States with Medicaid expansions spend more per enrollee overall than nonexpansion states, and nearly half of expansion states’ enrollees have a chronic condition, a May 28 KFF Health News report found.
On May 22, a number of Medicaid provisions that could cut federal Medicaid spending by more than $700 billion in the next ten years passed the House of Representatives. The provisions only apply to states that adopted the ACA expansion.
KFF Health News used data from 2021 T-MSIS Research Identifiable Demographic-Eligibility and Claims Files to identify Medicaid expansion enrollees, utilization and chronic conditions. Enrollees included in the report were ages 19 to 64, had full Medicaid coverage for at least one month and were not dually enrolled in Medicare.
Here are six things to know:
1. Adults in expansion states are more likely, at 62%, to use prescription drugs, compared to 55% of those in nonexpansion states.
2. Behavioral health treatment is also more popular among those in expansion states (30% versus 23%).
3. High utilization of both prescription drugs and behavioral health services likely reflects that one-third of adults have a chronic physical health condition and a quarter have a chronic behavioral health condition, according to the report. However, these utilization rates are lower among adults who qualified on the basis of having a disability.
4. About 90% of adults eligible on the basis of disability in expansion states use any healthcare service, compared to 77% of adults in nonexpansion states.
5. About 75% of adults who qualified for Medicaid on the basis of low income used healthcare services, compared to 66% of their counterparts in nonexpansion states. Low-income adults on Medicaid have higher utilization of outpatient care (64% versus 58%) and prescription drugs (55% versus 47%).
6. Of adults with disabilities, 25% of those in expansion states use long-term care, compared to 12% in nonexpansion states. They also have a higher utilization rate of behavioral health treatment services at 62%, compared to 44%.
