Historical and Projected Trends in Medicaid. VI. State Demographics

10/30/2006

a. Distribution of State Expenditures

State spending on Medicaid has increased faster than any other major spending category over the past five years. Medicaid spending as a percent of total state spending has risen from 19.5 percent in 1999 to an estimated 21.9 percent in 2004, now surpassing spending on elementary and secondary education as the top expenditure category for states.

Figure 6

Figure 6: Total State Expenditures by Function, FY2004

Source: State Expenditure Report, 2004, National Association of State Budget Officers


The percent of total expenditures spent on Medicaid by state can be seen in Figure A2 of the Appendix. Tennessee had the highest percent of its state expenditures going toward Medicaid at 35.2 percent and Wyoming had the lowest at 4.6 percent.

Medicaid per capita expenditures by state averaged $4,072 in 2003, the most recent year available (see Appendix Figure A3). New York had the highest per capita spending at $7,583 and California had the lowest at $2,520.

b. Percent of State Populations Covered by Medicaid

Medicaid, on average, now covers 26 percent of all children and 8 percent of all non elderly adults. These figures vary by area with states such as Arkansas, New Mexico, and the District of Columbia covering at least 40 percent of their children, and states such as Vermont, Maine and the District of Columbia covering at least 13 percent of their adult populations (see Table 3).

Low-Income Populations

States have a great degree of flexibility to set income eligibility levels at higher amounts than the federal minimum requirements. As a result, there is wide variation in the extent to which states cover their low-income populations. On average, states enroll 58 percent of their low-income children in Medicaid. Enrollment percentages range from 35 percent to 75 percent. Several states, such as Maine, Vermont, Arkansas, and the District of Columbia enroll over 70 percent of their low-income children in Medicaid (see Figure 7).11 Other states, such as Colorado and Nevada have less than 40 percent enrolled.

The lower percentage of low-income adults enrolled in states’ Medicaid programs reflects the fact that most childless adults, regardless of income level, are not eligible. States on average enroll 27 percent (ranging from 14 to 48 percent) of their low-income adults in Medicaid. Maine, Tennessee, Vermont, Rhode Island, Massachusetts, and the District of Columbia enroll over 40 percent of this population (see Figure 8), while Nebraska, Utah, Colorado, Texas, New Hampshire, Virginia, and Nevada enroll less than 20 percent.

Elderly individuals are covered by the Medicare program, but are also eligible for coverage under Medicaid if they are low-income. These individuals are called dual eligibles, being covered under both programs.12 States on average enroll 25 percent (ranging from 5 to 44 percent) of their low-income elderly individuals in Medicaid (see Figure 9). Tennessee, Mississippi, and Vermont enroll over 40 percent of this population, while New Hampshire, Illinois, Indiana, Nebraska, and Wisconsin enroll less than 15 percent.

Table 3. Nonelderly with Medicaid

  Child 0-18 Adult 19-64 Child 0-18 Adult 19-64
number number percentage percentage
United States 20,514,050 13,754,300 26 8
Alabama 344,190 218 620 30 8
Alaska 60,040 31,470 30 8
Arizona 462,600 320,150 29 10
Arkansas 283,830 117,280 40 7
California 3,057,610 2,030,100 30 9
Colorado 184,980 125,920 15 4
Connecticut 174,920 170,420 20 8
Delaware 44,200 36,310 21 7
Dist of Columbia 50,000 48,550 43 13
Florida 1,100,030 588,690 26 6
Georgia 722,280 324,540 30 6
Hawaii 67,960 47,310 22 6
Idaho 110,220 45,980 27 6
Illinois 682,200 435,860 20 6
Indiana 399,770 220,300 24 6
Iowa 151,020 99,850 20 6
Kansas 148,680 82,800 20 5
Kentucky 298,860 230,820 29 9
Louisiana 435,160 183,300 35 7
Maine 104,070 125,790 34 16
Maryland 274,380 125,640 19 4
Massachusetts 334,100 419,110 21 10
Michigan 711,200 484,850 27 8
Minnesota 223,350 199,450 17 6
Mississippi 312,380 174,140 39 10
Missouri 404,390 263,490 27 8
Montana 65,360 38,760 29 7
Nebraska 109,970 47,400 23 5
Nevada 97,960 53,000 15 4
New Hampshire 52,750 18,130 16 2
New Jersey 363,580 259,840 16 5
New Mexico 219,830 102,410 42 9
New York 1,521,090 1,407,830 31 12
North Carolina 586,860 344,300 26 7
North Dakota 28,090 22,090 18 6
Ohio 695,400 470,130 23 7
Oklahoma 256,250 97,740 28 5
Oregon 209,900 151,000 24 7
Pennsylvania 648,660 516,660 21 7
Rhode Island 74,450 77,450 28 12
South Carolina 333,380 208,540 31 9
South Dakota 53,540 26,090 26 6
Tennessee 392,350 463,070 27 13
Texas 1,868,510 719,120 28 5
Utah 133,450 70,010 17 5
Vermont 54,870 48,440 38 13
Virginia 335,110 158,010 17 3
Washington 487,750 288,540 31 8
West Virginia 142,430 98,580 34 9
Wisconsin 357,240 236,150 25 7
Wyoming 33,180 14,610 26 5

Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on pooled March 2004 and 2005 Current Population Surveys. Total US numbers are based on March 2004 estimates.


Figure 7: Percent of Low-Income Children Enrolled in Medicaid 3-Year Average 2002-2004

Source: ASPE Tabulations of the Census Bureau's Current Population Survey, 2003-2005.


Figure 8

 

Figure 8: Percent of Low-Income Adults Enrolled in Medicaid 3-Year Average 2002-2004

Source: ASPE Tabulations of the Census Bureau's Current Population Survey, 2003-2005.


Figure 9

 

Figure 9: Percent of Low-Income Elderly Enrolled in Medicaid

Source: ASPE Tabulations of the Census Bureau's Current Population Survey, 2003-2005.


11 For this analysis the low-income level was set at 100 percent of the FPL.
12 There are various categories of dual eligibles (QMB, SLMB, QI, QWD), having some of their Medicare premiums and/or cost sharing requirements paid by Medicaid depending on their income level. Additionally, as specified under the MMA of 2005, Medicare now pays for the prescription drug expenses of the elderly, previously paid for by the Medicaid program.

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