Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
CHIROPRACTIC CARE 
Medicaid Coverage 
JUNE GIBBS BROWN 
Inspector General 
SEPTEMBER 1998 
OEI-06-97-00480  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them.  This statutory mission is carried out through a 
nationwide program of audits, investigations, inspections, sanctions, and fraud alerts.  The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General.  It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public.  The 
inspection reports provide findings and recommendations on the efficiency, vulnerability, and 
effectiveness of departmental programs. 
OEI's Dallas Regional Office prepared this report under the direction of Chester B. Slaughter, 
Regional Inspector General.  Principal OEI staff included: 
REGION  HEADQUARTERS 
Clark Thomas  Alan Levine 
Nancy Watts  Barbara Tedesco 
Lisa White 
To obtain copies of this report, please call the Dallas Regional Office at (214) 767-3310. 
Reports are also available on the World Wide Web at our home page address: 
http://www.dhhs.gov/progorg/oei  E X E C U T I V E  S U M M A R Y

PURPOSE 
To determine and describe the current and anticipated chiropractic care benefits provided under 
each State Medicaid program. 
BACKGROUND 
Recent changes to Medicare chiropractic coverage policy under the Balanced Budget Act of 1997 
require that the Health Care Financing Administration (HCFA) establish, by January 1, 2000, new 
utilization guidelines for Medicare chiropractic care in cases where spinal subluxation has not 
been demonstrated by x-ray.  The Balanced Budget Act also eliminates the Medicare requirement 
for supporting x-rays by the year 2000.  Additionally, recent changes in New York State law 
require private insurers to include chiropractic coverage in their benefit packages. 
To better understand the impact of these changes on the Medicare and Medicaid programs and to 
learn more about other forms of utilization control, we undertook this inspection resulting in two 
reports.  This report, "Chiropractic Care; Medicaid Coverage, (OEI-06-97-00480)" describes 
current and expected chiropractic care benefits under State Medicaid programs.  A companion 
report, "Chiropractic Care; Controls Used by Medicare, Medicaid, and Other Payers, (OEI-04-97-
00490)" examines Medicare, Medicaid, and private insurers' mechanisms for controlling 
expenditures and protecting the chiropractic benefit from potential waste and abuse. 
A particular concern in the Medicaid program was whether there were any indications of potential 
explosive growth in the program overall. 
FINDINGS 
Thirty States Report Offering Some Form of Medicaid Chiropractic Benefit Under a Fee-For-
Service Arrangement. 
Twenty six States cover all categorically needy Medicaid eligible beneficiaries and twenty of these 
extend coverage to those considered to be medically needy but who do not qualify for financial 
assistance.  All 30 States provide coverage for children under Early Periodic Screening, Diagnosis 
and Treatment (EPSDT) plans. 
Conditions and Chiropractic Services Which Qualify for Reimbursement Vary by State. 
Twenty States reported they only reimburse manual manipulation of the spine for treatment of 
spinal subluxation.  Five States offer additional coverage for the treatment of back pain associated 
with nerve root damage.  Eight States report they cover any treatment considered medically 
necessary. 
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i  States Impose a Variety of Limits on the Number and Duration of Chiropractic Treatments a 
Beneficiary May Receive. 
The number of chiropractic treatments a beneficiary may receive is limited in twenty six States. 
These limits range from one treatment per day to one treatment per year.  Some States also limit 
the length of the period within which beneficiaries can receive treatment. 
Twelve States Have Changed the Level of Their Chiropractic Benefit Since 1990. No 
Tendency of General Expansion of Benefits is Evident, However. 
Only two States adopted program changes that only limited their programs over the period.  The 
remainder made changes that resulted in both expansions and limits.  In some cases, such as 
Louisiana, later changes directly offset earlier ones, while other States expanded to include 
additional beneficiaries while limiting their numbers or duration of treatments.  No State reported 
pending plans to expand their fee for service chiropractic benefit.  Of the States reporting no 
current coverage, none indicated immediate plans to add a chiropractic benefit, although South 
Carolina reported the issue is under study. 
Chiropractic Care Comprises a Small Proportion of Total State Medicaid Expenditures.  No 
Consistent Trends in Expenditures Appear. Some States Experienced Decreasing Costs over 
Time, While Others Saw Only Minor Fluctuations in Expenditure Levels. 
