MACStats: Medicaid and CHIP Program Statistics · 6/3/2015  · 82 | JUNE 2014 SECTION 1 | REPORT TO THE CONGRESS ON MEDICAID AND CHIP FIGURE 1. Medicaid Enrollment and Spending,

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MACStats: Medicaid and CHIP

Program Statistics

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MACStats Table of Contents

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Section 1. Trends in Medicaid Enrollment and Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

. edicaid nrollment and pending, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

. Annual ro th in edicaid nrollment and pending, . . . . . . . . . . . . . . 83

A . edicaid eneficiaries ersons erved by ligibility roup, thousands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Section 2. Health and Other Characteristics of Medicaid/CHIP Populations. . . . . . . . . . . . . . . 87

TABLE 2. Health Insurance and Demographic Characteristics of Non-Institutionalized Individuals

Age 0–18 by Source of Health Insurance, 2010–2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

TABLE 3. Health Characteristics of Non-Institutionalized Individuals Age 0–18 by Source of

Health Insurance, 2010–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

TABLE 4. Use of Care by Non-Institutionalized Individuals Age 0–18 by Source of Health

Insurance, 2010–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

TABLE 5. Health Insurance and Demographic Characteristics of Non-Institutionalized Individuals

Age 19–64 by Source of Health Insurance, 2010–2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

TABLE 6. Health Characteristics of Non-Institutionalized Individuals Age 19–64 by Source of

Health Insurance, 2010–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

A . se of are by on nstitutionali ed ndividuals Age by ource of ealth Insurance, 2010–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

TABLE 8. Health Insurance and Demographic Characteristics of Non-Institutionalized Individuals

Age 65 and Older by Source of Health Insurance, 2010–2012. . . . . . . . . . . . . . . . . . . . . . . . . 99

TABLE 9. Health Characteristics of Non-Institutionalized Individuals Age 65 and Older by Source

of Health Insurance, 2010–2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

TABLE 10. Use of Care by Non-Institutionalized Individuals Age 65 and Older by Source of

Health Insurance, 2010–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Section 3. Medicaid Enrollment and Benefit Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

TABLE 11. Medicaid Enrollment by State, Eligibility Group, and Dual Eligible Status,

thousands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

A . edicaid enefit pending by tate, ligibility roup, and ual ligible tatus, millions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

A . edicaid enefit pending er ull ear uivalent nrollee by tate and ligibility roup, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

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. istribution of edicaid enefit pending by ligibility roup and ervice ategory, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

. edicaid enefit pending er ull ear uivalent nrollee by ligibility roup and ervice ategory, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

. istribution of edicaid nrollment and enefit pending by sers and on sers of ong erm ervices and upports, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

. istribution of edicaid enefit pending by ong erm ervices and upports se and ervice ategory, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

. edicaid enefit pending er ull ear uivalent nrollee by ong erm ervices and upports se and ervice ategory, . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Section 4. Medicaid Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

TABLE 14. Percentage of Medicaid Enrollees in Managed Care by State and Eligibility Group,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

A . ercentage of edicaid enefit pending on anaged are by tate and ligibility roup, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Section 5. Technical Guide to the June 2014 MACStats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

TABLE 16. Medicaid and CHIP Enrollment by Data Source and Enrollment Period, 2011 . . . . . . . . . . 135

A . edicaid and nrollment by ata ource and nrollment eriod Among Children Under Age 19, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

TABLE 18. Medicaid and CHIP Enrollment by Data Source and Enrollment Period Among

Adults Age 19–64, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

TABLE 19. Medicaid and CHIP Enrollment by Data Source and Enrollment Period Among

Adults Age 65 and Older, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

A . edicaid enefit pending in and ata by tate, billions . . . . . . .

A . ervice ategories sed to Ad ust edicaid enefit pending in to Match CMS-64 Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

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Overview

MACStats, a standing section in all MACPAC reports to the Congress, presents data and information

on edicaid and the tate hildrens ealth nsurance rogram that other ise can be difficult to find and are spread out across multiple sources. he une edition of A tats is divided into five sections.

Section 1: Trends in Medicaid Enrollment and Spending f ro th in edicaid spending and enrollment has varied over the years, reflecting shifts in federal

and state policy along with changing economic conditions ( igures and 2).

f Enrollment trends vary by eligibility group. Non-disabled children experienced the largest

enrollment increase in absolute numbers bet een fiscal year and Table 1).

However, enrollment among the smaller group of individuals qualifying for Medicaid on the basis

of a disability showed the largest percentage increase over this time period.

Section 2: Health and Other Characteristics of Medicaid/CHIP Populations

f The characteristics of individuals enrolled in Medicaid and CHIP differ from those with other types

of coverage, but there is also great diversity ithin the edicaid population Tables 2–10).

f edicaid enrollees generally report being in poorer health and using more services than individuals who have other health insurance or who are uninsured (Tables 3, 6, and 9).

Section 3: Medicaid Enrollment and Benefit Spending f Individuals eligible on the basis of a disability and those age 65 and older account for about a

quarter of Medicaid enrollees, but about two-thirds of program spending (Tables 11 and 12).

f edicaid spending per enrollee is affected by large numbers of individuals ith limited benefits in some states (Table 13).

f Users of Medicaid long-term services and supports are a small but high-cost population

( igures ).

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Section 4: Medicaid Managed Care f About half of Medicaid enrollees are in comprehensive risk-based managed care plans. When

limited benefit plans and primary care case management programs are also included, more than percent of enrollees are in some form of managed care Table 14).

f he national percentage of edicaid benefit spending on any form of managed care ranges from about 10 percent among enrollees age 65 and older to more than 40 percent among non-disabled

child and adult enrollees (Table 15).

Section 5: Technical Guide to the June 2014 MACStatshis section provides supplemental information to accompany the tables and figures in ections

of MACStats. It describes some of the data sources used in MACStats, the methods that MACPAC

uses to analy e these data, and reasons hy numbers in A tats tables and figures such as those on enrollment and spending may differ from each other or from those published else here.

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Key Points

Trends in medicaid Enrollment and spending

f medicaid spending and enrollment are affected by both federal and state policy

choices and economic factors. for example, the Congress made a number of

changes that expanded eligibility for pregnant women and children between 1984

and 1990, with delayed effective dates or phase-in provisions that resulted in

substantial growth in the number of enrollees through the mid-1990s (figure 1).

Economic recessions spurred enrollment growth at the beginning and end of the

first decade of the 2000s.

f Prior to the 1990s, spending tended to grow at a faster annual rate than enrollment

(figure 2). in recent decades, annual growth rates for spending and enrollment have

tracked more closely.

f Enrollment trends vary by eligibility group. Children (excluding those eligible on

the basis of a disability) experienced the largest enrollment increase in absolute

numbers, from 9.6 million in fy 1975 to 30.2 million in fiscal year (fy) 2011

(Table 1). However, enrollment among the smaller group of individuals qualifying for

medicaid on the basis of a disability showed the largest percentage increase over

this time period (3.9 percent).

1S E C T I O N

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FIGURE 1. Medicaid Enrollment and Spending, FY 1966–FY 2013

0

5

10

15

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35

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55

60

Full-Year Equivalent Enrollees(m

illions)No

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(bill

ions

)

Federal Fiscal Year

Enrollment

Spending

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

$550

$600

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1980

1982

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1988

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2012

Notes: spending consists of federal and state medicaid expenditures for benefits and administration, excluding the vaccines for Children program. Numbers exclude coverage financed by CHiP. Enrollment data for fiscal year (fy) 2011–2013 are projected. data prior to fy 1977 have been adjusted to the current federal fiscal year basis (october 1 to september 30). The amounts in this figure may differ from those published elsewhere due to slight differences in the timing of data and the treatment of certain adjustments. Enrollment counts are full-year equivalents and, for fiscal years prior to fy 1990, have been estimated from counts of persons served. (see section 5 of maCstats for a discussion of how enrollees are counted.)

Source: data compilation provided to maCPaC by the office of the actuary, Centers for medicare & medicaid services (Cms), april 2014.

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FIGURE 2. Annual Growth in Medicaid Enrollment and Spending, FY 1969–FY 2013

Annu

al G

row

th R

ate

Federal Fiscal Year

-5%

0%

5%

10%

15%

20%

25%

30%

1969

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Enrollment

Spending

Notes: spending consists of federal and state medicaid expenditures for benefits and administration, excluding the vaccines for Children program. Numbers exclude coverage financed by CHiP. Enrollment data for fiscal year (fy) 2011–2013 are projected. data prior to fy 1977 have been adjusted to the current federal fiscal year basis (october 1 to september 30). annual growth rates prior to fy 1969 (not shown here) exceed 30 percent, reflecting the program’s initial startup period. The amounts in this figure may differ from those published elsewhere due to slight differences in the timing of data and the treatment of certain adjustments. Enrollment counts used to calculate growth rates are full-year equivalents and, for fiscal years prior to fy 1990, have been estimated from counts of persons served. (see section 5 of maCstats for a discussion of how enrollees are counted.)

Source: data compilation provided to maCPaC by the office of the actuary, Centers for medicare & medicaid services (Cms), april 2014.

