Medicare Compliance & Reimbursement

Out-of-pocket expenses getting out of control, says CBPP.

It looks as if Medicaid beneficiaries already struggling to afford care could have a tougher road ahead. Based on the findings of a pair of recent reports, the Center on Budget and Policy Priorities is casting a grim future for Medicaid beneficiaries trying to make ends meet on ever-thinning budgets.

Despite the fact that it's now harder than ever for average Medicaid beneficiaries to afford their out-of-pocket expenses, these patients may end up paying more in the near future as Medicaid looks to increase cost sharing to deal with $10 billion in spending cuts, according to CBPP's "Out-Of-Pocket Medical Expenses For Medicaid Beneficiaries Are Substantial And Growing," published May 31.

"Contrary to common assumptions, the out-of-pocket medical expenses that Medicaid beneficiaries pay are significant, and they have been growing rapidly in recent years," the report states. The most glaring increases in patient spending were on copayments and prescription drugs, but out-of-pocket expenses also included deductibles, coinsurance, and amounts paid for uncovered medical services, reports CBPP. 
 
Medicaid Benes Absorb Higher Average Costs

In the report, CBPP asserts that Medicaid beneficiaries have borne the brunt of more cost-sharing increases, on average, than better-heeled adults with private insurance.
 
During the study time span, CBPP found that out-of-pocket expenses for adult Medicaid beneficiaries below the poverty line (or about $16,090 for a family of three) grew 9.4 percent annually. This bump in expenses far exceeded the 4.6-percent average annual income increase beneficiaries gained during the same span.

CPBB also discovered that costs only increased 6 percent per year for privately insured adults with incomes above 200 percent of the poverty line (or about $32,180 for a family of three). The findings excluded Medicaid beneficiaries who were elderly or disabled.

Statistics aside, Medicaid beneficiaries will likely be targeted to pick up the slack when states start slashing Medicaid budgets. And with $10 billion in cuts looming, there will be a lot of Medicaid slack very soon, CBPP reports in "The Effect Of Increased Cost-Sharing In Medicaid: A Summary Of Research Findings," also published May 31.

"Some have argued that copayments should be increased because Medicaid beneficiaries pay little ... for care and do not bear financial responsibility for it." However, the CBPP analysis has shown that this is untrue, writes report author Leighton Ku.