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Profile of the Medicaid Expansion Population: Demographics, Enrollment, and Utilization

January 2018
Full report

Analysis of the Medicaid expansion population found that costs increased steadily over time while enrollees’ health needs shifted to chronic care. Per member per month spending on prescription drugs grew with enrollment duration and, by month eight, surpassed inpatient costs as the largest share of spending.

More than 11 million individuals have newly enrolled in Medicaid, since states expanded the program under the Affordable Care Act to working age adults (age 19-64) with incomes below 138 percent of the federal poverty level. However, information on healthcare utilization and spending among these new enrollees has been limited.

This study conducted by Avalere Health and funded by the Elevance Health Public Policy Institute analyzes data from several managed care organizations across multiple states to observe enrollment and cost trends of the expansion population over time. This study offers insights which can inform policy and program changes and assist state regulators in establishing payment rates and program standards.


  • Enrollment and demographic trends
  • Claims and utilization trends
  • Claims and utilization by type of service

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Designing Medicaid per capita caps should account for the variation in needs across eligibility groups. Spending can vary by a factor of 34 when looking at more detailed groupings of enrollees.

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