i
n fa
mily
Mot
her,
no fa
ther
24.0
*13
.7*
39.0
23.4
*Fa
ther
, no
mot
her
3.9
3.
6
4.3
5.3
Bo
th p
rese
nt68
.4*
81.0
*50
.865
.8*
No
pare
nts
3.6
*1.
7*
6.0
5.6
Fa
mily
inco
me
Has
inco
me
less
than
138
per
cent
FPL
32.9
*7.
2*
69.1
41.9
*H
as in
com
e in
rang
es s
how
n be
low
Less
than
100
per
cent
FPL
22.7
*3.
9*50
.125
.1*
100–
299
perc
ent F
PL23
.0*
12.7
*34
.838
.930
0–39
9 pe
rcen
t FPL
27.9
*38
.1*
12.8
28.0
*40
0 pe
rcen
t FPL
or h
ighe
r26
.3*
45.3
*2.
37.
9*
EXH
IBIT
38.
Cov
erag
e, D
emog
raph
ic, a
nd H
ealth
Cha
ract
eris
tics
of N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
0–18
by
Prim
ary
Sour
ce
of H
ealth
Cov
erag
e, 2
014
December 2015106
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
EXH
IBIT
38.
(co
ntin
ued)
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lPr
ivat
e2M
edic
aid/
CHIP
3U
nins
ured
4
Oth
er d
emog
raph
ic c
hara
cter
istic
sCi
tizen
of U
nite
d St
ates
97.4
%98
.7%
*97
.5%
84.6
%*
Rece
ives
SSI
61.
5*0.
6*3.
00.
3*Fa
mily
rece
ives
WIC
7.6*
1.8*
16.3
5.1*
Hea
lthCu
rren
t hea
lth s
tatu
sEx
celle
nt o
r ver
y go
od84
.5*
89.9
*77
.280
.2
Goo
d13
.8*
9.1*
20.0
17.7
Fa
ir or
poo
r1.
7*1.
0*2.
82.
2 BM
I7
Hea
lthy
wei
ght (
BMI l
ess
than
25)
77.6
*81
.8*
72.7
65.2
O
verw
eigh
t (BM
I 25–
29)
14.1
11
.6*
16.8
22.7
O
bese
(BM
I 30
or h
ighe
r)8.
3 6.
6*10
.512
.1
Spec
ial n
eeds
, im
pairm
ents
, and
hea
lth c
ondi
tions
Has
spe
cial
hea
lth c
are
need
s814
.4*
12.2
*18
.29.
8*Re
ceiv
es s
peci
al e
duca
tion
or e
arly
inte
rven
tion
serv
ices
7.2*
5.7*
9.1
5.5*
Has
impa
irmen
t req
uirin
g sp
ecia
l equ
ipm
ent
1.3
1.3
1.5
†H
as im
pairm
ent l
imiti
ng a
bilit
y to
cra
wl, w
alk,
run,
or p
lay9
1.6
1.3*
2.0
†H
as im
pairm
ent l
imiti
ng a
bilit
y to
cra
wl,
wal
k, ru
n, o
r pl
ay th
at is
exp
ecte
d to
last
12+
mon
ths9
1.3
1.1*
1.8
†
Ever
bee
n to
ld h
e or
she
has
sel
ecte
d co
nditi
ons
ADH
D/AD
D108.
4*6.
8*11
.14.
2*As
thm
a13
.5*
12.4
*15
.411
.9
Autis
m9
2.2
2.1
2.3
† Ce
rebr
al p
alsy
90.
3 †
0.4
† Co
ngen
ital h
eart
dis
ease
1.0
0.9
1.0
† Di
abet
es0.
1 †
0.2
† Do
wn
synd
rom
e90.
2 †
0.1
† In
telle
ctua
l dis
abili
ty (m
enta
l ret
arda
tion)
91.
0 0.
8 1.
2†
Oth
er d
evel
opm
enta
l del
ay9
3.3
2.8*
3.8
2.3*
MACStats: Medicaid and CHIP Data Book 107
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
EXH
IBIT
38.
(co
ntin
ued)
Not
es: F
PL is
fede
ral p
over
ty le
vel.
SSI i
s Su
pple
men
tal S
ecur
ity In
com
e. W
IC is
Sup
plem
enta
l Nut
ritio
n Pr
ogra
m fo
r Wom
en, I
nfan
ts, a
nd C
hild
ren.
BM
I is
body
mas
s in
dex.
ADH
D is
att
entio
n de
ficit
hype
ract
ivity
dis
orde
r. AD
D is
att
entio
n de
ficit
diso
rder
. Per
cent
age
calc
ulat
ions
for e
ach
item
in th
e ex
hibi
t exc
lude
indi
vidu
als
with
mis
sing
and
unk
now
n va
lues
. Sta
ndar
d er
rors
are
ava
ilabl
e on
line
in d
ownl
oada
ble
Exce
l file
s at
htt
ps:/
/ww
w.m
acpa
c.go
v/m
acst
ats/
heal
th-a
nd-o
ther
-cha
ract
eris
tics-
of-b
enef
icia
ries-
serv
ice-
use-
and-
acce
ss-to
-car
e/. D
ue to
diff
eren
ces
in m
etho
dolo
gy (s
uch
as th
e w
ordi
ng o
f que
stio
ns, l
engt
h of
reca
ll pe
riods
, and
pro
mpt
s or
pro
bes
used
to e
licit
resp
onse
s), e
stim
ates
ob
tain
ed fr
om d
iffer
ent s
urve
y da
ta s
ourc
es w
ill v
ary.
For
exa
mpl
e, th
e N
atio
nal H
ealth
Inte
rvie
w S
urve
y (N
HIS
) is
know
n to
pro
duce
hig
her e
stim
ates
of s
ervi
ce u
se th
an th
e M
edic
al E
xpen
ditu
res
Pane
l Sur
vey
(MEP
S). F
or p
urpo
ses
of c
ompa
ring
grou
ps o
f ind
ivid
uals
(as
in th
is e
xhib
it), t
he N
HIS
pro
vide
s th
e m
ost r
ecen
t inf
orm
atio
n av
aila
ble.
For
ot
her p
urpo
ses,
suc
h as
mea
surin
g le
vels
of u
se re
lativ
e to
a p
artic
ular
ben
chm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
chi
ldre
n un
der a
ge 1
9, re
gard
less
of c
over
age
sour
ce. I
n th
is e
xhib
it, th
e fo
llow
ing
hier
arch
y w
as u
sed
to a
ssig
n in
divi
dual
s w
ith
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
: Med
icar
e, p
rivat
e, M
edic
aid/
CHIP
, oth
er, u
nins
ured
. Not
sep
arat
ely
show
n ar
e th
e es
timat
es fo
r tho
se c
over
ed b
y M
edic
are
(gen
eral
ly c
hild
ren
with
end
-sta
ge re
nal d
isea
se),
any
type
of m
ilita
ry h
ealth
pla
n, o
r oth
er g
over
nmen
t-spo
nsor
ed p
rogr
ams.
Cov
erag
e so
urce
is d
efin
ed a
s of
the
time
of th
e su
rvey
inte
rvie
w. S
ince
an
indi
vidu
al m
ay h
ave
mul
tiple
cov
erag
e so
urce
s or
cha
nges
ove
r tim
e, re
spon
ses
to s
urve
y qu
estio
ns m
ay re
flect
cha
ract
eris
tics
or e
xper
ienc
es
asso
ciat
ed w
ith a
cov
erag
e so
urce
oth
er th
an th
e on
e as
sign
ed in
this
exh
ibit.
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
.4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te- o
r oth
er g
over
nmen
t-spo
nsor
ed h
ealth
pla
n, o
r m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce, s
uch
as
acci
dent
s or
den
tal c
are.
5 Du
e to
the
fact
that
a h
iera
rchy
was
use
d in
this
exh
ibit
to a
ssig
n in
divi
dual
s w
ith m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce (s
ee n
ote
1), t
he M
edic
aid/
CHIP
pe
rcen
tage
s sh
own
in th
is ro
w e
xclu
de in
divi
dual
s w
ho a
lso
have
Med
icar
e (w
hich
is ra
re fo
r chi
ldre
n) o
r priv
ate
cove
rage
. Com
pone
nts
do n
ot s
um to
100
per
cent
bec
ause
no
t all
cove
rage
sou
rces
are
sho
wn.
6 Ch
arac
teris
tic is
list
ed u
nder
dem
ogra
phic
s be
caus
e lo
w in
com
e is
one
of t
he c
riter
ia fo
r SSI
elig
ibili
ty. H
owev
er, S
SI re
ceip
t is
also
an
indi
cato
r of d
isab
ility
. For
a c
hild
to
be e
ligib
le fo
r SSI
, he
or s
he m
ust h
ave
a m
edic
ally
det
erm
inab
le p
hysi
cal o
r men
tal i
mpa
irmen
t tha
t res
ults
in m
arke
d an
d se
vere
func
tiona
l lim
itatio
ns a
nd th
at is
gen
eral
ly
expe
cted
to la
st a
t lea
st 1
2 m
onth
s or
resu
lt in
dea
th.
7 Su
rvey
info
rmat
ion
is li
mite
d to
chi
ldre
n ag
e 2
or o
lder
.8
Due
in p
art t
o ch
ange
s in
the
2011
Nat
iona
l Hea
lth In
terv
iew
Sur
vey
(NH
IS) q
uest
ionn
aire
, the
def
initi
on o
f chi
ldre
n w
ith s
peci
al h
ealth
car
e ne
eds
diff
ers
slig
htly
from
the
defin
ition
MAC
PAC
used
in re
port
s be
fore
201
3. T
he d
efin
ition
app
lied
here
is b
ased
on
an a
ppro
ach
deve
lope
d by
the
Child
and
Ado
lesc
ent H
ealth
Mea
sure
men
t Ini
tiativ
e (C
AHM
I) to
iden
tify
“chi
ldre
n w
ith c
hron
ic c
ondi
tions
and
ele
vate
d se
rvic
e us
e or
nee
d” in
the
2007
NH
IS a
nd o
ther
prio
r res
earc
h. (S
ee C
AMH
I, 20
12, I
dent
ifyin
g ch
ildre
n w
ith
chro
nic
cond
ition
s an
d el
evat
ed s
ervi
ce u
se o
r nee
d (C
CCES
UN) i
n th
e N
atio
nal H
ealth
Inte
rvie
w S
urve
y (N
HIS
), Po
rtla
nd, O
R: O
rego
n H
ealth
and
Sci
ence
Uni
vers
ity; D
avid
off,
A.J.
, 20
04, “
Iden
tifyi
ng c
hild
ren
with
spe
cial
hea
lth c
are
need
s in
the
Nat
iona
l Hea
lth In
terv
iew
Sur
vey:
A n
ew re
sour
ce fo
r pol
icy
anal
ysis
,” H
ealth
Ser
vice
s Re
sear
ch 3
9, n
o. 1
: 53–
71.)
Und
er th
e ch
ildre
n w
ith s
peci
al h
ealth
car
e ne
eds
defin
ition
app
lied
here
, a c
hild
mus
t hav
e at
leas
t one
dia
gnos
ed o
r par
ent-r
epor
ted
cond
ition
exp
ecte
d to
be
an o
ngoi
ng
heal
th c
ondi
tion
and
also
mus
t mee
t at l
east
one
of f
ive
crite
ria re
late
d to
ele
vate
d se
rvic
e us
e or
ele
vate
d ne
ed, i
nclu
ding
repo
rted
unm
et n
eed
for c
are.
For
mor
e in
form
atio
n on
the
met
hods
use
d to
iden
tify
child
ren
with
spe
cial
hea
lth c
are
need
s, s
ee h
ttps
://w
ww
.mac
pac.
gov/
mac
stat
s/da
ta-s
ourc
es-a
nd-m
etho
ds/.
9 Su
rvey
info
rmat
ion
is li
mite
d to
chi
ldre
n ag
e 0
to 1
7.10
Su
rvey
info
rmat
ion
is li
mite
d to
chi
ldre
n ag
e 2
to 1
7.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
December 2015108
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lPr
ivat
e2M
edic
aid/
CHIP
3U
nins
ured
4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%53
.5%
37.6
%5.
6%Co
ntac
t with
hea
lth c
are
prof
essi
onal
s (p
ast 1
2 m
onth
s)
N
umbe
r of t
imes
saw
a d
octo
r or o
ther
hea
lth p
rofe
ssio
nal,
excl
udin
g de
ntal
vis
its a
nd in
patie
nt h
ospi
tal s
tays
Non
e9.
4 8.
0 8.
330
.7*
At le
ast 1
90.6
92
.0
91.7
69.3
*1
26.0
26
.6
24.9
28.2
2–
337
.3
37.9
37
.928
.8*
4 or
mor
e27
.2
27.5
29
.012
.3*
Saw
sel
ecte
d he
alth
pro
fess
iona
ls in
an
offic
e-ba
sed
or c
linic
set
ting6
Gen
eral
doc
tor
83.2
85
.1
84.6
58.3
*G
ener
al d
octo
r, nu
rse
prac
titio
ner,
phys
icia
n as
sist
ant,
mid
wife
, or o
b-gy
n84
.5
86.5
85
.761
.4*
Med
ical
spe
cial
ist
13.5
15
.0*
12.3
6.5*
Eye
doct
or24
.0*
26.4
*21
.617
.7
Men
tal h
ealth
pro
fess
iona
l7.
