title: Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010-Fiscal Year 2011.
abstract: To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments.
  
  
  
  Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer).
  
  
  
  Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim.
  
  
  
  Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a substantial proportion of the gap between Medicaid and Medicare payments.
  
  
  
  Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included.
authors.affiliation: Office of the Actuary at the Centers for Medicare & Medicaid Services, Baltimore, MD.|National Health Statistics Group, CMS Office of the Actuary, Baltimore, MD.
authors.forename: Devin A
authors.initials: DA
authors.lastname: Stone
authors.affiliation: National Health Statistics Group, CMS Office of the Actuary, Baltimore, MD.
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Dickensheets
authors.affiliation: National Health Statistics Group, CMS Office of the Actuary, Baltimore, MD.
authors.forename: John A
authors.initials: JA
authors.lastname: Poisal
mesh_terms: D018588:Fee-for-Service Plans / Q000191:economics*; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007345:Insurance Claim Review; D007902:Length of Stay; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D014481:United States
keywords: Inpatient hospitals; Medicaid; Medicare; payments