1. Maryland How Do Premiums Affect Enrollment?
Tricia Roddy
Maryland Department of Health and Mental Hygiene
June 28, 2004

2. Managed Care Program – HealthChoice Based on January 2004 enrollment
Maryland’s HealthChoice Program Provides Services To 75% Of All Medicaid Recipients
Managed Care Program – HealthChoice
Based on January 2004 enrollment

3. Budgetary Language Expanded Premium Requirements To More Recipients
Prior to FY 2004
The income standard for MCHP Premium was between 200% and 300% of FPL
Premiums are set at 2% of the annual income of a family of two, regardless of the actual number of children
$41 for incomes between 200% and 250% of FPL
$52 for incomes between 250% and 300% of FPL
FY General Assembly Budgetary Language
The income standard for MCHP Premium was expanded to include children with family income of 185% to 200% of FPL for FY 2004 only
Premiums were set at 2% of the annual income of a family of two at 185% of FPL, regardless of the actual number of children ($37 per family per month)

4. The Number Who Disenrolled Was Lower Than Expected
An Urban Institute study estimated declines in enrollment of 16% when participants are charged premiums that equal 1% of family income, enrollment declines of about 49% if premiums equal three percent
In Maryland, the decline in enrollment (28%) was lower than expected for this population group
Source: Leighton Ku. “Charging The Poor More For Health Care: Cost-Sharing in Medicaid.” Center on Budget and Policy Priorities. May 7, 2003.

5. Premium’s Impact On Enrollment Was Immediate and Somewhat Temporary
Since December 2003, enrollment has been steadily growing
Between November 2003 and January 2004, enrollment grew by 10%
In a comparable period last year, enrollment was relatively static
As of March 31, 2004, 158 (or 9%) disenrollees have re-enrolled

6. Department Conducted Survey To Study The Premium Expansion
Determine the impact of the premium on enrollment
Determine whether families had obtained other health coverage since their children disenrolled
Determine whether there were differences between enrollees and disenrollees in terms of utilization, family size, age, race/ethnicity, and geography

7. Premium Not The Main Reason For Why Children Disenrolled
360 parents/guardians were surveyed in February 2004
Key Findings
A majority said the premium was not the main reason their child left MCHP
63% thought $37/month per family was affordable
Over half said they had obtained other health insurance for their child

8. Source: Maryland encounter data
While Enrolled, Children Who Disenrolled Were Less Likely to Access Services
Percentage of the Population Accessing Well-Child Services by Age, CY 2002
Source: Maryland encounter data

9. Distribution of Family Size for Children in 185-200% FPL Families
Families With More Than One Child Were More Likely To Stay On The Program
Families with 1 child accounted for the majority of disenrollment between Sept. 03 and Jan. 04
Distribution of Family Size for Children in % FPL Families

10. A Slightly Larger Proportion Of African-Americans Disenrolled
Racial/Ethnic Distribution of Children who Disenrolled Compared to Children who Remained Enrolled (12/31/03)
Source: Maryland encounter data

11. Very Little Difference With Regard To Age Distribution
Age Distribution of Children who Disenrolled Compared to Children Who Remained Enrolled (12/31/03)
Source: Maryland encounter data

12. Little Differences Among Geographic Regions
Regional Distribution of Children Who Disenrolled Compared to Children who Remained Enrolled (12/31/03)
Source: Maryland encounter data

13. Lessons Learned
Survey findings indicate that the premium did not cause the majority of disenrollments
Most of the disenrolled had obtained other insurance
Disenrolled children used fewer services while enrolled
Disenrolled children were more likely to be in families with only one child enrolled
There were few differences between enrolled and disenrolled children with regard to age, race/ethnicity, or region

14. What Does This Mean For Maryland?
Cost sharing should be explored before making more serious cuts, such as reductions in services and eligibility
CMS should reevaluate its cost sharing policies
Cost sharing should be explored when designing new programs to cover more of the uninsured