Not minimizing the fraud aspect, but I’m curious how much of the high spend relative to other states is just an artifact of an apples to oranges comparison of a city to entire states? It’s quite common for DC to look like an outlier on state comparisons for lots of metrics. Seems plausible here that both the share of the population on Medicaid and spend per enrollee wouldn’t look that anomalous when compared with peer cities
Your first question is somewhat easier to answer than the second. DC is 18th among the 50 largest cities by Medicaid enrollment share (this is based on the ACS, not admin counts as those are not usually reported at the city level, so take it with a grain of salt). A lot of the variation is explained by whether you are in an expansion state or not.
One piece of suggestive evidence against the idea that spend per enrollee is driven largely by city/state differences is the very similar cost DC incurs for expansion adults versus the states (again, all sorts of caveats apply).
Is there a reason expansion adults would not be a target for these sorts of fraudulent billings but non-expansion adults would not be? Fascinating article, thanks for brinding light to this issue!
I would say two things, both speculative. My first guess would be that many of the patients involved are classified as disabled (chronic substance abuse disorders, psychiatric disorders) and not as expansion adults. And I suspect that DC’s expansion population for 2023 was more inflated by the FFCRA’s continues enrollment requirement than that of other jurisdictions, so in reality DC’s spending per expansion adult may be higher than it seems. But I have no good evidence for either story (yet!), so I did not include them in the piece.
Not minimizing the fraud aspect, but I’m curious how much of the high spend relative to other states is just an artifact of an apples to oranges comparison of a city to entire states? It’s quite common for DC to look like an outlier on state comparisons for lots of metrics. Seems plausible here that both the share of the population on Medicaid and spend per enrollee wouldn’t look that anomalous when compared with peer cities
Your first question is somewhat easier to answer than the second. DC is 18th among the 50 largest cities by Medicaid enrollment share (this is based on the ACS, not admin counts as those are not usually reported at the city level, so take it with a grain of salt). A lot of the variation is explained by whether you are in an expansion state or not.
One piece of suggestive evidence against the idea that spend per enrollee is driven largely by city/state differences is the very similar cost DC incurs for expansion adults versus the states (again, all sorts of caveats apply).
Is there a reason expansion adults would not be a target for these sorts of fraudulent billings but non-expansion adults would not be? Fascinating article, thanks for brinding light to this issue!
I would say two things, both speculative. My first guess would be that many of the patients involved are classified as disabled (chronic substance abuse disorders, psychiatric disorders) and not as expansion adults. And I suspect that DC’s expansion population for 2023 was more inflated by the FFCRA’s continues enrollment requirement than that of other jurisdictions, so in reality DC’s spending per expansion adult may be higher than it seems. But I have no good evidence for either story (yet!), so I did not include them in the piece.