Number 323 March 2007

Traffic Safety Facts

Traffic Tech – Technology Transfer Series

Estimated Minimum Savings to a State’s Medicaid 

Budget by Implementing A Primary Seat Belt Law: 

Arkansas, Colorado, Florida, and Missouri

U.S. Department of Transportation 400 Seventh Street SW., Washington, DC 20590

National Highway Traffic Safety Administration

For front seat occupants of passenger cars, seat belts can reduce the risk of death by 45% and the risk of serious non-fatal

injuries by 50%. One method proven to be successful in increasing belt use is enacting primary seat belt laws in States.

According to the National Highway Traffic Safety Administration, passing a primary law can increase seat belt use rates

among non-users by 40%. A primary seat belt law allows a

police officer to issue a seat belt citation whenever they observe an unbelted front seat occupant. A secondary law allows police to only issue a seat belt citation if the vehicle has

been stopped for another violation.

Currently, only 25 States have primary laws. A 2003 study estimated that if all States had primary laws from 1995 to 2002,

over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a State’s budget

for Medicaid and other State medical expenditures. NHTSA

contracted with Preusser Research Group to examine the

minimum estimated savings on direct medical costs paid

through Medicaid if primary belt laws were implemented in

four States: Arkansas, Colorado, Florida, and Missouri.

Method

For Arkansas, Colorado, Florida, and Missouri, 2005 Hospital Discharge Data were analyzed, including only cases

where the external cause of injury was a motor vehicle crash.

The number of patients discharged after crash-related injuries and the number of these patients classified as having 

Traumatic Brain Injuries (TBI) and/or Spinal Cord Injuries

(SCI) is in Table 1. TBI and SCI tend to lead to long-term

post-hospitalization costs, continuing over one’s lifetime.

Table 1 also shows the costs billed to the State as Medicaid

or other sources paid by the State relative to the amount of

direct hospital costs.

Long-term direct medical costs vary greatly depending on

the injury. According to the Craig Hospital, during the first 

year after the injury has been incurred, post-hospitalization

TBI costs per person are estimated at $40,000 for rehabilitation and other medical costs. Subsequent year costs were estimated from the National Institute of Health values pertaining to traumatic brain injuries, lifetime costs for such injuries

and average lifespan of people with TBI. Beyond the first 

year, the average direct medical cost estimate was $26,871

per person per year. This study’s estimates did not include

peripheral costs such as lost wages and productivity.

Table 1. Costs Billed to States as Medicaid or Other 

Sources Paid Directly by the State

AR CO FL MO

# of patients discharged after 

crash-related injuries 4,721 4,639 16,691 7,901

# of patients classified as 

TBI or SCI 846 1,120 4,134 2,698

Direct hospital costs* $154.5 $261.4 $788.6 $321.5

Costs billed to State as Medicaid 

or other sources paid by State* $23.8 $37.7 $83.3 $75.7

*in millions

To estimate long term SCI costs, an analysis by University

of Alabama’s National Spinal Cord Injury Statistical Center

report was used. For the first year, average yearly expenses 

ranged from $200,000 to over $700,000 per person, depending on injury severity. For each year thereafter, average yearly costs were from $15,000 to over $100,000.

Finding an estimate of the percentage of TBI and SCI patients

likely to become Medicaid recipients is difficult. According 

to the Craig Institute, the proportion of those with TBI on

Medicaid doubles in the year following injury and for SCI,

25.4% of all SCI patients will become Medicaid patients within five years after injury.

Traumatic Brain Injury Costs

In 2005, 94 TBI patients on Medicaid were discharged from

Arkansas hospitals, 5 of whom died; 104 TBI patients onMedicaid were discharged in Colorado, 6 of whom died; 332 TBI

patients on Medicaid were discharged in Florida, 31 of whom

died; and 517 TBI patients on Medicaid were discharged from

Missouri hospitals, 23 of whom died. The patients that died

sustained only acute hospital costs. Actual hospital charges

were $5.0 million in Arkansas, $9.2 million in Colorado; $28.8

million in Florida; and $34.2 million in Missouri. Survivors
TRAFFIC TECH is a publication to disseminate information about

traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as you wish. If

you would like to receive a copy, contact Melissa Cheung, MPH,

Editor, fax 202-366-7096, e-mail: melissa.cheung@dot.gov.

generated this acute care cost and $40,000 per person of additional health care costs for the first year and another $26,871 

per person for each year after.

