Medicaid: Big Decisions Ahead

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Presentation transcript:

Medicaid: Big Decisions Ahead Medicaid in 2008 and Beyond Thursday, July 10, 2008 United Hospital Fund

Medicaid: Big Decisions Ahead Cindy Mann Georgetown University Health Policy Institute Center for Children and Families Washington, D.C. crm32@georgetown.edu ccf.georgetown.edu Medicaid in 2008 and Beyond Challenges and Prospects Thursday, July 10, 2008 United Hospital Fund

Medicaid: Big Decisions Ahead Transition agenda Fiscal relief? Medicaid regulations SCHIP reauthorization Broader health reform

Transition Agenda: The Time to Get Ready is Now New Management 2008 Nov.

SCHIP? Expires March 31, 2009 Taking care of unfinished business or pulled into health reform? Major Medicaid components Financing New options

Broader Health Reform: The Context THE MAIN EVENT? … HEALTH SYSTEM REFORM …

Health Insurance Coverage of the Nonelderly Population, 2006 The majority of nonelderly obtain health insurance coverage through their employer. However, the share of employees with job-based coverage has been dropping. Public programs provide coverage for some of those with low-incomes who do not have access to employer-based or other insurance. Still, in 2006, 46.5 million nonelderly lacked health insurance, representing 18 percent of the total nonelderly population. 260.0 Million

Health Insurance Coverage of the Nonelderly Population, 2006 The majority of nonelderly obtain health insurance coverage through their employer. However, the share of employees with job-based coverage has been dropping. Public programs provide coverage for some of those with low-incomes who do not have access to employer-based or other insurance. Still, in 2006, 46.5 million nonelderly lacked health insurance, representing 18 percent of the total nonelderly population. 260.0 Million SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Health Insurance Coverage of the Nonelderly Population, 2006 The majority of nonelderly obtain health insurance coverage through their employer. However, the share of employees with job-based coverage has been dropping. Public programs provide coverage for some of those with low-incomes who do not have access to employer-based or other insurance. Still, in 2006, 46.5 million nonelderly lacked health insurance, representing 18 percent of the total nonelderly population. 260.0 Million SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Health Insurance Coverage of the Nonelderly Population, 2006 The majority of nonelderly obtain health insurance coverage through their employer. However, the share of employees with job-based coverage has been dropping. Public programs provide coverage for some of those with low-incomes who do not have access to employer-based or other insurance. Still, in 2006, 46.5 million nonelderly lacked health insurance, representing 18 percent of the total nonelderly population. 260.0 Million SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Health Insurance Coverage of the Nonelderly Population, 2006 The majority of nonelderly obtain health insurance coverage through their employer. However, the share of employees with job-based coverage has been dropping. Public programs provide coverage for some of those with low-incomes who do not have access to employer-based or other insurance. Still, in 2006, 46.5 million nonelderly lacked health insurance, representing 18 percent of the total nonelderly population. 260.0 Million SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Broader Health Reform: The Issues Facing Medicaid

Many Important Issues Coverage requirements and options

Total = 46.5 million uninsured Other Adults without Children 21% Potential Role for Medicaid The Nonelderly Uninsured, by Age and Income Groups, 2006 Total = 46.5 million uninsured Other Children 6% Other Parents 8% Other Adults without Children 21% Note: Low-income includes those with family incomes less than 200% of the federal poverty level. Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Potential Role for Medicaid The Nonelderly Uninsured, by Age and Income Groups, 2006 Total = 46.5 million uninsured Low-Income Children 14% Other Children 6% Other Parents 8% Low-Income Parents 17% 65% are Low-Income Other Adults without Children 21% Low-Income Adults without Children 34% Note: Low-income includes those with family incomes less than 200% of the federal poverty level. Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS. 15

Many Important Issues Coverage requirements and options Scope of coverage & affordability

Health Conditions that limit work Income and Health Status of Medicaid and the Low-Income Privately Insured, 2002 Percent of Enrolled Adults Low-Income and Privately Insured Medicaid Health Conditions that limit work Poor Fair or Poor Health SOURCE: Coughlin et. al, “Assessing Access to Care Under Medicaid: Evidence for the National and Thirteen States,” Health Affairs 24(4):1073-1083. Based on a 2002 NSAF analysis for Kaiser Commission on Medicaid and the Uninsured.

