K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicaid’s Origin Enacted in 1965 as companion legislation to Medicare (Title XIX) Established an entitlement Provided federal matching grants to states to finance care Focused on the welfare population: –Single parents with dependent children –Aged, blind, disabled Included mandatory services and gave states options for broader coverage

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 1 Medicaid Today 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 over 13 million elderly and persons with disabilities, including over 6 million Medicare beneficiaries Guarantees entitlement to individuals and federal financing to states Federal and state expenditures of $300 billion—with federal government funding 57% Pays for nearly 1 in 5 health care dollars and 1 in 2 nursing home dollars

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 2 Medicaid’s Role for Selected Populations Note: “Poor” is defined as living below the federal poverty level - $14,680 for a family of three in SOURCE: KCMU, KFF, and Urban Institute estimates; Birth data: NGA, MCH Update. Percent with Medicaid Coverage: Families Aged & Disabled Poor Near Poor All Children Low-Income Children Low-Income Adults Births (Pregnant Women) Medicare Beneficiaries People with Severe Disabilities People Living with HIV/AIDS Nursing Home Residents

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 3 Poor Near-Poor (<100% Poverty) ( % Poverty) Poor Near-Poor (<100% Poverty) ( % Poverty) Poor Near-Poor (<100% Poverty) ( % Poverty) Children Parents Adults without children Note: Medicaid/Other Public includes SCHIP and other state programs, Medicare, and military-related coverage. The federal poverty level was $14,680 for a family of three in SOURCE: KCMU and Urban Institute analysis of March 2004 Current Population Survey. Medicaid’s Role for Children and Adults, 2003

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 4 Medicaid Enrollees and Expenditures by Enrollment Group, 2003 Note: Total expenditures on benefits excludes DSH payments. SOURCE: KCMU estimates based on CBO and OMB data, Children 19% Elderly 26% Disabled 43% Adults 12% Children 48% Elderly 9% Disabled 16% Adults 27% Total = 52.4 millionTotal = $252 billion

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 5 Spending on Dual Eligibles as a Share of Medicaid Spending on Benefits, FY2002 Total Spending on Benefits = $232.8 Billion SOURCE: Urban Institute estimates prepared for KCMU based on an analysis of 2000 MSIS data applied to CMS-64 FY2002 data. Spending on Dual Eligibles 42% Prescription Drugs ($13.4 Billion) Non- Prescription ($82.7 Billion) Spending on Other Groups ($136.7 Billion) 36% 59% 6%

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 6 Medicaid Expenditures by Service, 2003 Total = $266.1 billion SOURCE: Urban Institute estimates based on data from CMS (Form 64), prepared for KCMU. Inpatient Hospital 13.6% Physician/ Lab/ X-ray 3.7% Outpatient/Clinic 6.7% Drugs 10.0% Other Acute 6.3% Payments to MCOs 15.6% Nursing Facilities 16.8% ICF/MR 4.4% Mental Health 1.8% Home Health and Personal Care 13.0% Payments to Medicare 2.3% DSH Payments 5.4% Acute Care 58.2% Long- Term Care 36.0%

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 7 National Spending on Nursing Home and Home Health Care, 2003 Total = $110.8 billion SOURCE: CMS, National Health Accounts, Total = $40 billion Nursing Home CareHome Health Care Medicaid 46% Medicare 12% Out-of- Pocket 28% Private Insurance 8% Other 6% Medicaid 25% Medicare 32% Out-of- Pocket 17% Private Insurance 21% Other 5%