1*6.
2*8.
9†
Doct
or, f
or e
mot
iona
l or b
ehav
iora
l pro
blem
4.2*
3.0*
6.2
†De
ntis
t79
.0*
82.7
*77
.056
.8*
Any
heal
th p
rofe
ssio
nal,
excl
udin
g de
ntal
788
.4
90.4
*88
.867
.7*
Any
heal
th p
rofe
ssio
nal,
incl
udin
g de
ntal
96.7
98
.1*
96.9
82.3
*H
ad a
t lea
st 1
ove
rnig
ht h
ospi
tal s
tay8
4.9*
4.5*
6.1
2.5*
Rece
ived
car
e at
hom
e1.
0 0.
8*1.
3†
Rece
ipt o
f app
ropr
iate
car
e (p
ast 1
2 m
onth
s)H
ad w
ell-c
hild
che
ckup
983
.8
85.8
84
.956
.3*
Had
mor
e th
an 1
5 of
fice
or c
linic
vis
its1.
9
2.0
2.
0†
Num
ber o
f em
erge
ncy
room
vis
itsN
one
83.0
*87
.3*
76.8
84.1
*At
leas
t 117
.0*
12.7
*23
.215
.9*
111
.8*
9.8*
15.2
9.0*
2–3
4.0*
2.4*
6.2
4.3
4 or
mor
e1.
1*0.
4*1.
8†
Had
at l
east
1 e
mer
genc
y ro
om v
isit,
and
mos
t rec
ent v
isit
was
for a
ser
ious
hea
lth p
robl
em9.
9*8.
1*13
.06.
9*
EXH
IBIT
39.
Use
of C
are
amon
g N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
0–18
by
Prim
ary
Sour
ce o
f Hea
lth C
over
age,
201
4, D
ata
from
N
atio
nal H
ealth
Inte
rvie
w S
urve
y
MACStats: Medicaid and CHIP Data Book 109
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
EXH
IBIT
39.
(co
ntin
ued)
Not
es: O
b-gy
n is
obs
tetr
icia
n-gy
neco
logi
st. P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
exhi
bit e
xclu
de in
divi
dual
s w
ith m
issi
ng a
nd u
nkno
wn
valu
es. S
tand
ard
erro
rs a
re
avai
labl
e on
line
in d
ownl
oada
ble
Exce
l file
s at
htt
ps:/
/ww
w.m
acpa
c.go
v/m
acst
ats/
heal
th-a
nd-o
ther
-cha
ract
eris
tics-
of-b
enef
icia
ries-
serv
ice-
use-
and-
acce
ss-to
-car
e/. D
ue to
di
ffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t su
rvey
dat
a so
urce
s w
ill v
ary.
For
exa
mpl
e, th
e N
atio
nal H
ealth
Inte
rvie
w S
urve
y (N
HIS
) is
know
n to
pro
duce
hig
her e
stim
ates
of s
ervi
ce u
se th
an th
e M
edic
al E
xpen
ditu
res
Pane
l Sur
vey
(MEP
S). F
or p
urpo
ses
of c
ompa
ring
grou
ps o
f ind
ivid
uals
(as
in th
is e
xhib
it), t
he N
HIS
pro
vide
s th
e m
ost r
ecen
t inf
orm
atio
n av
aila
ble.
For
oth
er p
urpo
ses,
suc
h as
mea
surin
g le
vels
of u
se re
lativ
e to
a p
artic
ular
ben
chm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
chi
ldre
n un
der a
ge 1
9, re
gard
less
of c
over
age
sour
ce. I
n th
is e
xhib
it, th
e fo
llow
ing
hier
arch
y w
as u
sed
to a
ssig
n in
divi
dual
s w
ith
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
: Med
icar
e, p
rivat
e, M
edic
aid/
CHIP
, oth
er, u
nins
ured
. Not
sep
arat
ely
show
n ar
e th
e es
timat
es fo
r tho
se c
over
ed b
y M
edic
are
(gen
eral
ly c
hild
ren
with
end
-sta
ge re
nal d
isea
se),
any
type
of m
ilita
ry h
ealth
pla
n, o
r oth
er g
over
nmen
t-spo
nsor
ed p
rogr
ams.
Cov
erag
e so
urce
is d
efin
ed a
s of
the
time
of th
e su
rvey
inte
rvie
w. S
ince
an
indi
vidu
al m
ay h
ave
mul
tiple
cov
erag
e so
urce
s or
cha
nges
ove
r tim
e, re
spon
ses
to s
urve
y qu
estio
ns m
ay re
flect
cha
ract
eris
tics
or e
xper
ienc
es
asso
ciat
ed w
ith a
cov
erag
e so
urce
oth
er th
an th
e on
e as
sign
ed in
this
exh
ibit.
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
.4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te- o
r oth
er g
over
nmen
t-spo
nsor
ed h
ealth
pla
n, o
r m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce, s
uch
as
acci
dent
s or
den
tal c
are.
5 Du
e to
the
fact
that
a h
iera
rchy
was
use
d in
this
exh
ibit
to a
ssig
n in
divi
dual
s w
ith m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce (s
ee n
ote
1), t
he M
edic
aid/
CHIP
pe
rcen
tage
s sh
own
in th
is ro
w e
xclu
de in
divi
dual
s w
ho a
lso
have
Med
icar
e (w
hich
is ra
re fo
r chi
ldre
n) o
r priv
ate
cove
rage
. Com
pone
nts
do n
ot s
um to
100
per
cent
bec
ause
no
t all
cove
rage
sou
rces
are
sho
wn.
6 Pa
rent
s m
ay re
port
enc
ount
ers
with
a b
road
rang
e of
hea
lth p
rofe
ssio
nals
(e.g
., sp
eech
ther
apis
t or s
ocia
l wor
ker)
but t
he q
uest
ion
is li
mite
d to
vis
its in
a d
octo
r’s o
ffice
or c
linic
.7
Perc
enta
ges
are
low
er th
an fo
r a m
easu
re s
how
n ea
rlier
in th
is e
xhib
it be
caus
e th
e m
easu
re s
how
n in
this
row
is li
mite
d to
off
ice
and
clin
ic s
ettin
gs.
8 In
clud
es s
tays
for n
ewbo
rns.
9 Su
rvey
info
rmat
ion
is li
mite
d to
chi
ldre
n ag
e 0
to 1
7.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
December 2015110
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
mos
t rec
ent i
nter
view
1
Tota
lPr
ivat
e2M
edic
aid/
CHIP
3U
nins
ured
4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%54
.5%
35.5
%8.
7%Co
ntac
t with
hea
lth c
are
prof
essi
onal
s (p
ast 1
2 m
onth
s)
N
umbe
r of t
imes
saw
a d
octo
r or o
ther
hea
lth p
rofe
ssio
nal,
excl
udin
g de
ntal
vis
its a
nd in
patie
nt h
ospi
tal s
tays
Non
e23
.418
.9*
25.5
43.5
*At
leas
t 176
.681
.1*
74.5
56.5
*1
23.3
22.6
23.7
26.4
2–3
25.6
27.0
25.8
16.9
*4
or m
ore
27.7
*31
.6*
25.1
13.3
*H
ad a
t lea
st 1
ove
rnig
ht h
ospi
tal s
tay
2.4*
2.1*
3.2
†Re
ceiv
ed c
are
at h
ome
0.9
0.7
1.4
†Sa
w a
gen
eral
den
tist
45.9
*52
.2*
41.5
24.2
*Sa
w a
n or
thod
ontis
t9.
2*13
.0*
4.5
4.4
Rece
ipt o
f app
ropr
iate
car
e (p
ast 1
2 m
onth
s)H
ad d
enta
l cle
anin
g, p
roph
ylax
is, o
r pol
ishi
ng43
.1*
50.0
*37
.920
.9*
Had
mor
e th
an 1
5 of
fice
or c
linic
vis
its6
3.9
4.6
3.1
†N
umbe
r of e
mer
genc
y ro
om v
isits
Non
e87
.8*
89.7
*84
.091
.3*
At le
ast 1
12.2
*10
.3*
16.0
8.7*
19.
7*8.
6*12
.16.
5*2–
32.
2*1.
4*3.
4†
4 or
mor
e0.
4†
††
Not
es: P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
exhi
bit e
xclu
de in
divi
dual
s w
ith m
issi
ng a
nd u
nkno
wn
valu
es. S
tand
ard
erro
rs a
re a
vaila
ble
onlin
e in
dow
nloa
dabl
e Ex
cel
files
at h
ttps
://w
ww
.mac
pac.
gov/
mac
stat
s/he
alth
-and
-oth
er-c
hara
cter
istic
s-of
-ben
efic
iarie
s-se
rvic
e-us
e-an
d-ac
cess
-to-c
are/
. Due
to d
iffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t sur
vey
data
sou
rces
will
var
y. F
or
exam
ple,
the
Nat
iona
l Hea
lth In
terv
iew
Sur
vey
(NH
IS) i
s kn
own
to p
rodu
ce h
ighe
r est
imat
es o
f ser
vice
use
than
the
Med
ical
Exp
endi
ture
s Pa
nel S
urve
y (M
EPS)
. For
pur
pose
s of
com
parin
g gr
oups
of i
ndiv
idua
ls, t
he N
HIS
pro
vide
s th
e m
ost r
ecen
t inf
orm
atio
n av
aila
ble.
For
oth
er p
urpo
ses,
suc
h as
mea
surin
g le
vels
of u
se re
lativ
e to
a p
artic
ular
be
nchm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
EXH
IBIT
40.
Use
of C
are
amon
g N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
0–18
by
Prim
ary
Sour
ce o
f Hea
lth C
over
age,
201
3, D
ata
from
M
edic
al E
xpen
ditu
res
Pane
l Sur
vey
MACStats: Medicaid and CHIP Data Book 111
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
chi
ldre
n un
der a
ge 1
9, re
gard
less
of c
over
age
sour
ce. I
n th
is e
xhib
it, th
e fo
llow
ing
hier
arch
y w
as u
sed
to a
ssig
n in
divi
dual
s w
ith
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
: Med
icar
e, p
rivat
e, M
edic
aid/
CHIP
, oth
er, u
nins
ured
. Not
sep
arat
ely
show
n ar
e th
e es
timat
es fo
r tho
se c
over
ed b
y M
edic
are
(gen
eral
ly c
hild
ren
with
end
-sta
ge re
nal d
isea
se),
any
type
of m
ilita
ry h
ealth
pla
n, o
r oth
er g
over
nmen
t-spo
nsor
ed p
rogr
ams.
Cov
erag
e so
urce
is d
efin
ed a
s of
the
time
of th
e m
ost r
ecen
t sur
vey
inte
rvie
w. S
ince
an
indi
vidu
al m
ay h
ave
mul
tiple
cov
erag
e so
urce
s or
cha
nges
ove
r tim
e, re
spon
ses
to s
urve
y qu
estio
ns m
ay re
flect
cha
ract
eris
tics
or
expe
rienc
es a
ssoc
iate
d w
ith a
cov
erag
e so
urce
oth
er th
an th
e on
e as
sign
ed in
this
exh
ibit.
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
.4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te- o
r oth
er g
over
nmen
t-spo
nsor
ed h
ealth
pla
n, o
r m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce, s
uch
as
acci
dent
s or
den
tal c
are.
5 Du
e to
the
fact
that
a h
iera
rchy
was
use
d in
this
exh
ibit
to a
ssig
n in
divi
dual
s w
ith m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce (s
ee n
ote
1), t
he M
edic
aid/
CHIP
pe
rcen
tage
s sh
own
in th
is ro
w e
xclu
de in
divi
dual
s w
ho a
lso
have
Med
icar
e (w
hich
is ra
re fo
r chi
ldre
n) o
r priv
ate
cove
rage
. Com
pone
nts
do n
ot s
um to
100
per
cent
bec
ause
no
t all
cove
rage
sou
rces
are
sho
wn.
6 Re
flect
s in
form
atio
n fr
om th
e of
fice-
base
d an
d ho
spita
l out
patie
nt d
epar
tmen
t file
s in
MEP
S.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
MEP
S da
ta.
EXH
IBIT
40.
(co
ntin
ued)
December 2015112
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lPr
ivat
e2M
edic
aid/
CHIP
3U
nins
ured
4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%53
.5%
37.6
%5.
6%Ti
mel
ines
s of
car
e (p
ast 1
2 m
onth
s)H
as a
usu
al s
ourc
e of
car
e95
.9
98.0
*96
.670
.8*
Had
the
sam
e us
ual s
ourc
e of
med
ical
car
e 12
mon
ths
ago
89.2
91
.5*
89.7
66.3
*Do
es n
ot h
ave
a us
ual s
ourc
e of
car
e, a
nd a
cces
s ba
rrie
r is
the
reas
on6
1.1 *
0.3
0.6
12.3
*
Had
trou
ble
findi
ng a
doc
tor o
r was
told
that
cov
erag
e or
ne
w p
atie
nts
wer
e no
t acc
epte
d73.
0*1.
7*4.
65.