Many Important Issues Coverage requirements and options Scope of coverage & affordability Financing

= & Impact of 1% Growth in Unemployment 1% $1.4 3-4% Decline in State Revenues 1.1% = 1.0% & 1% Increase in National Unemployment Rate Increase in Medicaid and SCHIP Enrollment (million) Increase in Uninsured (million) A one percent rise in the nation's unemployment rate is projected to increase the number of uninsured by 1.1 million and result in an additional 1 million (600,000 children and 400,000 adults) enrolling in Medicaid, increasing state Medicaid spending by $1.4 billion at time when their tax revenues would fall by 3 to 4 percent. Source: S. Dorn, B. Garrett, J. Holahan, and A. Williams, “Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses,” Kaiser Commission on Medicaid and the Uninsured (April 2008).

Federal vs. State Responsibility “Duals” Account for 4 of every $10 in Medicaid Spending Total Medicaid Expenditures = $303.6 billion Other Aged and Disabled $79.2 billion 26.1% “Dual” Eligibles $133.3 billion 43.9% Adults $32.0 billion 10.5% Children $47.5 billion 15.6% Unknown $11.6 billion 3.8% Source: Urban Institute estimates based on data from the Medicaid Statistical Information System (MSIS) and Medicaid Financial Management Reports (CMS Form 64) prepared for the Kaiser Commission on Medicaid and the Uninsured, 2008. 20

Federal vs. State Responsibility “Duals” Account for Nearly 4 out of $10 in Spending Growth Total growth in Medicaid Spending between 2001 and 2005: $101.8 billion “Dual” Eligibles 37% Adults 17% Children 23% Non “Duals” 23% Source: Urban Institute estimates based on data from the Medicaid Statistical Information System (MSIS) and Medicaid Financial Management Reports (CMS Form 64) prepared for the Kaiser Commission on Medicaid and the Uninsured, 2008.

Concerns At the Federal Level “Future growth in spending per beneficiary for Medicare and Medicaid …will be the most important determinant of long term trends in federal spending” - Peter Orszag, Director of CBO

Medicare and Medicaid Spending as a Percentage of GDP Alternative Fiscal Scenario Note: *For 2007, numbers are actual and on a fiscal year basis. **Spending for Medicare beneficiaries is net of premiums. Source: Congressional Budget Office

Common Concerns: Different Solutions Stop spending on “autopilot” – cap federal payments “Brookings-Heritage Fiscal Seminar” Reform the health care system Peter Orszag, CBO

Many Important Issues Coverage requirements and options Scope of coverage & affordability Financing Enrollment Public/private interface Access to providers Quality measures LTC?

Public’s View of Medicaid

Public’s View of Medicaid Percentage Very or mostly favorable 50 Source: Survey by Robert Wood Johnson Foundation, conducted by Public Opinion Strategies, August 2007. 27

Public’s View of Medicaid Percentage Very or mostly favorable 50 Half and half 22 Source: Survey by Robert Wood Johnson Foundation, conducted by Public Opinion Strategies, August 2007. 28

Public’s View of Medicaid Percentage Very or mostly favorable 50 Half and half 22 Very or mostly unfavorable 14 No opinion, never heard of, don’t know/refused Source: Survey by Robert Wood Johnson Foundation, conducted by Public Opinion Strategies, August 2007. 29

Public Opinion about Medicaid Voters believe that the government should play a role in helping to provide coverage for low-income, uninsured children and parents, seniors, and people with disabilities. Voters perceive that the nation faces a health care crisis, not a Medicaid crisis. 78% consider Medicaid to be very important Source: Survey by Lake Research Assoc., for CCF and CBPP, Fall 2007.

Thank You