What is this Thing Called Medicaid

1
What is this Thing Called Medicaid?
2
Medicaid is 40

• Enacted in 1965 as companion legislation to
  Medicare (Title XIX)
• Established an entitlement
• Provided federal matching grants to states for
  providing health care
• Focused on the welfare population
• Single parents with dependent children
• Aged, blind, disabled
• Included mandatory services and gave states
  options for broader coverage

3
40 Years of New Jobs for Medicaid

• 1965-Cover AFDC Families
• 1967-EPSDT created to find and treat child health
  problems
• 1971-Nursing Homes become a covered service
• 1972-Cover SSI
• 1980s-DSH program for Uncompensated Hospital
  Care
• 1981-Home and Community Service Waivers
  authorized
• 1984-Coverage of pregnant women and children as
  poor as AFDC
• 1985-Texas starts Medically Needy Coverage
• 1988-MediCARE cost-sharing coverage of Medicare
  eligibles to 100 FPL
• 1989-EPSDT Comprehensive Care Program, coverage
  of pregnant women and children under age 6 below
  133 FPL
• 1995-Managed Care Expansions in Texas
• 1996-De-link Welfare and Medicaid
• 1997-CHIP Starts
• 1999-Childrens Eligibility Simplification in
  Texas
• 2005-Katrina Coverage, Womens Health Waiver,
  Buy-in for working individuals with disabilities
  in Texas
• 2006-States Rescue Federal Medicare Part D
  Implementation

4
Medicaids Evolution
Millions of Medicaid Beneficiaries
(52 Million Beneficiaries)
SOURCE KCMU analysis of data from the Health
Care Financing Administration and Centers for
Medicare and Medicaid Services, 2004.
K A I S E R C O M M I S S I O N
O N Medicaid and the Uninsured
5
Medicaid Today

• The Nations Largest Health Care Program
• Federal and state expenditures of 300 billion
  with federal government funding 57
• Medicaid provides health and long-term care
  coverage for over 52 million, low-income people
• Comprehensive, low-cost health coverage for 39
  million people in low-income families
• Acute and long-term care coverage for more than
  13 million elderly and persons with disabilities
  Including over 6 million Medicare beneficiaries
• Medicare enrollment is 42 million and will spend
  300 billion
• Guarantees entitlement to individuals and federal
  financing to states
• Pays for nearly 1 in 5 health care dollars,
  and 1 in 2 nursing home dollars

6
Medicaid Services

• Mandatory Services Required by Federal law
• Inpatient/outpatient hospital
• Physician services
• Lab and x-ray
• EPSDT
• Ambulance
• Home health
• Rural Health Clinics/FQHCs
• Nursing facilities
• For children under age 21, states must provide
  all medically necessary services

• Optional Services allowed by Federal Law
• Rx coverage (all states cover, though limitation
  allowed for certain populations)
• Hospice
• Dental care
• Private duty nursing
• Case management
• Podiatry
• Chiropractic
• Eyewear
• Hearing aids
• Mental health counseling

7
Medicaid Expenditures by Service, 2003
DSH Payments 5.4
Inpatient Hospital 13.6
Home Health and Personal Care 13.0
Physician/ Lab/ X-ray 3.7
Mental Health 1.8
ICF/MR 4.4
Long-Term Care 36.0
Outpatient/Clinic 6.7
Acute Care 58.2
Drugs 10.0
Nursing Facilities 16.8
Other Acute 6.3
Payments to MCOs 15.6
Payments to Medicare 2.3
Total 266.1 billion
SOURCE Urban Institute estimates based on data
from CMS (Form 64), prepared for KCMU.
8
US Medicaid Enrollees and Expendituresby
Enrollment Group, 2003
Elderly 9
Elderly 26
Disabled 16
Adults 27
Disabled 43
Children 48
Adults 12
Children 19
Total 52.4 million
Total 252 billion
Note Total expenditures on benefits excludes DSH
payments. SOURCE KCMU estimates based on CBO
and OMB data, 2004.
9
Texas Medicaid Enrollees and Expenditures by
Enrollment Group, 2004
Elderly Disabled 21
Elderly Disabled 59
Adults 9
Children 70
Adults 11
Children 30
Total 2.6 million
Total 14.7 billion
Note August 2005 the number of children
enrolled 67.6 Adults dropped to 7 (HHSC data)
SOURCE HHSC
10
Income Caps for Medicaid and CHIPin Texas, 2006
21,708
33,200
30,710/yr
30,710/yr
22,078/yr
222
200
16,600
7,236
185
185
2,256
3,696
133
100
74
13.6
22.3
Income Limit as Percentage of Federal Poverty
Income Annual Income is for a family of 3,
except Individual Incomes shown for SSI and Long
Term Care
11
Texas Medicaid Who it Helps
December 2005, HHSC data.
Total enrolled 12/1/2005 2,707,681
12
Growing Pressure on Government Spending
State General Fund Spending
Federal Outlays
Total 499 Billion
Total 2.3 Trillion
SOURCE CBO, Baseline Budget Outlook, January
2005 National Association of State Budget
Officers, 2003 State Expenditure Report, 2004.
13
Elephant in the RoomBudget Wish Lists Come and
Go,But 'Entitlements' Outweigh All They Cost 3
Billion a Day,Rise 8 a Year, Leave BushLittle
Room to Maneuver By JACKIE CALMES Staff
Reporter of THE WALL STREET JOURNALFebruary 3,
2006 Page A1
President Bush on Monday will tell the nation
what he wants done with the budget next fiscal
year. But the significance of his proposals and
Congress's response is dwarfed by one daunting
fact Some 84 cents of every dollar the
government spends is essentially committed before
he and the legislators even have at it. That is
the amount that goes to three all-but-untouchable
elements interest on the federal debt defense
and homeland security and, above all,
"entitlements" programs such as Medicare,
Medicaid and Social Security. It leaves just
one-sixth of spending for nearly everything else
the government does domestically, from
secretaries' salaries to research -- what is
known in budget jargon as "discretionary"
spending.
Entitlements are the real elephant in the room.
Formulas for spending on these social programs
are set by law. Anyone eligible can collect. And
the programs are growing far faster than either
inflation or the economy, some 8 a year.
Medicare, at 391 billion this year, is close to
equaling the entire domestic discretionary slice
of the budget. Add in Social Security and the
federal share of the state-run Medicaid program
for the poor, and the big-three entitlements
total 1.1 trillion for this year -- 3 billion a
day.
14
The Elephant in the Room Is Medicaid Too Big?
15
Compared to What?
16
Compared to What?
17
Medicaid Enrollees are Poorer and Sicker Than The
Low-Income Privately Insured Population
Percent of Enrolled Adults
Low-Income and Privately Insured
Medicaid
Poor
Health Conditions that limit work
Fair or Poor Health
SOURCE Coughlin et. al, 2004 based on a 2002
NSAF analysis for KCMU.
18
Per Capita Spending Growth Medicaid vs. Private
Health Spending 2000-2003
Medicaid Acute Care Spending Per Enrollee
Private Coverage Health Care Spending Per
Person1
Employer-Sponsored Insurance Monthly Premiums2
Medicaid Long-Term Care Spending Per Enrollee
Source John Holahan and Arunabh Ghosh,
Understanding the Recent Growth in Medicaid
Spending, 2000-2003, Health Affairs Web
Exclusive, 26 January 2005. Prepared for the
Kaiser Commission on Medicaid and the Uninsured.
1 Strunk and Ginsburg, 2004. 2 Kaiser/HRET
Survey, 2003.
19

