Forecasting Long-term Trends in Medicaid Enrollment and Spending

Since 2005, Economists at Evergreen Economics have developed long-term (20-year) forecasts of Medicaid enrollment, utilization, and spending for 220 demographic subgroups—including groupings by gender, Alaska Native/non-Native status, and for 11 age groups—and 20 categories of services provided through Alaska's Medicaid program.

The purpose of the long-term forecast is to inform the Department of Health and Social Services and the Alaska legislature of the long-term trends in Medicaid enrollment and spending under the assumption that the current mix of Medicaid services remains relatively constant and that eligibility criteria do not substantially change. While it is likely Alaska’s Medicaid program will experience changes (e.g. Alaska-initiated Medicaid expansion in September 2015), the assumption of no change is necessary to show how Medicaid spending in Alaska will likely evolve given the structure of the program as it existed at the time of the forecast.

The long-term forecast follows a highly structured modeling approach to develop annual estimates of spending on Medicaid services. Beginning with a 20-year forecast for each of the 220 demographic sub-groups, the forecast builds on the results of each previous step to develop estimates of enrollment, utilization, and intensity-of-use of Medicaid services, and finally, projected spending on Medicaid services.

Projecting Enrollment and Spending on Medicaid Expansion

In 2015, the Alaska Department of Health and Social Services engaged Evergreen to project enrollment and spending associated with Medicaid expansion. To develop estimates of the newly eligible population, Evergreen relied on data from the Alaska Behavioral Risk Factor Surveillance System (BRFSS) annual survey, an approach unique among researchers studying Medicaid expansion by the states. Using this approach, Evergreen’s estimate of first-year enrollment and spending by those newly eligible for Medicaid was within 5 percent of actual enrollment and spending.

Estimating the Impact of Chronic Disease Self-Management Programs

In 2014, the Alaska Department of Health and Social Services and the Alaska Diabetes Program engaged Evergreen to conduct statistical analysis to determine the impact that participating in a chronic disease self-management program had on Medicaid cost for people with diabetes. Based on the results of the statistical analysis, Evergreen estimated the potential savings to Alaska’s Medicaid program from expanding the self-management program statewide.