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Foreword
Health care spending now consumes 13.6 percent of the Gross Domestic Product, with state governments as the single largest purchasers of health care in most markets. Total state spending for health care in fiscal year 1997 was $207.6 billion, about a fifth of national health care expenditures in that year.
This report arrays, for the first time, total spending for health care in each state across programs and using a common format. These data help to explain why states, until recently passive bill payers, are becoming active purchasers. Moreover, states are increasingly discussing common concerns about purchasing with their counterparts in the private sector.
States purchase health care for persons in every income and age group. These persons include public employees, their dependents and retirees, Medicaid recipients, children in families with low incomes, persons with mental illness or developmental disabilities, and prisoners. Many states also subsidize the care of patients of teaching hospitals and clinics. A number of states subsidize insurance for some adults who are employed in the private sector.
The report is a collaboration between the Reforming States Group (RSG) and the National Association of State Budget Officers (NASBO) that was facilitated by the Milbank Memorial Fund (the Fund). NASBO is a non-partisan professional organization for governorsí state finance officers that provides research and educational information on major public policy issues. The RSG, organized in 1992, is a voluntary association of leaders in health policy in the legislative and executive branches of government from over forty states. The Fund is an endowed national foundation, established in 1905, that works with decision makers in the public and private sectors to carry out nonpartisan analysis, study, research, and communication on significant issues in health policy.
This report was planned and supervised by members of the Executive Committee of NASBO and the Steering Committee of the RSG. John Colmers, Vice Chair of the RSG Steering Committee and Executive Director of the Maryland Health Care Access and Cost Commission, and Mark Ward, Director, Division of Budget and Finance, Missouri Department of Administration, developed the survey instrument and supervised a field test of it. State budget officers and members of their staffs in the fifty states and Puerto Rico compiled the data. Staff of NASBO aggregated the data reported by each state and prepared the executive summary and other general information. Legislators and executive branch officials discussed a draft of the report at three regional meetings of the RSG late in 1998.
The collaborators chose to include no comparative analysis in the report and make no judgements as to the appropriateness of the program area or magnitude of state expenditures. Officials in individual states, however, are likely to examine spending across states, choosing their own peers and items for comparison.
This first report on total state spending provides a baseline for arraying and comparing data in the future. NASBO, the RSG and the Fund intend to produce a second report, using fiscal year 1998 data. Responses from users of the reports will determine whether, and at what intervals, similar reports appear in the future
Daniel M. Fox
President, Milbank Memorial Fund
Sandy Praeger
Chair, Reforming States Group
Chair, Public Health and Welfare Committee
Kansas Senate
Gloria Timmer
Executive Director
National Association of State Budget Officers
Acknowledgments
The following persons participated in meetings to plan this report and/or reviewed it in draft. They are listed in the positions they held at the time of their participation.
Robert A. Bittenbender, Secretary, Pennsylvania Office of the Budget and President, National Association of State Budget Officers; Tim Burgess, Director, Georgia Office of Planning and Budget and Vice Chair, Health, Human Services, and Justice Committee, National Association of State Budget Officers; John M. Colmers, Executive Director, Maryland Health Care Access and Cost Commission and Vice Chair, Reforming States Group Steering Committee; John F. Cosgrove, Chair, Insurance Committee, Florida House of Representatives and Member, Reforming States Group Steering Committee; George Delaney, Director, Colorado Office of Planning and Budgeting and Chair, Health, Human Services, and Justice Committee, National Association of State Budget Officers; Mark Gibson, Policy Advisor for Health Care, Human Services and Labor, Office of the Governor of Oregon and Member, Reforming States Group Steering Committee; Lee Greenfield, Chair, Health and Human Services Finance Division, Minnesota House of Representatives and Immediate Past Chair, Reforming States Group Steering Committee; Lynne Koga, Director, Office of Planning and Budget, Office of the Governor of Utah and President-Elect, National Association of State Budget Officers; Jane Maroney, Chair, Human Needs and Development Committee, Delaware House of Representatives and Member, Reforming States Group Steering Committee; Sandy Praeger, Chair, Public Health and Welfare Committee, Kansas Senate and Vice Chair, Reforming States Group Steering Committee; Brian Roherty, Executive Director, National Association of State Budget Officers; Stan Stancell, Chief Deputy Director, California Department of Finance and Chair, Health, Human Services and Justice Committee, National Association of State Budget Officers; Gloria Timmer, Budget Director, Governorís Office, State of Kansas and President, National Association of State Budget Officers; Mark Ward, Deputy Commissioner, Missouri Division of Budget and Planning; Richard A. Westman, Minority Leader, Vermont House of Representatives and Member, Reforming States Group Steering Committee.
Mary Dingrando was the lead staff member of the National Association of State Budget Officers for the project, with assistance from Patrick Casados, Stacey Mazer, Nick Samuels, Lezlee Thaeler, and Kerry Wiersma.
Executive Summary
Economic Overview
States ended fiscal year 1997 in a strong financial position. The U.S. economy reveled in strong 3.7 percent growth, mild 2.0 percent inflation, 4.6 percent unemployment, low interest rates, and a seemingly unstoppable stock market. While the national economy continues to show overall strength, some regions have experienced moderation in their rates of growth. According to the most recent NASBO Fiscal Survey of States, the past few years represent a divergence from previous economic recoveries in that states continue to hold the line on spending while approving moderate tax cuts and building up healthy balances.
Outlook for the States
For the most part, states have benefited from the improving economy and have seen revenue collections increase and demand for some social services decrease. A few individual state economies face long-term adjustments and are not likely to regain momentum for several years due to continuing economic and demographic pressures. International and national policies are producing a new economic order that precludes postrecovery assumptions associated with the normal business cycle. The long-term prospects of slower economic growth and a decline in federal aid heighten the likelihood of constrained state spending in the future.
State Expenditures
States have emerged from a period in which balancing the budget overshadowed most other policy issues. Expenditures are coming in on target, and revenues are frequently exceeding projections. This period of economic expansion has enabled states to stabilize their operations. Total state spending in 1997, which captures both operating and capital expenditures, was approximately $783 billion, up 4.3 percent over 1996. Federal funds reflect a 4.0 percent increase, while state funds reflect a 4.2 percent increase. From 1995 to 1996, total state spending increased at the same rate, 4.3 percent, from $720 billion to $751 billion.
Total State Health Care Expenditures
Health care is the single most important cost-driver for the state and federal governments. At the state level, health expenditures are often viewed narrowly as only Medicaid or they are distributed into different programmatic areas, whereby the total is often obscured. The purpose of this report is to identify and summarize the amount of state-funded health expenditures in each of the following broad categories: Medicaid, state employees, public health services, corrections, higher education health care, insurance and access expansion, community-based services, and state facility-based services.
