Georgetown Center for

1
Georgetown Center for Children and Families
Strengthening Medicaid Project
Vikki Wachino Consultant http//ccf.georgetown.edu
/index/strengthening-medicaid May 29, 2008 The
Council of State Governments
2
Medicaids Role in theHealth Care System
Figure 1
Health Insurance Coverage 29 million children
15 million adults in low-income families 14
million elderly and persons with disabilities
Assistance to Medicare Beneficiaries 7.5
million aged and disabled 18 of Medicare
beneficiaries
Long-Term Care Assistance 1 million nursing home
residents 43 of long-term care services
MEDICAID
State Capacity for Health Coverage 43 of federal
funds to states
Support for Health Care System and Safety-net 15
of national health spending
Source Kaiser Commission on Medicaid and the
Uninsured.
3
Medicaid Enrollees and Expendituresby Enrollment
Group, 2007
Figure 2
Elderly 9
Elderly 22
Disabled 16
Adults 26
Disabled 44
Children 49
Adults 14
Children 20
Total 60.5 million
Total 169.6 billion
SOURCE Center for Children and Families analysis
of March 2008 CBO Medicaid Baseline.
4
Figure 3
Trends in the Uninsured Rate of Low-Income
Children, 1997 - 2005
Source Georgetown CCF analysis based on data
from the National Health Interview Survey,
November 2006. Beginning in 2004, the NHIS
changed its methodology for counting the
uninsured. This results in the data for 2004 and
later years not being directly comparable to the
data for 1997 2003.
5
Figure 4
States Are Moving Forward (2006-2007)
WA
NH
VT
MT
ME
ND
OR
MN
MA
ID
WI
SD
NY
WY
MI
RI
CT
IA
PA
NV
NE
NJ
OH
IL
UT
IN
DE
CO
CA
WV
KS
VA
MD
MO
KY
NC
DC
TN
OK
AZ
SC
AR
NM
GA
AL
MS
LA
TX
AK
FL
HI
Implemented or Recently Adopted Legislation to
Improve Childrens Coverage (29 states including
DC)
Source As of January 31, 2008 based on a review
by the Center for Children and Families of state
initiatives in 2006 and 2007.
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Figure 5
More Than 25 States Project or Expect Budget
Shortfalls
WA
NH
VT
MT
ME
ND
OR
MN
MA
ID
WI
SD
NY
WY
MI
RI
CT
IA
PA
NV
NE
NJ
OH
IL
UT
IN
DE
CO
CA
WV
KS
VA
MD
MO
KY
NC
DC
TN
OK
AZ
SC
AR
NM
GA
AL
MS
LA
TX
AK
FL
HI
Projected Gap in FY 2009
Expect Gap in FY 2009, Size Unknown
Expect Gap in FY 2010
Source E. McNichol and I. Lav, 22 States Face
Total Budget Shortfall of At Least 39 Billion in
2009 6 Others Expect Budget Problems. Center on
Budget and Policy Priorities, revised March 14,
2008.
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Key Themes Public Opinion about Medicaid
Figure 6

• Voters believe that the government should play a
  role in helping to provide coverage for
  low-income, uninsured children and parents,
  seniors, and people with disabilities.
• Voters perceive that the nation faces a health
  care crisis, not a Medicaid crisis.
• While we reform the system as a whole, we need to
  keep Medicaid strong for those who need it.

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The Medicaid Program Enjoys Strong Public Support
Figure 7

• 78 voters consider Medicaid to be very important

9
Figure 8
Public Views on Key Medicaid Policy Issues
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Key Public Messages on Medicaid
Figure 9

• We have a health care crisis, not a Medicaid
  crisis, and need to keep Medicaid strong
• The federal government should take more financial
  responsibility for Medicaid
• Reflects public awareness that growing health
  care costs, an aging population, and uncertain
  economic conditions challenge states
• Medicaid is the primary health program for
  children, and we need to invest more to make sure
  children get the services they need
• With more employers reducing or dropping health
  benefits, Medicaid needs to cover more low-income
  working families who lose health coverage

11

Figure 10

• Keeping Medicaid strong is central to achieving
  key health care reform goals like expanding
  coverage and controlling costs
• Project develops fresh approaches and
  recommendations to strengthen the program,
  focusing on
• Maintaining and improving access to high-quality,
  cost effective care for all Medicaid
  beneficiaries
• Putting Medicaid on sound financial footing while
  ensuring that resources are used as efficiently
  as possible
• Covering more uninsured low-income Americans

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Advancing Efficient Management and Purchasing of
Prescription Drugs
Figure 11
State Recommendations from Policy Paper No. 4

• Improve management of prescription drugs
• Rely on clinical evidence to manage the pharmacy
  benefit
• Adopt best practices for managing high-cost
  patients and high prescribers
• Strengthen drug utilization review programs

13
Advancing Efficient Management and Purchasing of
Prescription Drugs
Figure 12
State Recommendations from Policy Paper No. 4

• Use Medicaids purchasing power to get the best
  possible price
• Obtain supplemental rebates to maintain
  clinically sound preferred drug lists
• Require manufacturers, pharmacies, etc. to report
  actual sales prices and/or acquisition costs

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Measuring and Improving Quality of Care in
Medicaid
Figure 13
State Recommendations from Policy Paper No. 3

• For health care to be high quality, it must be
  safe, effective, timely, patient-centered,
  equitable, and efficient, according to the
  Institute of Medicine
• Maintaining stable enrollment is key
• Lack of coverage negatively effects access and
  makes quality hard to manage

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Key Approaches to Measuring and Improving Quality
Figure 14
State Recommendations from Policy Paper No. 3

• Develop core quality measures through a
  state/federal and public/private consensus
  development process
• Federal development and reporting of quality
  performance across states is needed
• Create state quality improvement advisory
  councils to coordinate across programs, develop
  measures, and monitor impact
• States can also establish quality partnerships
  with providers, purchasers, and experts
• Test specific pay-for-performance incentives for
  quality and evaluate their impact on
  beneficiaries, providers, and quality of care

16
Apply Innovative Health Information Technology
Approaches to Medicaid
Figure 15
State Recommendations from Policy Paper No. 1
Refocus Medicaid IT systems on sharing health
information to promote patient health

• Use electronic prescribing to reduce errors and
  increase efficiency
• Convey health information to beneficiaries
  through automated telephone systems
• Expand the use of electronic health records to
  increase coordination across providers
• Improve access to electronic personal health
  records to give beneficiaries access to their own
  health information

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Federal Action That Could Strengthen Medicaid
Figure 16

• Strengthen Medicaid drug rebate policies to help
  both states and the federal government get better
  prices on prescription drugs
• Play a leadership role in developing quality
  measures, with active state participation
• Stabilize Medicaid financing during economic
  downturns, through an automatic increase in the
  federal matching rate
• Over the long term, realign fiscal
  responsibilities between the federal government
  and the states

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Georgetown Center for Children and Families
Strengthening Medicaid Project
Figure 18

• Additional issue briefs to be released this year
• Promoting good health and healthy behaviors
• Premium assistance Integrating Medicaid with
  private coverage
• Maintaining access and improving provider
  payments
• Simplifying coverage and reducing complexity for
  beneficiaries and states
• Streamlining program management
• Visit the Strengthening Medicaid web site
  http//ccf.georgetown.edu/index/strengthening-medi
  caid.