DISAPPEARANCE OF AMERICAN INDIANS
The Continued Disappearance of American Indians and Alaska Natives Mario D. Garrett, Ph.D. and Kurt A. Menke, M.A.
Misreporting in Medicaid At the time of writing this monograph, Mario D. Garrett was Director of Data Analysis Service and Kurt A. Menke was a GIS Specialist with the Earth Data Analysis Center at the University of New Mexico.
C
I
Medicaid nformation often determines resources, and these resources in turn determine the quality and scope of federal and state services. Although the collection of racial data is authorized under the Title VI of the Civil Rights Act of 1964, and despite its importance as a tool for assessing the progress of stated federal goals to reduce disparities in health care, little attention has been paid to the accuracy of this data. Federal agencies operating under the U.S. Department of Health and Human Services (DHHS), which provide and pay for much of the nation’s health care, continue to use inaccurate data for racial groups. This practice dramatically affects services and benefits for the nation’s smallest racial group: American Indians and Alaska Natives.
ongress granted authority to DHHS in designating parameters of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding claims standards. Despite a DHHS recommendation for the inclusion of racial/ethnic identifiers as “required,” the final HIPAA regulation designated the reporting of such data as “not used” and, therefore, not to be considered. This is a “significant reversal of an otherwise expanding (DHHS) commitment to racial and ethnic data collection and reporting” (Perot and Youdelman, 2001).1 In a multi-racial society, collecting racial data represents not only good civic practice but serves as an effective means of determining whether programs are meeting their goals and legal standards. These standards have been established under a broad range of bills, regulations, acts, and initiatives.
66
Within the DHHS, the agency primarily responsible for delivering health care services, is the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration. CMS operates the nation’s two largest health programs, Medicare and Medicaid. Enacted in 1965, these two programs consumed, in 2002, just under one fifth of the total national budget. Twelve percent of the national budget will be dedicated to Medicare (estimated $226 billion), while seven percent is slated for Medicaid (estimated $142 billion). These are the largest health budgets in the world. 1 Perot R.T., and Youdelman, M., “Racial, Ethic, and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices” September 2001, www.cmwf.org
Medicaid Medicaid is a cooperative venture between federal and state governments to provide medical care to the needy. Medicaid is the largest program providing health-related services to America’s poorest people. Within broad Federal guidelines each state: 1) establishes its own eligibility standards; 2) determines the scope of services; 3) sets the rate of payment for services; and 4) administers its own programs. Medicaid provisions vary considerably from state to state, as well as within each state over time. This monograph addresses racial disparities in Medicaid data. DHHS Secretary Tommy G. Thompson2 recently stressed that CMS is to be more consumeroriented. Being consumer-oriented implies knowing who consumers are, what they need, how to deliver services to them, and where programs may be failing to meet their obligations. In 1997, the National Indian Council on Aging (NICOA), with support from the U.S. Administration on Aging (AOA), began a cooperative study with CMS and the Indian Health Service (IHS) to investigate Medicaid utilization by IHS AI/AN clients. Through a Memorandum of Understanding, IHS provided its user population’s social Alabama security numbers, enabling CMS to Alaska compare records in its Medicaid files. Arkansas California Medicaid data is collected by state. Colorado Twenty-two states (listed on the right) Delaware provided CMS with comprehensive Florida Medicaid data, enabling the Georgia identification of AI/ANs based on social security numbers.
Federal health standards: 1) Initiative to Eliminate Racial and Ethnic Disparities in Health (1998) 2) Consumer Bill of Rights and Responsibilities (1997) 3) Benefits Improvement and Protection Act (2000) 4) Report of the U.S. Commission on Civil Rights (1999) 5) Executive Order 13166 Improving Access to Services for Persons with Limited English Proficiency (2000) 6) Minority Health and Health Disparities Research and Education Act (2000) 7) U.S. Department of Health and Human Services Improving Race and Ethnicity Data (1997) Plan to Improve the Collection and Use of Racial and Ethnic Data (1999) Health People 2000 and Health People 2010 Title VI Regulations
“... ensuring that the agency is more consumer-oriented, more responsive to the needs of everyone they deal with...” Remarks by DHHS Secretary Tommy G. Thompson 2
Indiana New Jersey Kansas Pennsylvania Kentucky Rhode Island Maine Utah Minnesota Vermont Mississippi Wisconsin Missouri New Hampshire
67
DISAPPEARANCE OF AMERICAN INDIANS
Note that four of the five states with the largest AI/AN 3 populations are missing. No Medicaid data were available for Arizona, New Mexico, Texas, or Oklahoma. California, with the nation’s largest AI/AN population, was the only top-five state represented in the database.
