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Medicaid: Efforts to Identify, Predict, or Manage High-Expenditure Beneficiaries

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Summary

Medicaid spending is projected to hit $1 trillion by 2026. Studies have found a small percentage of beneficiaries account for a large amount of its spending. Many high-cost beneficiaries have poorly managed chronic conditions that can result in costly services—such as emergency room visits—that are preventable.

We asked officials in 7 states what they do to manage health care costs and improve care for high-cost Medicaid beneficiaries. All of the states said they coordinate care across a patient’s providers to better manage physical and mental conditions. Some states also tried to address beneficiaries’ basic needs, such as food and housing.

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