On June 24, the non-profit National Institute for Health Care Management (NIHCM) Foundation released a data brief, Understanding U.S. Health Care Spending, analyzing total U.S. health care spending.  Examining data from the National Health Expenditure Accounts (NHEAs) and the Medical Expenditure Panel Survey (MEPS), the brief notes that annual health care spending reached $2.5 trillion in 2009, or 17.6 percent of the Gross Domestic Product (GDP).  The brief also notes that spending increased 29 percent between 2005 and 2009, averaging $8,100 per person in 2009.  The Foundation found that costs are highly concentrated among a small number of high-cost patients, with approximately 5 percent of the population accounting for 47.5 percent of all spending, while 50 percent of the population accounts for only 3 percent of spending.  The brief also notes that rising prices have played a larger role than increased utilization rates in driving recent cost growth.

From the report:

On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP).  The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them.  The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care.  The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP.  Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP.  The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements.  The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.

From the report:

This report published in Psychiatric Services reviewed the recently implemented reimbursement policies for screening and brief intervention for substance misuse by Medicaid, finding that though many states allow the reimbursement of this service, current policy is not sufficient at promoting high utiltization.

Fussell, H. E., Rieckmann, T.R., and Quick M.B. Medicaid reimbursement for screening and brief intervention for substance misuse.  Psychiatric Services, 62: 306-309. doi: 10.1176/appi.ps.62.3.306. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/3/306

Authors: Holly E. Fussell, Traci R. Rieckmann, and Mary Beth Quick

This report published in Psychiatric Services analyzed spending on mental health and substance use disorder treatment in the Department of Veterans Affairs, finding that from 2000 to 2006 costs decreased each year. However, in 2007, the agency experienced a large increase in spending.

Wagner, T. H., Sinnott, P. and Siroka, A. M.  Mental health and substance use disorder spending in the Department of Veterans Affairs. Psychiatric Services, 62:389-395. doi: 10.1176/appi.ps.62.4.389. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/4/389

Authors: Todd H. Wagner, Patricia Sinnott, and Andrew M. Siroka

On March 15, the Medicaid and CHIP Payment and Access Commission (MACPAC) presented its first annual Report to the Congress on Medicaid and CHIP.  The report found that Medicaid covered 68 million individuals in FY2010, with state and federal spending totaling $406 billion, or 8.1 percent of federal outlays.  In addition, MACPAC determined that the Children’s Health Insurance Program (CHIP) covered 8 million children in FY2010 at a total cost of $11 billion.  Finally, the report also notes that the  Substance Abuse and Mental Health Services Administration (SAMHSA) determined that Medicaid financed 25 percent of behavioral health treatment in 2003.

From the report:

Medicaid and the State Children’s Health Insurance Program (CHIP) are sources of health care coverage for 76 million people, almost one quarter of the population. Medicaid finances health care and related services for more than 30 million low-income children, more than 10 million low-income persons with disabilities, and 6 million low- income seniors with Medicare. CHIP finances health coverage for 8 million uninsured children in families with moderate incomes above Medicaid eligibility levels.

This is the first report of the Medicaid and CHIP Payment and Access Commission (MACPAC) to the Congress. The purpose of this initial report is to contribute to a better understanding of the Medicaid and CHIP programs, their roles in the U.S. health care system, and the key policy and data issues to be addressed. This first report also sets out an analytic framework that serves as the foundation for the Commission’s future work with respect to access and payment. Also included in the Report is a compilation of Medicaid and CHIP program information, including state-specific information about program enrollment, spending, eligibility levels, Medicaid benefits covered, and the federal medical assistance percentage (FMAP). This section of the Report, called MACStats, will be a standing supplement in all Commission reports to the Congress.

Full Report: MACPAC: Report to the Congress on Medicaid and CHIP 

Medicaid and CHIP Payment and Access Commission. (2011). Report to the Congress on Medicaid and CHIP.

This report from the Kaiser Family Foundation provides an overview of spending and participation for home and community-based services financed by Medicaid. It notes that though spending on such services has more than doubled since 1995 and continued progress is hopeful because of certain provisions in the Affordable Care Act, progress may also be slowed with the budget challenges that many states are facing.

From the report:

Two decades after the passage of the Americans with Disabilities Act, developing home and community-based service (HCBS) alternatives to institutional care has remained a priority for many state Medicaid programs. While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19 percent in 1995 to 42 percent in 2008. Building on previous policy initiatives to rebalance long-term services and supports, the 2010 Patient Protection and Affordable Care Act (ACA) provides new opportunities to further state efforts to expand community-based care for seniors and people with disabilities under Medicaid. However, many states continue to wrestle with the ongoing impacts of the worst recession in decades, resulting in difficult budget situations and creating uncertainties for continued progress. This report, based on annual data tracking conducted by the Kaiser Commission on Medicaid and the Uninsured and researchers at the University of California, San Francisco over the past nine years, presents a summary of the main trends to emerge from the latest (2007) expenditures and participant data for the three main Medicaid HCBS programs: (1) optional 1915(c) HCBS waivers, (2) the mandatory home health benefit, and (3) the optional state plan personal care services benefit. It also presents 2009 findings on the policies used in these three programs, including eligibility criteria, provider, service and waiting list data, as well as provider reimbursement rates for the home health benefit and the personal care services benefit.

Full Report: Medicaid Home and Community-Based Service Programs: Data Update (PDF | 1.16 MB) 

Kaiser Family Foundation. (2011). Medicaid Home and Community-Based Services Programs: Data Update.