For purposes of this report, states were asked to report direct personal health expenditures. This includes expenditures to cover physical health conditions as well as mental health and substance abuse services. It does not include expenditures for subsistence and personal care. Spending detailed in this report for public health services, corrections, higher education health care, community-based services, and state facility-based services does not reflect total spending in these areas but, rather, direct personal health expenditures in those categories.
In demographic data collected for fiscal year 1997, states report a total population of 267.3 million. Medicaid caseload is almost 33 million, state employees total approximately 3 million, adult inmates total 1.1 million, and juveniles incarcerated total 110,240.
In fiscal year 1997, states spent $207. 6 billion on health care (see Table 1). In the context of total state spending, health care represented approximately 27 percent of state budgets. Figure 1 shows the proportion of total state health care expenditures from all funding sources relative to total state spending.
Figure 1: State Health vs. Non-Health Spending, Fiscal Year 1997.
As shown in Figure 2, the findings of this survey for fiscal year 1997 regarding state spending shares for health care spending are as follows: 77.2 percent for Medicaid, 5.9 percent for state employees, 1.4 percent for corrections, 3.3 percent for higher education health care, 0.3 percent for state insurance and access expansion, 3.8 percent for public health services, 3.7 percent for community-based services, and 4.5 percent for state facility-based services. Table 22 highlights the share of each stateís health care spending budget allocated to various programs and shows the wide variation in spending patterns among states.
Figure 2: Total Share Health Care Expenditures, Fiscal Year 1997
Each state reported its health care spending by funding source (state general funds, federal funds, and other state funds) for each of the eight categories. General fund revenues are received from broad-based state taxes and account for approximately 40 percent of total state health care expenditures. The general fund accounts for between 22.1 percent and 97.4 percent of the spending in each of the eight categories, with corrections receiving a high of 97.4 percent and insurance and access expansion receiving a low of 22.1 percent. Federal funds, which account for approximately 48 percent of total health care expenditures, are received by states directly from the federal government for specific purposes. The amount of federal funding in each category ranges from less than 1 percent of insurance and access expansion to 56.2 percent of Medicaid expenditures. Other state funds expenditures, which provide about 12 percent of total state health care expenditures, represent dedicated state funds. Those funds are the primary source of spending for insurance and access expansion, at almost 78 percent of expenditures, while providing only 1.3 percent of corrections health care expenditures.
State Health Care SpendingMedicaid
Medicaid is a means-tested program with rules mandated by the federal government. It is administered by states and provides medical care for low-income individuals. Participation in the Medicaid program is voluntary, although all states have elected to do so because of the matching federal funds. The jointly funded program requires state matching funds based on a federal rate that varies according to state per capita personal income.
States must provide Medicaid coverage to certain population groups (members of families with children and pregnant women, and persons who are aged, blind, or disabled) and have the option of covering other populations. Certain basic medical services must be provided; additional services may be covered if the state chooses. Covered services include inpatient hospital care, nursing homes, state facilities for the mentally retarded, home health care, physician services, outpatient hospital care, and prescription drugs.
In fiscal year 1997, states report a total Medicaid caseload of nearly 33 million, with expenditures of approximately $160.3 billion. Medicaid commands the largest share of total state health care expenditures, representing 77.2 percent of health care spending.
Individual statesí Medicaid spending ranges from 44.8 percent to 90.6 percent of total health care spending. In terms of the total state budget, Medicaid also represents the second largest share of spending, 20.5 percent. Table 2 shows Medicaid expenditures for the fifty states and Puerto Rico. (For state-specific information, see Explanatory Notes.)
Approximately 56 percent of Medicaid is financed by federal funds, with the remaining 44 percent split between the state general fund and other state funds. Fund shares for 1997 are provided in Figure 3.
Figure 3: Medicaid
State Employees
Health expenditures for state employees totaled $12.1 billion in fiscal year 1997, representing 5.9 percent of total state health spending and 1.6 percent of all state spending. These expenditures include health care premiums for state employees, the medical portion of workersí compensation, and Medicare payroll taxes paid on behalf of state employees. Of these, state employee health premiums of $10.3 billion represent 85 percent of total state employee health expenditures.
About two-thirds of the $12.1 billion represents general funds; the remainder includes other state and federal funds. Health expenditures for state employees represent 2.3 to 22.2 percent of total health spending. Approximately two-thirds of the states spent between 2 and 7 percent of total health spending on state employees.
These amounts reflect only the employer portion of the costs, and no out-of-pocket or employee cost-sharing is included in the total. Services covered may include prescription drugs, mental health, and vision programs where available. Amounts for self-insured plans include direct care and administrative costs. Amounts for state employee health premiums include benefits for dependents and for retirees and their dependents. Educational employees are excluded from the figures. The total number of state employees in fiscal year 1997 was nearly 3 million.
Fund shares for 1997 are provided in Figure 4. Some states reported only total fund spending rather than general funds, other state funds, and federal funds spending. Spending for these states appears in the undesignated fund source category.
Figure 4: State Employees
Corrections
Corrections health care expenditures generally reflect direct personal health expenditures for incarcerated adults and juveniles, including spending to cover both somatic conditions as well as mental health and substance abuse treatment. Services included in the corrections health care expenditures range from general health care to hospital and emergency room visits, infirmary medications, contractual medical services, and state-employed medical staff.
Given the ìtough on crimeî public sentiment, corrections health care spending may increase over the next few years. To combat crime, elected officials have instituted longer sentences, mandatory sentences for repeat offenders, less generous parole, and higher sentencing rates for most serious crimes. Many states also are struggling to define a juvenile justice philosophy in an environment that often lacks a juvenile justice system and appropriate facilities. Tougher measures for juvenile offenders continue to be the trend. Each of the above-mentioned factors could potentially increase corrections health care costs in the future.
States report a total of about 1.1 million adult inmates and 110,240 incarcerated juveniles. In 1997 states estimate they spent $2.8 billion on total corrections health care costs. Of this amount, $2.7 billion was spent on adult inmates and $117.7 million was spent on juveniles. Total corrections health care spending accounts for 0.4 percent of total state budgets and 1.4 percent of total state health care expenditures. Overall spending for corrections in 1997 was 3.8 percent of state budgets, or $29.7 billion. Tables 7, 8, and 9 reflect state totals for corrections health care spending, adult corrections health care spending, and juvenile corrections health care spending, respectively. (For state-specific information, see Explanatory Notes.)
Among the states, corrections health care spending ranged from 0.3 percent to 4.8 percent of total health care spending, or from $1.9 million to $452.7 million. Expenditures for adult corrections health care ranged from $1.7 million to $437.3 million for total funds expenditures. Expenditures for juvenile corrections health care ranged from $0 to $15.4 million for total funds expenditures. (For state-specific information, see Explanatory Notes.) Fund shares for 1997 are provided in Figure 5.
