Medicaid

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Medicaids Role for Children in the United States
2
Jocelyn Guyer Georgetown University Health
Policy Institute Center for Children and
Families Washington, D.C. jag99_at_georgetown.edu www
.ccfgeorgetown.edu February 27, 2006
3
Childrens Sources of Health Care Coverage,
2003-2004
All Children
Low-Income Children
Total 77.7 million
Total 33.3 million
Note Medicaid includes the State Childrens
Health Insurance Program (SCHIP). Source Health
Insurance In America 2004 Data Update. Kaiser
Commission on Medicaid and the Uninsured,
November 2005.
4
Medicaid Enrollees and Expenditures by
Enrollment Group, 2003
(Total 52 million)
(Total 252 billion)
Note Total expenditures on benefits excludes DSH
payments Source Kaiser Commission on Medicaid
and the Uninsured estimates based on CBO and OMB
data, 2004.
5
Changes in Childrens Health Insurance Coverage
Rates, 2003-2004(Percentage Point Differences)
Change in Number of Uninsured 2000-2004 -400,000
children
Source Health Insurance Coverage in America
2004 Data Update. Kaiser Commission on Medicaid
and the Uninsured, November 2005.
6
Trends in the Uninsured Rate of Low-Income
Children, 1997 - 2004
Source Georgetown CCF analysis based on R.A.
Cohen, M.E. Martinez. Health Insurance Coverage
Estimates from the National Health Interview
Survey, January-March 2005.
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Emerging Issues in Medicaid

• Federal Developments
• Reconciliation bill
• Presidents budget and other developments in
  Washington
• State Developments

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Medicaid Cuts in the Deficit Reduction Act
5-year numbers
Size of Cut Share of Total
(in billions)
Reduced Benefits Higher Cost Sharing Reducing
Payments for Prescription Drugs Tighter
Restrictions on Asset Transfers Other (e.g.,
restrictions on provider taxes)
1.3 1.9 3.9 2.4 2.1
11 17 33 21 18
28
More than a quarter of all cuts come from
increases in reduced benefits and increased cost
sharing.
Source Georgetown CCF analysis based on CBOs
estimate of the Budgetary Effects of Title V of
the Deficit Reduction Act of 2005. December 18,
2005.
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Benefit Changes

• New state option to provide reduced package of
  benefits (benchmark benefits) to some groups
• No real standard for benchmark benefits,
  particularly for dental care
• Flexibility applies primarily to parents not on
  welfare and children
• Cannot be used when a state newly expands
  coverage
• For children, states required to provide an EPSDT
  wrap-around benefit
• States can vary the benefits provided within a
  group

10
Cost Sharing Changes - State Options

• State option to allow providers to deny care when
  people are unable to make a co-payment
• For people above 100 of federal poverty level
  (FPL), copayments up to 10 or 20 of cost
• Drafting error leaves unclear the rules that
  apply to people below 100 of FPL
• Option to impose premiums above 150 of FPL
• Aggregate cap of 5 of income

11
Proposed Medicaid Cuts in the Presidents FY 2007
Budget
Legislative Regulatory Total
Gross Cuts New Initiatives Net Cuts
-4.9 3.2 -1.7
-12.2 0 -12.2
17.2 3.2 -14.0

87 of proposed cuts are from regulatory
proposals
Note Numbers may not add up due to
rounding. Source Georgetown CCF analysis based
on the Budget of the United States Government, FY
2007.
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State Developments

• State fiscal pressures easing, but Medicaid
  remains a strain
• Waivers in a new era that allows for far more
  sweeping changes
• Major shifts in financing (VT)
• Defined contribution plans (FL)
• Tiering of benefits (KY)
• States continue to use state plan amendments to
  reduce/expand coverage

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Federal Waiver Guidelines Have Changed

• 1115 Waivers Before HIFA
• States were required to maintain Medicaid and
  SCHIP benefits and cost sharing protections
• Under the HIFA Waivers
• States have no limitations on cost sharing for
  optional Medicaid beneficiaries and for
  expansion populations who dont meet Medicaids
  categorical criteria
• States are not required to provide wrap-around
  coverage for optional Medicaid or SCHIP
  beneficiaries
• Benefit requirements for mandatory Medicaid
  beneficiaries are waived if participation is
  voluntary for the beneficiary

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Upcoming Debates

• Presidents Fiscal Year 2007 Budget
• Medicaid legislative proposals unlikely to be
  seriously considered
• BUT, Administration may move forward on its own
• New Medicaid waiver initiative
• Changes to Medicaid regulations
• Medicaid Commission
• SCHIP Reauthorization

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Medicaid Standards Matter
Kevin has asthma and at one point
needed 13 medications a day
Brandie has multiple medical and developmental
problems. She needs daily speech and
occupational therapy