To compare Medicaid fee‐for‐service () inpatient hospital payments to expected Medicare payments.
Medicaid and Medicare claims data, Medicare's ‐ grouper and inpatient prospective payment system pricer ( pricer).
Medicaid inpatient hospital claims were run through Medicare's ‐ grouper and 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 (), graduate medical education (), 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.
