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Spending in Medicaid is concentrated among a small percentage of enrollees with very high costs, suggesting opportunities to develop cost-containment strategies that focus on this group while maintaining access to appropriate care. This brief uses data from the Medicaid Statistical Information System Summary File to examine the distribution of Medicaid spending for all enrollees with a focus on "high-cost" individuals. In 2001, 8 percent of Medicaid enrollees exceeded $10,000 in annual spending and accounted for roughly two-thirds of Medicaid dollars. Most other enrollees spent less than $5,000. (Available from the Kaiser Commission on Medicaid and the Uninsured)