Black Beneficiaries Generated Lower Medicaid Spending, Utilization

While reviewing health care spending statistics between White and Black Medicaid enrollees, JAMA researchers found disparities that showed lower service use and lower Medicaid spending among the Black population for both adults and children.

Although Medicaid beneficiaries make up a diverse population, existing disparities have historically received limited attention. To uncover differences in Medicaid spending between Black and White people, researchers conducted a cross-sectional study that used data from three states in 2016.

Researchers used data from 1,966,689 enrollees in the study, including both adults and children. Of this population, 867,183 identified as non-Hispanic Black, and 1,099,506 identified as non-Hispanic White.

While reviewing the data for adults, which refers to beneficiaries ages 19 years and older, researchers found that Black Medicaid enrollees spent an average of $317 less than White enrollees. There was also a significant difference among children (patients 18 years and younger), where there was a $256 lower average annual spending.

Researchers also collected data regarding disparities between utilization of primary care and other services. When comparing the number of primary care encounters per 100 adult enrollees yearly, Black enrollees had 19.3 fewer encounters. Among children, Black enrollees had 90.1 fewer primary care encounters per 100 enrollees annually.

Black enrollees did, however, have higher emergency department use and rates of HEDIS preventive screenings. Researchers shared that this could be due to the underuse of resources, as many emergency department visits were avoidable.

Based on the results that pointed toward existing disparities in healthcare among Medicaid enrollees, researchers concluded that these disparities demand increased attention. Improving health equity is essential for widespread and effective healthcare and will allow all enrollees to receive the required care.

Despite these conclusions, various limitations existed within the study. Due to limited data, researchers were only able to collect information on non-Hispanic Black and non-Hispanic White enrollees. The challenge of gathering race and ethnicity data is a common barrier for private and public payers alike, as previous studies described how Medicare data on minority groups could lead to skewed results.

Other limitations were tied to how health measures rely solely on claims data and that two of the three states are in the South.

Many factors can potentially lead to healthcare disparities.

In March 2021, Mark Friedberg of Blue Cross Blue Shield of Massachusetts stated that disparities are often due to limited equity measures. Kedar Mate, president and chief executive officer at the Institute for Healthcare Improvement (IHI), also stated that structural issues often exist in Medicaid that favor employer-sponsored health plans.

The COVID-19 pandemic, which disproportionately impacted non-White communities, also affected Medicaid spending and utilization. A study from February 2021 reported that Medicare, another public payer, experienced drops in utilization across races and services. According to the study, Black and Hispanic communities experienced a 32 percent and 34 percent decrease in care utilization in April 2020.