Figure 5: Corrections
Higher Education Health Care
For purposes of this report, higher education health care spending generally reflects state funding for the operation of state university-based teaching hospitals, including any state funds for health care premiums and coverage of teaching hospital employees. Teaching hospitals provide a setting for clinical teaching of medical students. Under close supervision of faculty/physicians, students have the opportunity to learn––by observation and limited participation––about patient diagnosis and treatment. Teaching hospitals also provide a setting for students to participate in clinical research.
Higher education health care spending reflects expenditures for students who receive training at teaching hospitals as well as patients and employees of the hospitals. Expenditures related to physician loan repayment programs, other incentive programs, and student health clinics are not included in higher education health care spending.
Not included in this report are direct state appropriations to educate students in degree-granting programs in medicine, dentistry, nursing, and the allied health professions. These programs include those within states and others (e.g., in Washington, Wyoming, Alaska, Montana, and Idaho [WWAMI]) that involve interstate agreements and subsidies.
In 1997 states estimate they spent approximately $6.9 billion on higher education health care costs. Higher education health care spending accounts for 0.9 percent of total state budgets. Overall higher education spending accounts for 10.6 percent of state budgets, or $83 billion. Higher education health care spending accounts for 3.3 percent of total state health care expenditures.
As a percent of total health care spending, higher education ranged from 0.0 to 20.5 percent. As shown in Table 10, expenditures ranged from $0 to $1.07 billion in total funds. (For state-specific information, see Explanatory Notes.)
Nine states reported no higher education health care spending. Based on information reported in the Integrated Postsecondary Education Data System (IPEDS) Institutional Characteristics Survey for 1996-1997, eight of the nine states that reported no higher education health care spending do not have teaching hospitals.
As shown in Figure 6, fund shares for 1997 are approximately 29 percent general funds, 31 percent federal funds, and 39 percent other state funds. Some states reported only total fund spending rather than general funds, other state funds, and federal funds spending. Spending for these states appears in the undesignated fund source category.
Figure 6: Higher Education Health Care
State Insurance and Access Expansion
States are taking various measures to extend health care coverage through state-only funded insurance programs and public-private partnerships. In addition to state-designed health insurance programs for children and their families, state insurance and access expansion includes state funding provided for high-risk pools and insurance subsidies. Some states have set up state-subsidized pools that enable people who have difficulty purchasing health care (due to high risk or pre-existing conditions) in the private market to buy health insurance. Participants are required to pay premiums under these programs.
As shown in Table 11, insurance and access expansion expenditures totaled $598.6 million in fiscal year 1997, representing 0.3 percent of total state health care expenditures. In terms of the total state budget, insurance and access expansion expenditures represent 0.1 percent of spending. Twenty-one states reported expenditures ranging from 0.1 to 5.1 percent of total health care spending. Expenditures in the fifty states range from $0.1 million to $142.2 million. Twenty-five states did not report any expenditures in this category. While not included in the total, Puerto Ricoís expenditures of $612 million are significant and reflect the recent privatization of their health care program for low-income people.
With additional child health funding from the State Childrenís Health Insurance Program (SCHIP), states hope to provide free or low-cost health care to at least half of the nationís uninsured children. The SCHIP program, which was created by the Balanced Budget Act of 1997, provides federal grants to states to design comprehensive health insurance programs for uninsured, low-income children. Congress authorized funding of the SCHIP program through 2007, specifying the following amounts: $4.3 billion for each of the years 1998-2001, $3.2 billion for each of the years 2002-2004, $4.1 billion for each of the years 2005-2006, and $5.0 billion for 2007. The SCHIP program is an entitlement for states, not for individuals, and these amounts are mandatory appropriations. Prior to the passage of the SCHIP program, Medicaid was the predominant way that states provided public funding for childrenís health insurance. The law allows states to use this new source of funds to expand insurance coverage under their existing Medicaid program, or to create a new state childrenís health insurance program, or a combination of both. States had access to these new funds starting October 1, 1997. This report, however, does not reflect any expenditures by any state for SCHIP.
As shown in Figure 7, fund shares for 1997 are predominantly other state funds, 77.6 percent, followed by general funds, 22.1 percent, and federal funds at 0.3 percent.
Figure 7: State Insurance and Access Expansion
Public Health Care
As defined in this report, public health care spending generally reflects direct personal health expenditures for rural or other local health clinics, state funds for Indian health care, and funds spent for the health care portion of AIDS grants. For purposes of this study, public health care does not include subsistence, personal care, or general public health.
The clients served by the public health care expenditures are specific to the programs offered and range from infants to the elderly and from patients to medical professionals. Programs included in public health care are:
- local health clinics
- non-federal Indian health care
- Ryan White AIDS grant
- icensing boards and regulatory oversight
Within the total for public health care expenditures are other public health care costs. Examples of these include:
- pharmaceutical assistance for the elderly
- childhood immunization
- chronic disease hospitals and programs
- hearing aid assistance
- Alzheimerís disease-adult day care
- health grants
- medically handicapped children
- Women, Infants, and Children (WIC)
- pregnancy outreach and counseling
- chronic renal disease
- AIDS testing
- breast and cervical cancer screening
- tuberculosis (TB) programs
- emergency health services
- adult genetics
- Phenylketonuria (PKU)
- health promotion and education programs
In 1997 states estimate they spent almost $7.8 billion on total public health-related costs, representing 3.8 percent of total health care expenditures (see Tables 12-17). Total public health care spending represented 1.0 percent of total state budgets. As a percent of total health care spending, total public health-related services ranged from 0.4 percent to 28.8 percent, with expenditures of $3.5 million to $1.6 billion. (For state-specific information, see Explanatory Notes.)
Within the total expenditures for public health services are the other public health care expenditures listed above. Total funds expenditures for other public health care ranged from $0 to $439.3 million. As shown in Figure 8, fund shares for 1997 are approximately 40 percent federal funds, 31 percent general funds, and 30 percent other state funds.
Figure 8: Public Health Care
State Facility-Based Services
As shown in Table 18, expenditures for state facility-based services totaled approximately $9.3 billion in fiscal year 1997, representing 4.5 percent of total state health spending and 1.2 percent of all state spending. Expenditures for state-operated long-term care facilities include all medical and room and board costs for veteransí homes and other nursing facilities not covered by Medicaid.
