Examining Implications for Medicare Beneficiaries April 10, 2017 - - PowerPoint PPT Presentation

Medicaid Per-Capita Allotments: Examining Implications for Medicare Beneficiaries

April 10, 2017 Hashtag: #PerCapitaCaps

Medicaid Financing Basics

• Nearly 1 in 4 Americans are served by

Medicaid;

• For 2015, $509 billion in expenditures shared

by state & federal government - 62% federal/38% state (Source: Kaiser Family Fdn)

• For each state, the state & federal share are set

by a statutory formula, named the Federal Medical Assistance Percentage or FMAP

Base FMAP in FY 2017

• Varies by state from 50% to 74.63% (Source: CRS)
• Based on each state’s per capita income

relative to per capita income nationwide

• OPEN-ENDED: For each dollar spent by state

Medicaid program (for allowable purposes), the federal government covers the FMAP percentage

Enhanced FMAPs for Specific Purposes

• 1. Medicaid eligibility and enrollment systems:
• a. 90% for establishment
• b. 75% for maintenance
• 2. ACA Medicaid expansion Enhanced FMAP:

90-100%

• 3. Certain other populations, services and

provider types

Per Capita Cap Concept

# of enrollees X

• avg. per person cost set from a base year

X a trending factor (based on CPI or GDP +x%) =

Cap on federal contribution for any given year

Impact Can Vary by Design

• Which populations are included in the

cap

• Each population’s trending factor
• Base year coverage & spending patterns
• Which Medicaid spending (e.g. DSH or

MSPs) is excluded from cap?

• Cap established via statute or waiver

What changes are permitted to Medicaid standards and requirements (flexibility)

Further Details

Kaiser Family Foundation: Medicaid Enrollment and Spending Growth: FY 2016 and 2017 – Oct. 13, 2016 CRS: Federal Medical Assistance Percentage - Febuary 9, 2016 GAO: MEDICAID: Key Policy and Data Considerations for the Establishment of a Per Capita Cap on Federal Funding – August 2016