0
Tim
elin
ess
of c
are
(pas
t 12
mon
ths)
Dela
yed
med
ical
car
e du
e to
any
acc
ess
barr
ier i
ndic
ated
be
low
9.7 *
6.5*
12.1
24.3
*
Dela
yed
beca
use
of c
osts
2.8 *
1.8
2.1
17.9
*De
laye
d fo
r pro
vide
r-rel
ated
reas
ons8
6.6 *
4.9 *
8.8
8.2
Dela
yed
due
to la
ck o
f tra
nspo
rtat
ion
1.6 *
0.2 *
3.4
† U
nmet
nee
d fo
r sel
ecte
d ty
pes
of c
are
due
to c
ost
Med
ical
car
e1.
6*0.
9 1.
113
.5*
Men
tal h
ealth
car
e or
cou
nsel
ing9
0.8
0.8
0.5
1.9 *
Dent
al c
are
4.3
2.7*
4.9
16.6
*Pr
escr
iptio
n dr
ugs
1.6
0.9*
2.0
5.7 *
Eyeg
lass
es1.
8 1.
0*2.
17.
8*Sp
ecia
list c
are
1.2
0.7
1.2
6.2 *
Follo
w-u
p ca
re1.
1 0.
6*1.
26.
4*
Not
es: P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
tabl
e ex
clud
e in
divi
dual
s w
ith m
issi
ng a
nd u
nkno
wn
valu
es. S
tand
ard
erro
rs a
re a
vaila
ble
onlin
e in
dow
nloa
dabl
e Ex
cel
files
at h
ttps
://w
ww
.mac
pac.
gov/
mac
stat
s/he
alth
-and
-oth
er-c
hara
cter
istic
s-of
-ben
efic
iarie
s-se
rvic
e-us
e-an
d-ac
cess
-to-c
are/
. Due
to d
iffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t sur
vey
data
sou
rces
will
var
y. F
or e
xam
ple,
th
e N
atio
nal H
ealth
Inte
rvie
w S
urve
y (N
HIS
) is
know
n to
pro
duce
hig
her e
stim
ates
of s
ervi
ce u
se th
an th
e M
edic
al E
xpen
ditu
res
Pane
l Sur
vey
(MEP
S). F
or p
urpo
ses
of
com
parin
g gr
oups
of i
ndiv
idua
ls (a
s in
this
exh
ibit)
, the
NH
IS p
rovi
des
the
mos
t rec
ent i
nfor
mat
ion
avai
labl
e. F
or o
ther
pur
pose
s, s
uch
as m
easu
ring
leve
ls o
f use
rela
tive
to a
pa
rtic
ular
ben
chm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
EXH
IBIT
41.
Mea
sure
s of
Acc
ess
to C
are
amon
g N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
0–18
by
Prim
ary
Sour
ce o
f Hea
lth C
over
age,
201
4
MACStats: Medicaid and CHIP Data Book 113
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
chi
ldre
n un
der a
ge 1
9, re
gard
less
of c
over
age
sour
ce. I
n th
is e
xhib
it, th
e fo
llow
ing
hier
arch
y w
as u
sed
to a
ssig
n in
divi
dual
s w
ith
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
: Med
icar
e, p
rivat
e, M
edic
aid/
CHIP
, oth
er, u
nins
ured
. Not
sep
arat
ely
show
n ar
e th
e es
timat
es fo
r tho
se c
over
ed b
y M
edic
are
(gen
eral
ly c
hild
ren
with
end
-sta
ge re
nal d
isea
se),
any
type
of m
ilita
ry h
ealth
pla
n, o
r oth
er g
over
nmen
t-spo
nsor
ed p
rogr
ams.
Cov
erag
e so
urce
is d
efin
ed a
s of
the
time
of th
e su
rvey
inte
rvie
w. S
ince
an
indi
vidu
al m
ay h
ave
mul
tiple
cov
erag
e so
urce
s or
cha
nges
ove
r tim
e, re
spon
ses
to s
urve
y qu
estio
ns m
ay re
flect
cha
ract
eris
tics
or e
xper
ienc
es
asso
ciat
ed w
ith a
cov
erag
e so
urce
oth
er th
an th
e on
e as
sign
ed in
this
exh
ibit.
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
.4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te- o
r oth
er g
over
nmen
t-spo
nsor
ed h
ealth
pla
n, o
r m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce, s
uch
as
acci
dent
s or
den
tal c
are.
5 Du
e to
the
fact
that
a h
iera
rchy
was
use
d in
this
exh
ibit
to a
ssig
n in
divi
dual
s w
ith m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce (s
ee n
ote
1), t
he M
edic
aid/
CHIP
pe
rcen
tage
s sh
own
in th
is ro
w e
xclu
de in
divi
dual
s w
ho a
lso
have
Med
icar
e (w
hich
is ra
re fo
r chi
ldre
n) o
r priv
ate
cove
rage
. Com
pone
nts
do n
ot s
um to
100
per
cent
bec
ause
no
t all
cove
rage
sou
rces
are
sho
wn.
6 Re
ason
s gi
ven
by th
ose
who
repo
rted
no
usua
l pla
ce o
f car
e th
at w
ere
clas
sifie
d as
acc
ess
barr
iers
incl
ude
the
follo
win
g: to
o ex
pens
ive/
cost
, pre
viou
s do
ctor
not
ava
ilabl
e,
pare
nt d
oes
not k
now
whe
re to
go,
and
spe
aks
a di
ffer
ent l
angu
age.
7 Pa
rent
repo
rted
one
of t
hese
bar
riers
in th
e pa
st 1
2 m
onth
s: tr
oubl
e fin
ding
a d
octo
r or p
rovi
der,
doct
or’s
off
ice/
clin
ic d
id n
ot a
ccep
t chi
ld’s
insu
ranc
e co
vera
ge, o
r off
ice/
clin
ic d
id n
ot a
ccep
t the
chi
ld a
s a
new
pat
ient
.8
Incl
udes
any
of t
he fo
llow
ing:
par
ent c
ould
not
get
an
appo
intm
ent,
had
to w
ait t
oo lo
ng to
see
doc
tor,
coul
d no
t go
whe
n op
en, c
ould
not
get
thro
ugh
on p
hone
, par
ent
spea
ks a
diff
eren
t lan
guag
e.9
Surv
ey in
form
atio
n is
lim
ited
to c
hild
ren
age
2 or
old
er.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
EXH
IBIT
41.
(co
ntin
ued)
December 2015114
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
s
Prim
ary
cove
rage
sou
rce
at ti
me
of in
terv
iew
1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%3.
6%*
66.2
%*
10.5
%16
.3%
*Co
vera
geLe
ngth
of t
ime
with
any
cov
erag
e du
ring
year
Full
year
77.3
*96
.0*
93.6
*79
.9–
Pa
rt y
ear
10.0
*4.
0*6.
4*20
.120
.6
No
cove
rage
dur
ing
year
12.6
–
–
–
79.4
De
mog
raph
ics
Age
19–
2513
.5*
†12
.2*
20.4
15.9
*26
–44
43.0
*14
.7*
42.4
*47
.251
.8*
45–
5422
.5*
26.5
*23
.8*
17.8
19.7
55
–64
20.9
*57
.3*
21.7
*14
.512
.6
Gen
der
Mal
e49
.0*
49.3
*49
.7*
36.1
54.3
*Fe
mal
e51
.0*
50.7
*50
.3*
63.9
45.7
*Ra
ceH
ispa
nic
16.9
*8.
5*
11.5
*25
.136
.0*
Whi
te, n
on-H
ispa
nic
63.6
*69
.1*
71.0
*46
.044
.1
Blac
k, n
on-H
ispa
nic
12.7
*18
.9
10.1
*22
.113
.9*
Oth
er n
on-w
hite
, non
-His
pani
c6.
9
3.5
*7.
4
6.8
5.9
M
arita
l sta
tus
Mar
ried
53.3
*37
.6*
61.3
*31
.639
.0*
Wid
owed
25.0
*20
.6*
21.4
*38
.031
.8*
Divo
rced
or s
epar
ated
11.2
*29
.4*
9.1
*15
.912
.4*
Livi
ng w
ith p
artn
er1.
6
6.5
*1.
2*
2.0
1.7
N
ever
mar
ried
8.7
*5.
8*
6.9
*12
.315
.0*
Fam
ily in
com
eLe
ss th
an 1
38 p
erce
nt F
PL21
.8*
49.2
*7.
9*
65.5
43.8
*H
as in
com
e in
rang
es b
elow
Less
than
100
per
cent
FPL
14.6
*31
.6*
4.7*
47.5
29.8
*10
0–29
9 pe
rcen
t FPL
18.1
*36
.7
11.2
*32
.832
.2
200–
399
perc
ent F
PL28
.8*
22.4
*31
.4*
15.2
28.2
*40
0 pe
rcen
t FPL
or h
ighe
r38
.5*
9.3*
52.8
*4.
49.
7*
EXH
IBIT
42.
Cov
erag
e, D
emog
raph
ic, a
nd H
ealth
Cha
ract
eris
tics
of N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
19–
64 b
y Pr
imar
y So
urce
of
Hea
lth C
over
age,
201
4
MACStats: Medicaid and CHIP Data Book 115
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
s
Prim
ary
cove
rage
sou
rce
at ti
me
of in
terv
iew
1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Educ
atio
nLe
ss th
an h
igh
scho
ol11
.6%
*24
.2%
5.2%
*26
.3%
26.2
%
Hig
h sc
hool
dip
lom
a/G
ED24
.9*
33.8
20
.0*
36.1
34.8
So
me
colle
ge32
.3*
33.3
*33
.4*
28.0
28.8
Co
llege
or g
radu
ate
degr
ee31
.3*
8.7
41.5
*9.
610
.2
Oth
er d
emog
raph
ic c
hara
cter
istic
sCi
tizen
of U
nite
d St
ates
89.9
*98
.8*
93.8
*88
.172
.2*
Pare
nt o
f a d
epen
dent
chi
ld37
.3*
12.2
*37
.6*
48.6
36.5
*Cu
rren
tly w
orki
ng72
.4*
10.1
*83
.2*
43.3
63.9
*Ve
tera
n6.
2*10
.1*
5.5*
2.0
3.8*
Rece
ives
SSI
or S
SDI6
5.5*
76.5
*0.
8*17
.80.
8*Re
ceiv
es S
SI2.
6*18
.9*
0.3*
14.4
0.3*
Rece
ives
SSD
I3.
6*66
.7*
0.5*
6.6
0.6*
Hea
lthCu
rren
t hea
lth s
tatu
sEx
celle
nt o
r ver
y go
od64
.2*
14.1
*72
.2*
44.9
56.3
*G
ood
24.9
*21
.2*
22.4
*31
.331
.2
Fair
or p
oor
10.9
*64
.7*
5.4*
23.7
12.4
*BM
IH
ealth
y w
eigh
t (BM
I les
s th
an 2
5)35
.8*
25.5
*36
.9*
32.9
35.8
O
verw
eigh
t (BM
I 25–
30)
34.0
*28
.8
34.7
*29
.634
.9*
Obe
se (B
MI 3
0 or
hig
her)
30.1
*45
.7*
28.4
*37
.529
.3*
Smok
ing
stat
usCu
rren
t sm
oker
18.9
*32
.1
14.1
*29
.628
.2
Form
er s
mok
er18
.4*
28.1
*19
.5*
14.4
13.8
N
ever
sm
oked
62.7
*39
.7*
66.4
*56
.058
.0
Lim
itatio
ns a
nd h
ealth
con
ditio
nsH
as b
asic
act
ion
diffi
culty
or c
ompl
ex a
ctiv
ity lim
itatio
nAn
y ba
sic
actio
n di
ffic
ulty
724
.9*
86.4
*18
.7*
40.1
24.8
*An
y co
mpl
ex a
ctiv
ity li
mita
tion8
11.6
*84
.1*
5.2*
28.8
8.9*
Eith
er o
ne26
.6*
92.4
*19
.7*
44.4
26.2
*H
as fu
nctio
nal l
imita
tion9
27.0
*85
.3*
21.9
*39
.925
.2*
EXH
IBIT
42.
(co
ntin
ued)
December 2015116
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
s
Prim
ary
cove
rage
sou
rce
at ti
me
of in
terv
iew
1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Has
diff
icul
ty w
alki
ng w
ithou
t equ
ipm
ent
3.3%
*34
.3%
*1.
2%*
7.7%
1.7%
*H
as h
ealth
con
ditio
n re
quiri
ng s
peci
al e
quip
men
t4.
0*35
.0*
1.8*
8.3
2.6*
Nee
ds h
elp
with
any
of t
he fo
llow
ing
ADLs
Pers
onal
car
e1.
3*12
.5*
0.4*
4.6
0.5*
Bath
ing
0.8*
8.0*
0.2*
3.2
†Ea
ting
0.2*
2.3*
†0.
8†
Tran
sfer
ring
0.6*
6.5*
0.2*
1.9
†To
iletin
g0.
4*4.
2*0.
1*1.
3†
Get
ting
arou
nd in
hom
e0.
5*5.
5*0.
1*1.
7†
Num
ber o
f ADL
s ne
edin
g as
sist
ance
Non
e98
.9*
89.2
*99
.7*
96.0
99.6
*1–
20.