Examples of other state facilities include:
- schools for the blind
- schools for the deaf
- mental health hospitals
- facilities for the developmentally disabled
- substance abuse facilities
- veteransí homes
- rehabilitation facilities
Of the $9.3 billion, approximately 66 percent represents general funds, 14 percent represents federal funds, and 20.2 percent represents other state funds. States spending on services provided in state-based facilities ranged from 0.1 percent to 16.9 percent of total health spending. About one-third of the states spent between 2 and 6 percent, six states spent less than 2 percent, six states spent more than 10 percent, and one state did not spend any amount on what was defined as state health spending on services provided in state-based facilities. Fund shares for 1997 are shown in Figure 9.
Figure 9: State Facility-Based Services
Community-Based Services
Expenditures for community-based services totaled $7.7 billion (see Table 21), representing 3.7 percent of total health spending and 1.0 percent of all state spending in fiscal year 1997. Services in this category exclude those eligible for reimbursement under the Medicaid program, which are reported elsewhere.
Examples of services include:
- rehabilitation services
- alcohol and drug abuse treatment
- mental health community services
- developmental disabilities community services
- vocational rehabilitation services
States exhibit a considerable range of community-based service expenditures as a percent of total health spending. Fourteen states spent 2 percent or less, sixteen states spent over 5 percent, and five states did not spend any amount on what was defined as community-based services. Of the $7.7 billion, approximately 62 percent represents general funds, 17 percent represents federal funds, and 21 percent represents other state funds. Fund shares for 1997 are provided in Figure 10.
Figure 10: Community-Based Services
Definitions
Fiscal Year 1997
State fiscal year beginning in calendar year 1996 and ending in calendar year 1997.State General Fund Expenditures
The general fund is the predominant fund for financing a stateís operations. Revenues are received from broad-based state taxes.Other State Fund Expenditures
These funds largely represent state funds provided for health care through sources other than the general fund.Federal Fund Expenditures
Funds received directly from the federal government.Health Expenditures
Personal health expenditures, including spending to cover somatic conditions as well as mental health and substance abuse treatment. Does not include subsistence, personal care, or general public health (except direct health care services).Medicaid Expenditures
Information reported on the HCFA-64 report, with the subcategories of the report incorporated and converted to state fiscal year. All Medicaid expenditures are reported under this category; to avoid double counting, Medicaid expenditures are not included in any other responses.Other Direct Health Expenditures
Includes only the health expenditures defined above for state hospitals, state-operated schools, alcohol and drug treatment (not prevention), childhood immunizations, developmental disability, and mental health (including community services). In the final report, items listed in this category were divided into the following three categories: Other Public Health Expenditures, Other State Facility Expenditures, and Community-Based Services.Public Health-Related Expenditures
Includes local health clinics, Ryan White AIDS grant expenditures, Indian health, and regulatory and licensing expenditures. Also includes items listed by states under ìOther Direct Health Expendituresî that could be classified as public health expenditures, such as childhood immunizations.State Facility-Based Services Health Expenditures
Includes state-operated long-term care facilities, veteransí homes, and ìOther Direct Healthî services provided in state facilities including mental health facilities, developmentally disabled facilities, schools for the blind, and so on.Community-Based Services Health Expenditures
Includes ìOther Direct Healthî mental health services, developmentally disabled services, substance abuse services, and so on.State Insurance and Access Expansion
Includes state funding provided for high-risk pools and insurance subsidies. Also includes health care coverage extended through state-only funded insurance programs and public-private partnerships.State Employee Health Premiums
Premiums for insurance products and direct care plus administrative expenses for self-insured products. This population includes employees and retirees and their dependents. Carved-out benefits for such services as prescription drugs, mental health, and vision are also included. Funds from employees in employee flexible spending (cafeteria) accounts are excluded as well as the state employee match. K-12 employees are not included because health care premiums for such employees are usually budgeted through the local school districts and as such are not state costs. Colleges and universities are not included.Corrections Health Care Expenditures
Personal health expenditures, including spending to cover somatic conditions as well as mental health and substance abuse treatment. Does not include subsistence, personal care, or general public health (except direct health care services). These expenditures are reported separately for adults and juveniles.State-Operated Long-Term Care Facilities
Includes all costs (medical, room and board, other) for veteransí homes or other nursing facilities that are not covered by Medicaid.Local Health Clinics
Includes state assistance provided to rural or other local health clinics.Medical Portion of Workersí Compensation
Includes the amount spent for state employees.Non-Federal Indian Health Care
If applicable, includes state funds spent for Indian health care.Ryan White AIDS Grant
Includes funds spent for the health care portion of AIDS grants.Higher Education Health Care
State support to fund the operation of state university-based teaching hospitals, including any state funds for health care premiums or coverage of teaching hospital employees. Excludes physician loan repayment or other incentive programs and student health clinics. Also excludes direct state appropriations to educate students in degree-granting programs in medicine, dentistry, nursing and the allied health professions.Medicare Payroll Taxes
Includes the amount attributable to state employees. The same definition of state employees as for State Employee Health Premiums is followed.
General Notes
The report presents aggregate and individual data on the statesí direct personal health expenditures in the following categories: Medicaid, state employees, corrections, higher education health care, state-only insurance and access expansion, public health-related services, state facility-based services, and community-based services. This includes expenditures to cover somatic conditions, as well as mental health and substance abuse treatment. It does not include expenditures for subsistence and personal care. Spending detailed in this report for public health-related services, corrections, higher education health care, community-based services, and state facility-based services does not represent the totality of spending in these areas. Rather, it represents direct personal health expenditures in these categories as defined above. Estimated total state budget information detailed on the state profiles was obtained from the NASBO 1997 State Expenditure Report. Numbers may not add due to rounding.
State specific pie charts may or may not contain all categories (Medicaid, state employees, corrections, higher education health care, state-only insurance and access expansion, public health-related services, state facility-based services, and community-based services); some states did not report direct health expenditures in all categories.
Some methodological issues with the reporting of state expenditures within these categories are listed below.
Medicaid: The amounts reported are those reflected on the HCFA-64 Form and converted to state fiscal year.
State Employees: Some states were unable to break out state employee-related expenditures by fund source and included only total fund expenditures for state employees.
Corrections: Due to variations among the states, the data reported may include different items. For example, some juvenile corrections services are operated by the counties, with state support via grants; some juvenile health care expenditures are funded through grants to county child welfare programs; and expenditure data may or may not include data on county correctional systems.
Higher Education Health Care: Due to variations in state operations, the data reported may reflect different types of higher education health care expenditures for different states. For example, not all states have teaching hospitals associated with their medical schools, the expenditures may include hospital employee benefits costs in some states but not others, and some statesí expenditures may include operating costs whereas others may not.
Public Health-Related Expenditures: The data do not include all expenditure information for state health departments, and most states reported a variety of programs in the expenditure data.