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TABLE 1. Medicaid Beneficiaries (Persons Served) by Eligibility Group, FY 1975–FY 2011 (thousands)

Year Total Children Adults Disabled Aged Unknown1975 22,007 9,598 4,529 2,464 3,615 1,8011976 22,815 9,924 4,773 2,669 3,612 1,8371977 22,832 9,651 4,785 2,802 3,636 1,9581978 21,965 9,376 4,643 2,718 3,376 1,8521979 21,520 9,106 4,570 2,753 3,364 1,7271980 21,605 9,333 4,877 2,911 3,440 1,0441981 21,980 9,581 5,187 3,079 3,367 7661982 21,603 9,563 5,356 2,891 3,240 5531983 21,554 9,535 5,592 2,921 3,372 1341984 21,607 9,684 5,600 2,913 3,238 1721985 21,814 9,757 5,518 3,012 3,061 4661986 22,515 10,029 5,647 3,182 3,140 5171987 23,109 10,168 5,599 3,381 3,224 7371988 22,907 10,037 5,503 3,487 3,159 7211989 23,511 10,318 5,717 3,590 3,132 7541990 25,255 11,220 6,010 3,718 3,202 1,1051991 27,967 12,855 6,703 4,033 3,341 1,0351992 31,150 15,200 7,040 4,487 3,749 6741993 33,432 16,285 7,505 5,016 3,863 7631994 35,053 17,194 7,586 5,458 4,035 7801995 36,282 17,164 7,604 5,858 4,119 1,5371996 36,118 16,739 7,127 6,221 4,285 1,7461997 34,872 15,791 6,803 6,129 3,955 2,1951998 40,096 18,969 7,895 6,637 3,964 2,6311999 39,748 18,233 7,446 6,690 3,698 3,6822000 41,212 18,528 8,538 6,688 3,640 3,8172001 45,164 20,181 9,707 7,114 3,812 4,3492002 46,839 21,487 10,847 7,182 3,789 3,5342003 50,716 23,742 11,530 7,664 4,041 3,7392004 54,250 25,415 12,325 8,123 4,349 4,0372005 56,276 25,979 12,431 8,205 4,395 5,2662006 56,264 26,358 12,495 8,334 4,374 4,7032007 55,210 26,061 12,264 8,423 4,044 4,4182008 56,962 26,479 12,739 8,685 4,147 4,9122009 60,880 28,344 14,245 9,031 4,195 5,0662010 63,730 30,024 15,368 9,341 4,289 4,70920111 65,831 30,175 16,069 9,609 4,331 5,646

Notes: beneficiaries (enrollees for whom payments are made) are shown here because they provide the only historical time series data directly available prior to fiscal year (fy) 1990. most current analyses of individuals in medicaid reflect enrollees. for additional discussion, see section 5 of maCstats. The increase in fy 1998 reflects a change in how medicaid beneficiaries are counted: beginning in fy 1998, a medicaid-eligible person who received only coverage for managed care benefits was included in this series as a beneficiary. Excludes medicaid-expansion CHiP and the territories.

Children and adults who qualify for medicaid on the basis of a disability are included in the disabled category. in addition, although disability is not a basis of eligibility for aged individuals, states may also report some enrollees age 65 and older in the disabled category. Unlike the majority of the June 2014 maCstats, this table does not recode individuals age 65 and older who are reported as disabled, due to a lack of necessary detail in the historical data. generally, individuals whose eligibility group is unknown are persons who were enrolled in the prior year but had a medicaid claim paid in the current year.

1 This table shows the number of beneficiaries. see Table 11 for the number of medicaid enrollees in fy 2011, which is larger than the number of beneficiaries. due to the unavailability of several states’ medicaid statistical information system (msis) annual Person summary (aPs) data for fy 2011, which is the source used in prior editions of this table, maCPaC calculated enrollment from the full msis data files that are used to create the aPs files. as a result, fy 2011 figures shown here are not directly comparable to earlier years. for maCPaC’s analysis, 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 beneficiary counts shown here are unduplicated using this national id.

Sources: for fy 1999 to fy 2011: maCPaC analysis of medicaid statistical information system (msis) data. for fy 1975 to fy 1998: Centers for medicare & medicaid services (Cms), Medicare & Medicaid statistical supplement, 2010 edition, Table 13.4. http://www.cms.gov/research-statistics-data-and-systems/statistics-Trends-and-reports/medicaremedicaidstatsupp/2010.html.

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Key Points

Health and other Characteristics of medicaid/CHiP Populations

Children under age 19, 2010–2012 (Tables 2–4)

f more than a third (37.4 percent) of children were reported to be medicaid or CHiP

enrollees at the time of the survey, while 53.8 percent of children were in private

coverage, and 7.4 percent were uninsured.

f Children enrolled in medicaid or CHiP were more likely to be Hispanic (35.2 percent)

than are privately insured children (12.7 percent) and less likely to be Hispanic than

are uninsured children (39.9 percent); medicaid/CHiP children were more likely to be

non-Hispanic black (23.2 percent) than are privately insured (10 percent) or uninsured

children (11.7 percent).

f Children enrolled in medicaid or CHiP were more likely than privately insured or

uninsured children to be in fair or poor health and to have certain impairments and

health conditions (e.g., attention deficit hyperactivity disorder/attention deficit disorder

(adHd/add), asthma, autism).

f Children enrolled in medicaid or CHiP were more likely to have had a visit to the

emergency department in the past year and to have been regularly taking prescription

medications for at least three months.

f differences in self-reported health status exist among children enrolled in medicaid or

CHiP. among these children, 21.6 percent of those receiving supplemental security

income (ssi) were reported to be in fair or poor health, compared to 14.6 percent for

non-ssi children with special health care needs (CsHCN) and 1.1 percent for children

who are neither ssi nor CsHCN.

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f Prevalence of specific health conditions varies among children enrolled in medicaid or CHiP. The prevalence

of adHd/add among children enrolled in medicaid or CHiP was 38.5 percent for children receiving ssi,

38.7 percent for non-ssi CsHCN, and 2.1 percent for children who were neither receiving ssi nor CsHCN.

The prevalence of asthma for children receiving ssi was 31.9 percent, compared to 39.4 percent for

non-ssi CsHCN and 11.7 percent for children who were neither ssi nor CsHCN.

f ssi children and non-ssi CsHCN were each nearly twice as likely to visit health care providers four or more

times within a year as are children with medicaid or CHiP who are neither ssi nor CsHCN.

Adults age 19 to 64, 2010–2012 (Tables 5–7)

f Nearly 1 in 10 (9.7 percent) of non-institutionalized adults age 19 to 64 reported that they were enrolled

in medicaid.

f medicaid enrollees in this age group were more likely to be female and to be the parent of a dependent

child, compared to those with private insurance, medicare, or no insurance.

f adults younger than 65 enrolled in medicaid (who are generally eligible on the basis of being the parent

of a dependent child, pregnant, or disabled) reported that they were in worse health than were those

enrolled in private coverage or the uninsured, but were in better health than those enrolled in medicare

(nearly all of whom are eligible for that program on the basis of a disability).

f adults younger than 65 enrolled in medicaid were more likely than those with private insurance to have

had four or more visits to a doctor or other health professional in the past 12 months.

f adults with medicaid were more likely than those with private insurance or no insurance to have visited

the emergency department during the past year.

f among adults younger than 65 enrolled in medicaid, 11.4 percent reported they also were enrolled

in medicare. Conversely, of the medicare enrollees in this age group, 30.9 percent also were enrolled

in medicaid.

f differences in self-reported health exist among 19- to 64-year-olds enrolled in medicaid. individuals

dually enrolled in medicaid and medicare, as well as non-dual ssi beneficiaries, report fair or poor

health (62.0 and 57.1 percent, respectively) at much higher rates than do non-ssi, non-dual enrollees

(20.6 percent).

f among 19- to 64-year-olds enrolled in medicaid, those who were also enrolled in medicare or ssi were

more likely to have limitations in activities of daily living (adls)—as well as the presence of chronic

conditions such as depression, hypertension, heart disease, diabetes, arthritis, asthma, and chronic

bronchitis—than the overall medicaid population for this age group.

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f adults younger than 65 who enrolled in medicaid as well as medicare or ssi also had higher use of

care—in particular, for at-home care and visits to a doctor or other health professional in the past

12 months—than 19- to 64-year-old medicaid enrollees overall. They were also more likely than

19- to 64-year-old medicaid enrollees overall to have had an emergency department visit in the

past 12 months.

Adults age 65 and older, 2010–2012 (Tables 8–10)

f among non-institutionalized adults age 65 and older, 7.6 percent reported being enrolled in medicaid.

most of these medicaid enrollees (91.8 percent) reported being dually eligible for medicare, which

covered nearly all individuals age 65 and older.

f medicaid enrollees age 65 and older were more likely to be female and less likely to be white (non-

Hispanic) than were those with medicare or private coverage.

f Compared to those enrolled in private coverage or medicare, medicaid enrollees age 65 and older were

more likely to report being in fair or poor health, being in worse health compared to 12 months before,

and having any of several limitations in their adls. medicaid enrollees age 65 and older were also more

likely to have lost all of their natural teeth or have any of a number of specific chronic conditions (such as

depression, diabetes, and chronic bronchitis).

f medicaid enrollees age 65 and older were also more likely than those with private or medicare coverage

to have received at-home care, to have had multiple visits to a doctor or other health professional, and to

have visited an emergency department in the past 12 months.

f because more than three-quarters of medicaid enrollees age 65 and older had functional limitations and

therefore drive the overall characteristics of enrollees in this age range, this group of medicaid enrollees

does not show significant differences from the total medicaid population age 65 and older as often as do

those with no functional limitations.

f Compared to the overall group of medicaid enrollees age 65 and older, medicaid enrollees who had no

functional limitations were less likely to be 85 years old or older, to report being in fair or poor health, and

to have any of several specific chronic health conditions. They were also less likely to have visited a doctor

or other health professional or to have visited an Ed in the past 12 months.

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This section uses data from the federal National

Health Interview Survey (NHIS) to describe how

Medicaid and State Children’s Health Insurance

Program (CHIP) enrollees differ from individuals

with other types of coverage in terms of their

self-reported demographic, socioeconomic, and

health characteristics as well as their use of care. It

also explores how subpopulations of individuals

enrolled in Medicaid or CHIP can differ markedly

from one another, even within the same age group.

Our analysis divides the U.S. population into

three age groups corresponding to key eligibility

pathways in Medicaid and CHIP: children age 0 to

18, adults age 19 to 64, and adults age 65 and older.

