Date

Fact sheet

Medicaid Facts and Figures

Medicaid Facts and Figures

Enrollment

  • 71,395,465 individuals were enrolled in Medicaid and CHIP in the 51 states that reported enrollment data for October 2019.[1]
    • 64,699,741 individuals were enrolled in Medicaid.
    • 6,695,724 individuals were enrolled in CHIP.
  • New adult group enrollment (VIII Group) was 15,181,880 for the 3rd quarter of 2018.[2]

Spending

  • Total expenditures:
    • In fiscal year (FY) 2017, total Medicaid and CHIP actual expenditures amounted to $600 billion.[3]
    • Medicaid average cost by beneficiary category, 2016[4]

Beneficiary Category

Children (Ages 0-19)

Adults (Ages 20-64)

Expansion Adults (Ages 20-64)

Persons with Disabilities (Ages 0-64)

Aged (65+)

Average Medicaid Expenditures per Beneficiary

$3,555

$5,159

$5,965

$19.754

$14,700

  • Total expenditures bullet continued
    • Medicaid outlays as percentage of the federal budget: 9.5 percent, FY 2018[5]
  • Growth rates: 
    • Medicaid expenditures are estimated to have increased 2.7 percent to $616.1 billion in 2018, with Federal expenditures having grown an estimated 4.4 percent to $386.5 billion. The Federal share of all Medicaid expenditures is estimated to have been 63 percent in 2018. State Medicaid expenditures are estimated to have decreased 0.1 percent to $229.6 billion.
    • From 2018 to 2027, expenditures are projected to increase at an average annual rate of 5.3 percent and to reach $1,007.9 billion by 2027. Medicaid expenditures are projected to increase from 3.1 percent of GDP in 2017 to 3.3 percent of GDP in 2027.[6]
    • Per-enrollee expenditures over this time period are forecast to be the highest among expansion adults (4.9%), and faster than the total per-enrollee growth at (4.3%). See below table:

Spending, enrollment, and spending per enrollee growth rates by eligibility category: projected average annual expenditure growth rates, 2018-2027[7]

Eligibility Category

Benefit Expenditures

Enrollment

Per Enrollee Benefit Expenditures

Aged

6.5%

3.2%

3.3%

Blind and disabled

5.1%

1.0%

4.1%

Children

5.5%

1.0%

4.4%

Non-expansion adults

4.4%

0.5%

3.9%

Expansion adults

6.1%

1.1%

4.9%

Total

5.5%

1.1%

4.3%

  • State expenditures:
    • Overall, expenditures on Medicaid for FY2017, including federal funds, consumed 28.9 percent of state budgets, the second highest item and only slightly  behind education (including higher education) at 29.7 percent.

Program integrity

  • PERM results:[8] Through the Payment Error Rate Measurement (PERM) program, HHS estimates Medicaid and CHIP improper payments on an annual basis, utilizing federal contractors to measure three components: FFS, managed care, and eligibility.  The PERM program uses a 17-state rotational approach to measure the 50 states and the District of Columbia over a three-year period.  Under this approach, each state is measured once every three years and national improper payment rates include findings from the most recent three-year cycle measurements.  Each time a cycle of states is measured, the new findings are utilized and the respective cycle’s previous findings are removed.  The FY 2019 national Medicaid improper payment rate estimate is 14.9 percent. The FY 2019 national improper payment rate estimate for CHIP is 15.83 percent. The FY 2019 improper payment rate for each Medicaid component is:
    • Medicaid FFS: 16.30 percent
    • Medicaid managed care: 0.12 percent
    • Medicaid eligibility: 8.36 percent
  • Program integrity recoveries: In FY 2017, total federal and state share Medicaid program integrity collections were approximately $785.1 million.

Health status

  • Health Status of Adult Beneficiaries of Medicaid/CHIP as compared with Adults in Other Insurance Programs:[9]
    • 43% of Medicaid and CHIP beneficiaries rated their health as excellent or very good compared with 14% on Medicare, 71% on private insurance and 58% who were uninsured.
    • 38% of Medicaid and CHIP beneficiaries were obese (BMI 30 or higher), compared with 48% on Medicare, 29% on private insurance and 32% who were uninsured.
    • 28% of Medicaid and CHIP beneficiaries were current smokers compared with 30% on Medicare, 11% on private insurance and 25% who were uninsured.
    • 42% of Medicaid and CHIP beneficiaries had a basic activity limitation, compared with 83% with Medicare, 20% with private insurance, and 26% who were uninsured.
    • 28% of Medicaid and CHIP beneficiaries had ever been told they had hypertension, compared with 54% with Medicare, 22% with private insurance, and 18% who were uninsured.
  • Beneficiary experience: 56 percent of adults enrolled in Medicaid responded “Always” when asked if they received needed care.[10]
  • Health care utilization: In 2017, 83 percent of adults had at least one (1) visit to a doctor or other health professional. Thirty-two percent of adults had at least one (1) emergency department visit, and 12 percent of adults had at least one (1) overnight hospital stay.[11]

Other key facts

  • Medicaid Covered Births: Medicaid was the source of payment for 42.3% of all 2018 births.[12]
  • Long term support services: Medicaid is the primary payer for long-term services and supports. In 2017, Medicaid paid for 30.2 percent of expenditures for nursing care facilities and continuing care retirement communities.[13]
     

[1] October 2019 Medicaid & CHIP Enrollment Data Highlights, available at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.

[2] Quarterly Medicaid Enrollment Data - New Adult Group: July – September 2018 Medicaid MBES Enrollment, available at https://www.medicaid.gov/medicaid/program-information/downloads/medicaid-and-chip-enrollment-data/viii-group-break-out-q4-2018.xlsx.

[3] 2018 Actuarial Report on the Financial Outlook for Medicaid

[4]Medicaid & CHIP Beneficiaries at a Glance, CMS Medicaid & CHIP Health Care Quality measures, December 2019

[5] President’s FY 2020 Budget

[6] 2018 Actuarial Report on the Financial Outlook for Medicaid

[7] Id.

[9] MACStats: Medicaid and CHIP Data Book, published 2018, Exhibit 43. Available at: https://www.macpac.gov/wp-content/uploads/2018/12/December-2018-MACStats-Data-Book.pdf. MACPAC Analysis of National Health Interview Survey data from 2017. Data for non-institutionalized adults ages 19 to 64. Note that the Medicare beneficiaries referred to in these bullets are either Dual Beneficiaries or Medicare-only beneficiaries who qualified on the basis of a particular health condition like End Stage Renal Disease.

[10] Medicaid & CHIP Beneficiaries at a Glance, CMS Medicaid & CHIP Health Care Quality measures, December 2019.

[11] Id.

[12] National Center for Health Statistics. Key Birth Statistics (2018 data, released 2019). Available at:  https://www.cdc.gov/nchs/nvss/births.htm