- State Health Care Spending by Region
- Table 1: Total State Health Care Expenditures
- Table 2: Medicaid Expenditures
- Table 3: Total State Employee Health Expenditures
- Table 4: State Employee Health Premium Expenditures
- Table 5: Medical Portion of Workers' Compensation Expenditures
- Table 6: Medicare Payroll Tax Expenditures
- Table 7: Total Corrections Health Care Expenditures
- Table 8: Adult Corrections Health Care Expenditures
- Table 9: Juvenile Corrections Health Care Expenditures
- Table 10: Higher Education Health Care Expenditures
- Table 11: Insurance and Access Expansion Expenditures
- Table 12: Total Public Health Related Expenditures
- Table 13: Local Health Clinic Expenditures
- Table 14: Ryan White AIDS Grant Expenditures
- Table 15: Non-Federal Indian Health Expenditures
- Table 16: Licensing Boards and Regulatory Oversight Expenditures
- Table 17: Other Public Health Expenditures
- Table 18: Total State Facility-Based Services Health Expenditures
- Table 19: State Operated Long-Term Care Facility Expenditures
- Table 20: Other State Facility Expenditures
- Table 21: Community-Based Services Health Expenditures
- Table 22: Shares of Health Care Spending as a Percent of Total Health Care Spending
Explanatory Notes Submitted by Particular States by RegionNew England
Connecticut
Medicaid: Medicaid is gross appropriated in Connecticut. Federal financial participation (FFP) is deposited as revenue.
State Employee Health Premiums: Other state funds and federal funds as well as other funds are included in the total. Premiums for state employees in the vocational-technical high schools and the colleges and universities are also included in the numbers for the general fund and total funds.
Juvenile Corrections: Juvenile Corrections is included in Medicaid Managed Care.
State-Operated Long-Term Care Facilities: Figures reflect $30.6 million non-ICF/MR from the Department of Mental Retardation (DMR), $28.1 million other clinical from DMR, and $1.4 million from the Department of Veterans Affairs (DVA).
Other State Facilities: Figures include non-Medicaid expenditures of $103.5 million in the Department of Mental Health and Addiction Services, $22.6 million in Department of Children and Families (DCF), and $16.3 million in Department of Veterans Affairs.
Higher Education Health Care: Does not include clinical operation (patient-generated revenue including Medicaid and Medicare).
Medicare Payroll Taxes: Includes all state employees, including employees of colleges, universities, and vocational-technical high schools.
Maine
Other Public Health: Childhood Immunizations: These costs reflect all expenditures related to immunization including salaries, general operations, drugs, contracts with private agencies, and so on.
Massachusetts
State Employee Health Premiums: Includes medical, dental, and vision.
Medical Portion of Workersí Compensation: Information not available by fund.
Higher Education Health Care: Includes $53.2 million in spending from ìother sourcesî: student fees, endowment grants, and enterprise revenue.
Community-Based Services: Does not include prevention for substance abuse.
Adult Corrections: Includes only direct state corrections spending and is not inclusive of spending for county correctional systems.
New Hampshire
State Employee Health Premiums: State employee health premium figures include postsecondary technical education employees.
Rhode Island
Adult Corrections: Total includes correctional health care expenditures, such as cost to local hospitals and emergency rooms, infirmary medications, contractual medical services, and FTE medical staff costs.
Juvenile Corrections: Total includes cost of 2.0 FTE RN positions. State funds spent for inmates only.
State-Operated Long-Term Care Facilities: Rhode Island does not have a state-operated long-term care facility; state spending on this facility has been incorporated in State Corrections Health Care Expenditures. Total spending in fiscal year 1997 for the hospital system is as follows: state general fund: $43.4 million; federal funds: $57.1 million; and other state funds: $0.7 million.
Medical Portion of Workersí Compensation: Figure includes Workersí Compensation expenditures for treatment services, hospital or other care facilities, and medicine and drugs.
Vermont
Insurance and Access Expansion: Amounts included in Medicaid spending figure.
Mid Atlantic
Delaware
Medicaid: General fund and total funds figures include expenditures for wrap-around services.
State Employee Health Premiums: Other state funds and federal funds combined.
Adult Corrections: State general fund and total funds include AIDS education expenditures.
Medical Portion of Workersí Compensation: Funds are budgeted within each agency and then transferred to a central location for expenditure.
Medicare Payroll Taxes: Other state funds and federal funds are combined.
Maryland
Medicaid: Total Medicaid statewide not limited to provider reimbursement.
Insurance and Access Expansion: Includes Maryland AIDS Insurance Assistance; AIDS Insurance Payment Program; Maryland Pharmacy Program.
State Employee Health Premiums: Total is state contribution only. Employee contributions increase total expenditure to $390.1 million.
Medicare Payroll Taxes: Represents 1997 calendar year expenses.
New Jersey
Medicaid: Other state funds are from the Casino Revenue Fund. Expenditures listed do not include administration or expenditures for Personal Care Services by Division of Medical Assistance and Health Services as per instructions. Personal Care Services expenditures consisted of $24.6 million in other state funds (Casino Revenue Fund) and $24.6 million in federal funds for a total of $49.2 million in fiscal year 1997. Expenditures include Medicaid expenditures for nursing homes, nursing home peer groups, and community care waivers as per instructions.
Insurance and Access Expansion: Expenditures are for the New Jersey ACCESS Program.
Local Health Clinics: Funds are from Public Health Priority Funding (State Aid).
Higher Education Health Care: Expenditures are for health benefit costs only and do not include operational costs.
Licensing and Regulatory: Expenditures for Health Care Licensing Boards in fiscal year 1997 are as follows: Board of Dentistry, $901,000; Medical Examiners, $5,651,000; Nursing, $3,908,000; Optometrists, $394,000; Pharmacy, $1,582,000; Ophthalmology, $211,000; Board of Psychology, $417,000; Chiropractic Examiners, $538,000; Physical Therapy, $300,000; Audiology/Speech, $111,000; Respiratory Care, $196,000; Orthotics/Occupational Therapy, $4,000. Total expended: $14,216,000. (Licensees fund the Boardsí operations through license fees, fines, penalties, and so on. No state funds support their operations.)
Other Public Health:
- Pharmaceutical Assistance to the Aged and Disabled: other state funds are from the Casino Revenue Fund/Department of Health and Senior Services.
- Hearing Aid Assistance: Other state funds are from the Casino Revenue Fund/Department of Health and Senior Services.
- Alzheimerís Disease: Other state funds are from the Casino Revenue Fund/Department of Health and Senior Services.
- Community-Based Services: Home Care Expansion Program: Other state funds are from the Casino Revenue Fund/Department of Health and Senior Services. Expenditures may fall under the excluded category of Personal Care, as they include only several services delivered to in-home clients.