Tables for each age group explore the following

self-reported characteristics from the survey data:

health insurance coverage and demographics, health

characteristics, and use of health care. (See Section

5 for a discussion of how estimates of insurance

coverage may vary depending on the data source

and the time period examined.)

he data are presented in t o parts. irst, e provide comparisons of edicaid enrollees in that age group to individuals with other sources

of health insurance. Second, we show estimates for

selected subgroups of edicaid enrollees in that age group. The data presented are for the

combined edicaid population because, as described in Section 5, surveys like the NHIS

generally do not support valid estimates separately

for Medicaid and CHIP enrollees.

Our analyses of subgroups of children are divided

into three groups:

f children who receive Supplemental Security

ncome benefits and are therefore disabled under that program s definition

f children who do not receive SSI, but who are

classified as children ith special health care needs (CSHCN); and

f children who neither receive SSI nor are

considered CSHCN.

Our analyses of Medicaid enrollees age 19 to 64

years old are divided into three categories, the first two of which are primarily composed of persons

with disabilities:

f individuals also enrolled in Medicare (dually

eligible individuals), nearly all of whom have

obtained their Medicare coverage after a

two-year waiting period following their initial

receipt of Social Security Disability Insurance

benefits

f Medicaid enrollees receiving SSI who are not

enrolled in Medicare; and

f Medicaid enrollees who are neither SSI nor

Medicare enrollees.

Our analyses of Medicaid enrollees age 65 and

older focus on the differences between those

reporting a functional limitation and those not

reporting a functional limitation. Individuals with

a functional limitation are those who reported any

degree of difficulty ranging from only a little difficult to can t do at all performing any of a do en activities such as al ing specified distances, moving objects such as a chair, or going

out to do things like shopping) by themselves and

without special equipment. It should be noted

that individuals with functional limitations can

vary substantially in their health needs from being bedridden to being relatively healthy but

responding that walking a quarter of a mile is

only a little difficult. ndividuals in institutions such as nursing homes or assisted living facilities

are not interviewed in the NHIS.)

Page 17

J U N E 2 0 1 4 | 91

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

Page 18

92

| J

UN

E 2

01

4

| R

EPOR

T TO TH

E CO

NG

RES

S ON

MED

ICA

ID A

ND

CH

IPSECTION 2

TABLE 2. Health Insurance and Demographic Characteristics of Non-Institutionalized Individuals Age 0–18 by Source of Health Insurance, 2010–2012

Selected Sources of Insurance1 Medicaid/CHIP2

All

children

Medicaid/

CHIP2 Private3 Uninsured4

Medicaid/

CHIP

children SSI

Non-SSI

CSHCN5

Neither

SSI nor

CSHCN

Health Insurance Coverage 37.4% 53.8% 7.4% 100.0% 3.4% 17.6% 79.1%

Age (categories sum to 100%)

0–5 32.2%* 38.8% 28.9%* 23.0%* 38.8% 19.5%* 26.7%* 42.4%*

6–11 31.3 31.5 31.6 29.3 31.5 38.7* 37.5* 29.8*

12–18 36.5* 29.7 39.5* 47.7* 29.7 41.7* 35.8* 27.8*

Gender (categories sum to 100%)

male 51.3% 50.5% 51.8% 51.6% 50.5% 62.5%* 60.6%* 47.8%*

female 48.7 49.5 48.2 48.4 49.5 37.5* 39.4* 52.2*

Race (categories sum to 100%)

Hispanic 23.4%* 35.2% 12.7%* 39.9%* 35.2% 20.6%* 24.1%* 38.4%*

white, non-Hispanic 55.5* 37.1 70.7* 40.9* 37.1 41.3 47.6* 34.6*

black, non-Hispanic 15.2* 23.2 10.0* 11.7* 23.2 35.7* 25.4 22.1

other and multiple races, non-Hispanic 5.9* 4.5 6.5* 7.5* 4.5 2.3* 2.9* 4.9

Health insurance

medicaid/CHiP 37.4%* 100.0% 2.3%* – 100.0% 100.0% 100.0% 100.0%

Private 53.8* 3.3 100.0* – 3.3 5.5 5.8* 2.7 see Table 4 for notes.

Source: maCPaC analysis of the 2010–2012 National Health interview survey (NHis).

Page 19

J U N E 2 0 1 4 | 93

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

2

TABL

E 3.

He

alth

Cha

ract

eris

tics

of N

on-In

stitu

tiona

lized

Indi

vidu

als

Age

0–18

by

Sour

ce o

f Hea

lth In

sura

nce,

201

0–20

12

Sele

cte

d S

ourc

es

of

Insu

rance

1M

edic

aid

/CH

IP2

All

childre

n

Medic

aid

/

CH

IP2

Pri

vate

3U

nin

sure

d4

Medic

aid

/

CH

IP

childre

nSSI

Non-S

SI

CSH

CN

5

Neit

her

SSI

nor

CSH

CN

Child

ren

with

dis

abili

ties

or w

ith s

peci

al h

ealth

car

e ne

eds

rece

ives

sup

plem

enta

l sec

urity

inco

me

(ssi

)1.

5%*

3.4%

0.4%

*0.

7%3.

4%10

0.0%

*–

–Ch

ildre

n w

ith s

peci

al h

ealth

car

e ne

eds

(CsH

CN)5

15.4

*20

.113

.3*

10.9

20.1

74.0

*610

0.0%

*–

Curr

ent h

ealth

sta

tus

(cat

egor

ies

sum

to 1

00%

)Ex

celle

nt o

r ver

y go

od82

.5%

*73

.5%

88.9

%*

78.9

%73

.5%

44.4

%*

54.5

%*

79.0

%*

goo

d15

.3*

22.3

10.2

*18

.922

.333

.9*

30.9

*19

.9*

fair

or p

oor

2.2*

4.2

1.0*

2.2

4.2

21.6

*14

.6*

1.1*

Impa

irmen

tsim

pairm

ent r

equi

ring

spec

ial e

quip

men

t1.

1%*

1.7%

0.9%

*0.

7%1.

7%12

.6%

*5.

5%*

0.4%

*im

pairm

ent l

imits

abi

lity

to c

raw

l, w

alk,

run

, pla

y71.

9*3.

01.

4*1.

13.

020

.3*

11.3

*0.

4*im

pairm

ent l

aste

d, o

r exp

ecte

d to

last

12+

mon

ths7

1.7*

2.7

1.2*

0.8

2.7

19.9

*9.

8*0.

3*Sp

ecifi

c he

alth

con

ditio

nsEv

er to

ld c

hild

has

:ad

Hd

/ad

d8

8.2%

*10

.7%

7.1%

*5.

7%10

.7%

38.5

%*

38.7

%*

2.1%

*as

thm

a14

.017

.312

.5*

10.4

*17

.331

.9*

39.4

*11

.7*

autis

m7

1.0

1.3

1.0*

0.7

1.3

12.4

*4.

3*0.

0*Ce

rebr

al p

alsy

70.

3*0.

40.

2*†

0.4

5.8*

1.2*

0.0*

Cong

enita

l hea

rt d

isea

se1.

2*1.

61.

1*1.

01.

68.

1*4.

3*0.

7*d

iabe

tes

0.2

0.2

0.2

†0.

2†

1.1*

†d

own

synd

rom

e70.

10.

20.

1†

0.2

3.0*

0.4

†in

telle

ctua

l dis

abili

ty (m

enta

l ret

arda

tion)

70.

9*1.

50.

6*†

1.5

16.9

*5.

1*0.

1*o

ther

dev

elop

men

tal d

elay

74.

5*5.

84.

0*3.

25.

837

.5*

21.3

*0.

9*si

ckle

cel

l ane

mia

70.

2*0.

30.

1*0.

20.

3†

0.7*

0.2

see

Tabl

e 4

for n

otes

.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 20

94 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 2

TABL

E 4.

Us

e of

Car

e by

Non

-Inst

itutio

naliz

ed In

divi

dual

s Ag

e 0–

18 b

y So

urce

of H

ealth

Insu

ranc

e, 2

010–

2012

Sele

cte

d S

ourc

es

of

Insu

rance

1M

edic

aid

/CH

IP2

All

childre

n

Medic

aid

/

CH

IP2

Pri

vate

3U

nin

sure

d4

Medic

aid

/

CH

IP

childre

nSSI

Non-S

SI

CSH

CN

5

Neit

her

SSI

nor

CSH

CN

rece

ived

wel

l-chi

ld c

heck

-up

in p

ast 1

2 m

onth

s780

.1%

*81

.8%

82.5

%53

.6%

*81

.8%

85.7

%85

.9%

*80

.7%

regu

larly

taki

ng p

resc

riptio

n dr

ug(s

) for

3+

mon

ths7

13.4

*15

.912

.9*

5.7*

15.9

46.7

*54

.6*

5.6*

Num

ber o

f tim

es s

aw a

doc

tor o

r oth

er h

ealth

pro

fess

iona

l in

past

12

mon

ths

(cat

egor

ies

sum

to 1

00%

)N

one

9.7%

*8.

8%7.

4%*

30.2

%*

8.8%

5.3%

*3.

1%*

10.2

%*

121

.2*

19.3

21.6

*26

.6*

19.3

14.0

*10

.7*

21.5

*2–

336

.635

.538

.3*

28.0

*35

.525

.2*

26.0

*38

.1*

4+32

.5*

36.3

32.7

*15

.2*

36.3

55.4

*60

.3*

30.2

*Nu

mbe

r of e

mer

genc

y ro

om v

isits

in p

ast 1

2 m

onth

s (c

ateg

orie

s su

m to

100

%)

Non

e80

.4%

*73

.1%

85.0

%*

83.8

%*

73.1

%64

.4%

*58

.0%

*76

.8%

*1

12.8

*15

.811

.0*

10.4

*15

.818

.418

.6*

15.0

2–3

5.4*

8.3

3.4*

4.5*

8.3

9.8

15.9

*6.

