Government Involvement in Health Care Part Two. State Govt Fed Govt Medicaid Title XIX of the Social Security Act Health Care program for certain low.

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Presentation transcript:

Government Involvement in Health Care Part Two

State Govt Fed Govt Medicaid Title XIX of the Social Security Act Health Care program for certain low income persons (NEED based program) Administered by each state –Federal mandates –State options Funded by Federal and State Government

Medicaid Groups Eligible – Mandatory –Children < 6, pregnant women, family income ≤ 133% FPL (FPL on next slide) –Supplemental security income (SSI) Aged Needy, Blind Needy, Disabled Needy –Children <19, income ≤ FLP –Some foster care children –Certain Medicare beneficiaries, ≤ 74% FPL Many states are expanding eligibility (SCHIP) State Govt Fed Govt

2005 HHS Poverty Guidelines Size of Family Unit 48 States Alaska Hawaii 1$9,570$11,950$11, ,83016,03014, ,09020,11018, ,35024,19022, ,61028,27026, ,87032,35029, ,13036,43033, ,39040,51037,260 Fed Gov t

Medicaid Mandatory Services –Hospital services (inpatient and outpatient) –Physician services –Diagnostic services –Skilled nursing facility services –Rural Health Clinic services –Prenatal care/vaccines-child –Family planning –Nurse practitioner services Optional Services –Clinic services –Dental –Eye glasses –Intermediate care facilities- mentally retarded –Physical therapy –Prescription drugs –Rehabilitation services –Transportation services –Some home/community services State Govt Fed Govt

Medicaid Federal Government pays 50-83% of costs depending on the state Federal Match in Nebraska is ~ 60% (61% for fiscal year 2005) 64.5% of recipients are children, low incomes –< 26% of the dollars go here 27% of recipients are aged or disabled –Consume 66% of the dollars Largest Medicaid expenditure–long term care State Govt Fed Govt

NE Medicaid Expenditures (Accessed 9/3/05) State Govt

U.S. Medicaid Expenditures (Accessed 9/3/05) Fed. Govt.

U.S. Expenditures Compared to Number of Enrollees- Medicaid (2003) (Accessed 9/3/05) - Fed. Govt.

Fed. Govt. Other major Federal Health Coverage Plans Veterans Administration Dept. of Defense (Military Services) & Tri- Care [Formerly CHAMPUS] (Military Dependents) Federal Employee Plan Indian Health Service / U.S. Public Health Service State & Local Plans for poor and uninsured.

Government Involvement in Health Care This concludes Part Two