California, Iowa, Maine, Montana, and North Dakota appear to have experienced a slight 
downward trend in chiropractic payments relative to total expenditures between 1994 and 1996, 
while Vermont's expenditures decreased sharply.  Louisiana and Indiana saw relatively large 
increases in 1995 which diminished in 1996.  With the exception of Louisiana, where limiting 
eligibility to EPSDT beneficiaries likely drove expenditures down sharply between 1995 and 
1996, we are unable to correlate States' expenditure patterns with their reported benefit coverages 
and limits. 
CONCLUSION 
While thirty States offer some form of coverage for chiropractic care under their Medicaid fee-
for-service plans, State reported utilization data show no discernable trends suggesting explosive 
growth in Medicaid expenditures.  Also, no State reported legislative or regulatory plans to 
expand their Medicaid chiropractic benefit beyond current coverage. 
COMMENTS 
The Assistant Secretary for Management and Budget (ASMB) provided comments on this report. 
ASMB asked us to further explain the growth in Medicaid chiropractic expenditures in the State 
of Utah.  We provided this information on page eight of this report.  The full text of these 
comments appears in Appendix A. 
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ii  T A B L E  O F  C O N T E N T S

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

!  State chiropractic coverage and eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

!  Limits to coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

!  Changes in coverage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

!  State expenditures  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

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 INTRODUCTION

PURPOSE 
To determine and describe the current and anticipated chiropractic care benefits provided under 
each State Medicaid program. 
BACKGROUND 
Chiropractic Care 
Traditional chiropractic philosophy holds that the principal cause of disease is a bone out of place 
along the spine.  Because nerves branch off the spine between the vertebrae to every part of the 
body, chiropractors theorized that a slight misalignment of the vertebrae could pinch a nerve 
extending to another part of the body causing pain and disease.  Relieving that pressure through 
spinal manipulation should, therefore, eliminate or ameliorate the disease.  Currently, 
chiropractors are prohibited from prescribing drugs or performing surgery.  While some are 
willing to treat problems beyond back pain, many rely on x-rays to locate a kink in the spine that 
may cause the back pain and limit their treatment to that ailment. 
Chiropractors commonly treat patients by manual manipulation of the spine, using either their 
hands or hand held devices to adjust spinal alignment.  The Agency for Health Care Policy and 
Research (AHCPR) has found that this method of treatment is effective for patients suffering from 
acute low back problems, especially when used within the first month of symptoms. 
Section 273 of the 1972 Social Security Act Amendments expanded the Medicare definition of 
"physician" to include chiropractors.  Expansion of this definition allowed chiropractors to 
participate in the Medicare and Medicaid programs. 
Current Medicaid Coverage 
Coverage of chiropractic care is an optional benefit available to Medicaid beneficiaries 
in some States.  Medicaid coverage of chiropractic care is limited to services that are provided by 
a chiropractor licensed by the State and consist of treatment by means of manual manipulation of 
the spine.  States may also allow chiropractors to provide and bill for x-ray services, although 
there is no Federal Medicaid requirement that x-rays must be provided before services may be 
reimbursed.  The mechanisms used to control expenditures on chiropractic treatments vary among 
the States providing benefits.  Several have no restrictions and some simply require that the 
treatment be deemed medically necessary.  Others restrict the number of visits or length of 
treatment period.  Among these States, the limits range widely as well. 
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i  Medicare Coverage 
Medicare chiropractic coverage is limited to manual manipulation of the spine to correct a 
subluxation, defined as a functional or structural abnormality involving one or more of the 
vertebrae.  Medicare does not pay for spinal manipulations that provide preventative or 
maintenance care.  Medicare currently requires an x-ray to determine or demonstrate that a 
subluxation exists.  An x-ray for this purpose is covered by Medicare if ordered, taken, and 
interpreted by a physician who is a doctor of medicine or of osteopathy, but not when ordered by 
a chiropractor.  In 1996 Medicare allowed charges for chiropractic care totaled more than $294 
million and averaged about $24 per claim. 