5*4+

1.5*

2.8

0.6*

1.3*

2.8

7.4*

7.5*

1.6*

Note

s: C

HiP

is s

tate

Chi

ldre

n’s

Hea

lth in

sura

nce

Prog

ram

. ssi

is s

uppl

emen

tal s

ecur

ity in

com

e. C

sHCN

is c

hild

ren

with

spe

cial

hea

lth c

are

need

s. a

dH

d is

atte

ntio

n de

ficit

hype

ract

ivity

dis

orde

r. ad

d is

atte

ntio

n de

ficit

diso

rder

.

* d

iffer

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 ha

s a

rela

tive

stan

dard

err

or o

f gre

ater

than

50

perc

ent.

– Q

uant

ity z

ero;

am

ount

s sh

own

as 0

.0 ro

und

to le

ss th

an 0

.1.

1 H

ealth

insu

ranc

e co

vera

ge is

def

ined

at t

he ti

me

of th

e su

rvey

. Tot

als

of h

ealth

insu

ranc

e co

vera

ge m

ay s

um to

mor

e th

an 1

00 p

erce

nt b

ecau

se in

divi

dual

s m

ay h

ave

mul

tiple

sou

rces

of c

over

age.

res

pons

es to

rece

nt-c

are

ques

tions

are

bas

ed o

n th

e pr

evio

us 1

2 m

onth

s, d

urin

g w

hich

tim

e th

e in

divi

dual

may

hav

e ha

d di

ffere

nt c

over

age

than

that

sho

wn

in th

e ta

ble.

Not

sep

arat

ely

show

n ar

e th

e es

timat

es o

f chi

ldre

n co

vere

d by

med

icar

e (g

ener

ally

ch

ildre

n w

ith e

nd-s

tage

rena

l dis

ease

), a

ny ty

pe o

f mili

tary

hea

lth p

lan

(va

, Tr

iCar

E, a

nd C

Ham

P-va

), o

r oth

er g

over

nmen

t-sp

onso

red

prog

ram

s.

2 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.

3 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.

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

-spo

nsor

ed o

r oth

er g

over

nmen

t-sp

onso

red

heal

th p

lan,

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, s

uch

as a

ccid

ents

or d

enta

l car

e.

5 d

ue in

par

t to

chan

ges

in th

e 20

11 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

) que

stio

nnai

re, t

he C

sHCN

def

initi

on d

iffer

s sl

ight

ly fr

om th

e de

finiti

on u

sed

in m

aCPa

C re

port

s pr

ior t

o 20

13. T

he C

sHCN

def

initi

on a

pplie

d he

re is

ba

sed

on a

n ap

proa

ch d

evel

oped

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.

(see

Cam

Hi,

iden

tifyi

ng c

hild

ren

with

chr

onic

con

ditio

ns a

nd e

leva

ted

serv

ice

use

or n

eed

(CCC

EsU

N) i

n th

e N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

), P

ortla

nd, o

r: o

rego

n H

ealth

and

sci

ence

Uni

vers

ity, 2

012;

a.J

. dav

idof

f, id

entif

ying

chi

ldre

n w

ith s

peci

al h

ealth

car

e ne

eds

in th

e N

atio

nal H

ealth

inte

rvie

w s

urve

y: a

new

reso

urce

for p

olic

y an

alys

is, H

ealth

ser

vice

s re

sear

ch 3

9 (1

): 5

3-71

, 200

4). C

sHCN

in th

is a

naly

sis

mus

t hav

e at

leas

t one

di

agno

sed

or p

aren

t-re

port

ed c

ondi

tion

expe

cted

to b

e an

ong

oing

hea

lth c

ondi

tion

and

also

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

CsH

CN, s

ee te

xt a

nd e

ndno

tes

in s

ectio

n 5

of m

aCst

ats.

6 fo

r a c

hild

to b

e el

igib

le fo

r ssi

, one

of t

he c

riter

ia is

that

the

child

has

a m

edic

ally

det

erm

inab

le p

hysi

cal o

r men

tal i

mpa

irmen

t(s) t

hat r

esul

ts in

mar

ked

and

seve

re fu

nctio

nal l

imita

tions

and

gen

eral

ly is

exp

ecte

d to

last

at l

east

12

mon

ths

or re

sult

in d

eath

. Thu

s, c

hild

ren

who

are

elig

ible

for s

si s

houl

d m

eet t

he c

riter

ia fo

r bei

ng a

CsH

CN; h

owev

er, s

ome

do n

ot. w

hile

we

do n

ot h

ave

enou

gh in

form

atio

n to

ass

ess

the

reas

ons

that

thes

e m

edic

aid/

CHiP

ch

ildre

n w

ho a

re re

port

ed to

hav

e ss

i did

not

mee

t the

crit

eria

for C

sHCN

, it c

ould

be

beca

use:

(1) t

he p

aren

t err

oneo

usly

repo

rted

in th

e su

rvey

that

the

child

ren

rece

ived

ssi

, or (

2) th

e N

His

con

ditio

n lis

t did

not

cap

ture

, or t

he

pare

nt d

id n

ot re

cogn

ize,

any

of t

he N

His

con

ditio

ns a

s re

flect

ing

the

child

’s c

ircum

stan

ces.

7 Q

uest

ion

only

ask

ed fo

r chi

ldre

n ag

e 0

to 1

7.

8 Q

uest

ion

only

ask

ed fo

r chi

ldre

n ag

e 2

to 1

7.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 21

J U N E 2 0 1 4 | 95

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

2

TABL

E 5.

He

alth

Insu

ranc

e an

d De

mog

raph

ic C

hara

cter

istic

s of

Non

-Inst

itutio

naliz

ed In

divi

dual

s Ag

e 19

–64

by S

ourc

e of

Hea

lth

Insu

ranc

e, 2

010–

2012

Sele

cte

d S

ourc

es

of

Insu

rance

1M

edic

aid

2

Adult

s

age

19

–6

4M

edic

aid

2P

riva

te3

Medic

are

Unin

sure

d4

Medic

aid

adult

s age

19

–6

4

Medic

are

(dual

eligib

les)

Non-d

ual

SSI

Neit

her

SSI

nor

Medic

are

Heal

th In

sura

nce

Cove

rage

9.7%

65.1

%3.

6%21

.0%

100.

0%11

.4%

15.1

%73

.5%

Age

(cat

egor

ies

sum

to 1

00%

)19

–24

13.8

%*

20.3

%11

.6%

*2.

4%*

18.6

%*

20.3

%3.

5%*

13.5

%*

24.2

%*

25–4

443

.1*

45.5

41.8

*19

.5*

50.0

*45

.527

.1*

34.5

*50

.8*

45–5

423

.4*

19.4

25.1

*27

.8*

19.6

19.4

33.1

*27

.1*

15.8

*55

–64

19.7

*14

.721

.6*

50.2

*11

.8*

14.7

36.2

*24

.9*

9.2*

Gend

er (c

ateg

orie

s su

m to

100

%)

mal

e49

.1%

*35

.8%

49.0

%*

49.3

%*

54.2

%*

35.8

%41

.9%

*45

.6%

*32

.9%

*fe

mal

e50

.9*

64.2

51.0

*50

.7*

45.8

*64

.258

.1*

54.4

*67

.1*

Race

(cat

egor

ies

sum

to 1

00%

)Hi

span

ic15

.7%

*21

.5%

10.0

%*

9.6%

*31

.1%

*21

.5%

10.1

%*

13.6

%*

25.0

%*

whi

te, n

on-H

ispa

nic

65.7

*49

.473

.9*

68.6

*48

.349

.462

.8*

54.9

*46

.2*

blac

k, n

on-H

ispa

nic

12.5

*23

.89.

6*19

.0*

14.9

*23

.824

.427

.022

.9o

ther

and

mul

tiple

race

s, n

on-H

ispa

nic

6.1*

5.3

6.4*

2.8*

5.7

5.3

2.7*

4.5

5.9

Fam

ily c

hara

cter

istic

sPa

rent

of a

dep

ende

nt c

hild

537

.3*

47.7

37.4

*12

.9*

35.5

*47

.711

.3*

18.5

*59

.5*

Heal

th in

sura

nce

med

icai

d9.

7%*

100.

0%0.

4%*

30.9

%*

–10

0.0%

100.

0%10

0.0%

100.

0%m

edic

are

3.6*

11.4

1.1*

100.

0*–

11.4

100.

0*–

–Pr

ivat

e65

.1*

2.8

100.

0*19

.7*

–2.

83.

32.

62.

7

see

Tabl

e 7

for n

otes

.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 22

96 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 2

TABL

E 6.

He

alth

Cha

ract

eris

tics

of N

on-In

stitu

tiona

lized

Indi

vidu

als

Age

19–6

4 by

Sou

rce

of H

ealth

Insu

ranc

e, 2

010–

2012

Sele

cte

d S

ourc

es

of

Insu

rance

1M

edic

aid

2

Adult

s

age

19

–6

4M

edic

aid

2P

riva

te3

Medic

are

Unin

sure

d4

Medic

aid

adult

s age

19

–6

4

Medic

are

(dual

eligib

les)

Non-d

ual

SSI

Neit

her

SSI

nor

Medic

are

Disa

bilit

y an

d w

ork

stat

usre

ceiv

es s

uppl

emen

tal s

ecur

ity in

com

e (s

si)

2.4%

*19

.8%

0.3%

*20

.8%

0.5%

*19

.8%

41.8

%*

100.

0%*

–

rece

ives

soc

ial s

ecur

ity d

isab

ility

insu

ranc

e (s

sdi)

3.6*

14.7

1.4*

62.2

*0.

6*14

.765

.7*

19.3

*5.

9%*

wor

king

70.4

*34

.381

.3*

10.4

*60

.4*

34.3

10.2

*7.

