兰德-部分儿童医院的住院医疗补助使用情况（英）-2025_14页_304kb

Inpatient Medicaid Utilization Report Summary

Background
New legislation in July 2025 has changed Medicaid eligibility requirements, but this report focuses on current data without analyzing the potential impacts. Data is drawn from hospital cost reports (processed by RAND) to analyze inpatient utilization by patients covered by Medicaid at select children's hospitals. inpatient utilization refers to the percentage of hospitalizations paid for by Medicaid.

Methodology
The analysis used May 2025 CMS Hospital Enrollments and RAND Hospital Data cleaned datasets (covering services to children). Hospitals were selected if:

1. They self-reported pediatric services in CMS files.
2. They submitted cost reports (triggered by Medicare services).
3. Sufficient data was available to compute two metrics:
   • Medicaid inpatient discharge share: Percentage of discharges paid by Medicaid.
   • Medicaid inpatient day share: Percentage of inpatient days paid by Medicaid.

Conducted using Stata statistical software.

Key Results

• 106 hospitals identified; 74 provided usable data for 2023 and/or 2024.
  • 62 (83.7%) reported 2023 data; 12 (16.2%) reported 2024.
• Data available from 30 US states plus DC.
• Medicaid discharges average 47.2% (median 50.3%).
  • In 20 hospitals, >50% of discharges were Medicaid-covered.
• Inpatient days average 52.2% (median 55.0%).
  • In 46 hospitals across 22 states, >50% of days were Medicaid-covered.

Key Limitations

1. Limited hospital coverage (only ~28% of ~200 Children’s Hospital Association members included).
2. Self-reported children's hospital status; includes mixed (general + pediatric departments).
3. Possible misreporting; data not fully validated but presented as-is.
4. Fiscal year differences; no data standardized for comparison.
5. Excludes pediatric-specific changes in Medicaid eligibility.

Conclusion
The report highlights high variation in Medicaid use across children's hospitals, especially in the share of discharges and inpatient days. However, data limitations prevent generalizations about the overall healthcare system's impact from policy changes.

Footnotes:
^1 Includes Medicare/HMO data.