Excess Medical Expenditures Associated with Diabetes-Related Complications among Adult Medicaid Enrollees in Eight U.S. States
Authors: NG BOON PENG , SHRESTHA SUNDAR , SOLER ROBIN , SMITH BRYCE , ZHANG PING 
Published: June 2018

The financial burden imposed by diabetes on Medicaid is substantial. While most of this burden is due to treating diabetes-related complications, little information is available on how much Medicaid paid for those complications and variability by state. Using 2008-2012 Medicaid claims data, we estimated per-capita annual medical expenditures for treating selected diabetes-related acute and chronic complications among Medicaid enrollees. Our study population included adults aged 19-64 enrolled in fee-for-service plan from eight states with adequate sample size, stratified by eligibility criteria: disability vs. non-disability enrollees. Complication conditions were identified using ICD-9 codes and selected based on sufficient sample size to derive reliable estimates. We compared expenditures between those with and without selected complications to derive excess expenditures. Diabetes-related complications consumed a substantial amount of excess Medicaid health care resources across the eight states (Table). Excess expenditure levels varied by state, condition, and eligibility criteria, with ischemic heart disease and renal disease having the largest variation. Implementing effective diabetes prevention and control measures could reduce expenditures on complications.
Table: Estimated per capita excess annual medical expenditures among adult Medicaid enrollees associated with diabetes-related complications aged 19-64 years by eligibility-based disability status, (At US $ 2012 )ALCACTFLIAILNYOKDisability basedNeuropathy*2,2414,4426,3265,4377,7476,90610,5325,891Non-ESRD renal disease*7,92322,22615,25514,39615,25424,87534,00218,010Ischemic Heart Disease*4,82010,6197,9388,45412,38214,57921,28311,286Hypoglycemia5,94012,72616,98811,88312,47414,11718,10513,768One or more selected complications5,80115,59612,88111,69614,16517,88125,36214,260Non-disability basedNeuropathy*3,6814,7886,7524,4455,2266,7617,4546,799Non-ESRD renal disease*5,17817,48810,1717,4779,61417,05424,66313,553Ischemic Heart Disease*4,17614,90810,8677,26015,03114,38930,88612,200Hypoglycemia3,9648,47211,0877,2799,8319,76520,22911,102One or more selected complications4,75810,7429,7846,3659,17810,36919,64910,015Notes: All excess expenditures are statistically significant (P &lt; 0.01)AL: Alabama; CA: California; CT: Connecticut; FL: Florida; IA: Iowa; IL: Illinois; NY: New York; OK: Oklahoma*Non-ESRD renal disease identified based on ICD-9 codes for proteinuria/albuminuria, nephritis, anemia in chronic kidney disease, acute kidney failure, and other renal diseases without including ESRD, dialysis and transplant.; Ischemic heart disease was based on Chronic Conditions Data Warehouse algorithm. All complications were identified based on ICD-9 codes from the past studies; Medical expenditures were estimated using a generalized linear model with log link and gamma distribution, adjusted for age, sex, race/ethnicity, claims year and comorbidities; The excess medical expenditures associated with a diabetes-related complication were calculated as the difference in predicted expenditures for enrollees with and without the complication.

Disclosure
B. Ng: None. S. Shrestha: None. R. Soler: None. B. Smith: None. P. Zhang: None.