8*43

.5*

Curr

ent h

ealth

sta

tus

(cat

egor

ies

sum

to 1

00%

)Ex

celle

nt o

r ver

y go

od63

.5%

*40

.4%

71.2

%*

14.3

%*

55.4

%*

40.4

%12

.7%

*15

.1%

*49

.8%

*

goo

d25

.3*

28.8

22.6

*26

.631

.4*

28.8

25.2

27.8

29.6

fair

or p

oor

11.2

*30

.96.

2*59

.1*

13.2

*30

.962

.0*

57.1

*20

.6*

Heal

th c

ompa

red

to 1

2 m

onth

s ag

o (c

ateg

orie

s su

m to

100

%)

bette

r19

.4%

*21

.4%

19.6

%*

17.3

%*

17.9

%*

21.4

%20

.3%

20.9

%21

.7%

wor

se7.

7*14

.45.

6*25

.1*

9.5*

14.4

23.2

*21

.3*

11.7

*

sam

e72

.9*

64.2

74.8

*57

.6*

72.6

*64

.256

.5*

57.9

*66

.6*

Activ

ities

of d

aily

livi

ng (A

DLs)

Hel

p w

ith a

ny p

erso

nal c

are

need

s61.

3%*

6.6%

0.5%

*13

.9%

*0.

6%*

6.6%

19.8

%*

18.4

%*

2.1%

*

Hel

p w

ith b

athi

ng/s

how

erin

g0.

8*4.

40.

3*8.

5*0.

3*4.

412

.8*

14.0

*1.

1*

Hel

p w

ith d

ress

ing

0.7*

3.8

0.3*

7.7*

0.3*

3.8

11.7

*11

.1*

1.1*

Hel

p w

ith e

atin

g0.

3*1.

90.

1*3.

7*0.

1*1.

96.

1*6.

2*0.

4*

Hel

p w

ith tr

ansf

errin

g (in

/out

of b

ed o

r cha

irs)

0.6*

3.3

0.2*

6.7*

0.3*

3.3

11.0

*9.

2*0.

9*

Hel

p w

ith to

iletin

g0.

4*2.

50.

2*4.

8*0.

1*2.

57.

7*7.

9*0.

6*

Hel

p ge

tting

aro

und

in h

ome

0.6*

2.9

0.2*

6.1*

0.2*

2.9

9.6*

8.3*

0.8*

Num

ber o

f abo

ve A

DLs

repo

rted

(cat

egor

ies

sum

to 1

00%

)0

98.7

%*

93.5

%99

.5%

*86

.1%

*99

.4%

*93

.5%

80.2

%*

81.7

%*

97.9

%*

10.

2*0.

90.

1*2.

2*0.

1*0.

92.

7*2.

1*0.

4*

20.

3*1.

10.

1*2.

8*0.

2*1.

12.

7*3.

2*0.

4*

30.

2*1.

10.

1*2.

6*0.

1*1.

13.

9*2.

6*0.

4*

4+0.

6*3.

40.

2*6.

4*0.

2*3.

410

.5*

10.4

*0.

9*

Page 23

J U N E 2 0 1 4 | 97

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

2

TABL

E 6,

Con

tinue

d

Sele

cte

d S

ourc

es

of

Insu

rance

1M

edic

aid

2

Adult

s

age

19

–6

4M

edic

aid

2P

riva

te3

Medic

are

Unin

sure

d4

Medic

aid

adult

s age

19

–6

4

Medic

are

(dual

eligib

les)

Non-d

ual

SSI

Neit

her

SSI

nor

Medic

are

Spec

ific

heal

th c

ondi

tions

Curr

ently

pre

gnan

t73.

5%*

9.5%

2.8%

*†

1.6%

*9.

5%†

3.3%

*10

.9%

func

tiona

l lim

itatio

n829

.5*

47.1

25.6

*84

.3%

*27

.8*

47.1

83.0

%*

75.9

*35

.7*

diff

icul

ty w

alki

ng w

ithou

t equ

ipm

ent

3.4*

11.8

1.7*

31.7

*2.

0*11

.832

.9*

26.3

*5.

7*

Hea

lth c

ondi

tion

that

requ

ires

spec

ial e

quip

men

t (e

.g.,

cane

, whe

elch

air)

4.2*

11.9

2.7*

33.2

*2.

4*11

.933

.4*

25.6

*5.

8*

lost

all

natu

ral t

eeth

4.6*

8.9

3.4*

18.8

*5.

0*8.

921

.3*

16.1

*5.

5*

dep

ress

ed/a

nxio

us fe

elin

gs9

12.4

*25

.98.

3*36

.2*

16.7

*25

.939

.1*

40.5

*21

.0*

Ever

told

had

hyp

erte

nsio

n23

.7*

30.4

23.0

*56

.3*

18.9

*30

.454

.0*

45.2

*23

.8*

Ever

told

had

cor

onar

y he

art d

isea

se2.

5*4.

52.

1*14

.5*

1.5*

4.5

12.7

*7.

6*2.

6*

Ever

told

had

hea

rt a

ttack

1.8*

4.0

1.3*

11.6

*1.

5*4.

010

.4*

6.3*

2.5*

Ever

told

had

stro

ke1.

6*4.

41.

0*10

.7*

1.2*

4.4

12.2

*9.

0*2.

2*

Ever

told

had

can

cer

5.2*

5.9

5.7

14.4

*2.

8*5.

912

.9*

9.0*

4.2*

Ever

told

had

dia

bete

s6.

7*12

.35.

9*24

.8*

5.0*

12.3

26.5

*21

.5*

8.3*

Ever

told

had

art

hriti

s17

.3*

23.8

17.0

*55

.0*

11.4

*23

.854

.8*

37.0

*16

.2*

Ever

told

had

ast

hma

13.0

*20

.012

.2*

23.4

*11

.5*

20.0

30.0

*26

.8*

17.0

*

Past

12

mon

ths,

told

had

chr

onic

bro

nchi

tis3.

8*8.

02.

9*15

.8*

3.3*

8.0

18.8

*13

.0*

5.3*

Past

12

mon

ths,

told

had

live

r con

ditio

n1.

4*3.

31.

0*5.

6*1.

1*3.

35.

6*7.

1*2.

2*

Past

12

mon

ths,

told

had

wea

k/fa

iling

kid

neys

1.2*

4.0

0.7*

8.8*

1.2*

4.0

12.2

*6.

8*2.

2*

see

Tabl

e 7

for n

otes

.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 24

98 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 2

TABL

E 7.

Us

e of

Car

e by

Non

-Inst

itutio

naliz

ed In

divi

dual

s Ag

e 19

–64

by S

ourc

e of

Hea

lth In

sura

nce,

201

0–20

12

Sele

cte

d S

ourc

es

of

Insu

rance

1M

edic

aid

2

Adult

s

age

19

–6

4M

edic

aid

2P

riva

te3

Medic

are

Unin

sure

d4

Medic

aid

adult

s age

19

–6

4

Medic

are

(dual

eligib

les)

Non-d

ual

SSI

Neit

her

SSI

nor

Medic

are

Had

a u

sual

sou

rce

of c

are

80.1

%*

87.4

%89

.6%

*93

.9%

*45

.4%

*87

.4%

95.1

%*

92.1

%*

85.3

%*

rece

ived

at-h

ome

care

in p

ast 1

2 m

onth

s1.

2*4.

60.

8*9.

9*0.

4*4.

616

.9*

8.3*

2.0*

Num

ber o

f tim

es s

aw a

doc

tor o

r oth

er h

ealth

pro

fess

iona

l in

past

12

mon

ths

(cat

egor

ies

sum

to 1

00%

)N

one

22.2

%*

14.1

%15

.5%

*6.

4%*

48.4

%*

14.1

%5.

5%*

8.7%

*16

.4%

*1

18.3

*12

.919

.8*

5.8*

17.4

*12

.95.

0*9.

2*14

.8*

2–3

25.9

*20

.829

.6*

15.7

*17

.3*

20.8

14.3

*17

.822

.44+

33.6

*52

.335

.0*

72.1

*16

.9*

52.3

75.2

*64

.3*

46.4

*Nu

mbe

r of e

mer

genc

y ro

om v

isits

in p

ast 1

2 m

onth

s (c

ateg

orie

s su

m to

100

%)

Non

e80

.3%

*60

.9%

84.1

%*

60.4

%79

.4%

*60

.9%

54.4

%*

56.4

%*

62.7

%1

12.4

*18

.011

.5*

18.6

12.0

*18

.018

.017

.618

.22–

35.

1*13

.03.

4*12

.25.

9*13

.016

.5*

15.3

12.0

4+2.

2*8.

11.

0*8.

72.

6*8.

111

.1*

10.7

*7.

1

Note

s: s

si is

sup

plem

enta

l sec

urity

inco

me.

* d

iffer

ence

from

med

icai

d is

sta

tistic

ally

sig

nific

ant a

t the

0.0

5 le

vel.

† Es

timat

e ha

s a

rela

tive

stan

dard

err

or o

f gre

ater

than

50

perc

ent.

– Q

uant

ity z

ero;

am

ount

s sh

own

as 0

.0 ro

und

to le

ss th

an 0

.1 in

this

tabl

e.

1 H

ealth

insu

ranc

e co

vera

ge is

def

ined

as

cove

rage

at t

he ti

me

of th

e su

rvey

. Tot

als

of h

ealth

insu

ranc

e co

vera

ge m

ay s

um to

mor

e th

an 1

00 p

erce

nt b

ecau

se in

divi

dual

s m

ay h

ave

mul

tiple

sou

rces

of c

over

age.

res

pons

es to

rece

nt-

care

que

stio

ns a

re b

ased

on

the

prev

ious

12

mon

ths,

dur

ing

whi

ch ti

me

the

indi

vidu

al m

ay h

ave

had

diffe

rent

cov

erag

e th

an th

at s

how

n in

the

tabl

e. N

ot s

epar

atel

y sh

own

are

the

estim

ates

of i

ndiv

idua

ls c

over

ed b

y an

y ty

pe o

f m

ilita

ry h

ealth

pla

n (v

a, T

riC

arE,

and

CH

amP-

va) o

r oth

er g

over

nmen

t-spo

nsor

ed p

rogr

ams.