Percentage of AI/ANs in Medicaid that were classified correctly: 0 - 21.7 % 21.7 – 57.4 % 57.4 – 91.9 %
Inconsistent racial designation primarily results in under-representation. But inconsistent classification affects many other issues. CMS data provided to NICOA identified 21,485 AI/AN Medicaid beneficiaries. This number represents only 13 percent of AI/ANs reported to be in poverty in the 1990 Census for these 22 states. And it represents only 3.6 percent of the AI/ ANs in poverty throughout the United States (estimated total 603,188). In 1995, CMS identified 448,133 AI/ANs eligible for Medicaid services, but only 291,354 (65 percent) benefited from such services for that year.4 States which are most likely to underserve AI/ANs are Arizona, California, Alaska and Washington.
Map 1: American Indians and Alaska Natives correctly recorded as AI/AN in Medicaid for 1997
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2 “First Steps Taken in Reforming Medicare and Medicaid Agency,” Press Conference convened on Thursday, June 14, 2001 3 Brewer, Cynthia A., & Trudy A. Suchan, U.S. Census Bureau, Census Special Reports, Series CENSR/01-1. Mapping Census 2000: The Geography of U.S. Diversity, U.S. Government Printing Office, Washington, DC, 2001. Only one race. 4 HHS, HCFA, Medicaid Bureau, Medicaid Statistics: Program and Financial Statistics Fiscal Year 1995. HCFA Pub. No. 10129, November, 1996. 5 Garrett, Mario, & Menke, Kurt. NICOA Monograph Indians No More: Inconsistent Classification of American Indians and Alaska Natives in Medicare Vol 2 - Number 2.
Results Inconsistent racial designation in Medicaid parallels findings of inconsistent racial classification in Medicare.5 In Medicare 83 percent of AI/ANs were incorrectly classified as being of another race. In Medicaid, in the 22 states for which data was available, 55 percent of AI/AN beneficiaries were incorrectly classified as being of another race. Among these states, the best racial record was for Alaska, with 95 percent of all AI/ANs correctly classified while the worst were for Missouri, New Jersey, Georgia and California, with 84-98 percent of AI/ANs incorrectly classified. Inconsistent racial designation in Medicaid is not new, nor is it a surprising finding. Misclassification of AI/ANs in CMS is primarily due to incorrect coding by the Social Security Administration (SSA). CMS’ enrollment database (EDB), the basic source of a beneficiary’s race/ethnicity, comes from SSA entitlement records. Due to its awareness of incomplete race recording in the SSA database, CMS conducted a mail survey of beneficiaries in 1997. Surveys were mailed to 2.1 million beneficiaries whose race code on the EDB was “Unknown” or “Other,” in addition to all persons with a Hispanic surname or a foreign country of birth. Among the 858,520 beneficiaries who responded to the survey, 41 percent identified themselves as Hispanic, 30 percent White, 24 percent Asian, two percent African-American, and two percent as AI/ANs (Eggers and Greenberg 2000).
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Source: NICOA Medicaid extract using IHS patients’ Social Security number to identify AI/ANs
DISAPPEARANCE OF AMERICAN INDIANS
AI/ANs Misclassified as White Similar to the misclassification of AI/ANs in Medicare, the most common Medicaid database error was for AI/ANs to be identified as White. This occurred for 31 percent of the AI/AN beneficiaries in the database. As Map 2 illustrates, AI/ANs are more likely to be classified as White than as AI/AN in the states of California, Florida, Georgia, Missouri, Kentucky, and Indiana. Although Delaware and New Hampshire also show up as the top states for misclassifing AI/ANs, their data on Medicaid beneficiaries report only 10 and three AI/ANs, respectively.
Map 2: American Indians and Alaska Natives recorded as White in Medicaid for 1997
Map 3: American Indians and Alaska Natives recorded as Hispanic in Medicaid for 1997
AI/ANs Misclassified as Hispanic California and Florida are the top two states that misclassify AI/ANs as Hispanic. As Maps 2 and 3 illustrate, these two large states consistently misclassify AI/ANs both as White and Hispanic, followed by Georgia and Indiana. In New Jersey, out of 18 Medicaid beneficiaries that NICOA identifies as AI/AN, New Jersey misclassifies three as Hispanic.
AI/ANs Misclassified as African American
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Only 1.75 percent of AI/ANs in the Medicaid data are misclassified as African American. Map 4 portrays the two highest states that misclassify the highest proportion of AI/ANs as African American: New Jersey and Rhode Island. Although these numbers are small, there is a general tendency that states further east are more likely to misclassify AI/ANs as African American.