6*5.
0*†
2.4
†3–
40.
3*2.
7*†
0.8
†5–
60.
3*3.
1*†
0.8
†U
nabl
e to
wor
k no
w d
ue to
hea
lth p
robl
em7.
1*70
.8*
2.1*
19.6
4.3*
Lim
ited
in a
mou
nt o
r kin
d of
wor
k du
e to
hea
lth10
.1*
80.0
*4.
0*26
.47.
1*Lo
st a
ll na
tura
l tee
th4.
4*18
.9*
3.0*
6.8
4.7*
Has
dep
ress
ed o
r anx
ious
feel
ings
12.6
*35
.2*
8.5*
23.2
16.9
*Cu
rren
tly p
regn
ant10
4.4*
† 3.
9*7.
82.
5*Ev
er b
een
told
he
or s
he h
as s
elec
ted
cond
ition
sH
yper
tens
ion
24.2
*62
.0*
22.3
*29
.718
.7*
Coro
nary
hea
rt d
isea
se2.
0 11
.5*
1.5*
2.7
1.6*
Hea
rt a
ttac
k1.
9*11
.0*
1.2*
3.5
1.3*
Stro
ke1.
6*10
.5*
0.9*
3.6
0.9*
Canc
er3.
8 12
.0*
3.7
4.2
2.2*
Diab
etes
6.7*
27.1
*5.
3*10
.05.
1*Ar
thrit
is16
.8*
56.8
*15
.3*
19.2
11.5
*As
thm
a13
.2*
25.5
*12
.5*
17.0
10.6
*Ch
roni
c br
onch
itis
(pas
t 12
mon
ths)
3.3*
13.1
*2.
5*5.
83.
0*Li
ver c
ondi
tion
(pas
t 12
mon
ths)
1.3*
5.9*
1.0*
2.8
0.8*
Wea
k or
faili
ng k
idne
ys (p
ast 1
2 m
onth
s)1.
1*6.
9*0.
6*2.
61.
2*
EXH
IBIT
42.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 117
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Not
es: F
PL is
fede
ral p
over
ty le
vel.
SSI i
s Su
pple
men
tal S
ecur
ity In
com
e. S
SDI i
s So
cial
Sec
urity
Dis
abili
ty In
sura
nce.
BM
I is
body
mas
s in
dex.
ADL
is a
ctiv
ity o
f dai
ly li
ving
. Pe
rcen
tage
cal
cula
tions
for e
ach
item
in th
e ex
hibi
t exc
lude
indi
vidu
als
with
mis
sing
and
unk
now
n va
lues
. Sta
ndar
d er
rors
are
ava
ilabl
e on
line
in d
ownl
oada
ble
Exce
l file
s at
ht
tps:
//w
ww
.mac
pac.
gov/
mac
stat
s/he
alth
-and
-oth
er-c
hara
cter
istic
s-of
-ben
efic
iarie
s-se
rvic
e-us
e-an
d-ac
cess
-to-c
are/
.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
indi
vidu
als
age
19–
64, r
egar
dles
s of
cov
erag
e so
urce
. In
this
exh
ibit,
the
follo
win
g hi
erar
chy
was
use
d to
ass
ign
indi
vidu
als
with
m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce: M
edic
are,
priv
ate,
Med
icai
d/CH
IP, o
ther
, uni
nsur
ed. N
ot s
epar
atel
y sh
own
are
the
estim
ates
for t
hose
cov
ered
by
Med
icar
e, a
ny
type
of m
ilita
ry h
ealth
pla
n, o
r oth
er g
over
nmen
t-spo
nsor
ed p
rogr
ams.
Cov
erag
e so
urce
is d
efin
ed a
s of
the
time
of th
e su
rvey
inte
rvie
w. S
ince
an
indi
vidu
al m
ay h
ave
mul
tiple
co
vera
ge s
ourc
es o
r cha
nges
ove
r tim
e, re
spon
ses
to s
urve
y qu
estio
ns m
ay re
flect
cha
ract
eris
tics
or e
xper
ienc
es a
ssoc
iate
d w
ith a
cov
erag
e so
urce
oth
er th
an th
e on
e as
sign
ed in
this
exh
ibit.
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
. 4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te-s
pons
ored
or o
ther
gov
ernm
ent-s
pons
ored
hea
lth
plan
, or m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce,
such
as
acci
dent
s or
den
tal c
are.
5 Du
e to
the
fact
that
a h
iera
rchy
was
use
d in
this
exh
ibit
to a
ssig
n in
divi
dual
s w
ith m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce (s
ee e
arlie
r not
e), t
he M
edic
aid/
CHIP
per
cent
ages
sh
own
in th
is ro
w e
xclu
de in
divi
dual
s w
ho a
lso
have
Med
icar
e or
priv
ate
cove
rage
. Com
pone
nts
do n
ot s
um to
100
per
cent
bec
ause
not
all
cove
rage
sou
rces
are
sho
wn.
6 Ch
arac
teris
tic is
list
ed u
nder
dem
ogra
phic
s be
caus
e lo
w in
com
e is
one
of t
he c
riter
ia fo
r SSI
elig
ibili
ty, a
nd th
e in
abili
ty to
eng
age
in a
spe
cifie
d le
vel o
f wor
k ac
tivity
and
ea
rnin
gs (r
efer
red
to a
s su
bsta
ntia
l gai
nful
act
ivity
in fe
dera
l sta
tute
) is
one
of th
e cr
iteria
for S
SDI e
ligib
ility
. How
ever
, SSI
or S
SDI r
ecei
pt is
als
o an
indi
cato
r of d
isab
ility
. For
an
adul
t to
be e
ligib
le fo
r SSI
or S
SDI,
he o
r she
mus
t hav
e a
med
ical
ly d
eter
min
able
phy
sica
l or m
enta
l im
pairm
ent t
hat i
s ex
pect
ed to
last
at l
east
12
mon
ths
or re
sult
in d
eath
.7
Capt
ures
lim
itatio
ns o
r diff
icul
ties
in m
ovem
ent (
wal
king
, sta
ndin
g, b
endi
ng o
r kne
elin
g, re
achi
ng o
verh
ead,
and
usi
ng th
e ha
nds
and
finge
rs) a
nd s
enso
ry, e
mot
iona
l (i.e
., fe
elin
gs th
at in
terf
ere
with
acc
ompl
ishi
ng d
aily
act
iviti
es),
or m
enta
l (i.e
., di
ffic
ultie
s w
ith re
mem
berin
g or
exp
erie
ncin
g co
nfus
ion)
func
tioni
ng th
at a
re a
ssoc
iate
d w
ith s
ome
heal
th p
robl
em.
8 Re
flect
s a
limita
tion
in th
e ta
sks
and
orga
nize
d ac
tiviti
es th
at, w
hen
exec
uted
, mak
e up
num
erou
s so
cial
role
s, s
uch
as w
orki
ng, a
tten
ding
sch
ool,
or m
aint
aini
ng a
hou
seho
ld.
Adul
ts a
re d
efin
ed a
s ha
ving
a c
ompl
ex a
ctiv
ity li
mita
tion
if th
ey h
ave
one
or m
ore
of th
e fo
llow
ing
type
s of
lim
itatio
ns: s
elf-c
are
limita
tion,
soc
ial l
imita
tion,
or w
ork
limita
tion.
9 Fu
nctio
nal l
imita
tion
is d
efin
ed a
s “v
ery
diff
icul
t” o
r “ca
nnot
do”
for t
he fo
llow
ing
activ
ities
: gra
sp s
mal
l obj
ects
; rea
ch a
bove
one
’s h
ead;
sit
mor
e th
an 2
hou
rs; l
ift o
r ca
rry
10 p
ound
s; c
limb
a fli
ght o
f sta
irs; p
ush
a he
avy
obje
ct; w
alk
a 1/
4 m
ile; s
tand
mor
e th
an 2
hou
rs; s
toop
, ben
d, o
r kne
el.
10 In
form
atio
n is
lim
ited
to w
omen
age
19–
44.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
EXH
IBIT
42.
(co
ntin
ued)
December 2015118
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%3.
6%66
.2%
10.5
%16
.3%
Cont
act w
ith h
ealth
car
e pr
ofes
sion
als
(pas
t 12
mon
ths)
Num
ber o
f tim
es s
aw a
doc
tor o
r oth
er h
ealth
pro
fess
iona
l, ex
clud
ing
dent
al v
isits
and
inpa
tient
hos
pita
l sta
ysN
one
21.1
*6.
0*16
.2
17.0
48.6
*At
leas
t 178
.9*
94.0
*83
.8
83.0
51.4
*1
21.0
*7.
5*22
.7*
15.9
20.4
*2–
327
.0*
14.9
*30
.6*
24.3
16.5
*4
or m
ore
30.9
*71
.6*
30.4
*42
.814
.5*
Saw
sel
ecte
d he
alth
pro
fess
iona
ls in
an
offic
e-ba
sed
or c
linic
set
ting6
Gen
eral
doc
tor
66.1
*86
.0*
70.4
72
.138
.2*
Gen
eral
doc
tor,
nurs
e pr
actit
ione
r, ph
ysic
ian
assi
stan
t, m
idw
ife, o
r ob-
gyn
73.7
*88
.9*
78.5
80
.044
.8*
Med
ical
spe
cial
ist
21.6
54
.0*
23.2
22
.37.
4*Ey
e do
ctor
33.0
*41
.0*
38.2
*26
.314
.4*
Men
tal h
ealth
pro
fess
iona
l8.
0*25
.2*
6.6*
13.6
4.1*
Dent
ist
61.7
*47
.2
71.7
*49
.231
.6*
Any
heal
th p
rofe
ssio
nal,
excl
udin
g de
ntal
778
.9*
94.9
*84
.1*
81.6
51.3
*An
y he
alth
pro
fess
iona
l, in
clud
ing
dent
al87
.9
97.1
*93
.1*
89.5
62.9
*H
ad a
t lea
st 1
ove
rnig
ht h
ospi
tal s
tay
7.2*
22.5
*5.
7*14
.25.
2*Re
ceiv
ed c
are
at h
ome
1.2*
11.0
*0.
7*2.
6†
Rece
ipt o
f app
ropr
iate
car
e (p
ast 1
2 m
onth
s)H
ad c
hole
ster
ol c
heck
edAl
l ind
ivid
uals
69.1
87
.3*
73.1
71
.244
.9*
Men
age
35–
6473
.6*
86.7
77
.0
81.3
44.6
*In
divi
dual
s w
ith e
leva
ted
risk
of c
ardi
ac d
isea
se8
72.6
87
.2*
77.2
75
.045
.9*
Had
flu
shot
All i
ndiv
idua
ls35
.8*
53.7
*40
.0*
30.5
15.7
*
EXH
IBIT
43.
Use
of C
are
amon
g N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
19–
64 b
y Pr
imar
y So
urce
of H
ealth
Cov
erag
e, 2
014,
Dat
a fr
om
Nat
iona
l Hea
lth In
terv
iew
Sur
vey
MACStats: Medicaid and CHIP Data Book 119
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Indi
vidu
als
age
50–
6445
.4%
57.2
%*
47.8
%*
42.5
%20
.9%
*In
divi
dual
s w
ho h
ave
a ch
roni
c co
nditi
on o
r ar
e pr
egna
nt43
.3*
56.9
*47
.2*
36.6
20.1
*
Had
any
test
for c
olor
ecta
l can
cer (
age
50–
64)
20.7
25
.1
21.6
23
.27.
1*H
ad P
ap s
mea
r or t
est f
or c
ervi
cal c
ance
r (w
omen
age
21–
60)
55.9
43
.6*
61.8
*54
.133
.3*
Had
pro
fess
iona
l cou
nsel
ing
abou
t sm
okin
g (c
urre
nt s
mok
ers)
50.9
*68
.2*
54.3
60
.330
.4*
Had
mor
e th
an 1
5 of
fice
or c
linic
vis
its4.
9*23
.0*
4.1*
8.3
1.7*
Num
ber o
f em
erge
ncy
room
vis
itsN
one
82.1
*58
.0*
85.9
*65
.883
.5*
At le
ast 1
17.9
*42
.0*
14.1
*34
.216
.5*
111
.4*
19.7
10
.2*
16.6
10.7
*2–
34.
4*12
.6
2.9*
11.7
3.9*
4 or
mor
e2.
0*9.
8*1.
0*5.
91.
9*H
ad a
t lea
st 1
em
erge
ncy
room
vis
it, a
nd m
ost
rece
nt v
isit
was
for a
ser
ious
hea
lth p
robl
em12
.2*
31.6
*9.
8*23
.010
.1*
Not
es: O
b-gy
n is
obs
tetr
icia
n-gy
neco
logi
st. P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
exhi
bit e
xclu
de in
divi
dual
s w
ith m
issi
ng a
nd u
nkno
wn
valu
es. S
tand
ard
erro
rs a
re
avai
labl
e on
line
in d
ownl
oada
ble
Exce
l file
s at
htt
ps:/
/ww
w.m
acpa
c.go
v/m
acst
ats/
heal
th-a
nd-o
ther
-cha
ract
eris
tics-
of-b
enef
icia
ries-
serv
ice-
use-
and-
acce
ss-to
-car
e/. D
ue to
di
ffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t su
rvey
dat
a so
urce
s w
ill v
ary.