2 m

edic

aid

also

incl

udes

adu

lts re

port

ing

cove

rage

thro

ugh

the

CHiP

pro

gram

or o

ther

sta

te-s

pons

ored

hea

lth p

lans

. med

icai

d an

d CH

iP c

anno

t be

dist

ingu

ishe

d fro

m e

ach

othe

r in

the

Nat

iona

l Hea

lth in

terv

iew

sur

vey.

CH

iP

enro

llmen

t of a

dults

is s

mal

l, to

talin

g ap

prox

imat

ely

218,

000

ever

enr

olle

d du

ring

fy 2

012.

(see

mar

ch 2

014

maC

stat

s Ta

ble

3.)

3 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.

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

-spo

nsor

ed o

r oth

er g

over

nmen

t-spo

nsor

ed h

ealth

pla

n, o

r 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

acc

iden

ts o

r den

tal c

are.

5 Pa

rent

of a

dep

ende

nt c

hild

is d

efin

ed a

s an

adu

lt w

ith a

t lea

st o

ne d

epen

dent

chi

ld (b

iolo

gica

l, ad

opte

d, s

tep,

or f

oste

r) in

the

hous

ehol

d; a

dep

ende

nt c

hild

is d

efin

ed a

s a

child

age

18

and

unde

r or a

chi

ld a

ge 2

3 an

d un

der w

ho is

no

t wor

king

bec

ause

of g

oing

to s

choo

l.

6 o

nly

adul

ts w

ho re

port

nee

ding

ass

ista

nce

with

per

sona

l car

e ne

eds

are

aske

d ab

out e

ach

of th

e sp

ecifi

c pe

rson

al c

are

need

s. E

ach

spec

ific

pers

onal

car

e ne

ed is

repo

rted

as

the

over

all p

opul

atio

n pr

eval

ence

(rat

her t

han

the

prev

alen

ce a

mon

g th

ose

need

ing

help

with

any

per

sona

l car

e ne

eds)

.

7 Q

uest

ion

only

ask

ed fo

r fem

ales

age

18

to 4

9.

8 in

divi

dual

s w

ith a

func

tiona

l lim

itatio

n ar

e th

ose

who

repo

rted

any

deg

ree

of d

iffic

ulty

—ra

ngin

g fro

m “

only

a li

ttle

diffi

cult”

to “

can’

t do

at a

ll”—

doin

g an

y of

a d

ozen

act

iviti

es (e

.g.,

wal

king

a q

uart

er o

f a m

ile, s

toop

ing

or k

neel

ing)

by

them

selv

es a

nd w

ithou

t spe

cial

equ

ipm

ent.

9 re

port

s fe

elin

g sa

d, h

opel

ess,

wor

thle

ss, n

ervo

us, r

estle

ss, o

r tha

t eve

ryth

ing

was

an

effo

rt a

ll or

mos

t of t

he ti

me.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 25

J U N E 2 0 1 4 | 99

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

2

TABL

E 8.

He

alth

Insu

ranc

e an

d De

mog

raph

ic C

hara

cter

istic

s of

Non

-Inst

itutio

naliz

ed In

divi

dual

s Ag

e 65

and

Old

er b

y So

urce

of H

ealth

In

sura

nce,

201

0–20

12

Sele

cte

d S

ourc

es o

f In

sura

nce

1M

edic

aid

2

Adult

s a

ge

65+

Medic

aid

2P

rivate

3M

edic

are

All M

edic

aid

adult

s a

ge

65+

Functi

onal

lim

itati

on

4

No f

uncti

onal

lim

itati

on

Heal

th In

sura

nce

Cove

rage

7.6%

52.6

%95

.1%

100.

0%79

.0%

21.0

%Ag

e (c

ateg

orie

s su

m to

100

%)

65–7

455

.7%

55.5

%55

.3%

54.6

%55

.5%

53.9

%62

.1%

*75

–84

32.6

32.8

32.9

33.4

32.8

33.1

31.4

85+

11.7

11.7

11.8

12.0

11.7

13.0

6.6*

Gend

er (c

ateg

orie

s su

m to

100

%)

mal

e43

.8%

*32

.2%

43.7

%*

43.3

%*

32.2

%29

.7%

41.8

%*

fem

ale

56.2

*67

.856

.3*

56.7

*67

.870

.358

.2*

Race

(cat

egor

ies

sum

to 1

00%

)H

ispa

nic

7.4%

*23

.1%

3.3%

*6.

8%*

23.1

%21

.9%

28.1

%w

hite

, non

-His

pani

c79

.8*

49.0

87.8

*80

.9*

49.0

50.7

42.8

blac

k, n

on-H

ispa

nic

8.5*

17.4

6.0*

8.3*

17.4

17.4

17.4

oth

er a

nd m

ultip

le ra

ces,

non

-His

pani

c4.

3*10

.52.

9*4.

0*10

.510

.011

.7He

alth

insu

ranc

em

edic

aid

7.6%

*10

0.0%

0.9%

*7.

3%*

100.

0%10

0.0%

100.

0%m

edic

are

95.1

*91

.893

.9*

100.

0*91

.892

.688

.8Pr

ivat

e52

.6*

6.2

100.

0*52

.0*

6.2

5.5

8.6

see

Tabl

e 10

for n

otes

.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 26

100 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 2

TABL

E 9.

He

alth

Cha

ract

eris

tics

of N

on-In

stitu

tiona

lized

Indi

vidu

als

Age

65 a

nd O

lder

by

Sour

ce o

f Hea

lth In

sura

nce,

201

0–20

12

Sele

cte

d S

ourc

es o

f In

sura

nce

1M

edic

aid

2

Adult

s a

ge

65

+M

edic

aid

2P

rivate

3M

edic

are

All M

edic

aid

adult

s a

ge

65

+

Functi

onal

lim

itati

on

4

No f

uncti

onal

lim

itati

on

Disa

bilit

y an

d w

ork

stat

us

rece

ives

sup

plem

enta

l sec

urity

inco

me

(ssi

)3.

8%*

29.4

%0.

8%*

3.8%

*29

.4%

32.6

%17

.4%

*

wor

king

15.9

*4.

519

.3*

14.5

*4.

53.

19.

9*

Curr

ent h

ealth

sta

tus

(cat

egor

ies

sum

to 1

00%

)

Exce

llent

or v

ery

good

43.8

%*

20.8

%48

.4%

*43

.6%

*20

.8%

13.9

%*

47.1

%*

goo

d33

.7*

29.9

34.0

*33

.8*

29.9

29.0

33.3

fair

or p

oor

22.5

*49

.317

.6*

22.6

*49

.357

.1*

19.6

*

Heal

th c

ompa

red

to 1

2 m

onth

s ag

o (c

ateg

orie

s su

m to

100

%)

bette

r13

.7%

14.2

%13

.6%

13.7

%14

.2%

15.3

%10

.3%

*

wor

se11

.8*

21.0

10.5

*11

.8*

21.0

25.0

*5.

8*

sam

e74

.6*

64.8

75.9

*74

.5*

64.8

59.7

*83

.8*

Activ

ities

of d

aily

livi

ng (A

DLs)

Hel

p w

ith a

ny p

erso

nal c

are

need

s56.

8%*

20.4

%5.

1%*

6.9%

*20

.4%

24.7

%*

3.1%

*

Hel

p w

ith b

athi

ng/s

how

erin

g5.

0*15

.53.

6*5.

1*15

.518

.8*

2.4*

Hel

p w

ith e

atin

g1.

5*4.

80.

9*1.

5*4.

85.

81.

4*

Hel

p w

ith tr

ansf

errin

g (in

/out

of b

ed o

r cha

irs)

3.0*

9.6

2.1*

3.0*

9.6

11.4

2.1*

Hel

p w

ith to

iletin

g2.

3*7.

11.

7*2.

3*7.

18.

31.

9*

Hel

p ge

tting

aro

und

in h

ome

2.8*

9.5

1.9*

2.8*

9.5

11.5

1.9*

Num

ber o

f abo

ve A

DLs

repo

rted

(cat

egor

ies

sum

to 1

00%

)

093

.2%

*79

.8%

94.9

%*

93.1

%*

79.8

%75

.5%

*96

.9%

*

10.

9*2.

60.

7*0.

9*2.

63.

1†

21.

4*2.

81.

1*1.

4*2.

83.

5†

31.

4*4.

11.

2*1.

4*4.

15.

20.

0*

4+3.

1*10

.62.

1*3.

1*10

.612

.72.

1*

Page 27

J U N E 2 0 1 4 | 101

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

2

TABL

E 9,

Con

tinue

d

Sele

cte

d S

ourc

es o

f In

sura

nce

1M

edic

aid

2

Adult

s a

ge

65

+M

edic

aid

2P

rivate

3M

edic

are

All M

edic

aid

adult

s a

ge

65

+

Functi

onal

lim

itati

on

4

No f

uncti

onal

lim

itati

on

Spec

ific

heal

th c

ondi

tions

func

tiona

l lim

itatio

n465

.1%

*79

.0%

63.9

%*

65.7

%*

79.0

%10

0.0%

*0.

0%*

diff

icul

ty w

alki

ng w

ithou

t equ

ipm

ent

18.6

*38

.816

.0*

18.9

*38

.847

.2*

6.8*

Hea

lth c

ondi

tion

that

requ

ires

spec

ial

equi

pmen

t (e.

g., c

ane,

whe

elch

air)

20.7

*38

.918

.5*

21.0

*38

.947

.0*

8.5*

lost

all

natu

ral t

eeth

22.7

*41

.218

.5*

22.9

*41

.243

.730

.9*

dep

ress

ed/a

nxio

us fe

elin

gs6

9.3*

20.6

8.0*

9.3*

20.6

25.3

*3.

