HEALTH CARE ACCESS OPTIONS: Medicaid

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HEALTH CARE ACCESS OPTIONS Medicaid

• Presentation to
• Governor Kaines Health Reform Commission
• Health Care Access Workgroup

March 7, 2007
Department of Medical Assistance Services
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Summary of Medicaid/FAMIS Coverage Options

• M1 Expand Coverage of Children Ages 0-18
• M2 Expand Coverage of Parents Ages 19-64
• M3 Expand Coverage of Aged, Blind and Disabled
  Individuals
• M4 Expand Coverage of Pregnant Women over age
  19
• M5 Expand Coverage to Childless Adults ages
  19-64

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2007 Federal Poverty Level (FPL) Guidelines
Source 2007 Federal Poverty Guidelines, U.S.
Dept. of Health and Human Services
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M1 Expand Coverage of Children Ages 0-18

• Background
• Currently, under Medicaid, children ages 0-5 are
  covered up to 133 of the federal poverty level
  (FPL), and children ages 6-18 are covered up to
  100 of FPL.
• FAMIS children are covered from the Medicaid
  eligibility level up to 200 of FPL.
• Approach
• By increasing the amount of income that is
  disregarded when determining Medicaid and FAMIS
  eligibility, Virginia could cover additional
  uninsured children.
• Increasing the Title XIX (Medicaid) income level
  would shift some Title XXI (FAMIS) children into
  Medicaid. This would increase state outlays
  somewhat since the Title XIX federal match is
  lower than the Title XXI match. However, it
  would also free up Title XXI funds and permit
  coverage of FAMIS children at higher income
  levels.
• Notes There are additional uninsured children
  who are currently eligible, but not enrolled in
  Medicaid or FAMIS and who might enroll with some
  additional outreach.

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M1 Expand Coverage of Children Ages 0-18
(continued)

• Potential Effect on the Uninsured
• Moving children in the Medicaid expansion group
  into the pure Medicaid program would allow
  coverage of additional children with the SCHIP
  allotment.
• If we utilize the Urban Institute estimates,
  there are 21,200 uninsured children between 200
  and 300 FPL. If this was the target expansion,
  we would set the income disregards to move 30,000
  (21,200 uninsured plus an additional woodwork
  effect) children from the Expansion group to the
  pure Medicaid program
• the income level threshold to accomplish this
  would be somewhere between 100 and 133 percent
  FPL.

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M1 Expand Coverage of Children Ages 0-18
(continued)

• Estimated Budget Impact (tentative)
• This would result in a shift of previously
  enhanced federal match to GF of 6.4 million.
  Covering the additional 30,000 between 200-300
  FPL would cost an additional 15 million GF at
  the SCHIP enhanced match
• Total cost of 21.4 million GF
• Other Considerations
• Families could share some of the cost of this
  coverage expansion through premiums and
  co-payments. In addition, children at higher
  income levels (above 300 FPL) could be offered
  coverage through a buy-in
• This option will be influenced significantly by
  the outcome of the impending SCHIP
  reauthorization at the federal level.

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M2 Expand Coverage of Parents Ages 19-64

• Background
• Currently, Medicaid covers parents under the
  category of Low Income Families with Children
  if their income is less than 24 of FPL (on
  average statewide).
• Approach
• By increasing the amount of income that is
  disregarded for purposes of determining Medicaid
  eligibility, Virginia could increase the
  effective income eligibility limit up to 100 of
  FPL.
• Potential Effect on the Uninsured
• A Joint Legislative and Audit Review Commission
  (JLARC) study on the uninsured estimates there
  are 65,000 uninsured parents with income less
  than 100 of FPL.

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M2 Expand Coverage of Parents Ages 19-64
(continued)

• Estimated Budget Impact (tentative)
• According to JLARC, the total cost of covering
  this group would be 203 million (101.5 million
  GF) annually.
• While this would be a new cost to the state, the
  cost could be offset by a reduction in
  uncompensated care costs incurred by various
  healthcare providers (JLARC estimated 92.2
  million), thus reducing the net cost of this
  proposal.

