1. Medicaid in 2007—A precursor to broader entitlement and healthcare reform?
June
Jon Blum

2. The State of Medicaid in 2007 is Very Different From What We Would Have Predicted 12 Months Ago
Federal Medicaid Commission has failed to gain momentum
After a flurry of activity, state waiver activity is down
States have yet to implement cost containment tools authorized by the DRA
Implementation of Part D appears stable

3. In 2006 MA and VT Approved Major Coverage Initiatives, Which Led Other States to Consider Expanding Coverage
In 2006 and 2007, Over 20 States Have Introduced Plans to Expand Coverage for the Uninsured
Coverage Initiatives Proposed in 2006
Coverage Initiatives Proposed in 2006 & 2007 AK HI CA AZ NV OR MT MN NE SD ND ID WY OK KS CO UT TX NM SC FL GA AL MS LA AR MO IA VA NC TN IN KY IL MI WI PA NY WV VT ME RI CT DE MD NJ MA NH WA OH
D.C.
In 2006, a handfull of states proposed limited coverage expansions that use premium subsidies and public-private partnerships to increase coverage for employees in small businesses.
Implemented or approved coverage initiatives
Coverage expansion introduced by governor or legislature
No Recent Coverage Initiatives
Note: State initiatives to expand coverage to children only are not included in this map.
*Maine is proposing updates to its Dirigo Health plan, which was created in 2003.
Source: Avalere Health research and tracking, updated as of 6/6/07.
Note: State initiatives to expand coverage to children only are not included in this map.
Source: Avalere Health research and tracking, updated as of 6/6/07.

4. Eight Elements of Coverage Expansions
Public Program Expan-sions (new public $$)
Shared Funding Respon-sibilities
Effective targeting of eligible popula-
tions and funds
Coverage Expansions
Explicit tradeoffs between benefits and afforda-bility
Personal Respon-sibility
Facilitate Private Markets
Improve Healthy Lifestyles
Leverage Private Contribu-tions

5. Kennedy-Hatch SCHIP Reauthorization Principles
“Children must be the primary focus of the CHIP program”
“We propose adopting national pediatric quality standards”
“We support states in their efforts to prevent childhood obesity”
“We proposing eliminating existing barriers that make it difficult for states to provide premium support through CHIP for children in families with qualifying incomes that have access to employer-sponsored coverage”
“The current system of allocating CHIP funds should be better targeted”

6. Medicaid Enrollment in Managed Care Organizations (MCOs) Continues to Grow Nationally
Medicaid MCO Penetration, United States1
Top Medicaid MCO States in 2005
By Percent Enrollment1:
Tennessee = 100%
Arizona = 100%
Hawaii = 79%
By Total Enrollment1:
California = 3.2M
New York = 2.5M
Tennessee = 1.3M*
By Spending:
California = $5.5B
Pennsylvania = $4.3B
New York = $4.2B
Total Enrollees: 1995=9.8M; 2005=28.6M
*Tennessee recently reduced its Medicaid eligibility by 400,000 beneficiaries. This change will decrease total MCO enrollment in the state.
1 Avalere analysis of CMS Medicaid Managed Care Enrollment Reports.

7. State Healthy Lifestyle InitiativesAK HI CA AZ NV OR MT MN NE SD ND ID WY OK KS CO UT TX NM SC FL GA AL MS LA AR MO IA VA NC TN IN KY IL MI WI PA NY WV VT
ME* RI CT DE MD NJ MA NH WA OH
D.C.
States with Healthy Lifestyles Programs or Planning Programs
No Activity
*Updated as of January 2006.

8. Care Coordination for Dual EligiblesAK HI CA AZ NV OR MT MN NE SD ND ID WY OK KS CO UT TX NM SC FL GA AL MS LA AR MO IA VA NC TN IN KY IL MI WI PA NY WV VT
ME* RI CT DE MD NJ MA NH WA OH
D.C.
PACE
Other Medicare/ Medicaid Integration Project
Operates Multiple Programs
No Activity
*Updated as of January 2006.

9. Tomorrow’s Medicaid Challenges
Federal and state budgets
Long-Term Care
Federalization
Consensus on broader coverage solutions
Access to healthcare services
Erosion of Employer Sponsored Insurance
Appropriate role of private vs. public delivery