Recent changes to Medicare chiropractic coverage policy under the Balanced Budget Act of 1997 
eliminate the requirement for supporting x-rays effective January 1, 2000.  The Balanced Budget 
Act also requires that, by the year 2000, the Health Care Financing Administration (HCFA) 
establish new utilization guidelines for Medicare chiropractic care in cases where spinal 
subluxation has not been demonstrated by x-ray.  Additionally, recent changes in New York State 
law require private insurers to include chiropractic coverage in their benefit packages. 
To better understand the impact of these changes on the Medicare and Medicaid programs and 
learn more about other forms of utilization control, we undertook this inspection resulting in two 
reports.  This report, "Chiropractic Care; Medicaid Coverage, (OEI-06-97-00480)" describes 
current and expected chiropractic care benefits under State Medicaid programs.  The companion 
report, "Chiropractic Care; Controls Used by Medicare, Medicaid, and Other Payers, (OEI-04-97-
00490)" examines Medicare, Medicaid, and private insurers' mechanisms for controlling 
expenditures and protecting the chiropractic benefit from potential waste and abuse. 
A particular concern in the Medicaid program was whether there were any indications of potential 
explosive growth in the program overall. 
SCOPE AND METHODOLOGY 
We distributed a mailed questionnaire to the Medicaid Administrators in the 50 States and the 
District of Columbia.  We asked each State Administrator to forward this instrument to the 
individual most qualified to provide information about the chiropractic benefit.  All 51 
questionnaires were returned.  We followed with telephone interviews where we required 
clarification or additional information.  Published State Medicaid plans supplemented this 
information. 
Although some States offer chiropractic coverage under managed care plans, because variation 
between plans both within and across States is great and because encounter data about 
chiropractic visits is limited, the discussion below focuses on the extent of benefits under fee for 
service plans. 
We conducted this inspection in accordance with the Quality Standards for Inspections issued by 
the President's Council on Integrity and Efficiency. 
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ii  F I N D I N G S

Thirty States Report Offering Some Form of Medicaid Chiropractic Benefit Under a Fee For 
Service Arrangement. 
Twenty six States cover all categorically needy Medicaid eligible beneficiaries and twenty of these 
extend coverage to those considered to be medically needy but who do not qualify for financial 
assistance.  All thirty States provide coverage for children under Early Periodic Screening, 
Diagnosis and Treatment (EPSDT) plans.  Seventeen of these States also offer coverage to some 
beneficiaries under a managed care arrangement, including Oregon, which covers 85 percent of 
Medicaid beneficiaries under managed care.  The remaining States and the District of Columbia 
reported that they offer no fee for service Medicaid coverage of chiropractic care. 
TABLE 1.  CHIROPRACTIC COVERAGE by STATE 
MEDICALLY CATEGORICALLY  MEDICALLY  CATEGORICALLY 
STATE  NEEDY  NEEDY  EPSDT  STATE  NEEDY  NEEDY  EPSDT 
ARKANSAS  T  T  T  NEBRASKA  T  T  T 
NEW 
CALIFORNIA  T  T  HAMPSHIRE  T  T  T 
CONNECTICUT  T  T  T  NEW JERSEY  T  T 
FLORIDA  T  T  T  NEW YORK  T 
IDAHO  T  T  N. CAROLINA  T  T  T 
ILLINOIS  T  NORTH DAKOTA  T  T  T 
INDIANA  T  T  OHIO  T  T  T 
IOWA  T  T  T  OREGON  T  T 
KANSAS  T  PENNSYLVANIA  T  T  T 
LOUISIANA  T  T  T  SOUTH DAKOTA  T  T  T 
MAINE  T  T  T  TEXAS  T  T 
MASSACHUSETTS  T  T  T  UTAH  T  T  T 
MICHIGAN  T  T  T  VERMONT  T  T  T 
MINNESOTA  T  T  T  WEST VIRGINIA  T  T  T 
MONTANA  T  WISCONSIN  T  T  T 
Conditions and Chiropractic Services Which Qualify for Reimbursement Vary by State. 
Twenty States reported that they limit reimbursement to coverage of manual manipulation of the 
spine for treatment of spinal subluxation.  Five States also allow coverage for treatment of back 
pain associated with nerve root damage.  Eight States reported that they allow coverage of 
additional treatments considered medically necessary or acceptable under State chiropractic 
regulations.  One State, Kansas, covers only an annual chiropractic history and physical. 