1*

Ever

told

had

hyp

erte

nsio

n62

.0*

70.5

61.1

*62

.3*

70.5

73.9

57.6

*

Ever

told

had

cor

onar

y he

art d

isea

se15

.8*

19.6

16.0

*16

.1*

19.6

22.4

8.8*

Ever

told

had

hea

rt a

ttack

10.4

*13

.610

.0*

10.6

*13

.615

.37.

2*

Ever

told

had

stro

ke8.

2*15

.17.

1*8.

3*15

.117

.94.

5*

Ever

told

had

can

cer

24.2

*18

.826

.4*

24.7

*18

.820

.512

.1*

Ever

told

had

dia

bete

s20

.7*

31.1

19.2

*20

.8*

31.1

33.7

20.8

*

Ever

told

had

art

hriti

s49

.7*

57.4

51.2

*50

.4*

57.4

65.6

*25

.9*

Ever

told

had

ast

hma

10.6

*16

.010

.1*

10.7

*16

.017

.98.

0*

Past

12

mon

ths,

told

had

chr

onic

bro

nchi

tis5.

8*10

.35.

5*5.

9*10

.311

.74.

7*

Past

12

mon

ths,

told

had

live

r con

ditio

n1.

4*2.

91.

2*1.

4*2.

93.

6†

Past

12

mon

ths,

told

had

wea

k/fa

iling

kidn

eys

4.3*

9.3

3.5*

4.4*

9.3

11.0

2.9*

see

Tabl

e 10

for n

otes

.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 28

102 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 2

TABL

E 10

. Us

e of

Car

e by

Non

-Inst

itutio

naliz

ed In

divi

dual

s Ag

e 65

and

Old

er b

y So

urce

of H

ealth

Insu

ranc

e, 2

010–

2012

Sele

cte

d S

ourc

es o

f In

sura

nce

1M

edic

aid

2

Adult

s a

ge

65

+M

edic

aid

2P

rivate

3M

edic

are

All M

edic

aid

adult

s a

ge

65

+

Functi

onal

lim

itati

on

4

No f

uncti

onal

lim

itati

on

rece

ived

at-

hom

e ca

re in

pas

t 12

mon

ths

8.2%

*19

.0%

7.4%

*8.

4%*

19.0

%22

.9%

*3.

9%*

Num

ber o

f tim

es s

aw a

doc

tor o

r oth

er h

ealth

pro

fess

iona

l in

past

12

mon

ths

(cat

egor

ies

sum

to 1

00%

)N

one

6.4%

*6.

5%4.

8%*

5.9%

6.5%

4.7%

13.0

%*

110

.4*

6.4

10.4

*10

.3*

6.4

4.8

12.5

*2–

325

.5*

20.4

26.2

*25

.3*

20.4

19.0

25.6

4+57

.7*

66.7

58.6

*58

.5*

66.7

71.5

*48

.8*

Num

ber o

f em

erge

ncy

room

vis

its in

pas

t 12

mon

ths

(cat

egor

ies

sum

to 1

00%

)N

one

76.9

%*

66.9

%78

.0%

*76

.7%

*66

.9%

63.2

%80

.8%

*1

15.3

17.1

14.9

15.5

17.1

18.8

10.7

*2–

35.

9*10

.75.

5*6.

0*10

.711

.67.

1*4+

1.9*

5.3

1.6*

1.9*

5.3

6.4

1.3*

Note

s:

* d

iffer

ence

from

med

icai

d is

sta

tistic

ally

sig

nific

ant a

t the

0.0

5 le

vel.

† Es

timat

e ha

s a

rela

tive

stan

dard

err

or o

f gre

ater

than

50

perc

ent.

– Q

uant

ity z

ero;

am

ount

s sh

own

as 0

.0 ro

und

to le

ss th

an 0

.1 in

this

tabl

e.

1 H

ealth

insu

ranc

e co

vera

ge is

def

ined

as

cove

rage

at t

he ti

me

of th

e su

rvey

. Tot

als

of h

ealth

insu

ranc

e co

vera

ge m

ay s

um to

mor

e th

an 1

00 p

erce

nt b

ecau

se in

divi

dual

s m

ay h

ave

mul

tiple

sou

rces

of c

over

age.

res

pons

es to

re

cent

-car

e qu

estio

ns a

re b

ased

on

the

prev

ious

12

mon

ths,

dur

ing

whi

ch ti

me

the

indi

vidu

al m

ay h

ave

had

diffe

rent

cov

erag

e th

an th

at s

how

n in

the

tabl

e. N

ot s

epar

atel

y sh

own

are

the

estim

ates

of i

ndiv

idua

ls c

over

ed b

y an

y ty

pe o

f mili

tary

hea

lth p

lan

(va

, Tr

iCar

E, a

nd C

Ham

P-va

) or o

ther

gov

ernm

ent-

spon

sore

d pr

ogra

ms.

2 m

edic

aid

also

incl

udes

adu

lts re

port

ing

cove

rage

thro

ugh

CHiP

or o

ther

sta

te-s

pons

ored

hea

lth p

lans

.

3 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.

4 in

divi

dual

s w

ith a

func

tiona

l lim

itatio

n ar

e th

ose

who

repo

rted

any

deg

ree

of d

iffic

ulty

—ra

ngin

g fro

m “

only

a li

ttle

diffi

cult”

to “

can’

t do

at a

ll”—

doin

g an

y of

a d

ozen

act

iviti

es (

e.g.

, wal

king

a q

uart

er o

f a m

ile, s

toop

ing

or

knee

ling)

by

them

selv

es a

nd w

ithou

t spe

cial

equ

ipm

ent.

5 o

nly

adul

ts w

ho re

port

nee

ding

ass

ista

nce

with

per

sona

l car

e ne

eds

are

aske

d ab

out e

ach

of th

e fo

llow

ing

spec

ific

pers

onal

car

e ne

eds.

Eac

h ne

ed is

repo

rted

as

the

over

all p

opul

atio

n pr

eval

ence

(ra

ther

than

the

prev

alen

ce

amon

g th

ose

need

ing

help

with

any

per

sona

l car

e ne

eds)

.

6 re

port

s fe

elin

g sa

d, h

opel

ess,

wor

thle

ss, n

ervo

us, r

estle

ss, o

r tha

t eve

ryth

ing

was

an

effo

rt a

ll or

mos

t of t

he ti

me.

Sour

ce: m

aCPa

C an

alys

is o

f the

201

0–20

12 N

atio

nal H

ealth

inte

rvie

w s

urve

y (N

His

).

Page 29

J U N E 2 0 1 4 | 103

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

Page 30

104 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIP

Page 31

J U N E 2 0 1 4 | 105

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

3

Key Points

medicaid Enrollment and benefit spending

f individuals eligible on the basis of a disability and those age 65 and older account

for about a quarter of medicaid enrollees, but about two-thirds of program spending

(Tables 11 and 12).

f medicaid spending per enrollee is affected by large numbers of individuals with limited

benefits in some states (Table 13).

f among individuals dually enrolled in medicaid and medicare, those age 65 and older

account for about 60 percent of enrollment and medicaid benefit spending (Tables 11

and 12).

f a large share of medicaid spending for enrollees eligible on the basis of a disability

and enrollees age 65 and older is for long-term services and supports (lTss), while

a substantial portion of spending for non-disabled children and adults is for capitation

payments to managed care plans (figures 3 and 4).

f lTss users account for only about 6 percent of medicaid enrollees, but nearly half of all

medicaid spending (figure 5). acute care represents a minority of medicaid spending

for most lTss users (figure 6), and average medicaid benefit spending for these

individuals is more than 10 times that of enrollees who are not using lTss (figure 7).

f medicaid benefit spending per enrollee varies substantially across states (Table 13).

reasons for this variation may include the breadth of benefits that states choose to cover;

the proportion of enrollees receiving the full benefit package or a more limited version;

enrollee case mix (based on health status and other characteristics); the underlying

costs of delivering health care services in specific geographic areas; and state policies

regarding provider payments, care management, and other program features.

3S E C T I O N

Page 32

106 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 3

TABL

E 11

. M

edic

aid

Enro

llmen

t by

Stat

e, E

ligib

ility

Gro

up, a

nd D

ual-E

ligib

le S

tatu

s, F

Y 20

11 (t

hous

ands

)

Perc

enta

ge o

f Enro

llees

in E

ligib

ilit

y G

roup

1D

ual-

eligib

le E

nro

llees

2

All d

ual-

eligib

le

enro

llees

Dual-

eligib

le e

nro

llees

wit

h f

ull b

enefi

ts

Dual-

eligib

le e

nro

llees

wit

h lim

ited b

enefi

ts

Sta

teTota

lC

hildre

nA

dult

sD

isable

dA

ged

Tota

l

Perc

enta

ge

age 6

5+

Tota

l

Perc

enta

ge

age 6

5+

Tota

l

Perc

enta

ge

age 6

5+

Tota

l67

,605

47.4

%28

.3%

14.7

%9.

5%10

,179

59.0

%7,

552

59.3

%2,

627

58.3

%al

abam

a1,

061

50.7

17.3

20.8

11.1

212

55.1

9752

.411

557

.4al

aska

135

54.7

25.0

13.3

7.0

1553

.715

53.2

068

.9ar

izon

a1,

283

44.5

37.5

10.9

7.1

148

57.9

118

54.5

3071

.1ar

kans

as69

351

.516

.621

.810

.212

853

.270

59.3

5845

.8Ca

lifor

nia

11,6

9039

.043

.28.

98.

81,

295

70.2

1,26

070

.035

75.2

Colo

rado

762

57.4

21.3

13.5

7.9

9458

.269

60.6

2551

.4Co

nnec

ticut

785

40.4

36.1

9.8

13.7

155

66.5

8357

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76.8

del

awar

e24

339

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.86.

