The COVID Ratchet: How a $9.7 Billion Program Became a $23.5 Billion Program and Never Went Back
The COVID Public Health Emergency was supposed to be temporary. In Medicaid's largest home care program, the money doubled, the emergency ended, and the spending kept climbing.
$978 million a month.
That was the average monthly Medicaid expenditure for T1019 home care services prior to COVID.
Today it’s $1.93 billion.
The emergency ended in May 2023. The spending peaked in May 2024.
Read that again.
FRAMEWORK
IN TODAY’S ARTICLE:
Medicaid T1019 home care spending doubled during COVID and never came back down. Monthly spend is now 97.3% higher than pre-pandemic levels.
The spending acceleration happened AFTER the Public Health Emergency ended, not during it.
The number of billing entities grew 10.7%. The cost per claim grew 42.4%. The same entities are billing at permanently elevated rates.
The “unwinding” everyone talks about failed to materialize in the largest personal care program in the country.
Glossary at the bottom of today’s article.
$978 MILLION TO $1.93 BILLION.
SAME PROGRAM. SAME ENTITIES.
Before COVID, Medicaid’s T1019 program spent an average of $978 million per month on personal care and home health services.
It processed approximately 10.7 million claims per month across approximately 4,791 billing entities at an average cost of $90.74 per claim.
Today, that same program spends $1.93 billion per month. Through 5,302 billing entities. At $129.24 per claim.
The monthly spend is up 97.3%. The claims are up 39.4%. The billing entity count is up 10.7%.
The cost per claim is up 42.4%.
You can learn how the system extracts.
Or you can keep wondering why your taxes went up and nothing got better.
60,000+ physicians and healthcare operators read The Rojas Report daily.
Join them: Subscribe Here
