Spending Trends and COVID Impact

Spending Trends & COVID Impact

The pandemic didn't just disrupt Medicaid — it reshaped it. Utilization cratered in spring 2020, but the recovery wasn't a return to normal. It was a jump to a permanently higher baseline. Continuous enrollment provisions, telehealth expansion, and delayed care all contributed to a system that spends more, serves more people, and shows no signs of contracting.

Provenance

Methodological Guardrails

COVID Era Comparison

We split the data into three eras — Pre-COVID (2018-2019), COVID (2020-2021), and Post-COVID (2022-Oct 2024) — and compare average monthly spending to control for different era lengths.

SELECT * FROM medicaid.era_comparison

Post-COVID vs Pre-COVID Growth

SELECT
    category,
    MAX(CASE WHEN era = 'Pre-COVID (2018-2019)' THEN avg_monthly_paid_billions END) AS pre_covid,
    MAX(CASE WHEN era = 'COVID (2020-2021)' THEN avg_monthly_paid_billions END) AS covid,
    MAX(CASE WHEN era = 'Post-COVID (2022-2024)' THEN avg_monthly_paid_billions END) AS post_covid,
    ROUND((MAX(CASE WHEN era = 'Post-COVID (2022-2024)' THEN avg_monthly_paid_billions END)
     - MAX(CASE WHEN era = 'Pre-COVID (2018-2019)' THEN avg_monthly_paid_billions END))
    / MAX(CASE WHEN era = 'Pre-COVID (2018-2019)' THEN avg_monthly_paid_billions END) * 100, 1) AS pct_change
FROM medicaid.era_comparison
GROUP BY category
ORDER BY pct_change DESC

Every single category grew. But the growth stories are different:

• Home Health and Substance Use (~80%+ growth) — Structural shifts. Home health reflects the HCBS push away from institutional care. Substance use reflects the opioid crisis response.
• E&M, Dental, Mental Health (~50-60% growth) — Broad-based demand increases combined with Medicaid expansion and continuous enrollment.
• Surgery, Imaging (~40-50% growth) — Recovering deferred care from COVID plus underlying growth.

Monthly Trends by Category

SELECT * FROM medicaid.monthly_by_category
WHERE month <= '2024-10'
  AND category = '${inputs.selected_category.value}'

Try switching between categories. Notice how Mental Health barely dipped during COVID — demand for mental health services was relentless even during lockdowns, likely aided by rapid telehealth adoption. Compare that to Dental, which collapsed in spring 2020 (you can't do dentistry remotely) and took over a year to recover. Substance Use is the most concerning: spending keeps climbing but beneficiary counts have flattened in 2023-2024, suggesting rising per-person costs rather than more people getting help.

Key Takeaways

• [Descriptive, High confidence] Home health spending grew ~80% from pre-COVID to post-COVID — the dominant growth story in Medicaid
• [Descriptive, Medium confidence] Substance use spending up ~80% but beneficiaries only up ~20.6% — cost per person is spiking, raising questions about whether treatment is actually reaching more people
• [Descriptive, High confidence] Every category is higher post-COVID, both in spending and beneficiary counts
• [Descriptive, Medium confidence] Mental health showed steady growth through COVID with barely a dip — demand never let up
• The April 2020 collapse and recovery is visible across all categories, but the recovery trajectory varies dramatically — some categories snapped back in months, others took years

Citation: era and era_pivoted (source medicaid.era_comparison), plus filtered_cat (source medicaid.monthly_by_category).

Reproduce This Page

cd dashboard
export EVIDENCE_SOURCE__medicaid__token="<your_motherduck_token>"
export EVIDENCE_SOURCE__medicaid__database="medicaid"
npm run sources
npm run build
npm run preview
# then open http://localhost:3000/trends