- Respite Care: Other state funds are from the Casino Revenue Fund/Department of Health and Senior Services. Expenditures may fall under the excluded category of Personal Care, as they include only several services delivered to in-home clients.
- Alcohol and Drug Treatment: Excludes administration and prevention. Includes treatment and rehabilitation, services to women, Campus Program. Other state funds are from the Alcohol Trust Fund, Drug Enforcement and Demand Reduction (DEDR) Fund, Department of Human Services, and Department of Corrections Mutual Agreement Program.
New York
Insurance and Access Expansion: Most expenditures for Insurance and Access Expansion are reflected in the reported Medicaid expenditures.
Non-Federal Indian Health Care: Federal funds expenditures are from the Maternal and Child Health Block Grant.
Local Health Clinics: Federal funds expenditures are from the Maternal and Child Health Block Grant.
Other State Facilities: Mental health and developmental disabilities expenditures include $34.2 million in mental health expenditures incurred at Office of Mental Health satellite units located in state correctional facilities (forensics program).
Pennsylvania
Medicaid: There may be overlap between Medicaid, State Employee Health Premiums, and Medicare Payroll Taxes. The expenditures shown here include Medicaid program administration, which would include the cost of employee health care premiums.
Insurance and Access Expansion: Includes Childrenís Health Insurance Program and Catastrophic Loss Fund.
State Employee Health Premiums: Excludes the State System of Higher Education, Auditor General, School Building Authority, Legislature, and Judiciary. Includes Treasury, Attorney General, and active, annuitant, and State Police Programs. Distribution by source of funds is estimated.
Juvenile Corrections: State has a dual juvenile system with about half of the youth being maintained in county or private facilities. The state shares in the health care costs through grants to county child welfare programs, but the amount is unknown.
Medical Portion of Workersí Compensation: Estimated portion of Medical Portion of Workersí Compensation costs. Distribution by source of funds is estimated.
Higher Education Health Care: State-related, not owned universities.
Medicare Payroll Taxes: Agencies on the integrated central accounting system. Distribution by source of funds is estimated.
Great Lakes
Illinois
State Employee Health Premiums: Includes employees (unable to break out).
Medicare Payroll Taxes: Unable to break out by fund.
Indiana
State Employee Health Premiums: Other state funds and federal funds are figured together.
Higher Education Health Care: Other state funds includes debt service.
Michigan
Higher Education Health Care: Includes Medicaid-funded graduate medical education program expenditures at the University of Michigan hospital and a portion of the state support for the Joseph F. Young, Sr. psychiatric research and training program at Wayne State University.
State-Operated Long-Term Care Facilities: Figure represents fiscal year 1997 expenditures for veteransí homes.
Other State Facilities: Mental health spending includes spending on developmentally disabled clients; does not include spending on substance abuse.
Ohio
Total State Health Care Expenditures: Ohioís general fund expenditures may be overstated in comparison to other states because of the factors discussed in the Medicaid footnote.
Medicaid: Ohio deposits federal reimbursements for Medicaid, Temporary Assistance for Needy Families, and several other human services programs in its general fund. The total Medicaid amount includes Medicaid payments for graduate medical education. Other state fund data includes other state funds and revenue sources used as Medicaid match, such as provider taxes. It also includes $135.4 million estimated local funds used as Medicaid match.
Other Public Health: This response includes the Medically Handicapped Children program that provides funding for diagnosis and treatment and supportive services for children with special health care needs. The program also sets standards for specialized care for those children. Services are coordinated and provided in the community.
State-Operated Long-Term Care Facilities: The expenditures represent long-term care and domiciliary care at the Ohio Veterans Home.
Wisconsin
Juvenile Corrections: These funds are part of youth aid the state pays to counties to purchase juvenile corrections services from state institutions.
Local Health Clinics: Dollars may be funneled to these agencies from other categorical grants, but it is not possible to break these out.
Higher Education Health Care: Federal funds figure represents mostly research dollars.
Plains
Kansas
Insurance and Access Expansion: Represents Medical Portion of Workersí Compensation and Health Care Stabilization Fund.
State Employee Health Premiums: Federal funds portion unknown. Numbers include administrative service fees, claims, HMO premiums, and capitated prescription drugs.
State-Operated Long-Term Care Facilities: Represents spending for Kansas Soldiers Home.
Medical Portion of Workersí Compensation: Federal funds portion unknown.
Medicare Payroll Taxes: Federal funds portion unknown.
Licensing and Regulatory: Spending represents Board of Healing Arts.
Minnesota
Local Health Clinics: Unknown; grants not tracked at this level.
Non-Federal Indian Health Care: Unknown; grants not tracked at this level.
Missouri
Medicaid: Other state funds data include $273.5 million for hospital and nursing home provider taxes not expended from the state treasury.
Nebraska
Insurance and Access Expansion: The Comprehensive Health Insurance Pool is funded by assessments to health insurance carriers.
South Dakota
Insurance and Access Expansion: Public Entity Pool for Liability.
Southeast
Alabama
Insurance and Access Expansion: Insurance Program for high-risk pools became effective January 1, 1998.
State Employee Health Premiums: Amounts listed by fund source are estimates.
Local Health Clinics: Total includes clinic care and home health care plus Maternity Waiver Program.
Medical Portion of Workersí Compensation: For employees covered by the State Employees Injury Compensation Trust Fund. Does not include employees specifically exempt per Alabamaís code.
Medicare Payroll Taxes: For calendar year 1997. Amounts listed by fund source are estimates.
Arkansas
State Employee Health Premiums: Distinction between general fund and other state funds different from other questions due to accounting records.
Juvenile Corrections: Health care expenditures: Less than $10,000. Medical Portion of Workersí Compensation: Distinction between funds unavailable due to consolidated payments.
Medicare Payroll Taxes: Distinction between general fund and other state funds different from other questions due to accounting records.
Florida
State Employee Health Premiums: Total funds amount is currently unavailable because federal funds expenditures cannot be determined at this time.
Higher Education Health Care: Per NASBO survey definitions regarding higher education health care, the state of Florida currently has only two state university-based teaching hospitals.
Georgia
Medicaid: General funds include other state funds as reported in HCFA-64 reports.
Insurance and Access Expansion: State has a high-risk health insurance plan; however, the law creating the plan is only effective upon appropriation of funds. No funds have been appropriated.
State-Operated Long-Term Care Facilities: These numbers represent state-operated veteransí nursing homes. Funding for other state-operated long-term care facilities is included in both the Medicaid and the state facility categories.
Higher Education Health Care: Federal funds include other state funds; not possible to break out the two funding sources.
Medicare Payroll Taxes: Not possible to break out fund sources.
Kentucky
Other State Facilities: Mental Health/Mental Retardation Services: Exclude Medicaid funds, which are included in the data for Medicaid spending in fiscal year 1997.
