JOA - 2026-06-18 - Journal Article
Declining Medicaid Reimbursement for Total Hip and Knee Arthroplasty from 2014 to 2022: A Comparison of Expansion and Non-Expansion States.
Holle AM, Moore ML, Henderson AP, Verhey JT, Haglin JM, Deckey DG, Bingham JS
Topics
Key Takeaway
Inflation-adjusted Medicaid reimbursement for THA fell 31.9% (from $2,050 to $1,395) and for TKA fell 22.0% (from $2,024 to $1,579) between 2014 and 2022, with declines independent of Medicaid expansion status.
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Summary
This study analyzed inflation-adjusted Medicaid physician reimbursement trends for TKA and THA from 2014 to 2022 using a large insurance claims database, stratified by Medicaid expansion status. THA reimbursement declined at -4.7% per year (P=0.048) and TKA at -3.0% per year (P=0.003) in real dollars. Expansion and non-expansion states showed statistically equivalent decline rates for both procedures (P>0.05 for both comparisons).
Key Limitation
The study reports aggregate reimbursement without accounting for changes in procedure volume, case complexity, or facility type over time, making it impossible to determine whether declining rates reflect policy decisions or shifts in the payer's covered patient population.
Original Abstract
BACKGROUND
The purpose of this study was to evaluate national- and state-level trends in inflation-adjusted Medicaid physician reimbursement for total knee arthroplasty (TKA) and total hip arthroplasty (THA) from 2014 to 2022 and to assess whether these trends differ based on Medicaid expansion status.
METHODS
Average physician reimbursement per patient for TKA and THA from 2014 to 2022 was extracted from a large insurance claims database. All monetary values were adjusted for inflation using the Consumer Price Index and reported in 2022 United States dollars. For each procedure, the total percentage change in reimbursement over the study period as well as the average annual percentage change was calculated. Data were then broken down by state, and states were categorized based on Medicaid expansion status (expanded versus non-expanded).
RESULTS
Between 2014 and 2022, the national weighted average reimbursement for TKA declined from $2,024 to $1,579, representing an overall decrease of 22.0%. The annual percentage change for TKA reimbursement was -3.0% per year (P = 0.003). For THA, reimbursement decreased from $2,050 to $1,395, an overall reduction of 31.9%, with an annual percentage change of -4.7% per year (P = 0.048). When stratified by Medicaid expansion status, TKA reimbursement declined at similar rates in expansion states (-2.4%) and non-expansion states (-2.7%) (P > 0.05). Similarly, THA reimbursement declined with a percentage change of -3.2% in expansion states and -5.4% in non-expansion states (P > 0.05).
CONCLUSIONS
Medicaid reimbursement for TKA and THA procedures declined significantly from 2014 to 2022, with similar drops in both Medicaid expansion and non-expansion states.