Per capita Medicaid spending varies widely: GAO

Per capita spending on Medicaid beneficiaries varied widely across the country in fiscal 2008, according to an analysis by the Government Accountability Office.

In eight states, including New York, beneficiaries cost an average of at least $10,500. In contrast, in six states including California and Illinois, the per-enrollee cost was less than $6,000. The cost in 35 states and the District of Columbia fell between those two groups. Because of faulty data, Massachusetts was not included in the calculations.

California's program was the most frugal, spending roughly $3,800 per Medicaid enrollee. At the other end of the spectrum was Rhode Island, which spent $11,700. But the GAO noted that because of imperfect data, the numbers should be viewed with caution.

The analysis was requested by Sen. Orrin Hatch (R-Utah) and Rep. Fred Upton (R-Mich.). Growing out of his opposition to the Medicaid expansion under the Patient Protection and Affordable Care Act, Hatch called for additional scrutiny of the spending discrepancies.

There were wide disparities between the states even for the same types of beneficiaries. Disabled enrollees, for instance, cost an average of $9,000 in Alabama compared with $32,000 in New York. Vermont spent more than three times as much as California on each child enrollee. Care patterns also varied significantly between states. For instance, the percentage of elderly enrollees receiving long-term-care services varied from 18.4% in Florida to 65.6% in Iowa.

The overall differences in spending can be partly explained by variations in the makeup of each state's Medicaid population. West Virginia, for example, had the highest rates of elderly and disabled beneficiaries, who generally are more expensive to cover.

Last year, the federal government spent $267 billion for its contribution to the federal-state Medicaid program for low-income and disabled Americans. That number is expected to rise to nearly $600 billion by 2024, according to the Congressional Budget Office.

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