Floridas Medicaid Reform

1
Floridas Medicaid Reform

• Joan Alker and Jack Hoadley Georgetown Health
  Policy Institute,
• Duval County Medical Society Forum
• 2/23/07

2
The role of Medicaid in Florida

• Medicaid serves over 2.1 million Floridians --
  children, parents, pregnant women, people with
  disabilities, and seniors.
• 27 of Floridas children are enrolled in
  Medicaid slightly higher than national average.
  Also covers 51 of all deliveries.
• Pays for 63 of nursing home days.
• Federal-state matching program feds pick up
  58.76 of the cost.

3
Trends in state Medicaid activity
4
What trends do we see in state Medicaid policy?

• Post Deficit Reduction Act 2006 Some movement
  away from Medicaid waivers that included limiting
  benefits in different ways
• States opting for DRA changes rather than waivers
  include KY, WV, SC?,
• Budget pressures have eased somewhat which were
  the driving force behind many state actions 3-5
  years ago including FL

5
State Tax Revenue and Medicaid Spending Growth,
1997-2006
NOTE State Tax Revenue data is adjusted for
inflation and legislative changes. Preliminary
estimate for 2006. SOURCE Kaiser Commission on
Medicaid and the Uninsured Analysis of CMS Form
64 Data for Historic Medicaid Growth Rates and
KCMU / HMA Survey for 2006 Medicaid Growth
Estimates Analysis by the Rockefeller Institute
of Government for State Tax Revenue.
6
Floridas Medicaid Growth versus Growth in Cost
of Private Insurance
Based on projections from the 2006 Medicaid
Expenditure Social Services Estimating Conference.
Source Georgetown Health Policy Institute
analysis based on Kaiser HRET 2006 Annual Survey
Growth in Medicaid Average Monthly Caseload and
Growth in Medicaid Service Expenditures, Thomas
W. Arnold, Florida Medicaid Program An Overview,
01/09/07.
7
Public opinion

• Growing unease about our health care system.
• The number of uninsured Americans continues to
  rise (46.6 million in 2005), last year for the
  first time an increase in the number of uninsured
  kids (8.3 million in US 800,236 in Florida)
• Source Census Bureau 2005 CPS survey.

8
A marked shift in political climate towards focus
on the uninsured

• Federal level this year there will be a focus on
  reauthorizing the SCHIP program in the context of
  broader discussion of uninsured issue
• Presidential race promises to have lots of
  candidates with health proposals
• This coincides with a number of states that are
  looking to cover all children
• And there is a growing number of states looking
  to move towards universal coverage

9
State proposals

• States that have or are looking to cover all or
  more children include IL, PA, AZ, NY, OK, OR,
  WA, WI, UT

• Governors considering or moving forward on
  universal coverage proposals MA, VT, CA, CT, IL,
  PA, AZ

Medicaid waivers and public coverage are the
foundation for many of these efforts.
10
Our project

• Two-year independent evaluation of pilots in
  Duval and Broward counties.
• Funded by Jessie Ball DuPont Fund, with
  additional support from the Community Foundation
  in Jacksonville and the United Way of Northeast
  Florida.
• Project period, April 2006 March 2008

11
Our project, cont.

• Goal is to address how changes affect the
  experiences of children, parents, people with
  disabilities and others who receive their health
  care through Medicaid
• First brief, released September 2006, provides an
  overview of some of the key issues
• Lack of awareness of changes is widespread
• Some different issues for children and adults

12
What are the issues we are looking at?

• How do beneficiaries respond to the use of
  market-based concepts, such as consumer choice
  and plan competition?
• Are providers participating with reform plans?
• How are benefits changing?
• Do enhanced benefit accounts result in healthy
  choices?
• Does reform have an impact on the cost and
  quality of care?

13
What are our study methods?

• Site visits to Broward and Duval before reform
  and after one year
• Interviews with key stakeholders
• Focus groups with beneficiaries
• Survey of physicians in both counties
• Additional focus groups during initial enrollment
  period
• Review and analysis of written materials

14
How are we looking at choice?

• Analysis of choices available to beneficiaries
• Benefit variations
• Added benefits
• Preferred drug lists
• Provider networks
• Analysis of other information
• Enrollment materials
• Enrollment numbers
• Plan contracts