For
exa
mpl
e, th
e N
atio
nal H
ealth
Inte
rvie
w S
urve
y (N
HIS
) is
know
n to
pro
duce
hig
her e
stim
ates
of s
ervi
ce u
se th
an th
e M
edic
al E
xpen
ditu
res
Pane
l Sur
vey
(MEP
S). F
or p
urpo
ses
of c
ompa
ring
grou
ps o
f ind
ivid
uals
(as
in th
is e
xhib
it), t
he N
HIS
pro
vide
s th
e m
ost r
ecen
t inf
orm
atio
n av
aila
ble.
For
oth
er p
urpo
ses,
suc
h as
mea
surin
g le
vels
of u
se re
lativ
e to
a p
artic
ular
ben
chm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
indi
vidu
als
age
19–
64, r
egar
dles
s of
cov
erag
e so
urce
. In
this
exh
ibit,
the
follo
win
g hi
erar
chy
was
use
d to
ass
ign
indi
vidu
als
with
m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce: M
edic
are,
priv
ate,
Med
icai
d/CH
IP, o
ther
, uni
nsur
ed. N
ot s
epar
atel
y sh
own
are
the
estim
ates
for t
hose
cov
ered
by
any
type
of
mili
tary
hea
lth p
lan
or o
ther
gov
ernm
ent-s
pons
ored
pro
gram
s. C
over
age
sour
ce is
def
ined
as
of th
e tim
e of
the
surv
ey in
terv
iew
. Sin
ce a
n in
divi
dual
may
hav
e m
ultip
le
cove
rage
sou
rces
or c
hang
es o
ver t
ime,
resp
onse
s to
sur
vey
ques
tions
may
refle
ct c
hara
cter
istic
s or
exp
erie
nces
ass
ocia
ted
with
a c
over
age
sour
ce o
ther
than
the
one
assi
gned
in th
is e
xhib
it.
EXH
IBIT
43.
(co
ntin
ued)
December 2015120
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
2 Pr
ivat
e he
alth
insu
ranc
e co
vera
ge e
xclu
des
plan
s th
at p
aid
for o
nly
one
type
of s
ervi
ce, s
uch
as a
ccid
ents
or d
enta
l car
e.3
Med
icai
d/CH
IP a
lso
incl
udes
per
sons
cov
ered
by
othe
r sta
te-s
pons
ored
hea
lth p
lans
.4
Indi
vidu
als
wer
e de
fined
as
unin
sure
d if
they
did
not
hav
e an
y pr
ivat
e he
alth
insu
ranc
e, M
edic
aid,
CH
IP, M
edic
are,
sta
te- o
r oth
er g
over
nmen
t-spo
nsor
ed h
ealth
pla
n, o
r m
ilita
ry p
lan.
Indi
vidu
als
wer
e al
so d
efin
ed a
s un
insu
red
if th
ey h
ad o
nly
Indi
an H
ealth
Ser
vice
cov
erag
e or
had
onl
y a
priv
ate
plan
that
pai
d fo
r one
type
of s
ervi
ce, s
uch
as
acci
dent
s or
den
tal c
are.
5 Du
e to
the
fact
that
a h
iera
rchy
was
use
d in
this
exh
ibit
to a
ssig
n in
divi
dual
s w
ith m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce (s
ee n
ote
1), t
he M
edic
aid/
CHIP
per
cent
ages
sh
own
in th
is ro
w e
xclu
de in
divi
dual
s w
ho a
lso
have
Med
icar
e or
priv
ate
cove
rage
. Com
pone
nts
do n
ot s
um to
100
per
cent
bec
ause
not
all
cove
rage
sou
rces
are
sho
wn.
6 In
divi
dual
s m
ay re
port
enc
ount
ers
with
a b
road
rang
e of
hea
lth p
rofe
ssio
nals
(e.g
., sp
eech
ther
apis
t or s
ocia
l wor
ker)
but
the
ques
tion
is li
mite
d to
vis
its in
a d
octo
r’s o
ffic
e or
clin
ic.
7 Pe
rcen
tage
s ar
e lo
wer
than
for a
mea
sure
sho
wn
earli
er in
this
exh
ibit
beca
use
the
mea
sure
sho
wn
in th
is ro
w is
lim
ited
to o
ffic
e an
d cl
inic
set
tings
.8
Indi
vidu
als
of a
ny a
ge o
r sex
who
repo
rt h
yper
tens
ion
or d
iabe
tes,
or w
ho c
urre
ntly
sm
oke.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
EXH
IBIT
43.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 121
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
mos
t rec
ent i
nter
view
1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%3.
4%63
.7%
7.6 %
24.0
%
Cont
act w
ith h
ealth
car
e pr
ofes
sion
als
(pas
t 12
mon
ths)
Num
ber o
f tim
es s
aw a
doc
tor o
r oth
er h
ealth
pro
fess
iona
l, ex
clud
ing
dent
al v
isits
and
inpa
tient
hos
pita
l sta
ysN
one
27.7
*5.
1 *21
.821
.148
.9*
At le
ast 1
72.3
*94
.9*
78.2
78.9
51.1
*1
15.7
*6.
4*15
.9*
11.8
17.9
*2–
318
.310
.4*
20.4
*17
.813
.8*
4 or
mor
e38
.4*
78.1
*41
.9*
49.3
19.4
*H
ad a
t lea
st 1
ove
rnig
ht h
ospi
tal s
tay
6.7*
19.1
5.8*
16.0
4.3 *
Rece
ived
car
e at
hom
e1.
6 *12
.9*
0.8*
5.1
0.7*
Saw
a g
ener
al d
entis
t35
.8*
27.9
*45
.5*
21.4
15.9
*Sa
w a
n or
thod
ontis
t1.
2†
1.3
1.3
0.8
Rece
ipt o
f app
ropr
iate
car
e (p
ast 1
2 m
onth
s)H
ad d
enta
l cle
anin
g, p
roph
ylax
is, o
r pol
ishi
ng31
.0*
17.2
41.2
*15
.011
.2*
Had
mor
e th
an 1
5 of
fice
or c
linic
vis
its6
8.8*
30.4
*9.
1*13
.33.
5*N
umbe
r of e
mer
genc
y ro
om v
isits
Non
e86
.6*
67.0
89.5
*70
.987
.2*
At le
ast 1
13.4
*33
.010
.5*
29.1
12.8
*1
9.6 *
19.2
8.3 *
16.6
9.3 *
2–3
3.2*
10.9
2.0*
10.2
3.0*
4 or
mor
e0.
5*2.
9†
2.3
0.5*
Not
es: P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
exhi
bit e
xclu
de in
divi
dual
s w
ith m
issi
ng a
nd u
nkno
wn
valu
es. S
tand
ard
erro
rs a
re a
vaila
ble
onlin
e in
dow
nloa
dabl
e Ex
cel
files
at h
ttps
://w
ww
.mac
pac.
gov/
mac
stat
s/he
alth
-and
-oth
er-c
hara
cter
istic
s-of
-ben
efic
iarie
s-se
rvic
e-us
e-an
d-ac
cess
-to-c
are/
. Due
to d
iffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t sur
vey
data
sou
rces
will
var
y. F
or
exam
ple,
the
Nat
iona
l Hea
lth In
terv
iew
Sur
vey
(NH
IS) i
s kn
own
to p
rodu
ce h
ighe
r est
imat
es o
f ser
vice
use
than
the
Med
ical
Exp
endi
ture
s Pa
nel S
urve
y (M
EPS)
. For
pur
pose
s of
com
parin
g gr
oups
of i
ndiv
idua
ls, t
he N
HIS
pro
vide
s th
e m
ost r
ecen
t inf
orm
atio
n av
aila
ble.
For
oth
er p
urpo
ses,
suc
h as
mea
surin
g le
vels
of u
se re
lativ
e to
a p
artic
ular
be
nchm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
EXH
IBIT
44.
Use
of C
are
amon
g N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
19–
64 b
y Pr
imar
y So
urce
of H
ealth
Cov
erag
e, 2
013,
Dat
a fro
m
Med
ical
Exp
endi
ture
s Pa
nel S
urve
y
December 2015122
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
indi
vidu
als
age
19–
64, r
egar
dles
s of
cov
erag
e so
urce
. In
this
exh
ibit,
the
follo
win
g hi
erar
chy
was
use
d to
ass
ign
indi
vidu
als
with
m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce: M
edic
are,
priv
ate,
Med
icai
d/CH
IP, o
ther
, uni
nsur
ed. N
ot s
epar
atel
y sh
own
are
the
estim
ates
for t
hose
cov
ered
by
any
type
of
mili
tary
hea
lth p
lan
or o
ther
gov
ernm
ent-s
pons
ored
pro
gram
s. C
over
age
sour
ce is
def
ined
as
of th
e tim
e of
the
mos
t rec
ent s
urve
y in
terv
iew
. Sin
ce a
n in
divi
dual
may
hav
e m
ultip
le c
over
age
sour
ces
or c
hang
es o
ver t
ime,
resp
onse
s to
sur
vey
ques
tions
may
refle
ct c
hara
cter
istic
s or
exp
erie
nces
ass
ocia
ted
with
a c
over
age
sour
ce o
ther
than
the
one
assi
gned
in th
is e
xhib
it.2
Priv
ate
heal
th in
sura
nce
cove
rage
exc
lude
s pl
ans
that
pai
d fo
r onl
y on
e ty
pe o
f ser
vice
, suc
h as
acc
iden
ts o
r den
tal c
are.
3 M
edic
aid/
CHIP
als
o in
clud
es p
erso
ns c
over
ed b
y ot
her s
tate
-spo
nsor
ed h
ealth
pla
ns.
4 In
divi
dual
s w
ere
defin
ed a
s un
insu
red
if th
ey d
id n
ot h
ave
any
priv
ate
heal
th in
sura
nce,
Med
icai
d, C
HIP
, Med
icar
e, s
tate
- or o
ther
gov
ernm
ent-s
pons
ored
hea
lth p
lan,
or
mili
tary
pla
n. In
divi
dual
s w
ere
also
def
ined
as
unin
sure
d if
they
had
onl
y In
dian
Hea
lth S
ervi
ce c
over
age
or h
ad o
nly
a pr
ivat
e pl
an th
at p
aid
for o
ne ty
pe o
f ser
vice
, suc
h as
ac
cide
nts
or d
enta
l car
e.5
Due
to th
e fa
ct th
at a
hie
rarc
hy w
as u
sed
in th
is e
xhib
it to
ass
ign
indi
vidu
als
with
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
(see
not
e 1)
, the
Med
icai
d/CH
IP p
erce
ntag
es
show
n in
this
row
exc
lude
indi
vidu
als
who
als
o ha
ve M
edic
are
or p
rivat
e co
vera
ge. C
ompo
nent
s do
not
sum
to 1
00 p
erce
nt b
ecau
se n
ot a
ll co
vera
ge s
ourc
es a
re s
how
n.6
Refle
cts
info
rmat
ion
from
the
offic
e-ba
sed
and
hosp
ital o
utpa
tient
dep
artm
ent f
iles
in M
EPS.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
MEP
S da
ta.
EXH
IBIT
44.
(co
ntin
ued)
MACStats: Medicaid and CHIP Data Book 123
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
Char
acte
ristic
sPr
imar
y co
vera
ge s
ourc
e at
tim
e of
inte
rvie
w1
Tota
lM
edic
are
Priv
ate2
Med
icai
d/CH
IP3
Uni
nsur
ed4
Tota
l (pe
rcen
t dis
trib
utio
n ac
ross
cov
erag
e so
urce
s)5
100.
0%3.
6%66
.2%
10.5
%16
.3%
Conn
ectio
n to
the
heal
th c
are
syst
em (p
ast 1
2 m
onth
s)H
as a
usu
al s
ourc
e of
car
e82
.6*
93.6
*89
.3
87.7
48.2
*H
ad th
e sa
me
usua
l sou
rce
of m
edic
al c
are
12
mon
ths
ago
75.3
*83
.6*
81.1
*78
.446
.6*
Does
not
hav
e a
usua
l sou
rce
of c
are,
and
ac
cess
bar
rier i
s th
e re
ason
66.
2*2.
1 1.
5*3.
328
.9*
Had
trou
ble
findi
ng a
doc
tor o
r was
told
that
co
vera
ge o
r new
pat
ient
s w
ere
not a
ccep
ted7
5.0*
7.8
4.0*
8.4
6.6*
Tim
elin
ess
of c
are
(pas
t 12
mon
ths)
Dela
yed
med
ical
car
e du
e to
any
acc
ess
barr
ier i
ndic
ated
bel
ow18
.4*
31.1
*13
.6*
21.6
33.8
*
Dela
yed
beca
use
of c
osts
10.8
18
.0*
6.7*
9.5
28.0
*De
laye
d fo
r pro
vide
r-rel
ated
reas
ons8
8.6*
14.1
7.
8*11
.98.
1*De
laye
d du
e to
lack
of t
rans
port
atio
n1.
7*7.
8*0.
5*5.
22.
7*U
nmet
nee
d fo
r sel
ecte
d ty
pes
of c
are
due
to c
ost
Med
ical
car
e8.