• Medicaid Largest Source of Federal Funds in
  Texas State Budget
• Contingent on Texans federal tax dollars come
  back to Texas
• Provides nearly five times as many dollars to
  Texas as federal highway or public education
  funding.
• 10.8 billion Medicaid vs.. 2.2 billion
  highway, or 1.1 billion public education in FY
  2004
• In FY 2006, Federal funds will pay for over 60
  cents of every dollar in Texas Medicaid services
  (60.66).
• Every state dollar spent draws 1.54 in federal
  matching funds (2006).
• Only when federal matching funds for states
  Medicaid spending are added does the Medicaid
  budget exceed education in some states.

20
Medicaid Ranks Third in State Budgets

• Congressional Research Service reported on
  spending of state-only dollars in state budgets.
  On average for U.S. (2003)
• Elementary and secondary education 26.2
• Higher education 13.1
• Medicaid 12.6
• Medicaid and Corrections are the only functions
  in states that have seen their percentages
  increase since 1990.
• On average, states are spending more than three
  times of their state dollars on education rather
  than on Medicaid (CRS review of National
  Association of State Budget Officers (NASBO)
  data.)
• Non-Federal Spending (89.96 Billion) in the
  2006-2007 Texas Budget
• Public schools received 32 (28.59B)
• Higher education 20 (17.68B)
• Medicaid only 16 (14.1B)

21
Medicaid is a Mule Team Helping

• Children, families, pregnant women and workers
  without employer-sponsored health insurance and
  unable to afford the cost of coverage
• Persons with disabilities and chronic conditions,
  unable to find or afford health coverage
• Persons needing long term care, who have few
  other options to pay for nursing home or
  community-based care
• Providers in the health care safety net, with few
  other sources of funding
• Mental health, public health and school-based
  health programs reliant on public funding
• Gaps in Medicare for Low-income beneficiaries

22
Or Mighty Atlas with a Big Job
23
(No Transcript)
24
Number and Percent of Texas Children Enrolled in
Public Insurance by Age Group July 2004
100,000 Texas Children Enrolled in Public
Insurance All Others
Infants and Toddlers 0-1 Years
700,000 Children
Preschool 2-4
Years 1,100,000 Children
Elementary School 5-11 Years 2,300,000
Children
Public Insurance-400,000 (57)
Public Insurance-500,000 (45)
Public Insurance-800,000 (35)
Junior High School 12-14
Years 1,100,000 Children
High School 15-18 Years 1,400,000 Children
Public Insurance-300,000 (27)
Public Insurance-300,000 (21)
Numbers rounded to nearest 100,000 percentages
based off of rounded number


Source 8th Month
Eligibility File (Medicaid) CHIP Enrollment
File Research, Center for Strategic Decision
Support Texas Health Human Services
Commission. 2004 Population Projections by Age
2000-2003 Scenario, Texas State Data Center,
Texas Population Estimates Projections Program
University of Texas at San Antonio, 2004
(http//www.tdh.state.tx.us/dpa/popdata/menup.htm)
.


Prepared
by CHAT, January 2006