5 Percent of Medicaid Patients Account for Half of Program’s Costs

About 5 percent of Medicaid beneficiaries account for almost 50 percent of program spending, according to a new report from the nonpartisan Government Accountability Office.

The report says a small number of “super-utilizers” consume much of healthcare spending.

The GAO found that from 2009 to 2011, 5 percent of enrollees in Medicaid, the government health insurance program for the poor, made up 48 percent of costs; the most expensive 1 percent made up 25 percent of costs.

The dynamic is not unique to Medicaid. The Department of Health and Human Services found that in 2010, 5 percent of the overall population accounted for 50 percent of healthcare spending.

The report notes that Medicaid costs are expected to increase as more people are covered under ObamaCare’s expansion of the program. Therefore, studying high-expenditure enrollees “could enhance efforts to manage expenditures and facilitate improvements to care,” it notes.

Disabilities tend to contribute to high costs. The report finds that 63 percent of high-expenditure enrollees are disabled. Fifty-two percent have mental health conditions, 19 percent have substance abuse problems and 18 percent have diabetes.

In contrast to high-cost enrollees, the least expensive 50 percent of enrollees made up 8 percent of costs. About 12 percent of enrollees cost the program nothing at all.

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