Map 4: American Indians and Alaska Natives recorded as African American in Medicaid for 1997
Percentage of AI/ANs in Medicaid that were classified White 6 – 13.7 % 13.7 – 50 % 50 – 90.9 %
Percentage of AI/ANs in Medicaid that were classified Hispanic 0 – 0.7 % 0.7 – 2.5 % 2.5 – 16.7 %
Percentage of AI/ANs in Medicaid that were classified African American 0 – 3.3 % 3.3 – 10.6 % 10.6 – 30.4 %
71
DISAPPEARANCE OF AMERICAN INDIANS
Interpretation The identification of errors in federal and state databases indicates that racial misclassification–especially for, but not necessarily restricted to AI/ANs–is endemic. Three national studies on AI/AN misclassification and numerous regional studies detail these errors. Table 1 (opposite page) summarizes some of these findings. The first two columns report the total AI/AN population and those 65 years and older from the 1990 Census, followed by 2000 Census data, including the number of AI/ ANs in poverty by age groups. The total (column 11) provides a proxy of how many AI/ANs are needy and may qualify to receive Medicaid services. The next two columns represent the number of AI/ANs who are beneficiaries from the CMS Medicaid files by state, and how this number compares with the total number of AI/ANs in poverty (percent covered). Column 13 provides the proportion of AI/ANs who are in poverty receiving Medicaid.
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Islander, Hispanic, and Unknown. The subsequent two columns summarize the percent of correct classification, and then ranks this by state, with rank 1 being the state that classifies AI/ANs most accurately. The next two columns come from a national study conducted by the Indian Health Service (IHS). These data are based on state death certificates, compared with 12,086 records from the patient IHS registration system. The first column reports the percentage of inconsistent classification, while the following column ranks these with 1 again being the best classification.
Table 2: Top ten states that misclassify AI/ANs by study Rank 1 2 3 4 5 6 7 8 9
Even for those states that serve the highest percentage of poor AI/ANs, the proportion is less than a third (Minnesota reported the highest coverage with 22.6 percent). For those states that reported Medicaid data, approximately 10 percent of poor AI/ANs received Medicaid services.
The next eight columns represent data from this study on Medicaid race classification. These six columns report the race for which AI/ANs were classified White, African American, correctly classified as AI/AN, Asian and Pacific
Medicaid Missouri New Jersey Georgia California Indiana Florida Kentucky Louisiana Rhode Island
State Death Certificates West Virginia Dis. of Columbia Delaware Kentucky South Carolina New Jersey Georgia Maryland
Medicare Kentucky South Carolina New Jersey Georgia Maryland Pennsylvania Ohio New Hampshire Indiana
The last two columns of this table are extracted from a similar study commissioned by NICOA on Medicare. The first column reports the percentage of inconsistent classification while the last column represent the rank order with 1 being the best classification. There is an apparent consistency among states that misclassify AI/ANs across the board as Table 2 shows.
Total AI/AN
State
Sources: Census: Medicaid: State: Medicare:
TOTAL
Total 65+AI/ANs
117723
1059 4020 10536 1054 15478 1233 563 281 243 2508 653 149 700 1209 1024 362 1487 445 1111 245 610 926 2849 1903 358 1759 2121 664 1159 133 1118 7073 3963 5202 1016 1439 20458 2185 1181 526 386 2486 726 4137 717 87 959 4238 269 2367 348
Total AI/ANs Single Race
2475956
22430 98043 255879 17808 333346 44241 9639 2731 1713 53541 21737 3535 17645 31006 15815 8989 24936 8616 25477 7098 15423 15015 58479 54967 11652 25076 56068 14896 26420 2964 19492 173483 82461 99551 31329 24486 273230 45211 18348 5121 13718 62283 15152 118362 29684 2420 21172 93301 3606 47228 11133 2937 11490 27908 2479 39539 4350 1219 510 351 7519 4874 413 1971 3179 1888 778 2832 1201 3486 801 2241 1925 6816 5393 1383 3542 6055 1389 3616 338 2734 20461 10408 13796 2900 3216 36942 5340 2718 686 1700 5731 2101 14286 2290 308 2889 10667 647 5095 1237 298575
0-14
4975 31455 84070 4362 88768 10875 2434 558 306 11471 14665 586 5022 7882 3537 2669 6480 1658 6663 1856 3397 3856 15238 17005 3297 5521 18274 4943 6721 639 4852 54097 23333 25150 10774 5134 80804 11971 4218 1585 3061 23244 2930 29306 9698 502 4315 25731 611 13818 3419
697736
85+ 14833
96 475 1388 84 1480 150 57 22 22 279 2614 13 69 128 65 25 109 48 125 29 83 97 199 176 81 138 225 57 127 17 129 1192 489 531 99 133 1782 181 122 40 51 243 52 502 113 3 97 344 21 189 42
0-5 82580
