The growth of Medicaid outlays slowed dramatically to 9.8 percent in fiscal 1982, the first time it has ever dipped below double digits, according to government figures.
A government-funded survey, released last week, said a major reason for the slowdown was that states, under intense federal and local pressure, substantially reduced payments to hospitals, sought more efficient ways to buy services, imposed limits on services to the poor and required patients to pay more.
Another reason, government officials said, is the slowdown in the rate of inflation in the economy as a whole in 1982. Medicaid is still running at about double the general inflation rate.
The survey was conducted by the Intergovernmental Health Policy Project of George Washington University and the National Governors' Association State Medicaid Information Center.
It found that federal-state Medicaid payments in 1982 for health care of low-income people totaled $32.7 billion, 9.8 percent more than in 1981.
This was a much smaller increase than the 18.1 percent in 1981 and the 15 percent annual average for the latter half of the 1970s, according to the survey report.
According to figures supplied by the Department of Health and Human Services, annual increases in federal-state Medicaid outlays since the program was put in its current form in 1965 have ranged as high as 93 percent, in the program's second year when it was expanding most rapidly, and have never dipped below 11 percent.
The survey report said that restraining the cost of Medicaid has been the "dominant health policy priority in a majority of states" for the last several years.
It said that in 1982 about 30 states took some action to reduce or limit Medicaid benefits, eligibility or reimbursements to providers of health services.
The report said that, in addition to outright cutting of services or categories of eligibility, states are beginning to use leverage provided by Congress in 1981 when the Reagan administration forced through curbs on Medicaid outlays.
For example, at least two-thirds of the states took steps to shift nursing home patients to care in their own homes or at neighborhood clinics, which is substantially cheaper than institutionalization.
While most states were cutting back on services, the report said, some states expanded coverage or services in 1982 or restored some reductions made in earlier years.
Richard E. Merritt, director of the project, said "the pendulum may be starting to swing back; the states seem to have started focusing more on restraining wasteful cost increases and somewhat less on cutting off services."
Rep. Henry A. Waxman (D-Calif.), chairman of the House Medicaid and public health subcommittee, said in a statement that he did not consider the program-growth slowup primarily the result of restraining waste.
"Medicaid spending has declined because the Reagan cuts have meant many poor people are losing eligibility, and fewer services are available for those who are eligible. This is not holding down health costs. It is simply shifting the burden to state and local governments which cannot afford it," he said.
The report gave this numerical summary of 1982 developments:
* Nineteen states reduced reimbursements to hospitals for specified services, 16 reduced the amounts paid doctors for various services and 16 imposed limits on payments to nursing homes.
In at least 16 states, a prospective payment system was adopted to hold down hospital costs by setting a fixed fee in advance for care of certain patients. About a dozen states increased payments for certain medical services, but the overall trend was to curtail reimbursements.
* Ten states moved to block use of costly hospital emergency rooms for general health care.
* Eleven states imposed restrictions on hospital stays, and 14 increased the amounts patients must pay for some services, primarily prescription drugs, while 13 reduced the types of services provided.
On the other hand, 13 added services, such as neighborhood care to avoid institutionalization.
* While eight states reduced the categories of eligibility for Medicaid, 10 enlarged them, primarily by including pregnant low-income women and certain groups of children or by increasing income cutoffs.
* Thirty-two states sought federal permission to use local clinics or send health personnel into people's homes as an alternative to nursing home care.