Medicaid is the largest health coverage program in the United States. It is designed to help people who have chronic illnesses, developmental disability, and other challenging health issues. It’s name comes from the fact that this program used to be linked to welfare in many states. Now working parents, the elderly, and many children are covered.
Medicaid serves about 68 million people every year to make sure their health needs can be addressed in acute care and long-term care settings.
Although Medicaid serves anyone who qualifies for the program, there are certain demographics which are covered more frequently than others. Here are the key points to consider when going over the available Medicaid demographics.
Who Does Medicaid Serve Most Often?
- 61% of all adults who enroll into Medicaid have a chronic or disabling condition.
- People in ethnic or racial minority population groups make up about 50% of all Medicaid beneficiaries who are under the age of 65.
- About 50% of all Medicaid participants receive care at medical practices which have three or fewer total providers.
- 15% of the Medicaid enrollment involves individuals with a disability, but this accounts for 43% of the $75 billion [or more] in spending which occurs every year.
- Children also make up about half of the total number of people who are covered by this program, but they account for just 19% of the spending which occurs.
- Medicaid finances 40% of all births that occur in the United States, including prenatal care, labor, delivery, and up to 60 days of postpartum care.
- About 1 in 5 Americans have been served by Medicaid at some point in their lives.
- 50% of the long-term care expenses in the US are covered by the Medicaid program.
Medicaid does more than just provide basic health care. The Part D program, for example, provides drug coverage. About 462,000 people who enrolled into Medicaid in 2013 had end-stage renal disease. These benefits are still being offered despite the fact that inpatient hospital facilities, certified beds, and skilled facilities and declined over the past two decades. After the implementation of the Affordable Care Act, commonly known as Obamacare, many of these demographics are expected to change over the coming years.
How Will the Expansion of Medicaid Change Things?
- With the new health care changes, Americans that earn as much as 138% of the federal poverty line qualify for Medicaid.
- This will lower the average age of a Medicaid participant from 39 to 36.
- Before Obamacare, about half of Medicaid participants where White/Caucasian. After the expansion, about 59% of participants are White/Caucasian.
- Not all changes will be positive in cost – new qualifying individuals are expected to be more likely to drink and smoke, but also be less likely to be obese or have diabetes.
- Medicaid’s total contribution to US health care expenditure: 16.7%.
- Only 3 states: North Dakota, South Dakota, and Wyoming, spend less than $1 billion every year through the Medicaid program with administrative costs excluded.
- When adults and children without a disability or age issues are considered, Medicaid spends an average of $5,790 per year to treat each individual. For children, that figure is just $2,594.
Some of the places where Medicaid expenses are the most are rather surprising. For example, when full or partial benefits are considered, the top spending state for Medicaid is Alaska when per capital rates are considered. Rhode Island comes in second place and then New York is ranked third. California spends the most overall within the Medicaid program, but the actual per capita benefit is ranked just #47. This means certain geographic demographics of Medicaid may receive nearly $17,000 more in benefits every year under the same program qualifications.
Important Facts About Medicaid Demographics
- About 75% of the children who receive Medicaid have at least one working parent.
- 30% of American children are served by Medicaid in some way at least once over the course of an average year.
- Just 33% of pediatricians who accept Medicaid will help parents enroll patients or other eligible children.
- Medicaid helps to support 1.5 million institutional residents. This program also supports another 2.9 million community-based residents.
- 1 of every 5 Medicare beneficiaries is a dual eligible. Dual eligible beneficiaries are very poor and many have high health and long-term care needs.
- 16 states have decided not to proceed with Medicaid expansion at their level, which limits the eligible demographics somewhat as some people are covered and others are not based on where they live.
- Acute care takes up 68% of Medicaid’s annual budget.
- 5% of the highest spending enrollees account for 53% of the total expenditures the program faces every year.
Expanding coverage is a good thing for needy demographics of people. Allowing costs to spiral out of control, however, doesn’t make sense for the average taxpayer. Since 95% of enrollees account for 47% of the program’s total costs, the future of Medicaid depends on how the other 5% are treated. Looking at proactive care options and other beneficial treatments that could help to lower these costs could potentially fund an expansion in future needed areas, especially in the coverage of children. The growth of costs in acute care is an annualized 7.4%. Incoming revenues have been headed downward. Something is going to need to change.
Why Focus On The Medicaid Demographics?
- It is believed that 4.5 million children in the US qualify for Medicaid, but are not currently insured or enrolled into the program.
- About 5% of the hospitals in the United States provide about 47% of the inpatient care that children on Medicaid receive.
- Medicaid currently reimburses hospitals for about 77% of their total expenditures in treating children, which means spending cuts to this program could further reduce those payments.
- Pediatricians receiving Medicaid payments receive just 66% of what a private provider would receive.
- About 1 in 5 children have special health care needs, yet only 44% of the children in this category are covered by public insurance.
Children are by far the largest beneficiary of care under Medicaid and they also cost the least amount to provide the needed care. If children really are the future, then it makes sense to invest in their proper health care from a demographics standpoint. Each state in the US has different requirements based on how they operate the program, so each household must check to see if they meet local qualification standards. If so, then there is no reason why at least a child should go without health care. That’s why these key points of the Medicaid demographics are so important to know.
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