435 2772 13067 492 8372 906 202 61 45 1040 477 48 514 627 295 253 608 140 703 355 172 327 1267 2217 459 562 3046 668 620 19 379 8330 2956 2605 2081 555 8694 1111 451 282 259 4842 314 2336 1282 32 256 2799 41 1615 591
6-15 141904
721 4679 23891 822 15087 1626 220 57 43 1761 667 101 1031 1147 415 490 682 423 1179 428 373 701 2078 3749 763 1044 5289 1299 1015 63 558 15247 5022 4089 3114 865 13668 1822 940 551 544 7749 357 4692 2131 117 445 4505 93 2583 968
16-64 215 699 5699 173 2770 285 106 59 21 691 175 30 194 169 189 87 170 120 507 117 199 151 511 430 154 291 664 140 281 19 210 3629 1243 1837 421 211 3406 269 264 100 174 889 108 1058 450 16 73 781 26 403 168
65+
352198 31052
2891 10815 49341 2357 40406 5203 1056 293 295 7194 2594 354 2515 3296 1854 1443 2370 1768 3383 1361 1210 1866 5999 8290 1991 3414 11379 2669 2892 236 1768 33886 11829 12094 6142 4047 31414 6088 2690 971 1735 14600 1791 13298 5249 398 1843 12908 750 5733 2229
Total 607734
4262 18965 91998 3844 66635 8020 1584 470 404 10686 3913 533 4254 5239 2753 2273 3830 2451 5772 2261 1954 3045 9855 14686 3367 5311 20378 4776 4808 337 2915 61092 21050 20625 11758 5678 57182 9290 4345 1904 2712 28080 2570 21384 9112 563 2617 20993 910 10334 3956
Total 21529
494 3245 728 4316 639 3 1534 595 322 728 47 47 273 4068 411 368 10 18 65 46 1659 11 1902 -
% Covered 11.6 17.1 18.9 6.5 8.0 0.6 14.4 15.2 11.7 19 1.9 0.8 12.1 27.7 12.2 6.9 3 0.6 1.5 2.4 18.2 2 18.4 -
White 6602
216 135 268 2664 195 2 873 382 235 268 26 26 558 30 334 9 9 32 15 99 10 216 -
Black 378
30 2 16 43 14 97 57 18 16 5 5 18 12 12 1 3 6 14 1 1 7 11706
201 3067 418 683 315 1 333 84 53 418 14 14 0 3426 309 6 0 1 23 14 1524 0 802 101
22 13 8 9 2 3 9 14 15 4 2 -
Hispanic 550
4 18 228 92 81 32 13 8 1 1 27 1 1 3 1 29 10 -
Unknown 2182
25 24 689 21 147 31 3 18 1 1 273 25 49 2 3 3 2 865 -
% Inconsistent 59 5 43 84 51 67 78 86 84 43 70 70 100 16 25 98 100 94 65 70 8 100 58 9 1 5 16 7 11 15 18 17 6 12 13 21 3 4 20 22 19 10 14 2 23 8 -
Rank Order
State
4.3 2.3 43.6 11.1 4.2 28.1 5.9 3.3 28.6 31.7 9.8 4.1 38.7 4.8 7.2 5.4 2.5 14.9 8.6 3.6 26.3 17.3 1.9 47.1 7.2 9.9 14.1 3.4
1990 and 2000 Census, Current Population Survey (CPS) Housing and Household Economic Statistics Division’s Statistical Information Staff at (301)457-3242. Study funded by the U.S. Administration on Aging. Data from the Personal Summary File except for California, and Alaska which is extracted from the Long Term File. Indian Health Service, OPEL/Division of Program Statistics: Adjusting for Miscoding of the Indian Race on State Death Certificates, November 1996 Study funded by the U.S. Administration on Aging. Data extracted from the Denominator File. Published in NICOA’s Monograph Series, Volume 2- Number 2 Indian No More: Inconsistent Classification of American Indians and Alaska Natives in Medicare. 2001.
2015143
Alabama 18295 Alaska 86125 Arizona 204589 Arkansas 14320 California 248929 Colorado 28544 Connecticut 6800 Delaware 2199 District of Columbia 1559 Florida 42619 Georgia 15283 Hawaii 5596 Idaho 14677 Illinois 24077 Indiana 14494 Iowa 7811 Kansas 23250 Kentucky 6946 Louisiana 20075 Maine 6392 Maryland 14258 Massachusetts 12585 Michigan 58934 Minnesota 49507 Mississippi 8856 Missouri 22334 Montana 47769 Nebraska 12564 Nevada 20398 New Hampshire 2433 New Jersey 14647 New Mexico 134035 New York 59081 North Carolina 82606 North Dakota 25305 Ohio 22331 Oklahoma 252468 Oregon 41626 Pennsylvania 15976 Rhode Island 4267 South Carolina 8935 South Dakota 50369 Tennessee 12473 Texas 69872 Utah 24371 Vermont 2215 Virginia 16391 Washington 83212 West-Virginia 3099 Wisconsin 39725 Wyoming 9921
AI/AN
Medicaid
API
2000 Census AI/ANs in Poverty % Inconsistent
2000 Census
Rank Order 38 9 2 27 18 8 32 49 50 23 45 33 12 29 40 4 24 48 39 30 44 34 25 16 7 26 10 14 11 41 46 3 20 15 6 42 22 21 43 31 47 1 37 28 13 35 36 17 51 19 5
Medicare
94 81.2 64.4 94.7 91.3 78.5 93.1 91.7 96.4 93.1 87.7 87.2 94.7 81.4 88 98.8 94.1 88.1 95.9 93.5 94 80.1 80.8 94 80.2 76.7 84.2 95 97.1 70.6 84 91.3 79.8 95.1 90.4 88.3 95.3 90.8 97.1 73.9 93.9 91.8 68.1 93.7 93.7 83.5 86.4 77.4
% Inconsistent
Misclassification by states in Medicaid, state mortality records, and Medicare
35 12 1 39 25 7 29 49 50 27 45 30 19 18 40 13 20 48 38 21 44 31 36 9 11 37 10 5 16 41 46 3 15 26 8 42 23 22 43 24 47 4 34 28 2 32 33 14 51 17 6
Rank Order
1990 Census
55+
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DISAPPEARANCE OF AMERICAN INDIANS
Conclusion
Recommendations
Racial data not only allows the federal government to implement and monitor its own standards for meeting its obligations to all United States residents, but such data also allows American Indian tribes and Alaska Native corporations to identify their own needs and status.