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M3 Expand Coverage of Aged, Blind and Disabled
Individuals

• Background
• Currently, Medicaid covers the Aged, Blind and
  Disabled (ABD) group up to 80 of FPL.
• Approach
• The income limit for this group under Medicaid
  could be increased to 100 of FPL.
• The 2007 General Assembly considered but did not
  approve legislation to accomplish this
• Potential Effect on the Uninsured
• DMAS has estimated that 19,000 individuals would
  enroll the first year. By the fourth year of the
  program, DMAS projects an enrollment of 33,000.
• Note It is important to note that not all of
  these individuals would be considered uninsured,
  as many of these individuals will have coverage
  through Medicare (others may be waiting for
  Medicare coverage to begin). Some individuals 65
  and over are uninsured because they do not
  qualify for Medicare. For these individuals,
  Medicaid is their primary coverage.

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M3 Expand Coverage of Aged, Blind and Disabled
Individuals (continued)

• Estimated Budget Impact
• DMAS has estimated that nearly 19,000 individuals
  would enroll the first year for a total cost of
  81 million (40.6 million GF). By the fourth
  year of the program DMAS projects an enrollment
  of nearly 33,000 for a total cost of 300 million
  (150 million GF).
• Some of these costs would be offset by savings
  for these clients currently served by Community
  Service Boards at 100 general funds. 

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M4 Expand Coverage of Pregnant Women over age
19

• Background
• Currently, pregnant women are covered under the
  Medicaid and FAMIS programs up to 166 of FPL.
• Approach
• By increasing the amount of income that is
  disregarded for purposes of determining Medicaid
  and FAMIS eligibility, Virginia could cover
  additional uninsured pregnant women.
• The Governors budget included funding to
  increase coverage of pregnant women up to 200 of
  FPL.
• The General Assembly approved an increase to 185
  FPL

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M4 Expand Coverage of Pregnant Women over age
19(continued)

• Potential Effect on the Uninsured
• Increasing eligibility from 166 to 200 of FPL
  would cover an additional 900 pregnant women.
• Increasing to 185 FPL would cover roughly 500
  additional women
• Estimated Budget Impact
• Up to 200 FPLtotal of 7.3 million the first
  year (2.6 million GF)
• Up to 185 FPL. total of 4.2 million the first
  year (1.5 million GF)

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M4 Expand Coverage of Pregnant Women over age
19(continued)

• Other Considerations
• Virginia could also utilize income disregards to
  effectively increase the income limit for
  pregnant women under Medicaid (133 FPL) to move
  some of the women served through the FAMIS MOMS
  program into the Medicaid program.
• Much like Option M1 with children, this would
  cause some loss on federal match for individuals
  moving into Medicaid, but this would allow room
  under the FAMIS program to expand income
  eligibility at the enhanced match.

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M5 Expand Coverage to Childless Adults ages
19-64

• Background
• Childless adults are currently not covered under
  Medicaid or FAMIS unless they can also be
  classified under another covered category.
• Approach
• Virginia would need a federal Medicaid waiver to
  cover this groupa very lengthy process which may
  not be practicable.
• Waivers are required to be budget neutral,
  therefore the State would have to find savings
  elsewhere in Medicaid to cover childless adults.
• Potential Effect on the Uninsured
• The Urban Institute estimates that there are
  255,400 uninsured adults under 100 FPL. If one
  fourth to one third of these adults are parents,
  there would be at least 168,000 uninsured
  childless adults ages 19-64 under 100 of FPL.

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M5 Expand Coverage to Childless Adults ages
19-64 (continued)

• Estimated Budget Impact
• Under the federal waiver, Virginia would not be
  allowed to spend more to cover these additional
  individuals than is being spent on currently
  covered groups.
• Benefits for existing recipients, or payment
  rates for providers would likely have to be cut
  in order to cover childless adults.