Alliance for Health Reform Medicaid Briefing: Role of States
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Alliance for Health Reform Medicaid Briefing: Role of States Barbara Coulter Edwards, Principal Health Management Associates February 13, 2009 [email protected]
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Alliance for Health Reform Medicaid Briefing: Role of States. Barbara Coulter Edwards, Principal Health Management Associates February 13, 2009. [email protected]. Medicaid: A Partnership. Federally authorized, State administered Federal mandates, State options Eligibility - PowerPoint PPT Presentation
Transcript of Alliance for Health Reform Medicaid Briefing: Role of States
Alliance for Health Reform Medicaid Briefing:
Role of StatesBarbara Coulter Edwards,
PrincipalHealth Management
AssociatesFebruary 13, [email protected]
April 22, 2023
Medicaid: A PartnershipFederally authorized, State administeredFederal mandates, State options • Eligibility• Benefits• Reimbursement• Service delivery arrangementsStates buy health care in the
marketplace
April 22, 2023
State Plan Describes Program
Centers for Medicare and Medicaid Services (CMS) at HHS must approve State Plan, State Plan Amendments
Secretary of HHS has discretion to waive Medicaid requirements
State Plan (and waiver Terms and Conditions) become binding on state
April 22, 2023
Financing MedicaidStates pay for services, receive federal
reimbursement for a portion of spendingFederal Medical Assistance Percentage (FMAP)• minimum = 50% • maximum (‘09) = 75.67% (MS)Varies based on relationship of state’s per
capita income to national per capita incomeFMAP adjusted annually, lagging data(FMAP for administration fixed at 50%, with
enhanced percentages for information systems)
April 22, 2023 K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured
Figure 5
VA
Federal Medical Assistance Percentages (FMAP), FY 2009
AZ AR
MS
LA
WA
MN
ND
WY
ID
UTCO
OR
NV
CA
MT
IA
WI MI
NE
SD
ME
MOKS
OHIN
NY
IL
KY
TNNC
NH
MA
VT
PA
WV
CTNJ
DE
MD
RI
HI
DC
AK
SCNM
OK
GA
SOURCE: Federal Register, November 28, 2007 (Vol. 72, No. 228), pp 67305-67306, at http://edocket.access.gpo.gov/2007/pdf/07-5847.pdf and correction for North Carolina at Federal Register, Friday, December 7, 2007 (Vol. 72, No. 235), p. 69285, at http://edocket.access.gpo.gov/2007/pdf/C7-5847.pdf.
TX
IL
FL
AL
71+ percent (6 states)
50 percent (14 states)
62 to <71 percent (19 states including DC)
51 to <61 percent (12 states)
VA
April 22, 2023
How States Finance MedicaidState and/or local general fund revenues
appropriated to Medicaid (from sales, income, other general taxes)
“Permissible” health care-related taxes and “bona fide” provider-related donations
Inter-Governmental Transfers (IGTs)Certified Public Expenditures (CPEs)
April 22, 2023
Medicaid = State Budget Challenge
About 22% of total state spendingMedicaid costs typically grow at faster
rate than state revenues• Medical inflation• Aging population• Policy changes• Economy (Medicaid is “counter-
cyclical) States must balance their budgets
every year!
April 22, 2023
Source: Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses, Kaiser Commission on Medicaid and the Uninsured, April 2008
Impact of a 1% Growth in Unemployment
1%
Increase in National Unemployment Rate
=1.0 m 1.1 m
Increase in Medicaid and
SCHIP Enrollment
Increase in Uninsured
&$2.0 b
$1.4 b
$3.4 b
Increase in Medicaid and SCHIP Spending(billion)
State
Federal
1% increase in unemployment also = a 3-4% decline in state revenues
1.0%
April 22, 2023Medicaid Grows Faster than State Revenue
5.3%5.3% 6.6% 5.2% 5.1% 2.0%
-7.8% -3.5%
3.2% 3.7%
6.1% 7.1%8.2%
10.3%8.3%
6.3%3.0%
12.4%
7.4%
2.8%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
State Tax Revenue Medicaid Spending Growth
NOTE: State Tax Revenue data is adjusted for inflation and legislative changes. Preliminary estimate for 2006.
SOURCE: KCMU Analysis of CMS Form 64 Data for Historic Medicaid Growth Rates and KCMU / HMA Survey for 2006 Medicaid Growth Estimates; Analysis by the Rockefeller Institute of Government for State Tax Revenue.
April 22, 2023
Controlling Medicaid Spending
Short-term (balance the budget!)• Eligibility• Benefits/cost-sharing• Reimbursement*
April 22, 2023State Medicaid Cost Containment Strategies FY 03–07
4650
25
18 1713
10
48 50
21 19 1814
8
26
1015
912
17
59
3
26
10
20
50
43
78
46
18
29 27
43
ControllingDrug Costs
Reducing/FreezingProvider
Payments
Reducing/RestrictingEligibility
ReducingBenefits
IncreasingCopayments
DiseaseManagement
Long-TermCare
2003 2004 2005 2006 Adopted for 2007
NOTE: Past survey results indicate not all adopted actions are implemented.
SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September and December 2003, October 2004, October 2005, October 2006
April 22, 2023Medicaid Total Spending Projected to Double to Over $700 Billion in Ten Years: 2007 - 2017
314 330362 390
421455
492533
577625
677736
0
100200
300
400
500600
700
800
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Source: Health Management Associates estimates based on data from CBO and CMS, 2007.
All funds: Federal, State and Local
April 22, 2023
State Medicaid Challenge“Bend the trend” of cost growth:• Delivery system reforms – HIT, disease
management, pay for performance, service integration, centers of excellence
• Coverage reforms – prevention/primary care, comparative effectiveness, Medicare/Medicaid coordination, community LTC
• Consumer behavior, community wellness focus
• Increased rates of private coverage
April 22, 2023
Health Costs a Shared Concern
Medicaid buys in the health care marketplace
Impacts, and is impacted by, the larger system
Can only act within federal parametersUltimately, can’t resolve Medicaid’s
challenges in isolation of the realities of the larger health care system, federal health policy
