US Medicaid Managed Care and Premium Assistance Spending · USD bn

## What this measures

Medicaid benefit spending on payments to comprehensive and limited-benefit managed care plans, primary care case management, employer-sponsored premium assistance and Programs of All-Inclusive Care for the Elderly (PACE), net of rebates for drugs the plans provide, federal and state funds, in billions of dollars, nationally (states, DC and territories). One value per fiscal year, FY 2012 to FY 2024, from MACStats Exhibit 17's national total row.

## Why it matters

Most Medicaid enrollees now get their care through managed care plans paid a monthly amount per person, so this line carries most of the program's benefit spending and shows the shift away from fee-for-service.

## How to read it

FY 2024: $496 billion, 54.6% of benefit spending (FY 2012: $120 billion). The fee-for-service lines (us.medicaid.spending_by_service.*) cover the rest.

## What it does not say

Capitation payments to plans, not what the plans spend on care; the services they buy are not broken out. Benefits only (no administration), net expenditures as states report them on the CMS-64, including adjustments to earlier years that can swing a category from one year to the next. MACPAC changed its category definitions in the edition that first reported FY 2012 (mental health facilities moved to institutional LTSS; rehabilitative services, private duty nursing, targeted case management and hospice moved to other acute; managed-care drug rebates moved from drugs to managed care), so the series starts there. Each fiscal year comes from the one edition that published it; later state revisions are not reflected.

## Source

Medicaid and CHIP Payment and Access Commission (MACPAC), MACStats: Medicaid and CHIP Data Book, Exhibit 17 (Total Medicaid Benefit Spending by State and Category; Table 7 in editions before 2015) (https://www.macpac.gov/macstats/; earlier editions at https://www.macpac.gov/publication/macstats-archive/), from MACPAC's analysis of states' CMS-64 Financial Management Report expenditure data. Licence (https://www.macpac.gov/disclaimer/): "Because MACPAC is an agency of the federal government, the information on this site is in the public domain and may be freely copied and distributed. We would appreciate attribution when you cite our information." Read monthly by /api/cron/macpac-sync (src/lib/macpac/medicaid.ts).