Research on spending persistence has not focused on Medicaid and the Children’s Health Insurance Program (Medicaid/CHIP), which includes a complex and growing population.Objective of the Study:
The objective of the study was to describe patterns of expenditure persistence, mortality, and disenrollment among nondually eligible Medicaid/CHIP enrollees and identify factors predicting these outcomes.Research Design:
The study is based on New Jersey Medicaid/CHIP claims data from 2011 to 2014. Descriptive and multinomial regression methods were used to characterize persistently extreme spenders, defined as those appearing in the top 1% of statewide spending every year, according to demographics, Medicaid/CHIP eligibility, nursing facility residence, patient risk scores, and clinical diagnostic categories measured in 2011. Similar analyses were done for persistently high spenders (ie, always in the top 10% but not always top 1%) as well as decedents, disenrollees, and moderate spenders (ie, at least 1 year outside of the top 10%).Subjects:
Nondually eligible NJ Medicaid/CHIP enrollees in 2011.Results:
One fourth of extreme spenders in 2011 remained in that category throughout 2011–2014. Almost all (89.3%) of the persistently extreme spenders were aged, blind, or disabled. Within the aged, blind, or disabled population, the strongest predictors of persistently extreme spending were diagnoses involving developmental disability, HIV/AIDS, central nervous system conditions, psychiatric disorders, type 1 diabetes, and renal conditions. Individuals in nursing facilities and those with very high risk scores were more likely to die or have persistently high spending than to have persistently extreme spending.Conclusions:
The study highlights unique features of spending persistence within Medicaid/CHIP and provides methodological contributions to the broader persistence literature.