Palliative Care in Medicaid Actuarial Study

A 2/15/23 NAHC communication linked to an Actuarial Analysis of a Medicaid Palliative Care Benefit.

• Article: https://nashp.org/palliative-care-in-medicaid-costing-out-the-benefit-actuarial-analysis-of-medicaid-experience/ 
• Q&A: https://nashp.org/qa-actuarial-analysis-of-a-medicaid-palliative-care-benefit/

Key Findings:

1. Effective administration of a Medicaid palliative care benefit for the highest service utilizers could produce cost avoidance savings ranging between $231 and $1,165 per Medicaid member per month, with potential return on investment ranging between $0.80 and $2.60 for every $1 spent on palliative care.
2. At a minimum, it is expected that implementation of palliative care for all utilizers in a state Medicaid program would be overall cost neutral to the state while improving the quality of life for the members utilizing palliative care, as well as for their families.
3. No state Medicaid programs, however, offer a comprehensive or “stand-alone” palliative care benefit, although California has led the way with required coverage of community palliative care by its contracted managed care organizations, and several other states have recently expressed interest in adding palliative care as a covered benefit.
4. Medicaid members with disabilities and those receiving long-term services and supports (LTSS) have a higher prevalence of serious illness.
5. Medicaid members with serious illness use increasingly high levels of costly inpatient and emergency department services as they approach end-of-life.