U.S. flag

An official website of the United States government

Key Facts and Analytics that Shaped Proposed Directions for the IAP

We had a great in-person meeting on Monday in Baltimore with over 25 representatives from states joining us in the morning and an equal number of consumer advocates and providers for the afternoon session. We were thrilled with the thoughtful discussion and helpful feedback. As we hoped, these meetings are indeed helping us shape our thinking on IAP going forward. We’ll share a summary of the discussions soon after our third meeting next week in Chicago. 

In the meantime, we wanted to share some of the key facts and analytics that shaped our proposed directions for the IAP. First and foremost, Medicaid is a major and growing source of health coverage for the nation. By 2015, states will cover over 70 million people through Medicaid, and joint federal and state expenditures will likely exceed $500 billion. 

Second, Medicaid has distinctive features as a payor. The predominant service delivery arrangement for our beneficiaries – over 70% -- is through managed care. And Medicaid is the primary payor for institutional and long term care in the U.S., with about one-third of our total spending is in long term services and supports.

Third, we serve distinctive populations. Women and children are the majority of our beneficiaries, and Medicaid covers about one in three children and over half of all births in the U.S. At the same time, the majority of our spending is on people with disabilities and older adults, particularly beneficiaries eligible for both Medicare and Medicaid. On a related note, our spending is concentrated among high utilizers: 1 percent of beneficiaries represent about a quarter of spending, and 5 percent of the population represents 54% of spending.

And finally, Medicaid beneficiaries have distinctive clinical and psycho-social needs. Our top clinical diagnoses driving utilization are predominantly maternity care and behavioral health. Perhaps even more striking is the difference between Medicare and Medicaid for readmissions. Of the top ten diagnoses driving readmissions for Medicare, only three are in the top ten list for Medicaid.

These observations highlight the opportunities for IAP by shining light on the key pathways and features that define our program. Check out our latest IAP Fact Sheet (PDF, 150.96 KB) to learn more.

IAP Commentary
Stephen Cha, MD, Chief Medical Officer, Center for Medicaid and CHIP Services
Author Facet


Collections: IAP Commentary