Non-Federal Indian Health Care: We do not track this. We have no programs specifically for Native Americans.
Other Public Health:
- Public Health Services: Excludes Medicaid funds, which are included in the data for Medicaid spending in fiscal year 1997.
- Commission for Children with Special Health Needs: Excludes Medicaid funds, which are included in the data for Medicaid spending in fiscal year 1997.
Louisiana
Medicaid: Excludes payments to public providers.
State-Operated Long-Term Care Facilities: Federal Medicaid funds are shown in Medicaid expenditures.
Local Health Clinics: Excludes local expenditures for this purpose.
Insurance and Access Expansion: Louisiana spent $2.0 million for Insurance and Access Expansion; however, because the percentage relative to total state health care spending is less than 0.1 percent, the amount is not reflected on Table 22 or on the stateís pie chart.
Mississippi
Medical Portion of Workersí Compensation: The Medical Portion of Workersí Compensation expenditures could not be broken down by general fund, other state funds and federal funds. Also, not all state agencies are included in the Medical Portion of Workersí Compensation pool; most notably absent is the Department of Transportation and Public Safety.
Higher Education Health Care: Funding could not be broken down by general fund, other state funds, and federal funds. The total $26.1 represents premiums for colleges and universities but not junior/community colleges.
Medicare Payroll Taxes: Medicare payroll taxes are not broken down separately from some other taxes; therefore, for fiscal year 1997, we are unable to provide an amount for this item.
North Carolina
Medicaid: Includes county funds. State Employee Health Premiums: Other state funds includes federal and other receipts. There is about $116 million for public school employees not included, based on 1996 Actual.
State-Operated Long-Term Care Facilities: This represents state aid for long-term care. State long-term care facilities include psychiatric hospitals, developmental disability expenditures, and substance abuse treatment expenditures.
Medical Portion of Workersí Compensation: Includes $15 million for public school employees. Reports do not distinguish between the type of funds expended.
Tennessee
Insurance and Access Expansion: Tennessee spent $0.1 million for Insurance and Access Expansion; however, because the percentage relative to total health care spending is less than 0.1 percent, the amount is not reflected on Table 22 or on the stateís pie chart.
Virginia
Non-Federal Indian Health Care: Also included in local health care figure.
West Virginia
State Employee Health Premiums: Data estimated by fund source.
Licensing and Regulatory: Expenditures for health facility licensure and certification only.
Medical Portion of Workersí Compensation: Data estimated by fund source.
Medicare Payroll Taxes: Data estimated by fund source.
State-Operated Long-Term Care Facilities: Includes state-owned facilities only.
Southwest
New Mexico
State Employee Health Premiums: Data not available by fund source.
Non-Federal Indian Health Care: There are specific set-asides for Native Americans in mental health and substance abuse programs; however, Native Americans can receive all health services provided by the state. Most services are not segregated along racial or ethnic lines.
Higher Education Health Care: Data not available by fund source.
Other State Facilities: These expenditures are for direct service contracts and do not include administration. Of this amount, $22.4 million is state match for Medicaid waiver for developmentally disabled clients.
Community-Based Services: These expenditures are for direct service contracts and do not include administration.
Oklahoma
Medicaid: State share (total expenditures less federal share) less collections. Federal funds (HCFA line 6). Total funds includes state and federal expenditures from all agencies on Medicaid programs (HCFA line 6).
Higher Education Health Care: This represents indigent care funding in a teaching setting.
Insurance and Access Expansion: Oklahoma spent $0.2 million for Insurance and Access Expansion; however, because the percentage relative to total health care spending is less than 0.1 percent, the amount is not reflected on Table 22 or on the stateís pie chart.
Texas
Medicaid: Within Medicaid there is significant spending for community-based services and state facility-based services.
Community-Based Services: Expenditures include $7.2 million from corrections. There is significant spending for community-based services within Medicaid.
Other State Facilities: There is significant spending for state facility-based services within Medicaid.
Rocky Mountain
Colorado
Higher Education Health Care: Colorado spent $0.5 million for health care expenditures in higher education; however, because the amount relative to total health care expenditures is less than 0.1 percent, the amount is not reflected on Table 22 or on the stateís pie chart.
Idaho
Medical Portion of Workersí Compensation: Amount of medical claims paid for state employees.
Montana
Higher Education Health Care: Montana spent $0.1 million for health care expenditures in higher education; however, because the amount relative to total health care expenditures is less than 0.1 percent, the amount is not reflected on Table 22 or on the stateís pie chart.
Utah
Medical Portion of Workersí Compensation: This is the total amount paid for Medical Portion of Workersí Compensation. If there is a medical portion, it will have to be obtained from Medical Portion of Workersí Compensation. Also, these figures do not include higher education.
Medicare Payroll Taxes: Amounts do not include higher education.
Wyoming
Other State Facilities: $7.8 million of these expenditures represent state training school general fund share of ICF/MR and the federal share is shown in Medicaid.
Community-Based Services: $1.6 million of these expenditures are for state-funded nursing home, prescription drugs, medical care for foster children and pays for services from private providers. $7.9 million of these expenditures are for mental health and substance abuse community programs. These services are provided by local, private nonprofit corporations. $21.3 million of these expenditures are for a developmental disabilities waiver for adults and children. Services are provided by local, private non-profit corporations. Adult and children federal waiver costs are shown in Medicaid.
Far West
Alaska
Medicaid: Figures include medical assistance administration.
State Insurance and Access Expansion: Not applicable; self insured.
Higher Education Health Care: Not applicable.
California
State Employee Health Premiums: General fund includes $265.8 million for annuitant benefits. Total funds includes costs for active employees (from State Controllerís Office [SCO]) and for annuitants (from 1998-99 Governorís Budget 9650 Display). Applied fund split of 49 percent general fund, 23 percent other state funds and 28 percent federal funds to SCO data pursuant to Schedule 9 of 1998-99 Governorís Budget. Annuitant benefit costs are 100 percent general fund. Total costs include cost of health/dental/vision premiums.
State-Operated Long-Term Care Facilities: Veteransí homes.
Medical Portion of Workersí Compensation: Total funds from Department of Personnel Administration. Applied fund split of 49 percent general fund, 23 percent other state funds, and 28 percent federal funds based on actual 1996-97 state operation expenditures in Schedule 9. Includes medical payments made under Californiaís ìlegally uninsured,î pay-as-you-go system. Does not include cost for small percentage of state employees who are insured for Medical Portion of Workersí Compensation for a total premium cost of approximately $3.0 million.