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3  TABLE 2. CONDITIONS COVERED, by STATE 
SPINAL  NERVE 
STATE  SUBLUXATION  DAMAGE  OTHER or ADDITIONAL COVERAGE 
ARKANSAS  T 
CALIFORNIA  T  Strain, Sprain or dislocation of spine or neck 
CONNECTICUT  T 
FLORIDA  T  Other Medically Necessary Treatment 
IDAHO  T 
ILLINOIS  T 
INDIANA  T  Medically Necessary Treatment 
IOWA  T 
KANSAS  Chiropractic Screening Only 
LOUISIANA  T  T  Medically Necessary Treatment 
MAINE  T 
MASSACHUSETTS  T  T  Medically Necessary Treatment 
MICHIGAN  T 
MINNESOTA  T 
MONTANA  T  No Restriction By Medical Condition 
NEBRASKA  T 
NEW HAMPSHIRE  T 
Cover Any Conditions Within Scope of Chiropractic Care 
NEW JERSEY  T  T  Under State Law 
NEW YORK  T 
NORTH CAROLINA  T  T 
NORTH DAKOTA  T  T  Strains/sprains 
OHIO  T 
OREGON  T 
PENNSYLVANIA  T 
SOUTH DAKOTA  T 
TEXAS  T 
UTAH  T 
VERMONT  T 
WEST VIRGINIA  T 
WISCONSIN  T 
States Impose a Variety of Limits on the Number and Duration of Chiropractic Treatments a 
Beneficiary May Receive. 
The number of chiropractic treatments a beneficiary may receive is limited in 26 States.  These 
limits range from one treatment per day to one treatment per year, with Kansas reporting 
coverage of a single examination with an allowed reimbursement of one dollar. Some States also 
limit the length of the period within which beneficiaries can receive treatment.  Four States impose 
no limits, as their coverage only includes EPSDT eligible beneficiaries.  Tables 3 and 4 describe 
these limits and allowed exceptions, by State, as they affect Medicaid coverage of chiropractic 
care.  The companion report, "Chiropractic Care; Controls Used by Medicare, 
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4  Medicaid, and Other Payers, (OEI-04-97-00490)", considers these limits in greater detail as they 
are used to control utilization. 
TABLE 3. LIMITS TO COVERAGE, by STATE 
STATE  LIMITS to COVERAGE 
ARKANSAS  12 Treatments per State Fiscal Year for Adults. 
CALIFORNIA  2 Treatments per Month. (24 per year) 
No More Than 1 Visit in 24 hours. Maximum of 4 Exams or Treatments in Single Visit to 
CONNECTICUT  Home or Nursing Facility. (60 visits per year) 
FLORIDA  24 visits per calendar year. 
IDAHO  2 Office Visits per Month. (24 per year) 
INDIANA  5 Office Visits per Year, 50 Therapeutic Treatments per Year 
Acute Condition  40 Treatments in 6 months (80 per year) 
IOWA  Chronic Condition 2 Treatments per month 
1 Chiropractic History per Year 
KANSAS  1 Physical 
8 Treatments per Year Without Pre-authorization for EPSDT 
LOUISIANA  12 Treatments per Year Without Pre-authorization for Adults, Maximum of 18 
Acute Condition  2 Treatments per Week for 1 month 
MAINE  Chronic Condition 1 Treatment per Week 
20 Treatments per Year. State Does Not Cover Treatment and Initial Examination on the 
MASSACHUSETTS  Same Day 
MICHIGAN  18 Visits per 12 Month Period 
6 Manipulations per Month 
MINNESOTA  24 Manipulations per Year 
18 Visits in First 5 Months of Treatment 
NEBRASKA  1 Visit per Month Thereafter if Needed  (25 per year) 
NEW HAMPSHIRE  6 Treatments per State Fiscal Year 
NEW JERSEY  1 Treatment per Calendar Day (365 per year) 
NORTH CAROLINA  24 Visits per State Fiscal Year for Combination of All Physician Services 
OHIO  4 Treatments per Month (48 per year) 
OREGON  1 Treatment per Day (365 per year) 
PENNSYLVANIA  1 Treatment per Day (365 per year) 
1 Treatment per Day 
SOUTH DAKOTA  30 Treatments per 12 Month Period 
12 Treatments per Benefit Period 
TEXAS  Benefit Period is 12 months Beginning With First Treatment 
Limited to Number Appropriate for Diagnosis 
UTAH  1 Evaluation, All Additional Services are Preauthorized 
VERMONT  10 Treatments per Year 
WEST VIRGINIA  12 Treatments per 12 Month Period 
WISCONSIN  20 Treatments per Spell of Illness (New spell of illness required to exceed 20 per year) 
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5  Twelve States Allow Exceptions to Their Chiropractic Coverage Limits. 