1 13
.4*
4.1*
8.3
23.9
*M
enta
l hea
lth c
are
or c
ouns
elin
g2.
3*5.
1*1.
2*3.
35.
2*De
ntal
car
e12
.8*
28.0
*7.
0*20
.128
.4*
Pres
crip
tion
drug
s7.
8*19
.4*
4.1*
11.5
17.8
*Ey
egla
sses
7.2*
19.4
*3.
7*11
.116
.4*
Spec
ialis
t car
e5.
0*11
.0*
2.6*
6.9
12.4
*Fo
llow
-up
care
4.3
8.1*
2.1*
5.0
11.8
*
Not
es: P
erce
ntag
e ca
lcul
atio
ns fo
r eac
h ite
m in
the
tabl
e ex
clud
e in
divi
dual
s w
ith m
issi
ng a
nd u
nkno
wn
valu
es. S
tand
ard
erro
rs a
re a
vaila
ble
onlin
e in
dow
nloa
dabl
e Ex
cel
files
at h
ttps
://w
ww
.mac
pac.
gov/
mac
stat
s/he
alth
-and
-oth
er-c
hara
cter
istic
s-of
-ben
efic
iarie
s-se
rvic
e-us
e-an
d-ac
cess
-to-c
are/
. Due
to d
iffer
ence
s in
met
hodo
logy
(suc
h as
the
wor
ding
of q
uest
ions
, len
gth
of re
call
perio
ds, a
nd p
rom
pts
or p
robe
s us
ed to
elic
it re
spon
ses)
, est
imat
es o
btai
ned
from
diff
eren
t sur
vey
data
sou
rces
will
var
y. F
or e
xam
ple,
th
e N
atio
nal H
ealth
Inte
rvie
w S
urve
y (N
HIS
) is
know
n to
pro
duce
hig
her e
stim
ates
of s
ervi
ce u
se th
an th
e M
edic
al E
xpen
ditu
res
Pane
l Sur
vey
(MEP
S). F
or p
urpo
ses
of
com
parin
g gr
oups
of i
ndiv
idua
ls (a
s in
this
exh
ibit)
, the
NH
IS p
rovi
des
the
mos
t rec
ent i
nfor
mat
ion
avai
labl
e. F
or o
ther
pur
pose
s, s
uch
as m
easu
ring
leve
ls o
f use
rela
tive
to a
pa
rtic
ular
ben
chm
ark
or g
oal,
it m
ay b
e ap
prop
riate
to c
onsu
lt es
timat
es fr
om M
EPS
or a
noth
er s
ourc
e.
EXH
IBIT
45.
Mea
sure
s of
Acc
ess
to C
are
amon
g N
on-In
stitu
tiona
lized
Indi
vidu
als
Age
19–
64 b
y Pr
imar
y So
urce
of H
ealth
Co
vera
ge, 2
014
December 2015124
Section 5: Beneficiary Health, Service Use, and Access to Care
MAC
Stat
sSe
ctio
n 5
* Di
ffer
ence
from
Med
icai
d/CH
IP is
sta
tistic
ally
sig
nific
ant a
t the
0.0
5 le
vel.
† Es
timat
e is
unr
elia
ble
beca
use
it ha
s a
rela
tive
stan
dard
err
or g
reat
er th
an 3
0 pe
rcen
t.
– D
ash
indi
cate
s ze
ro; 0
.0%
indi
cate
s an
am
ount
less
than
0.0
5% th
at ro
unds
to z
ero.
1 To
tal i
nclu
des
all n
on-in
stitu
tiona
lized
indi
vidu
als
age
19–
64, r
egar
dles
s of
cov
erag
e so
urce
. In
this
exh
ibit,
the
follo
win
g hi
erar
chy
was
use
d to
ass
ign
indi
vidu
als
with
m
ultip
le c
over
age
sour
ces
to a
prim
ary
sour
ce: M
edic
are,
priv
ate,
Med
icai
d/CH
IP, o
ther
, uni
nsur
ed. N
ot s
epar
atel
y sh
own
are
the
estim
ates
for t
hose
cov
ered
by
any
type
of
mili
tary
hea
lth p
lan
or o
ther
gov
ernm
ent-s
pons
ored
pro
gram
s. C
over
age
sour
ce is
def
ined
as
of th
e tim
e of
the
surv
ey in
terv
iew
. Sin
ce a
n in
divi
dual
may
hav
e m
ultip
le
cove
rage
sou
rces
or c
hang
es o
ver t
ime,
resp
onse
s to
sur
vey
ques
tions
may
refle
ct c
hara
cter
istic
s or
exp
erie
nces
ass
ocia
ted
with
a c
over
age
sour
ce o
ther
than
the
one
assi
gned
in th
is e
xhib
it.2
Priv
ate
heal
th in
sura
nce
cove
rage
exc
lude
s pl
ans
that
pai
d fo
r onl
y on
e ty
pe o
f ser
vice
, suc
h as
acc
iden
ts o
r den
tal c
are.
3 M
edic
aid/
CHIP
als
o in
clud
es p
erso
ns c
over
ed b
y ot
her s
tate
-spo
nsor
ed h
ealth
pla
ns.
4 In
divi
dual
s w
ere
defin
ed a
s un
insu
red
if th
ey d
id n
ot h
ave
any
priv
ate
heal
th in
sura
nce,
Med
icai
d, C
HIP
, Med
icar
e, s
tate
- or o
ther
gov
ernm
ent-s
pons
ored
hea
lth p
lan,
or
mili
tary
pla
n. In
divi
dual
s w
ere
also
def
ined
as
unin
sure
d if
they
had
onl
y In
dian
Hea
lth S
ervi
ce c
over
age
or h
ad o
nly
a pr
ivat
e pl
an th
at p
aid
for o
ne ty
pe o
f ser
vice
, suc
h as
ac
cide
nts
or d
enta
l car
e.5
Due
to th
e fa
ct th
at a
hie
rarc
hy w
as u
sed
in th
is e
xhib
it to
ass
ign
indi
vidu
als
with
mul
tiple
cov
erag
e so
urce
s to
a p
rimar
y so
urce
(see
not
e 1)
, the
Med
icai
d/CH
IP p
erce
ntag
es
show
n in
this
row
exc
lude
indi
vidu
als
who
als
o ha
ve M
edic
are
or p
rivat
e co
vera
ge. C
ompo
nent
s do
not
sum
to 1
00 p
erce
nt b
ecau
se n
ot a
ll co
vera
ge s
ourc
es a
re s
how
n.6
Reas
ons
give
n by
thos
e w
ho re
port
ed n
o us
ual p
lace
of c
are
that
wer
e cl
assi
fied
as a
cces
s ba
rrie
rs in
clud
e th
e fo
llow
ing:
too
expe
nsiv
e/co
st, p
revi
ous
doct
or n
ot a
vaila
ble,
pa
rent
doe
s no
t kno
w w
here
to g
o, a
nd s
peak
s a
diff
eren
t lan
guag
e.
7 In
divi
dual
repo
rted
one
of t
hese
bar
riers
in th
e pa
st 1
2 m
onth
s: tr
oubl
e fin
ding
a d
octo
r or p
rovi
der,
doct
or’s
off
ice/
clin
ic d
id n
ot a
ccep
t chi
ld’s
insu
ranc
e co
vera
ge, o
r off
ice/
clin
ic d
id n
ot a
ccep
t the
chi
ld a
s a
new
pat
ient
.8
Incl
udes
any
of t
he fo
llow
ing:
indi
vidu
al c
ould
not
get
an
appo
intm
ent,
had
to w
ait t
oo lo
ng to
see
doc
tor,
coul
d no
t go
whe
n op
en, c
ould
not
get
thro
ugh
on p
hone
, ind
ivid
ual
spea
ks a
diff
eren
t lan
guag
e.
Sour
ce: M
ACPA
C, 2
015,
ana
lysi
s of
NH
IS d
ata.
EXH
IBIT
45.
(co
ntin
ued)
SECTION 6
Technical Guide to MACStats
MACStats: Medicaid and CHIP Data Book 127
Section 6: Technical Guide to MACStats
MAC
Stat
sSe
ctio
n 6
This technical guide provides supplementary information to help readers interpret the exhibits in this data book as well as to understand the data sources and methods used. In addition, we explain why MACPAC’s statistics, particularly those on enrollment and spending, may differ from each other or from those published elsewhere.1
Interpreting Medicaid and CHIP Enrollment and Spending NumbersPublished numbers for enrollment in Medicaid and the State Children’s Health Insurance Program (CHIP) can vary substantially depending on the source of data, the enrollment period examined, and the individuals included in the data.
Data sourcesMedicaid and CHIP enrollment and spending numbers are available from data which states and the federal government compile in the course of administering these programs. Program data are updated on different schedules, so the latest year of available data may differ depending on the source. MACPAC commonly uses the following types of administrative data, which are submitted by the states to the Centers for Medicare & Medicaid Services (CMS):
• Form CMS-64 data for state-level Medicaid spending;
• Medicaid Statistical Information System (MSIS) data for person-level detail;
• Medicaid managed care enrollment reports; and
• Statistical Enrollment Data System (SEDS) data for CHIP enrollment.
In addition, CMS recently began compiling two new administrative data sources, referred to here as performance indicator enrollment data and CMS-64 enrollment data.2 Notable differences between these sources include that the performance indicator enrollment data are published monthly by CMS and only include full-benefit Medicaid and CHIP enrollees, while CMS-64 enrollment data are published quarterly and include those with limited benefits but exclude CHIP enrollees. Both sources provide more up-to-date information than the MSIS. Although timelier reporting is expected under a new version of the MSIS, referred to as the transformed MSIS (T-MSIS), full implementation has been delayed and states are still in the process of transitioning to T-MSIS reporting.
MACStats also uses nationally representative surveys based on interviews of individuals including the National Health Interview Survey (NHIS) and the Medical Expenditures Panel Survey (MEPS). Estimates of Medicaid and CHIP enrollment from survey data tend to be lower those generated from administrative data, in part because survey respondents tend to underreport Medicaid and CHIP coverage. However, survey data provide many more details on individual and family circumstances (for example, health status, ease in accessing services, reasons for delaying care) and can therefore provide a richer picture of the individuals enrolled in Medicaid and CHIP.
Enrollment period examinedCharacterizations of the size of the Medicaid and CHIP populations may vary based on the enrollment period examined. The number of individuals enrolled at a particular point during the year will be lower than the total number enrolled at any point during an entire year. Point-in-time numbers are sometimes referred to as average, full-year equivalent, or person-year enrollment. These statistics are often used for budget analyses (such as those by the CMS Office of the Actuary) and when comparing enrollment and expenditure
December 2015128
Section 6: Technical Guide to MACStats
MAC
Stat
sSe
ctio
n 6
numbers. Per enrollee spending levels based on full-year equivalents ensure that amounts are not biased by individuals’ transitions in and out of Medicaid coverage during the year.
Enrollees versus beneficiariesDepending on the source and the year in question, data may reflect different ways of characterizing individuals in Medicaid. Certain terms commonly used to refer to people with Medicaid coverage have extremely specific definitions in administrative data sources provided by CMS:3
• Enrollees (less commonly referred to as eligibles) are individuals who are eligible for and enrolled in Medicaid or CHIP. Prior to fiscal year (FY) 1990, CMS did not track the number of Medicaid enrollees, and tracked only beneficiaries (see below). In some cases, CMS has estimated the number of enrollees prior to 1990.
• Beneficiaries, or persons served (less commonly referred to as recipients), are enrollees who receive covered services or for whom Medicaid or CHIP payments are made. Prior to FY 1998, individuals were not counted as beneficiaries if managed care payments were the only Medicaid payments made on their behalf. Beginning in FY 1998, however, Medicaid managed care enrollees with no fee-for-service (FFS) spending were also counted as beneficiaries, which increased the number of individuals reflected in enrollment statistics. Generally, the number of beneficiaries will approach the number of enrollees as more of these individuals use Medicaid-covered services or are enrolled in managed care.4 (In common usage outside of statistical publications from CMS, the term beneficiaries typically is synonymous with enrollees.)
Institutionalized and limited-benefit enrollees Administrative Medicaid data include enrollees who are in institutions such as nursing homes, as well as individuals who receive only limited benefits (for example, only coverage for emergency services). Survey data tend to exclude such individuals from counts of coverage. In percentage terms, the difference between estimates from administrative data versus survey data tends to be largest among older beneficiaries, who are more likely to be living in institutions (in which case they are excluded from most surveys) and receiving limited Medicaid benefits that pay only for their Medicare premiums and cost sharing (which may not be counted as Medicaid coverage in some surveys).
State Children’s Health Insurance Program enrolleesMedicaid-expansion CHIP enrollees are children who are entitled to the covered services of a state’s Medicaid program, but whose Medicaid coverage is generally funded with CHIP dollars. Depending on the data source, Medicaid enrollment and spending figures may include not only Medicaid enrollees funded with Medicaid dollars, but also Medicaid-expansion CHIP enrollees funded with CHIP dollars. For MACStats, we generally exclude Medicaid-expansion CHIP enrollees from Medicaid analyses, but some data sources do not allow these children to be broken out separately.