Medicare Payroll Taxes: Total fund data from State Controllerís Office. Applied fund split of 49 percent general fund, 23 percent other state funds, and 28 percent federal funds to SCO data pursuant to 1998-99 Governorís Budget Schedule 9 actual expenditures for 1996-97.
Hawaii
Higher Education Health Care: No teaching hospitals.
Nevada
Medicare Payroll Taxes: Unable to break down by fund; pay lump sum.
Oregon
Medicaid: A portion of Medicaid spending is for community-based services and state facility-based services.
Community-Based Services: Medicaid is used to support a portion of community-based services.
Other State Facilities: Medicaid is used to support a portion of state facility-based services.
Higher Education Health Care: Includes support of Oregon Health Sciences University (OHSU) operation; education costs, support of child development and rehabilitation; and support of health education centers.
Insurance and Access Expansion: Oregon spent $0.7 million for Insurance and Access Expansion; however, because the percentage relative to total health care spending is less than 0.1 percent, the amount is not reflected on Table 22 or on the stateís pie chart.
Puerto Rico
Medical Portion of Workersí Compensation: Expenditures are as follows: Premiums: $77.8 million state general fund; Medical Compensation: $169.8 million state general fund; Medical Services Expense: $189.5 million state general fund. Figures in table reflect premium expenditures only.
State Insurance and Access Expansion: Puerto Rico started its health reform in fiscal year 1993-94. Its most important objective is to provide access to all the citizens of Puerto Rico, regardless of their economic conditions, and to control the health services costs. Its beneficiaries are those up to 200 percent of Medicaid eligibility. Health reform is mostly financed by general fund resources, federal appropriations (Medicaid), and municipal funds. On June 30, 1997, there were 1,090,592 participants, and when this reform is completed, the government expects over 1,800,000 participants.
- Individual State Profiles by Region
- NEW ENGLAND:
- Connecticut
- Maine
- Massachusetts
- New Hampshire
- Rhode Island
- Vermont
- MID-ATLANTIC:
- Delaware
- Maryland
- New Jersey
- New York
- Pennsylvania
- GREAT LAKES:
- Illinois
- Indiana
- Michigan
- Ohio
- Wisconsin
- PLAINS:
- Iowa
- Kansas
- Minnesota
- Missouri
- Nebraska
- North Dakota
- South Dakota
- SOUTHEAST:
- Alabama
- Arkansas
- Florida
- Georgia
- Kentucky
- Louisiana
- Mississippi
- North Carolina
- South Carolina
- Tennessee
- Virginia
- West Virginia
- SOUTHWEST:
- Arizona
- New Mexico
- Oklahoma
- Texas
- ROCKY MOUNTAIN:
- Colorado
- Idaho
- Montana
- Utah
- Wyoming
- FAR WEST:
- Alaska
- California
- Hawaii
- Nevada
- Oregon
- Washington
- PUERTO RICO:
- Puerto Rico
Additional Resources
Web sites provide a good starting point for finding further information. Web site addresses for the Milbank Memorial Fund and NASBO are listed below along with other resources that readers may find useful:
- Milbank Memorial Fund
www.milbank.org- National Association of State Budget Officers
www.nasbo.org- National Governorsí Association
www.nga.org- National Conference of State Legislatures
www.ncsl.org- The U.S. Census Bureau
www.census.gov- RAND
www.rand.org- The Urban Institute
www.urban.org
Selected Web Resources for Medicaid:
- Health Care Financing Administration
www.hcfa.gov- Center for Health Care Strategies
www.chcs.org- The Medicaid Clearinghouse
www.handsnet.org/medicaid- Kaiser Commission on the Future of Medicaid
www.kff.org/state_health/- Administration for Children and Families
www.acf.dhhs.gov
Selected Web Resources for State Employees:
- Bureau of Labor Statistics (Employee Benefits)
www.bls.gov/ebshome.htm- Employee Benefit Research Institute
www.ebri.org
Selected Web Resources for Corrections:
- Bureau of Justice Statistics
www.ojp.usdoj.gov/bjs- Justice Information Center
www.ncjrs.org- National Institute of Justice
www.ojp.usdoj.gov/nij- Office of Juvenile Justice and Delinquency Prevention
www.ncjrs.org/ojjhome.htm- National Archive of Criminal Justice Data
www.icpsr.umich.edu/nacjd
Selected Web Resources for Higher Education:
- American Association of State Colleges and Universities
www.aascu.nche.edu- National Association of State Universities and Land Grant Colleges
www.nasulgc.nche.edu- American Council on Education
www.acenet.edu- Education Commission of the States
www.ecs.org- Washington Higher Education Secretariat
www.whes.org- Association of American Medical Colleges
www.aamc.org
Selected Web Resources (NGA publications) for Insurance and Access Expansion:
- New State Efforts to Provide Health Care Coverage for Uninsured Children––Spring 1997
www.nga.org/Pubs/IssueBriefs/1997/9704422UninsuredChildren.asp- State Strategies for Increasing Health Care Coverage for Children
www.nga.org/Pubs/IssueBriefs/1997/970304HealthCare.asp- State Medicaid Coverage of Pregnant Women and Children
www.nga.org/Pubs/IssueBriefs/1997/970930MCHUpdate.asp
Selected Web Resources for Public Health-Related Services:
- Indian Health Service
www.ihs.gov- National Immunization Program
www.cdc.gov/nip
Selected Web Resources for Community-Based Services:
- National Association of State Mental Health Program Directors (NASMHPD)
- NASMHPD Research Institute
www.nasmhpd.org/nri/- National Technical Assistance Center for State Mental Health Planning
www.nasmhpd.org/ntac/- National Mental Health Association
www.nmha.org- National Association of State Directors of Developmental Disabilities Services
www.nasddds.org- American Association on Mental Retardation
www.aamr.org
Selected Web Resources for State Facility-Based Services:
- Department of Veterans Affairs
www.va.gov- National Association of State Directors of Veterans Affairs
www.nasdva.com- National Association of State Mental Health Program Directors (NASMHPD)
www.nasmhpd.org- NASMHPD Research Institute
www.nasmhpd.org/nri- National Technical Assistance Center for State Mental Health Planning
www.nasmhpd.org/ntac/- National Mental Health Association
www.nmha.org- National Association of State Directors of Developmental Disabilities Services
www.nasddds.org
(To request a bound copy of this report, click here.
To see a complete list of Milbank reports, click here.
Be sure to specify which report you want,
your name, mailing address, and phone number.)Milbank Memorial Fund
645 Madison Avenue
New York, NY 10022
(c) 1998 Milbank Memorial Fund. This file may be redistributed electronically as long as it remains wholly intact, including this notice and copyright. This file must not be redistributed in hard-copy form. The Fund will freely distribute this document in its original published form on request.
Printed in the United States of America.
ISBN 1-887748-25-3
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