DISPROPORTIONATE MEDICAID EXPENDITURES: SELECT ANALYSES

DISPROPORTIONATE MEDICAID EXPENDITURES: SELECT ANALYSES

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

CONTENTS

PREFACE

Chapter 1: MEDICAID: DEMOGRAPHICS AND SERVICE USAGE OF CERTAIN HIGH-EXPENDITURE BENEFICIARIES

WHY GAO DID THIS STUDY

WHAT GAO FOUND

ABBREVIATIONS

BACKGROUND

NEARLY ONE-THIRD OF STATES’ MEDICAID EXPENDITURES WERE FOR HIGH-EXPENDITURE MEDICAID-ONLY BENEFICIARIES

DISABILITY, CERTAIN CONDITIONS, DELIVERY/CHILDBIRTH, AND LONG-TERM CARE RESIDENCY WERE STRONGLY ASSOCIATED WITH BEING A HIGH-EXPENDITURE MEDICAID-ONLY BENEFICIARY

HIGH-EXPENDITURE BENEFICIARIES HAD HIGH HOSPITAL EXPENDITURES AND SIGNIFICANTLY DIFFERENT SPENDING PATTERNS COMPARED WITH ALL OTHER MEDICAID-ONLY BENEFICIARIES

AGENCY COMMENTS

APPENDIX I. OBJECTIVES, SCOPE, AND METHODOLOGY

APPENDIX II. CHARACTERISTICS OF HIGH- EXPENDITURE MEDICAID-ONLY BENEFICIARIES

APPENDIX III. KEY CHARACTERISTICS ASSOCIATED WITH ESTIMATED PROBABILITY OF BEING A HIGH-EXPENDITURE BENEFICIARY

APPENDIX IV. CHARACTERISTICS OF HIGH-EXPENDITURE BENEFICIARIES IN THE TOP 1 PERCENT OF EXPENDITURES

APPENDIX V. SELECTED CASES OF MEDICAID-ONLY BENEFICIARIES WITH EXPENDITURESIN THE TOP 1 PERCENT

Chapter 2: MEDICAID DISPROPORTIONATE SHARE HOSPITAL PAYMENTS

SUMMARY

INTRODUCTION

BACKGROUND: MEDICAID DSH

DSH ALLOTMENTS

DSH PAYMENTS

DSH EXPENDITURES

STATE REPORTING AND AUDITING REQUIREMENTS

CONCLUSION

APPENDIX A. A CHRONOLOGY OF STATE DSH ALLOTMENTS CALCULATIONS

APPENDIX B. ACA DSH REDUCTIONS

APPENDIX C. IMD DSH LIMITS

APPENDIX D. STATE-BY-STATE DSH EXPENDITURES

INDEX