Misclassification of AI/ANs in the CMS enrollment database–which is the basic source of race/ethnicity of a beneficiary– comes from SSA entitlement records. This problem was identified by HCFA more than a decade ago.
Misclassification of race will continue to erode the visibility of AI/ANs in a national setting. In this context, numbers not only establish the presence of a racial group as a unique entity, but such information increases the ability of individual tribes and villages to monitor and respond to their changing health needs. It empowers tribes to be responsible for their own health management and monitoring. Without this information, and in the absence of such information being gathered independently by AI/ANs, the myriad of activities and research that are designed and funded by federal agencies, such as CMS and SSA, to promote better access to their programs, will not achieve their potential.
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The low proportion of AI/ANs not benefiting from Medicaid suggests that either many eligible AI/ANs are not being reached by CMS programs, or alternatively, the quality of race coding in the enrollment database is questionable. The contention of this monograph and other similar studies is that the primary cause of the apparent underutilization of Medicare and Medicaid by AI/ ANs is due to miscoding by SSA, and the subsequent inaccuracies reported by CMS. The continued reporting of information by federal agencies, utilizing inaccurate data, will erode the value of maintaining health data for AI/ANs and other racial groups.
238,107 34,485 257,363 2,028,789
1/ ALABAMA 1/ ALASKA ARIZONA 1/ ARKANSAS 1/ CALIFORNIA
734,015 100,760 211,188 128,144 93,970
813,251 329,418 3,073,241 1,167,988 62,280
1,290,776 342,475 511,171 1,523,120 153,130
594,962 89,537 1,843,661 2,324,810 215,801
123,992 653,236 1,413,208 342,668 518,595
46,121 964,015 19,764
1/ MISSOURI 1/ MONTANA NEBRASKA 1/ NEVADA 1/ NEW HAMPSHIRE
1/ NEW JERSEY 1/ NEW MEXICO NEW YORK NORTH CAROLINA 1/ NORTH DAKOTA
OHIO OKLAHOMA 1/ OREGON 1/ PENNSYLVANIA 1/ RHODE ISLAND
1/ SOUTH CAROLINA SOUTH DAKOTA 1/ TENNESSEE TEXAS 1/ UTAH
1/ VERMONT VIRGINIA 1/ WASHINGTON 1/ WEST VIRGINIA 1/ WISCONSIN
1/ WYOMING PUERTO RICO VIRGIN ISLANDS
35,983 173
120,771 300,535 629,997 296,447 180,361
220,674 52,126 952,473 645,978 140,036
813,089 401,228 896,151 87,594
252,882 89,343 859,517 511,841 44,676
506,398 74,115 148,160 71,199 90,345
184,348 533,292 682,290 343,748 151,798
935 15,493
705 311,541 57,659 14,776 80,023
326,308 185 414,173 458,055 3,966
426,783 21,658 458,668 15,172
296,751 8,850 688,544 515,303 1,008
226,649 640 29,859 23,871 876
307,223 102,428 488,168 80,703 298,883
25,612 44,774 82,799 431,382 -
647,000 1,817 552 567,071 145,694
27,613 95,626 46,817 106,929 663,851
260,790 4,797 141,972 876,628
9,847,580
1/ MEDICAID STATISTICAL INFORMATION SYSTEM (MSIS). SOURCE: HCFA, CMSO, HCFA-2082 REPORT JANUARY 27, 2000
561,085 908,238 1,362,890 538,413 485,767
314,936 241,933 644,482 720,615 170,456
1/ IOWA 1/ KANSAS 1/ KENTUCKY LOUISIANA 1/ MAINE
1/ MARYLAND MASSACHUSETTS 1/ MICHIGAN 1/ MINNESOTA 1/ MISSISSIPPI
443,904 24,871 99,097 554,463 421,513
1,221,978 184,614 123,176 1,363,856 607,293
1/ GEORGIA 1/ HAWAII 1/ IDAHO ILLINOIS 1/ INDIANA
271,369 166,353 525,911 238,916 -