Understanding Data on Health and Other Characteristics of Medicaid and CHIP PopulationsMACStats uses data from the federal National Health Interview Survey and the Medical Expenditures Panel Survey to describe Medicaid and CHIP enrollees in terms of their self-reported demographic, socioeconomic, and health
MACStats: Medicaid and CHIP Data Book 129
Section 6: Technical Guide to MACStats
MAC
Stat
sSe
ctio
n 6
characteristics as well as their use of care. Background information on these surveys is provided here, along with information on how children with special health care needs are identified using NHIS data.
National Health Interview Survey and Medical Expenditures Panel Survey dataThe NHIS is an annual face-to-face household survey of civilian non-institutionalized persons designed to monitor the health of the U.S. population through the collection of information on a broad range of health topics.5 A subsample of households that participated in the previous year’s NHIS undergo further interviews for the household component of the MEPS, which collects more detailed information on use of health care services and expenditures.6
Although other surveys are available, the NHIS is the main survey data source used in MACStats because it provides relatively timely estimates and because its sample size is large enough to produce reliable subgroup estimates and to detect meaningful differences between them. In addition, it is generally considered to be one of the best surveys for health insurance coverage estimates, and it captures detailed information on individuals’ health status.7
However, the NHIS is known to produce higher estimates of service use than the MEPS.8 As a result, MACStats includes estimates of service use from both sources. For purposes of comparing groups of individuals, the NHIS has the advantage of providing the most recent information available; for other purposes, such as measuring levels of service use relative to a particular benchmark or goal, consulting estimates from the MEPS or another source might be more appropriate.
The NHIS and MEPS have some limitations. As in most surveys, respondents do not always accurately report information about participation in programs such as Medicaid, CHIP, Medicare, Supplemental Security Income (SSI), and Social
Security Disability Insurance (SSDI). As a result, survey data may not match estimates of program participation computed from the programs’ own administrative data. In addition, although surveys typically ask about participation in Medicaid and CHIP in two different questions, program participation estimates are not reported separately. One reason for this is that many states’ CHIP and Medicaid programs use the same name, so respondents may not necessarily know which program funds their children’s coverage. Even when the programs have different names, it may be difficult for respondents and interviewers to correctly categorize the coverage. As a result, separate survey questions regarding participation in Medicaid and CHIP are generally used to minimize the undercounting of Medicaid and CHIP enrollees, not to produce valid estimates separately for each program. Thus, survey data analyses typically combine Medicaid and CHIP into a single category.
Children with special health care needsThe term, children with special health care needs (CSHCN), is defined by the U.S. Department of Health and Human Services’ Maternal and Child Health Bureau (MCHB) as a group of children who “have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”9 This definition is used by all states for policy and program planning purposes and encompasses children with disabilities and also children with chronic conditions (e.g., asthma, juvenile diabetes, sickle cell anemia) that range from mild to severe. The category of CSHCN covers a broader range of children than the category of children with conditions severe enough and family incomes low enough to qualify for SSI.10
MACPAC uses responses to several questions on the NHIS to identify such children. This definition includes children with at least one diagnosed or parent-reported condition expected to be an ongoing health condition, who also meet at least
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one of five criteria related to elevated service use or elevated need:
• The child is limited or prevented in his or her ability to do things most children of the same age can do.
• The child needs or uses medications prescribed by a doctor (other than vitamins).
• The child needs or uses specialized therapies such as physical, occupational, or speech therapy.
• The child has above-routine need or use of medical, mental health, home care, or education services.
• The child needs or receives treatment or counseling for an emotional, behavioral, or developmental problem.
Estimates for the category of CSHCN in this edition of MACStats are not directly comparable to those in MACPAC reports prior to 2013, which used a slightly different definition.11
Methodology for Adjusting Benefit Spending DataThe FY 2012 Medicaid benefit spending amounts presented in this data book were calculated based on MSIS data that have been adjusted to match total benefit spending reported by states in CMS-64 data.12 Although the CMS-64 provides a more complete accounting of spending than the MSIS and is preferred when examining state or federal spending totals, it cannot be used for analysis of benefit spending by eligibility group and other enrollee characteristics.13 Thus, we adjust MSIS amounts for several reasons:
• CMS-64 data provide an official accounting of state spending on Medicaid for purposes of receiving federal matching dollars; in contrast, MSIS data are used primarily for statistical purposes.
• The MSIS generally understates total Medicaid benefit spending because it excludes disproportionate share hospital payments and additional types of supplemental payments made to hospitals and other providers, Medicare premium payments, and certain other amounts.14
• The MSIS generally overstates net spending on prescribed drugs, because it excludes rebates from drug manufacturers.
• Even after accounting for differences in their scope and design, the MSIS still tends to produce lower total benefit spending than the CMS-64.15
• The extent to which the MSIS differs from the CMS-64 varies by state, meaning that a cross-state comparison of unadjusted MSIS amounts may not reflect true differences in benefit spending. See Exhibit 46 for unadjusted benefit spending amounts in the MSIS as a percentage of benefit spending in the CMS-64.
The methodology MACPAC uses for adjusting MSIS benefit spending data involves the following steps:
• We aggregate the service types into broad categories that are comparable between the two sources. This is necessary because there is not a one-to-one correspondence of service types in MSIS and CMS-64 data. Even service types that have identical names may still be reported differently in the two sources due to differences in the instructions given to states. Exhibit 47 provides additional detail on the categories used.
• We calculate state-specific adjustment factors for each of the service categories by dividing CMS-64 benefit spending by MSIS benefit spending.
• We then multiply MSIS dollar amounts in each service category by the state-specific factors to obtain adjusted MSIS spending. For example, in a state with an FFS hospital factor of 1.2, each Medicaid enrollee with
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hospital spending in the MSIS would have that spending multiplied by 1.2; doing so makes the sum of adjusted hospital spending amounts among individual Medicaid enrollees in the MSIS total the aggregate hospital spending reported by states in the CMS-64 (as noted later, MACPAC excludes some amounts from the CMS-64 hospital total).16
These adjustments to MSIS data are meant to provide more complete estimates of Medicaid benefit spending across states that can be analyzed by eligibility group and other enrollee characteristics. Other organizations, including the CMS Office of the Actuary, the Kaiser Commission on Medicaid and the Uninsured, and the Urban Institute, use similar methodologies although these may differ in some ways—for example, by using different service categories or producing estimates for future years based on actual data for earlier years.
Readers should note that due to changes in both methods and data, MSIS figures shown here are not directly comparable to earlier years. Key differences between the current and previous methodologies include the following:
• In the 2014 and 2015 editions of MACStats, we excluded disproportionate share hospital (DSH) payments from CMS-64 totals used to adjust MSIS spending. In earlier editions, DSH payments were included in CMS-64 totals. The rationale for doing so was that DSH payments are used to support hospitals that serve a large number of low-income and Medicaid patients, and could therefore be partially attributed to Medicaid enrollees in the MSIS. However, an examination of annual DSH report data submitted by states indicates that for some hospitals, Medicaid DSH payments far exceed their uncompensated care costs for Medicaid patients and may therefore be attributed largely to uninsured patients.17 As a result, we now exclude DSH payments from CMS-64 totals when we adjust MSIS spending.
• In the 2015 edition, we exclude incentive and uncompensated care pool payments made under Section 1115 waiver expenditure authority from CMS-64 totals used to adjust MSIS spending.18 In earlier editions, these payments were included in CMS-64 totals. Because these payments may be made for purposes other than Medicaid patient costs, we now exclude them when we adjust MSIS spending.
• In the 2015 edition, we shifted a portion of drug rebate amounts in the CMS-64 from fee for service to managed care for a small number of states that, despite reporting drug utilization data for managed care, reported little or no drug rebates for managed care.
• In the 2014 and 2015 editions, we obtained a more precise separation of home- and community-based services (HCBS) waiver spending in the MSIS, due to the use of more detailed MSIS data files than in editions of MACStats prior to 2014.
With regard to changes in data, complete MSIS Annual Person Summary (APS) files have not been available in a timely manner for use in the 2014 and 2015 editions of MACStats. Therefore, we calculated spending and enrollment from the full MSIS data files that are used to create APS files. In general, our calculations closely match those used to create the APS. However, our development of enrollment counts is a notable exception. In MACPAC’s analysis of the full MSIS data files, Medicaid enrollees were assigned a unique national identification (ID) number using an algorithm that incorporates state-specific ID numbers and beneficiary characteristics such as date of birth and gender. The state and national enrollment counts were then unduplicated using this national ID, which results in MACPAC reporting slightly lower enrollment counts than would be the case had we used APS files.
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State
Benefit spending totals included in analysis
Amounts excluded from CMS-64 benefit spending totals
Unadjusted MSIS CMS-64
MSIS as a percentage of CMS-64 DSH
Incentive and uncompensated
care pool waivers
Total $365,746 $389,456 93.9% $17,076 $8,624Alabama 4,107 4,569 89.9 458 –Alaska 1,294 1,331 97.3 20 –Arizona 8,223 7,516 109.4 195 194Arkansas 3,457 4,093 84.5 61 5California 35,154 45,504 77.3 2,102 2,560Colorado 3,688 4,534 81.3 189 –Connecticut 5,882 6,281 93.6 478 –Delaware 1,569 1,472 106.6 13 –District of Columbia 2,197 2,050 107.2 61 –Florida 18,865 16,602 113.6 365 939Georgia 9,098 8,110 112.2 416 –Hawaii 1,448 1,465 98.8 – 27Idaho 1,459 1,428 102.1 23 –Illinois 13,274 12,949 102.5 444 –Indiana 6,453 7,487 86.2 -1 –Iowa 3,391 3,439 98.6 52 4Kansas 2,559 2,593 98.7 74 –Kentucky 5,529 5,493 100.7 208 –Louisiana 5,587 6,625 84.3 733 –Maine 1,902 2,372 80.2 41 –Maryland 7,214 7,650 94.3 36 –Massachusetts 10,609 11,994 88.5 – 931Michigan 11,750 12,184 96.4 276 –Minnesota 8,654 8,846 97.8 48 –Mississippi 3,732 4,255 87.7 211 –Missouri 6,464 7,971 81.1 756 –Montana 807 955 84.5 17 –Nebraska 1,630 1,680 97.0 42 –Nevada 1,377 1,653 83.3 86 –New Hampshire 1,047 1,145 91.4 42 –New Jersey 8,752 9,146 95.7 1,243 –New Mexico 2,520 3,374 74.7 56 –
EXHIBIT 46. Medicaid Benefit Spending in MSIS and CMS-64 Data by State, FY 2012 (millions)
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State
Benefit spending totals included in analysis
Amounts excluded from CMS-64 benefit spending totals
Unadjusted MSIS CMS-64
MSIS as a percentage of CMS-64 DSH
Incentive and uncompensated
care pool waivers
New York $48,151 $49,668 96.9% $3,250 $387North Carolina 9,919 11,972 82.9 310 –North Dakota 766 743 103.0 1 –Ohio 15,752 15,808 99.7 544 –Oklahoma 3,732 4,606 81.0 36 –Oregon 3,756 4,518 83.1 69 –Pennsylvania 17,793 19,232 92.5 1,162 –Rhode Island 1,497 1,727 86.7 128 1South Carolina 4,644 4,391 105.8 457 –South Dakota 744 749 99.4 1 –Tennessee 12,216 7,520 162.5 102 1,176Texas 22,117 24,375 90.7 1,516 2,394Utah 2,365 1,870 126.5 33 –Vermont 1,077 1,311 82.1 37 5Virginia 6,005 6,692 89.7 215 –Washington 6,255 7,168 87.3 392 –West Virginia 3,049 2,714 112.3 75 –Wisconsin 5,641 7,096 79.5 0 –Wyoming 582 528 110.1 0 –
Notes: MSIS is Medicaid Statistical Information System. FY is fiscal year. DSH is disproportionate share hospital. Includes federal and state funds. MSIS and CMS-64 data reflect unadjusted amounts as reported by states. Both sources exclude spending on administration, the territories, and Medicaid-expansion CHIP enrollees; in addition, CMS-64 amounts exclude $8.0 billion in offsetting collections from third-party liability, estate, and other recoveries. See https://www.macpac.gov/macstats/data-sources-and-methods/ for a discussion of differences between MSIS and CMS-64 data. Beginning with the 2014 edition of MACStats, DSH payments were excluded from CMS-64 totals used to adjust MSIS spending; beginning with the 2015 edition, incentive and uncompensated care pool payments made under Section 1115 waiver authority were also excluded. For informational purposes, the DSH and waiver expenditure amounts that were excluded are shown here.
– Dash indicates zero; $0 indicates an amount less than $0.5 million that rounds to zero; negative sign indicates that state reported an amount less than zero (which may reflect, for example, a correction to an amount reported in a prior period).
Source: MACPAC, 2015, analysis of MSIS data as of December 2014 and CMS-64 Financial Management Report (FMR) net expenditure data as of June 2015.