227

53.1

1254

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dis

trict

of C

olum

bia

232

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8.1

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764

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rgia

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430

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67.4

3267

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761

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illin

ois

2,88

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256

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61.3

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ana

1,18

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472

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44.9

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ucky

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47.9

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ana

1,29

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220

457

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355

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59.3

mai

ne43

529

.626

.828

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459

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45.6

4577

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and

1,03

647

.030

.814

.47.

712

955

.884

55.3

4556

.7m

assa

chus

etts

1,51

925

.241

.722

.810

.325

951

.723

747

.722

95.1

mic

higa

n2,

340

50.5

27.2

16.0

6.3

291

46.3

249

45.4

4251

.4m

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sota

1,10

641

.637

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.49.

014

953

.113

552

.215

60.6

mis

siss

ippi

781

52.0

14.7

21.8

11.5

162

55.2

8457

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52.4

mis

sour

i1,

138

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47.4

2651

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onta

na13

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52.0

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53.5

Neb

rask

a25

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Page 33

J U N E 2 0 1 4 | 107

maCstats: mEdiCaid aNd CHiP Program sTaTisTiCs |

SE

CTI

ON

3

TABL

E 11

, Con

tinue

d

Perc

enta

ge o

f Enro

llees

in E

ligib

ilit

y G

roup

1D

ual-

eligib

le E

nro

llees

2

All d

ual-

eligib

le

enro

llees

Dual-

eligib

le e

nro

llees

wit

h f

ull b

enefi

ts

Dual-

eligib

le e

nro

llees

wit

h lim

ited b

enefi

ts

Sta

teTota

lC

hildre

nA

dult

sD

isable

dA

ged

Tota

l

Perc

enta

ge

age 6

5+

Tota

l

Perc

enta

ge

age 6

5+

Tota

l

Perc

enta

ge

age 6

5+

New

Jer

sey

1,19

452

.7%

18.1

%15

.9%

13.3

%23

662

.6%

206

61.6

%30

69.4

%N

ew m

exic

o65

156

.325

.711

.16.

974

59.4

4160

.333

58.2

New

yor

k5,

790

36.7

40.1

12.0

11.2

844

67.7

724

66.4

120

75.2

Nor

th C

arol

ina

1,94

851

.721

.117

.59.

734

054

.426

354

.077

56.0

Nor

th d

akot

a85

53.1

21.5

14.2

11.1

1657

.113

56.6

359

.0o

hio

2,33

947

.527

.117

.18.

337

448

.225

549

.912

044

.6o

klah

oma

907

54.3

24.4

13.9

7.5

124

52.5

101

52.3

2353

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rego

n72

948

.229

.114

.28.

510

955

.568

57.6

4052

.0Pe

nnsy

lvan

ia2,

529

43.8

21.0

25.2

10.0

444

54.1

367

52.7

7760

.7r

hode

isla

nd19

945

.021

.320

.513

.241

56.4

3555

.26

63.4

sout

h Ca

rolin

a96

149

.624

.117

.39.

016

353

.314

052

.623

57.4

sout

h d

akot

a13

257

.917

.514

.99.

822

58.1

1460

.18

54.8

Tenn

esse

e1,

533

51.8

21.0

17.6

9.5

279

51.7

156

50.7

123

53.0

Texa

s5,

136

63.4

14.0

13.4

9.2

714

64.5

435

66.4

278

61.5

Uta

h37

258

.724

.512

.24.

736

45.6

3144

.75

51.6

verm

ont

201

34.1

42.3

12.4

11.2

3758

.828

54.7

872

.6vi

rgin

ia1,

045

54.2

17.2

17.8

10.8

192

55.7

127

58.5

6550

.1w

ashi

ngto

n1,

397

56.3

21.3

15.2

7.2

181

54.1

132

57.4

4845

.2w

est v

irgin

ia44

047

.214

.828

.19.

987

49.1

5150

.536

47.1

wis

cons

in1,

274

39.0

36.2

13.2

11.5

227

62.7

206

62.5

2164

.1w

yom

ing

8965

.214

.913

.16.

812

51.5

751

.04

52.5

Note

s: E

nrol

lmen

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-f

inan

ced

med

icai

d co

vera

ge

(i.e.

, med

icai

d-ex

pans

ion

CHiP

) dur

ing

the

year

, the

y ar

e ex

clud

ed if

thei

r mos

t rec

ent e

nrol

lmen

t 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

enro

llees

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

isca

l yea

r (fy

) 201

1, w

hich

is th

e so

urce

use

d in

prio

r edi

tions

of t

his

tabl

e,

maC

PaC

calc

ulat

ed e

nrol

lmen

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. a

s a

resu

lt, fi

gure

s sh

own

here

are

not

dire

ctly

com

para

ble

to e

arlie

r yea

rs. f

or m

aCPa

C’s

ana

lysi

s, m

edic

aid

enro

llees

wer

e as

sign

ed

a un

ique

nat

iona

l ide

ntifi

catio

n (id

) num

ber u

sing

an

algo

rithm

that

inco

rpor

ates

sta

te-s

peci

fic id

num

bers

and

ben

efic

iary

cha

ract

eris

tics

such

as

date

of b

irth

and

gend

er. T

he s

tate

and

nat

iona

l enr

ollm

ent c

ount

s sh

own

here

are

un

dupl

icat

ed u

sing

this

nat

iona

l id

. alth

ough

sta

te-le

vel i

nfor

mat

ion

is n

ot y

et a

vaila

ble,

the

estim

ated

num

ber o

f ind

ivid

uals

eve

r enr

olle

d in

med

icai

d (e

xclu

ding

med

icai

d-ex

pans

ion

CHiP

) is

71.2

mill

ion

for f

y 20

12 a

nd 7

1.7

mill

ion

for f

y 20

13. T

hese

fy

2012

–fy

2013

figu

res

excl

ude

abou

t 1 m

illio

n en

rolle

es in

the

terr

itorie

s (m

aCPa

C co

mm

unic

atio

n w

ith th

e o

ffice

of t

he a

ctua

ry a

t the

Cen

ters

for m

edic

are

& m

edic

aid

serv

ices

, mar

ch 2

014)

.

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

a d

isab

ility

are

incl

uded

in th

e di

sabl

ed c

ateg

ory.

abo

ut 7

06,0

00 e

nrol

lees

age

65

and

olde

r are

iden

tifie

d in

the

data

as

disa

bled

; giv

en th

at d

isab

ility

is

not 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 d

ual-e

ligib

le e

nrol

lees

are

indi

vidu

als

who

are

cov

ered

by

both

med

icai

d an

d m

edic

are;

thos

e w

ith li

mite

d be

nefit

s on

ly re

ceiv

e m

edic

aid

assi

stan

ce w

ith m

edic

are

prem

ium

s an

d co

st s

harin

g. Z

eroe

s in

dica

te e

nrol

lmen

t cou

nts

less

than

500

that

roun

d to

zer

o.

Sour

ce: m

aCPa

C an

alys

is o

f med

icai

d st

atis

tical

info

rmat

ion

syst

em (m

sis)

dat

a as

of f

ebru

ary

2014

.

Page 34

108 | J U N E 2 0 1 4

| REPORT TO THE CONGRESS ON MEDICAID AND CHIPS

EC

TIO

N 3

TABL

E 12

. M

edic

aid

Bene

fit S

pend

ing

by S

tate

, Elig

ibili

ty G

roup

, and

Dua

l-Elig

ible

Sta

tus,

FY

2011

(mill

ions

)

Perc

enta

ge o

f B

enefi

t Spendin

g

Att

ributa

ble

to E

ligib

ilit

y G

roup

1D

ual-

eligib

le E

nro

llees

2

All d

ual-

eligib

le

enro

llees

Dual-

eligib

le e

nro

llees

wit

h f

ull b

enefi

ts

Dual-

eligib

le e

nro

llees

wit

h lim

ited b

enefi

ts

Sta

teTota

lC

hildre

nA

dult

sD

isable

dA

ged

Tota

l

Perc

enta

ge

age 6

5+

Tota

l

Perc

enta

ge

age 6

5+

Tota

l

Perc

enta

ge

age 6

5+

Tota

l3$3

86,3

54

19.0

%15

.3%

42.7

%23

.0%

$140

,298

59.7

%$1

34,3

15

60.1

%$5

,983

52

.3%

alab

ama

4,41

624

.110

.040

.625

.31,

626

67.8

1,42

469

.620

355

.7al

aska

1,29

027

.216

.538

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454

.435

354

.31

71.3

ariz

ona

8,82

418

.832

.434

.913

.91,

971

56.4

1,90

756

.264

63.4

arka

nsas

3,94

422

.15.

146

.726

.01,

630

60.5

1,43

263

.919

836

.6Ca

lifor

nia

52,6

3117

.516

.340

.925

.317

,805

67.6

17,6

9567

.611

066

.2Co

lora

do4,

196

21.9

14.3

42.0

21.8

1,42

260

.51,

385

60.9

3745

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nnec

ticut

5,84

416

.120

.334

.329

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858

56.9

2,72

956

.612

964

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elaw

are

1,40

119

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757

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558

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46.5

dis

trict

of C

olum

bia

2,06

711

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163

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263

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55.0

flor

ida

17,9

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63.0

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664

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20.9

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aii

1,60

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573

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68.0

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510

21.8

12.8

49.0

16.3

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46.3

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s12

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3,95

454

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54.5

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280

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6,06

319

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57.7

1,78

158

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953

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aine

33

33

33

33

33

3

mar

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380

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43.0

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24.1

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955

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297

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gan

11,7

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639

58.5

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658

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367

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651

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mis

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ippi

4,25

321

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.743

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587

64.7

1,38

667

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146

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uri

7,39

222

.09.

249

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589

52.0

2,52

952

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48.5

mon

tana

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37.9

26.0

383

64.5

363

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New

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