176,003 170,175 42,152 1,840 759,097
1/ COLORADO 344,916 CONNECTICUT 381,208 1/ DELAWARE 101,436 DISTRICT OF COLUMBIA 166,146 1/ FLORIDA 1,904,591
527,078 74,508 507,668 424,727 7,082,175
16,771,976
1,510 3,888 912 512,660 3,744 5,525 401 779 8,633
10,620 74,931 332 30,252 1,455 3,786 6,490 1,286 -
11,551 30,441 17,568 40,133 1,698 430 2,355 2,912 776
8,979 1,617 57,224 10,659 321
4,819 14,412 26,676 4,615
892 61 7,366 23,253 6,439
434 14,973 46,052 325 17,679 135 78
1,049 25,929 837 30,983
2,301 582 248 16 926
622 99 2,600 2,237 398
1,775 3,080 208 -
1,039 2,469 5,843 25,640 1,813
1 21,752 8,539 2,577 21
1,891 51,500 7,092 20,124 13,278
1,314 9,425 1,285 248
667 31,510 3,420 6,280 9,092
240 748 23,794 6,233
3,846 11 4,130 3,991
183 24,123 102,737 497 19,779
4,108 130 12,588 1,119,760 26,951
31,086 50,838 123,070 26,785
182,860 168,019 649,517 43,585 1,508
1,872 20,346 22,083 1,447
19,120 136,456 49,697 28,932 1,319
11,179 19,046 5,070 -
40,754 6,427 12,954 208,620 23,288
110,326 109,224 7,817 3,999 305,827
4,483 2,671 5,396 2,598,598
6,353,196
192,004,819 250,000,000 10,097,973
351,341,290 2,118,202,866 2,044,234,831 1,243,150,526 2,206,398,750
2,018,620,428 355,833,902 3,167,188,993 7,139,928,843 618,675,433
6,120,967,557 1,177,853,941 1,377,514,740 6,080,191,710 919,353,410
4,218,822,993 862,144,872 24,298,610,635 4,013,996,742 341,015,420
2,569,646,129 361,238,668 753,162,904 462,087,777 606,004,232
2,489,280,148 4,609,360,933 4,345,007,824 2,924,447,719 1,442,373,276
1,288,770,390 916,323,608 2,425,288,141 2,383,508,985 747,027,618
3,012,346,312 507,433,146 424,512,387 6,172,865,261 2,564,005,047
1,439,366,499 2,420,791,474 419,732,143 731,292,552 5,686,844,862
1,902,300,047 330,378,398 1,643,966,305 1,375,797,421 14,236,592,915
164,148,931 158,015
347,145,661 1,185,068,839 1,520,911,231 1,050,971,933 1,072,860,297
823,140,050 265,096,471 1,948,698,449 3,237,522,829 471,999,810
4,523,992,068 1,174,610,986 4,168,714,616 722,585,451
2,306,563,061 334,362,382 8,526,521,151 2,108,139,775 295,976,110
1,996,030,667 300,075,153 620,174,553 310,748,421 597,538,126
1,131,688,380 3,532,575,981 2,488,989,444 2,377,783,348 632,011,633
1,196,460,179 749,842,750 1,993,823,547 1,099,777,803 -
1,449,477,236 82,883,964 383,043,599 3,144,842,530 2,092,496,250
919,883,912 1,764,041,602 222,835,727 40,491,720 2,882,195,485
827,952,829 174,019,260 807,626,871 1,073,552,240 6,166,204,632
142,317,903,795 77,308,255,958
3,990,200 6,418,356 395,633 -
1,141,307 144,750 7,138,887 9,535,747 1,036,794
5,693,343 3,385,027 1,238,666 120,284 1,353,164
10,874,552 124,608,852 23,977,462 49,156,977 38,824,907
2,787,697 8,196,959 9,731,111 1,569
1,481,137 435,931 848,667,684 1,703,034 107,831,858 53,631,256 43,439,640 139,997,459 10,808,831
819,207,631 1,154,481 476,867 83,251,611 688,986,766 3,973,350 1,265,091,320 16,224,173 7,957,899 19,437,596
1,444,982,894 4,743,094 57,050,374 22,672,988 1,435,448,567 4,353,009 48,070,593 566,136
1,081,590,761 24,062,597 3,317,705,424 1,388,709,316 1,985,205
572,989,632 52 1,673,278 52,781,368 69,028,503 16,738,730 64,283,449 8,923,139 2,998,753 121,244
1,174,483,476 4,034,803 328,298,442 14,419,906 1,090,315,294 13,049,032 250,351,425 90,141,150 678,234,773 5,546,935
60,119,039 108,914,987 266,183,359 1,065,218,687 -
1,239,615,206 4,340,418 1,286,656 2,366,092,290 396,194,656