Spinal Cord Injury Costs

The number of SCI patients on Medicaid discharged from

Arkansas hospitals was 13; their actual hospital charges

were $1.4 million. In Colorado, there were 21 SCI patients on

Medicaid discharged with actual hospital charges of $8.1 million. In Florida, there were 13 SCI patients on Medicaid discharged, and their actual hospital charges were $4 million. In

Missouri, there were 52 SCI patients on Medicaid discharged,

with their actual hospital charges totaling $7.4 million.

Total Medicaid Costs

Table 2 summarizes estimated costs to Medicaid from motor

vehicle crashes from the first year the injury was incurred and 

subsequent years. Thus, the total first year cost is $36 million 

for Arkansas; $58.7 million for Colorado; $105.5 million for

Florida; and $132.6 million forMissouri. For subsequent years,

the cost is $6.7 million for Arkansas; $7.7 million for Colorado;

$21.4 million for Florida; and $30.7 million for Missouri.

Table 2. Estimated Costs to Medicaid From Motor Vehicle 

Injuries in Millions

AR CO FL MO

TBI 1st yr. $8.6 $13.1 $40.8 $54.0

Add. yrs. $4.8 $5.3 $16.2 $26.5

SCI 1st yr. $10.1 $25.2 $14.1 $44.5

Add. yrs. $2.0 $2.4 $5.2 $4.1

Other 1st yr. $17.4 $20.4 $50.6 $34.1

Add. yrs. n/a n/a n/a n/a

Total 1st yr. $36.0 $58.7 $105.5 $132.6

Add. yrs. $6.7 $7.7 $21.4 $30.7

Potential Savings 

by Adopting a 

Primary Law

1st yr. $0.6 $1.2 $2.3 $2.3

Add. yrs. $0.1 $0.2 $0.5 $0.5

Determining Costs Saved by Primary Law

Table 2 also shows the amount that could be saved by a State

by implementing a primary law. In 2005, the seat belt use

rate was 68.3% in Arkansas; Colorado’s was 79.2%, Florida’s

was 73.9%; and Missouri’s was 77.4%. Based on a 40% belt

use conversion rate, belt use could be expected to increase

by 12.68% in Arkansas; by 8.32% in Colorado; by 10.44% in

Florida; and by 9.04% in Missouri. The Federal Government

also reimburses a portion of States’ Medicaid expenditures.

The 2005 reimbursement rate for Arkansas, Colorado, Florida, and Missouri was 73.37%; 50.0%; 58.76%; and 61.60%,

respectively. Accounting for this reimbursement, the first 

year after implementing a primary law, Arkansas could

save $0.6 million; Colorado could save $1.2 million; Florida

could save $2.3 million; and Missouri could save $2.3 million. Figure 1 shows the projected yearly savings by passing

a primary law in 2007.

Figure 1. Projected Yearly Savings by Passing a Primary 

Law in 2007*

$0

$1

$2

$3

$4

$5

$6

$7

$8

$ Saved Millions

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Year

Arkansas

Colorado

Florida

Missouri

*Actual savings may be higher due to rising health care costs 

Discussion

Over the next 10 years, Arkansas can expect to save at least

$11.1 million; Colorado can expect to save at least $19.3 million; Florida can expect to save at least $43.2 million; and

Missouri can expect to save at least $46.8 million on their

annual budgets in medical costs alone by implementing primary seat belt laws in 2007.

This study reports the estimated minimum savings associated by implementing a primary law. So whenever multiple

credible values existed for an estimate, the lowest value was

chosen. Also, this study did not project cost increase over

time. Thus, Arkansas, Colorado, Florida, and Missouri could

expect to save even more money than the estimates reported

in this study by implementing a primary law.

How to Order

For a copy of Estimated Minimum Savings to a State’s Medicaid 

Budget by Implementing a Primary Seat Belt Law: Arkansas, Florida, Colorado and Missouri(Report for each State, 7pages eachplus

appendices), prepared by Preusser Research Group, write to

the Office of Behavioral Safety Research, NHTSA, NTI-130, 

400 Seventh Street SW., Washington, DC 20590, send a fax to

202-366-7096, or download from www.nhtsa.dot.gov.

400 Seventh Street SW., NTI-130

Washington, DC 20590