When medically necessary, treatment may continue beyond the standard limits in several States. 
Most require documentation or prior authorization before allowing exceptions, however. 
TABLE 4. EXCEPTIONS TO COVERAGE LIMITS, by STATE 
STATE  EXCEPTIONS TO COVERAGE LIMITS 
CONNECTICUT  Authorized Treatment Must be Initiated Within 6 Months of Date of Authorization 
IOWA  Medically Necessary Treatment May be Authorized Upon Review by Chiropractic Consultant 
MICHIGAN  Documented Medically Necessary Treatments Can Exceed Limits 
MINNESOTA  Prior Authorization and Documented Medical Necessity . Can Exceed Limit 
NEW HAMPSHIRE  Overridden by Medical Director with Substantial Evidence of Medical Necessity 
NORTH CAROLINA  Medically Necessary Treatment May be Authorized by Medical Director 
OHIO  Medically Necessary Treatment Can be Authorized by the Department on a Case by Case Basis 
SOUTH DAKOTA  Medically Necessary Treatment May be Authorized Upon Review by Chiropractic Consultant 
UTAH  Additional Services May be Approved Through Preauthorization 
VERMONT  Prior Authorization Based on Documentation of Medical Necessity 
Medical Necessity Documented and Reviewed by State Chiropractic Consultant. 
WEST VIRGINIA  No More Than 40 Total Treatments 
WISCONSIN  Medical Necessity Reviewed by Chiropractic Consultant 
Twelve States Have Changed the Level of Their Chiropractic Benefit Since 1990.  No 
Tendency of General Expansion of Benefits is Evident, However. 
Only two States adopted program changes that only limited their programs over the period.  The 
remainder made changes that resulted in both expansions and limits.  In some cases, such as 
Louisiana, later changes directly offset earlier ones.  Other States expanded to include additional 
beneficiaries while also limiting the numbers or duration of treatments.  No State reported 
pending plans to expand their fee for service chiropractic benefit.  Of the States reporting no 
current coverage, none indicated immediate plans to add a chiropractic benefit, although South 
Carolina reported the issue is under study. 
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6  TABLE 5. CHANGES IN COVERAGE SINCE 1990, by STATE 
STATE  YEAR  EXPAND  LIMIT  CHANGE 
1991  T  Expanded to include adults(7/91) 
1991  Limited coverage to under 21 only(12/1/91) 
1994  T  T  One x-ray per State fiscal year covered (7/94) 
ARKANSAS  1996  T  Expand to all ages (7/96) 
FLORIDA  1992  T  Treatment limit expanded from 12 to 24 per year 
Limited to EPSDT and 
ILLINOIS  1995  T  Qualified Medicare Beneficiaries 
INDIANA  1992  T  Treatment and diagnosis limits added 
1983  T  Limited or eliminated many services 
KANSAS  1991  T  Limited to history and physical for EPSDT 
1995  T  Limit to EPSDT only 
LOUISIANA  1997  T  Expanded to include all Medicaid beneficiaries 
1991  T  Eliminated adults 
1993  T  Reinstated adults with 12 visits per year 
MICHIGAN  1996  T  Increased 12 visits to 18 
NEBRASKA  1993  T  Limited number of treatments 
NEW HAMPSHIRE  1995  T  Allow coverage of x-rays 
NEW JERSEY  1997  T  Added initial diagnostic visit to coverage 
Budget neutral. Allows chiropractor to perform x-ray, no 
NORTH CAROLINA  1991  longer requires physicians. 