71,612,726 346,434,628 146,959,824 546,117,413 1,489,923,156
438,900,267 1,076,069 14,417,242 114,087,825 94,508,661 223,441,777 425,077,863 2,006,208 1,876,614,170 38,373,365
27,924,916,921 1,106,464,681
355,686 37,888
1,070,663 36,992,590 82,984,768 791,928 19,944,179
1,161,374 215,280 7,597,700 41,302,705 11,642,604
12,862,937 36,008,771 70,377,689 10,763,133
19,945,359 3,698,818 209,885,774 16,512,917 892,876
889,994 4,719,794 8,741,149 1,244,444
44,293,674 48,043,679 37,945,112 95,240,916 2,822,491
7,513,271 14,513,033 2,464,396 -
13,872,906 290,493,960 751,185 101,700,238 4,841,617
9,908,033 17,312,049 1,105,200 2,680,052 11,254,474
1,654,070 12,240,077 14,159,234 2,948,804 628,002,960
1,966,402,451
9,694,849 1,686,823
498,532 42,863,490 147,560,588 1,216,634 28,153,946
4,653,034 461,142 10,801,097 2,267,459,706 53,862,180
77,540,662 66,963,540 312,794,476 58,620,869
351,049,969 328,367,182 2,128,810,934 62,993,852 2,124,462
4,103,634 33,978,627 46,021,153 3,358,173
45,768,784 252,985,739 68,841,694 68,520,048 2,338,315
18,178,910 32,226,321 12,665,231 -
48,382,042 15,687,138 19,683,988 550,384,662 47,183,688
281,989,029 289,165,417 19,433,350 14,241,198 486,938,537
3,315,366 7,940,171 471,119,023 9,412,021 2,889,656,926
11,701,697,152
TOTAL WHITE BLACK AMER. INDIAN ASIAN OR PAYMENTS NOT HISPANIC NOT HISPANIC ALASK. NATIVE PAC. ISLANDER HISPANIC
MEDICAID VENDOR PAYMENTS BY RACE/ETHNICITY
51,367 964,015 19,914
131,639 689,571 915,214 373,090 538,229
656,263 83,111 1,454,799 2,680,583 198,730
1,402,364 459,570 537,465 1,720,000 148,797
857,898 339,527 3,500,292 1,201,681 62,115
772,622 93,298 210,261 130,662 98,340
603,562 953,469 1,354,718 557,232 526,604
321,119 246,598 653,553 723,864 195,839
1,223,439 182,460 116,718 1,784,159 610,146
346,928 402,547 105,153 138,722 2,040,541
628,220 87,873 649,302 426,080 6,191,269
41,361,532
40,249 -
129,962 314,040 670,018 343,131 187,321
251,122 49,424 963,006 739,597 146,326
883,444 428,563 1,036,265 85,136
259,995 92,276 975,344 526,527 45,043
537,215 69,648 146,079 75,951 94,836
210,449 532,005 718,380 355,580 160,692
277,085 170,132 537,100 231,218 -
441,075 25,039 99,797 713,454 426,177
172,252 180,483 43,908 2,666 824,278
273,245 37,940 250,559 258,183 1,806,631
17,838,846
1,083 -
761 332,198 61,404 18,218 83,707
373,442 178 417,128 543,971 4,253
460,334 23,122 496,909 15,128
307,264 9,236 819,724 529,550 1,011
235,406 604 30,199 25,025 969
335,488 105,065 502,143 85,478 334,520
26,527 46,234 84,798 441,877 -
654,613 1,822 550 763,561 151,049
27,617 99,614 48,219 123,675 704,220
322,829 5,477 42,748 143,381 804,451
10,646,780
4,273 -
246 809 25,583 6,608
799 30,455 3,470 7,477 10,604
36,703 10,537 1,521 241
2,105 54,191 8,351 20,514 14,061
20,920 8,578 2,818 23
1,139 2,254 6,304 27,012 1,825
1,846 3,330 219 -
625 101 2,346 2,968 423
2,268 642 257 21 1,022
1,304 34,922 92,322 826 27,731
482,594
162 -
464 15,763 48,392 432 18,593
1,186 60 7,517 26,005 6,827
5,547 15,287 29,882 4,670
9,528 1,682 71,262 11,269 321
400 2,418 3,101 877
13,757 30,943 18,724 42,220 1,981
4,061 6,690 1,283 -
10,774 76,438 342 38,551 1,556
3,793 6,030 423 954 9,319
2,477 4,640 4,796 932 465,987
1,028,316
TOTAL WHITE BLACK AMER. INDIAN ASIAN OR ELIGIBLES NOT HISPANIC NOT HISPANIC ALASK. NATIVE PAC. ISLANDER
MEDICAID ELGIBLES BY RACE/ETHNICITY