EXHIBIT 46. (continued)
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Service category MSIS service types1 CMS-64 service typesHospital • Inpatient hospital
• Outpatient hospital• Inpatient hospital non-DSH• Inpatient hospital non-DSH supplemental
payments• Inpatient hospital GME payments• Outpatient hospital non-DSH• Outpatient hospital non-DSH supplemental
payments• Emergency services for aliens2
• Emergency hospital services• Critical access hospitals
Non-hospital acute care
• Physician• Dental• Nurse-midwife• Nurse practitioner• Other practitioner• Non-hospital outpatient clinic• Lab and X-ray• Sterilizations• Abortions• Hospice• Targeted case management• Physical, occupational, speech, and
hearing therapy• Non-emergency transportation• Private duty nursing• Rehabilitative services• Other care, excluding HCBS waiver
• Physician• Physician services supplemental payments• Dental• Nurse-midwife• Nurse practitioner• Other practitioner • Other practitioner supplemental payments• Non-hospital clinic• Rural health clinic• Federally qualified health center• Lab and X-ray• Sterilizations• Abortions• Hospice• Targeted case management• Statewide case management• Physical therapy• Occupational therapy• Services for speech, hearing, and language• Non-emergency transportation• Private duty nursing• Rehabilitative services (non-school-based)• School-based services• EPSDT screenings• Diagnostic screening and preventive services• Prosthetic devices, dentures, eyeglasses• Freestanding birth center• Health home with chronic conditions• Tobacco cessation for pregnant women• Care not otherwise categorized
Drugs • Drugs (gross spending) • Drugs (gross spending)• Drug rebates
EXHIBIT 47. Service Categories Used to Adjust FY 2012 Medicaid Benefit Spending in the MSIS to Match CMS-64 Totals
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Service category MSIS service types1 CMS-64 service typesManaged care and premium assistance
• HMO (i.e., comprehensive risk based managed care; includes PACE)
• PHP• PCCM
• MCO (i.e., comprehensive risk-based managed care)
• MCO drug rebates• PACE• PAHP• PIHP• PCCM• Premium assistance for private coverage
LTSS non-institutional • Home health• Personal care• HCBS waiver
• Home health• Personal care• Personal care—1915(j)• HCBS waiver• HCBS—1915(i)• HCBS—1915(j)
LTSS institutional • Nursing facility• ICF/ID• Inpatient psychiatric for individuals
under age 21• Mental health facility for individuals
age 65 and older
• Nursing facility• Nursing facility supplemental payments• ICF/ID• ICF/ID supplemental payments• Mental health facility for individuals under age
21 or age 65 and older, non-DSH
Medicare3, 4 • Medicare Part A and Part B premiums• Medicare coinsurance and deductibles for QMBs
Notes: FY is fiscal year. MSIS is Medicaid Statistical Information System. DSH is disproportionate share hospital. GME is graduate medical education. HCBS is home and community-based services. EPSDT is Early and Periodic Screening, Diagnostic, and Treatment. HMO is health maintenance organization. PACE is Program of All-Inclusive Care for the Elderly. PHP is prepaid health plan. PCCM is primary care case management. MCO is managed care organization. PAHP is prepaid ambulatory health plan (a type of PHP). PIHP is prepaid inpatient health plan (a type of PHP). LTSS is long-term services and supports. ICF/ID is intermediate care facility for persons with intellectual disabilities. QMB is qualified Medicare beneficiary.
Service categories and types reflect fee-for-service spending unless noted otherwise. Service types with identical names in MSIS and CMS-64 data may still be reported differently in the two sources due to differences in the instructions given to states; amounts for those that appear only in the CMS-64 (e.g., drug rebates) are distributed across Medicaid enrollees with MSIS spending in the relevant service categories (e.g., drugs).1 Claims in the MSIS include both a service type (such as inpatient hospital, physician, personal care, etc.) and a program type (including HCBS waiver). When adjusting MSIS data to match CMS-64 totals, we count all claims with an HCBS waiver program type as HCBS waiver, regardless of their specific service type. Among claims with an HCBS waiver program type, the most common service types are other, home health, rehabilitation, and personal care.2 Emergency services for aliens are reported under individual service types throughout the MSIS, but primarily inpatient and outpatient hospital. As a result, we include this CMS-64 amount in the hospital category. 3 Medicare premiums are not reported in the MSIS. We distribute CMS-64 amounts proportionately across dually eligible enrollees in the MSIS for each state.4 Medicare coinsurance and deductibles are reported under individual service types throughout the MSIS. We distribute CMS-64 amount for QMBs across CMS-64 spending in the hospital, non-hospital acute, and LTSS institutional categories prior to calculating state-level adjustment factors, based on the distribution of Medicare cost sharing for hospital, Part B, and skilled nursing facility services among QMBs in 2010 Medicare data. See MedPAC and MACPAC, 2015, Data book: Beneficiaries dually eligible for Medicare and Medicaid, Table 4, fee-for-service Medicare Part A and Part B cost sharing incurred by dually eligible and non-dually eligible Medicare beneficiaries, https://www.macpac.gov/wp-content/uploads/2015/01/Duals_DataBook_2015-01.pdf.
Source: MACPAC, 2015, analysis of MSIS and CMS-64 Financial Management Report (FMR) net expenditure data.
EXHIBIT 47. (continued)
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Understanding Managed Care Enrollment and Spending DataThere are four main sources of data on Medicaid managed care available from CMS.
• Medicaid Managed Care Data Collection System (MMCDCS). The MMCDCS provides state-reported aggregate enrollment statistics and other basic information for each managed care plan within a state. CMS uses the MMCDCS to create an annual Medicaid managed care enrollment report, which is the source of information on Medicaid managed care most commonly cited by CMS, as well as by outside analysts and researchers.
• MSIS. The MSIS provides person-level and claims-level information for all Medicaid enrollees. For managed care, MSIS claims include records of each capitated payment made on behalf of an enrollee to a managed care plan (generally referred to as capitated claims), as well as records of each service received by the enrollee from a provider under contract with a managed care plan (which generally do not include payment amounts and may be referred to as encounter or dummy claims). All states collect encounter data from their Medicaid managed care plans, but some do not report them in the MSIS. Managed care enrollees may also have FFS claims in the MSIS if they used services beyond those covered by a managed care plan’s contract with the state.
• CMS-64. The CMS-64 Financial Management Report (FMR) provides aggregate spending information for Medicaid by major benefit categories, including managed care. The spending amounts reported by states on the CMS-64 are used to calculate their federal matching dollars.
• Statistical Enrollment Data System (SEDS). The SEDS provides aggregate statistics on CHIP enrollment and child Medicaid
enrollment that include the number covered under FFS and managed care systems. The SEDS is the only comprehensive source of information on managed care participation among separate CHIP enrollees across states.
Although the annual Medicaid managed care enrollment report generally contains the most recent information available from CMS on Medicaid managed care for all states, it does not provide information on many characteristics of enrollees in managed care (e.g., basis of eligibility and demographics such as age, sex, race, and ethnicity). It does provide information on whether individuals are dually eligible for Medicare. As a result, MACStats also includes statistics based on MSIS and CMS-64 data, such as the percentage of individuals enrolled in managed care by eligibility group and the percentage of Medicaid benefit spending attributable to managed care.
When examining managed care statistics from various sources, the following issues should be noted:
• Figures in the annual Medicaid managed care enrollment report published by CMS include Medicaid-expansion CHIP enrollees. Although we generally exclude these children (about 2 million, depending on the time period) from Medicaid analyses in MACStats, it is not possible to do so with CMS’s annual Medicaid managed care enrollment report data.19
• The types of managed care reported by states may differ somewhat between the Medicaid managed care enrollment report and the MSIS. For example, some states report a small number of enrollees in comprehensive risk-based managed care in one data source but not the other. Anomalies in MSIS data are documented by CMS as it reviews each state’s quarterly submission, but all issues may not be identified in this process.
• The Medicaid managed care enrollment report provides point-in-time figures. In contrast, MSIS data allow for reporting on the number of enrollees ever in managed care during a fiscal year or other period of time.
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Endnotes1 For technical guides to earlier editions of MACStats, see MACPAC’s June reports to Congress, which are accessible through the publications page of the MACPAC website; https://www.macpac.gov/publication/.2 CMS has been collecting Medicaid and CHIP performance indicator data on key processes related to eligibility and enrollment since late 2013. In part because the new Medicaid and CHIP performance indicator enrollment data do not identify newly eligible individuals for whom there is a higher federal matching rate, CMS is using a separate process to collect monthly Medicaid enrollment by eligibility category when states submit their CMS-64 quarterly expenditures. Specifically, a new CMS-64 enrollment form has been created to accompany the current expenditure forms. While enrollment is submitted at the same time as expenditures, there is not a direct link between the amount of federal expenditures claimed by states and the number of enrollees reported. Instead, CMS uses CMS-64 enrollment data for monitoring and oversight purposes.3 See, for example, Centers for Medicare & Medicaid Services (CMS), 2010, Medicare & Medicaid statistical supplement, 2010 edition, Brief summaries and glossary, Baltimore, MD: CMS, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareMedicaidStatSupp/2010.html. 4 States make capitated payments for all individuals enrolled in managed care plans, even if no health care services are used. Therefore, all managed care enrollees currently are counted as beneficiaries or persons served, regardless of whether or not they have any health service use.5 Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, 2015, About the National Health Interview Survey, http://www.cdc.gov/nchs/nhis/about_nhis.htm. 6 Agency for Health Care Research and Quality (AHRQ), U.S. Department of Health and Human Services, 2015, Medical Expenditures Panel Survey: Survey background, http://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp. 7 Kenney, G., and V. Lynch, 2010, Monitoring children’s health insurance coverage under CHIPRA using federal surveys, in Databases for estimating health insurance coverage for children: A workshop summary, edited by T.J. Plewes, Washington, DC: The National Academies Press. http://www.nap.edu/catalog/13024.html.8 Rhoades, J.A., J.W. Cohen, and S.R. Machlin, 2010, Methodological comparison of estimates of ambulatory health care use from the Medical Expenditure Panel Survey and other data sources, in JSM Proceedings, Section on Health Policy, Alexandria, VA: American Statistical Association, 2828–2837, https://www.amstat.org/sections/srms/proceedings/y2010/Files/307444_58577.pdf. 9 McPherson, M., et al., 1998, A new definition of children with special health care needs, Pediatrics 102: 137–140.
10 For children under age 18 to be determined disabled under SSI rules, the child must have at least one medically determinable physical or mental impairment that causes marked and severe functional limitations and that can be expected to cause death or last at least 12 months (§1614(a)(3)(C)(i) of the Social Security Act).11 For full details on the definition of CSHCN, see Medicaid and CHIP Payment and Access Commission (MACPAC), 2014, Technical guide to the June 2014 MACStats, in Report to the Congress on Medicaid and CHIP, June 2014, Washington, DC: MACPAC, https://www.macpac.gov/wp-content/uploads/2015/03/June-2014-MACStats.pdf.12 Medicaid benefit spending reported here excludes amounts for Medicaid-expansion CHIP enrollees, the territories, administrative activities, the Vaccines for Children program (which is authorized by the Medicaid statute but operates as a separate program), and offsetting collections from third-party liability, estate, and other recoveries.13 For a discussion of these data sources, see Medicaid and CHIP Payment and Access Commission (MACPAC), 2011, Improving Medicaid and CHIP data for policy analysis and program accountability, in Report to the Congress on Medicaid and CHIP, March 2011, Washington, DC: MACPAC, https://www.macpac.gov/wp-content/uploads/2015/01/MACPAC_March2011_web.pdf.14 Some of these amounts, including certain supplemental payments to hospitals and drug rebates, are lump sums that are not paid on a claim-by-claim basis for individual Medicaid enrollees. Nonetheless, we refer to these CMS-64 amounts as benefit spending, and the adjustment methodology described here distributes them across Medicaid enrollees with MSIS spending in the relevant service categories.15 U.S. Government Accountability Office (GAO), 2012, Medicaid: Data sets provide inconsistent picture of expenditures, Washington, DC: GAO, http://www.gao.gov/assets/650/649733.pdf; National Research Council, 2010, Administrative databases, in Databases for estimating health insurance coverage for children: A workshop summary, edited by T.J. Plewes, Washington, DC: The National Academies Press. http://www.nap.edu/catalog/13024.html16 The sum of adjusted MSIS benefit spending amounts for all service categories totals CMS-64 benefit spending, exclusive of offsetting collections from third-party liability, estate, and other recoveries. These collections are not reported by type of service in the CMS-64 and are not reported at all in the MSIS.17 See Centers for Medicare & Medicaid Services (CMS), 2015, Medicaid disproportionate share hospital (DSH) payments, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Medicaid-Disproportionate-Share-Hospital-DSH-Payments.html.18 For more on these payments, see Medicaid and CHIP Payment and Access Commission (MACPAC), 2015, Using Medicaid supplemental payments to drive delivery system reform, in Report to Congress on Medicaid and CHIP, June 2015, Washington, DC: MACPAC, https://www.macpac.gov/wp-content/uploads/2015/06/Using-Medicaid-Supplemental-Payments-to-Drive-Delivery-System-Reform.pdf.
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19 We generally exclude children enrolled in Medicaid-expansion CHIP from Medicaid analyses because their funding stream (CHIP, under Title XXI of the Social Security Act) differs from that of other Medicaid enrollees (Medicaid, under Title XIX). In addition, spending (and often enrollment) for the Medicaid-expansion CHIP population is reported by CMS in CHIP statistics, along with information on separate CHIP enrollees.
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