Began x-ray reimbursement and raised limits from 6 
treatments to 40 per year (more than 12 require prior 
WEST VIRGINIA  1992  T  approval) 
Chiropractic Care Comprises a Small Proportion of Total State Medicaid Expenditures.  No 
Consistent Trends in Expenditures Appear. Some States Experienced Decreasing Costs over 
Time, While Others Saw Only Minor Fluctuations in Expenditure Levels. 
We asked States to report data for the years 1994 through 1996, distinguishing between adult and 
EPSDT beneficiaries and between managed care and fee-for-service expenditures.  Few reported 
data in that form, either because the data was unavailable or could not be extracted in the form 
requested.  Several States indicated they did not maintain separate data for adult and EPSDT 
beneficiaries or did not disaggregate EPSDT expenditures.  Also, most States did not have 
managed care data within which chiropractic expenditures were identifiable. However, 15 States 
did provide financial data reflecting total Medicaid expenditures and allowed payments for 
chiropractic care under their fee-for-service plans.  Table 6. summarizes this information. 
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7  TABLE 6. STATE-REPORTED CHIROPRACTIC EXPENDITURES 
AND PERCENT OF TOTAL MEDICAID EXPENDITURES, 
by STATE 
1994  1995  1996 
Chiropractic  %  Chiropractic  %  Chiropractic  % 
STATE  Payment  Total  Payment  Total  Payment  Total 
ARKANSAS  36,912  0.0034  44,095  0.0035  36,407  N/A 
CALIFORNIA  638,226  0.0064  607,915  0.0056  632,545  0.0553 
IDAHO  42,117  0.0127  41,962  0.0117  52,622  0.0130 
INDIANA  7,068,000  0.3020  2,822,000  0.1388  6,736,000  0.2766 
IOWA  1,664,533  0.1665  1,676,029  0.1523  1,648,935  0.0384 
LOUISIANA  9,177,891  0.3412  15,995,086  0.5777  4,282,654  0.1746 
MAINE  408,795  0.0455  376,786  0.0384  359,034  0.0363 
MINNESOTA  1,758,851  0.0811  2,246,935  0.0843  1,814,085  0.0617 
MONTANA  Not Available  N/A  15,693  0.0049  10,488  0.0031 
NEW JERSEY  439,919  0.0111  568,693  0.0135  503,829  0.0115 
NORTH CAROLINA  459,733  0.0161  700,158  0.0208  770,540  0.0207 
NORTH DAKOTA  255,085  0.0898  231,086  0.0779  224,490  0.0753 
TEXAS  783,882  0.0101  777,752  0.0101  1,028,304  0.0134 
UTAH  64,451  0.0125  235,237  0.0423  349,088  N/A 
VERMONT  166,557  0.0409  116,211  0.0345  114,374  N/A 
Beyond noting that chiropractic care is a very small percentage of total Medicaid expenditures, 
few overall trends are apparent.  Within States, California, Iowa, Maine, Montana, and North 
Dakota appear to have experienced a slight downward trend in chiropractic payments relative to 
total expenditures, while Vermont's expenditures decreased sharply.  In all but three of the 
remaining States, chiropractic expenditures and their relative  proportion of State totals 
fluctuated only slightly over the three year period.  Utah's expenditures increased, while 
Louisiana, and Indiana saw relatively large increases in 1995 which diminished in 1996.  With the 
exception of Louisiana, where limiting eligibility to EPSDT beneficiaries likely drove expenditures 
down between 1995 and 1996, and Utah, where chiropractic coverage began in July of 1994 and 
expenditures rose over the next two years, we are unable to correlate States' expenditure patterns 
with their reported benefit coverages and limits. 
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8  CONCLUSION 
While thirty States offer some form of coverage for chiropractic care under their Medicaid fee-
for-service plans, State reported utilization data show no discernable trends suggesting explosive 
growth in Medicaid expenditures.  Also, no State reported legislative or regulatory plans to 
expand their Medicaid chiropractic benefit beyond current coverage. 
COMMENTS 
The Assistant Secretary for Management and Budget (ASMB) provided comments on this report. 
ASMB asked us to further explain the growth in Medicaid chiropractic expenditures in the State 
of Utah.  We provided this information on page eight of this report.  The full text of these 
comments appears in Appendix A. 
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9  A P P E N D I X  A

TEXT OF AGENCY COMMENTS 
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A - 1
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A - 2
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A - 3