facts
1,022,077
335,582
TOTAL WHITE BLACK AMER. INDIAN ASIAN OR RECIPIENTS NOT HISPANIC NOT HISPANIC ALASK. NATIVE PAC. ISLANDS HISPANIC
ALL JURISDICTIONS 40,649,482
STATE
MEDICAID RECIPIENTS BY RACE/ETHNICITY
4,782 -
206 25,396 109,817 699 21,540
5,110 126 12,947 1,280,864 28,724
1,407 55,968 136,041 26,695
189,885 173,187 759,184 45,537 1,640
1,712 21,085 22,998 1,629
23,554 136,792 58,319 32,231 1,600
11,600 20,212 5,097 -
42,039 6,513 13,680 265,041 25,813
115,446 114,419 8,202 4,765 336,323
5,575 2,946 246,508 5,349 2,515,612
6,924,815
HISPANIC
48,468 967,106,015 68,576,183 127,462,428 9,308,431 1,697,604 76,908,022 778,345 30,831,653 5,584,848 3,499,999 1,538,532 3,371,173 20,220,791 75,058,724 18,650,003 25,909,085 129,995 953,078 7,415,636 527,715 182,477,490 175,691,834 261,095,778 3,263,231 48,234 15,482,001 49,129,279 210,736,115 25,379,168 16,070 5,642 9,936,111 14,009,607 88,135 2,674,894 52,830,212 16,718,515 -
10,176 294,236,703 2,103,149 4,966,585 542,146 222,162 1,854,574 346,375 1,510,807 665,533 1,446,729 375,410 1,211,148 22,909,496 10,950,049 12,516,835 55,641,385 377,365 201,817 1,053,602 94,230 8,524,702 2,430,041 17,793,471 1,432,851 4,957 2,658,216 25,783,520 54,370,431 4,223,146 2,236 2,424 6,829,155 5,029,685 275,438 2,640,478 22,213,553 16,610,616 -
-
53,890,106 186,255,441 529,020,076 26,573,906 321,886,123
17,172,147 3,797,234 1,859,127,110 147,730,653
494,845,239 665,872,224 1,801,084,202 114,870,881
617,591,322 372,647,285 1,638,382,814 85,665,363 1,319,356
277,652,554 53,600,495 72,980,602 32,332,069 12,128,535
851,988,946 477,932,296 823,728,725 483,228,011 22,152,325
107,189,198 17,201,600 311,526,039 4,237,958
57,871,451 213,612,580 241,278,075 167,977,207
238,585,930 377,212,893 122,048,974 98,238,002 701,322,837
288,972,436 1,431,418,497 4,359,975 2,867,713,795
-
52,965,970 42,397,973 294,984,443 94,954,094
4,236,183 2,135,624 1,098,535,007 82,460,377
179,164,021 543,216,685 637,775,454 54,749,866
132,285,603 109,777,182 491,797,939 33,406,093 1,056,698
131,368,857 40,733,062 16,029,764 11,252,385
289,337,600 288,388,006 291,325,697 284,480,133 8,071,914
88,529,917 11,237,535 198,174,755 -
6,211,574 17,977,074 107,009,316
116,429,108 133,015,461 51,811,375 175,177 200,648,478
2,384,384 820,555,222
-
310,809 138,049,280 31,790,969 83,516,819
11,916,431 8,146 475,376,234 2,741,398
287,807,436 33,211,731 873,410,484 12,986,826
272,103,646 10,934,417 450,530,344 43,866,121 48,005
146,281,937 378,343 6,870,965 254,205
494,247,122 71,270,979 448,956,331 89,825,022 11,913,383
13,074,920 3,772,419 87,502,578 -
46,212,136 190,654,668 53,251,599
21,481,320 111,183,457 55,384,205 41,711,203 312,690,985
1,614,896 487,617,383
-
125,769 238,376 5,377,315 3,310,894
640 1,486,962 3,770,117 2,244,147
525,561 9,034,978 1,245,841 171,462
944,911 58,314,252 3,055,203 611,227 161,462
11,163,929 365,238 -
2,040,903 1,173,993 1,994,247 14,708,695 26,934
636,687 263,835 108,466 -
12,683 292,853 75,529
1,439,083 515,229 440,451 4,093 175,145
7,377 8,640,240
134,704,727
HISPANIC
5,424,759,152 2,465,159,044
6,971,046,006 584,061,196
19,296,223,487
TOTAL WHITE BLACK AMER. INDIAN ASIAN OR PAYMENTS NOT HISPANIC NOT HISPANIC ALASK. NATIVE PAC. ISLANDS
MEDICAID VENDOR PAYMENTS FOR PREPAID HEALTH CARE
Medicaid Utilization Medicaid utilization of services by race.
75
