Hoping For Economic Recovery, Preparing for Health Reform: A Look - - PowerPoint PPT Presentation

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Hoping For Economic Recovery, Preparing for Health Reform: A Look at Medicaid Spending, Coverage and Policy Trends

Presenting the Findings: Robin Rudowitz, Kaiser Family Foundation Vernon Smith, Health Management Associates Release: September 30, 2010

Report Authors: Vernon Smith, Kathleen Gifford and Eileen Ellis Health Management Associates Robin Rudowitz and Laura Snyder Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation

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Medicaid Today

Health Insurance Coverage

29.5 million children & 15 million adults in low-income families; 14 million elderly and persons with disabilities

State Capacity for Health Coverage

Federal share ranges 50% to 76%; ARRA FMAP ranges 62% to 85%

MEDICAID

Support for Health Care System and Safety-net

16% of national health spending; 40% of long-term care services

Assistance to Medicare Beneficiaries

8.8 million aged and disabled — 19% of Medicare beneficiaries

Long-Term Care Assistance

1 million nursing home residents; 2.8 million community-based residents

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Medicaid Enrollees and Expenditures by Enrollment Group, FFY 2007

Enrollees Expenditures on benefits

Children 20% Elderly 25% Disabled 42% Adults 12% Children 49% Elderly 10% Disabled 15% Adults 25%

Total = 58 million Total = $300 billion

SOURCE: KCMU and Urban Institute estimates based on 2007 MSIS and CMS64 data.

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State Tax Revenue, 1999 – 2010

• 20%
• 15%
• 10%
• 5%

0% 5% 10% 15% 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 SOURCE: Percent change in quarterly state tax revenue, US Census Bureau

• 9.4%

15.9%

• 12.2%
• 16.8%

2.5%

• 11.5%

0.9%

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Medicaid Enrollment Has Increased by Nearly 6 Million Since the Start of the Recession

40.4 41.9 42.6 42.3 42.8 44.8 48.5 Dec-03 Dec-04 Dec-05 Dec-06 Dec-07 Dec-08 Dec-09

SOURCE: Analysis for KCMU by Health Management Associates, using compiled state Medicaid enrollment reports

Monthly Enrollment in Millions

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WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL

NOTE: Reflects the enhanced FMAPs granted to states under ARRA. SOURCE: Federal Register, August 26, 2010 78 – 82 percent (10 states including DC) 70 – 77 percent (18 states) 63 – 69 percent (7 states) 62 percent (14 states)

Enhanced Federal Medical Assistance Percentages (FMAP), FY 2011

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Medicaid Today and Tomorrow

Health Insurance Coverage

for Certain Categories Minimum floor for

Health Insurance Coverage

to 133% FPL Assistance for

Duals / Long-Term Care

Support for

Health Care System

Additional

Federal Financing

for Coverage Additional Options

Long-Term Care / Coordination for Duals Shared Financing

States and Federal Govt.

MEDICAID

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About the Study

• 10th Annual Survey of Medicaid directors in all 50

states and DC

• Conducted in July and August 2010
• Report focuses on actions implemented in FY 2010

and adopted for FY 2011

• Purpose: To track trends in state budgets, Medicaid

spending, enrollment, policy initiatives and impact of federal policies such as ARRA

• Establish a baseline for evaluating changes as states

implement health reform

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How States Used ARRA Enhanced Medicaid Funding in FY 2009 and FY 2010

28 35 37 38 41 43 29 38 36 44 33 36 Avoided or Restored Eligibility Cuts Avoided or Reduced Provider Rate Cuts Avoided Benefit Cuts Closed or Reduced State General Fund Shortfall Helped Pay for Increases in Medicaid Enrollment Closed or Reduced Medicaid Budget Shortfall

FY 2009 FY 2010

SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, 2009 and 2010.

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Projected and Actual Total Medicaid Spending and Enrollment Growth for FY 2010

6.3% 6.6% 8.8% 8.5%

Total Spending Growth Enrollment Growth Projected for FY 2010 Actual for FY 2010

SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2009 and September 2010.

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Percent Change in Total Medicaid Spending and Enrollment, FY 1998 – FY 2011

4.7% 6.8% 8.7% 10.4% 12.7% 8.5% 7.7% 6.4% 1.3% 3.8% 5.8% 7.6% 8.8% 7.4%

• 1.9%

0.4% 3.2% 7.5% 9.3% 5.6% 4.3% 3.2% 0.2%

• 0.7%

3.1% 7.5% 8.5% 6.1% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Spending Growth Enrollment Growth

NOTE: Enrollment percentage changes from June to June of each year. Spending growth percentages in state fiscal year. SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2010.

2011 Adopted

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Change in State Share of Medicaid Spending, FY 2009 – FY 2011

• 10.9%
• 7.1%

13.1% 25.6% 5.3% Average for 2011 Did Not Assume ARRA Extension for 2011 (24 States) Assumed ARRA Extension for 2011 (27 States) First Decreases Ever in State Spending for Medicaid, Due to ARRA FMAP (2009 and 2010) 2009 2010

SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2010.

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State Policy Actions Implemented in FY 2010 and Adopted for FY 2011

36 41 15 32 36 27 16 32

States with Expansions / Enhancements States with Program Restrictions Adopted FY 2011 FY 2010 Provider Payments Eligibility Benefits Long Term Care

39 37 1 1 20 14 18 10

NOTE: Provider payment restrictions include rate cuts for any provider or freezes for nursing facilities or hospitals. SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2010.

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Medicaid edicaid and the and the Unins ninsur ured ed 20 16 1 1 5 21 27 8 5 14 39 33 20 10 25 37 30 12 9 29

States with Provider Rate Changes FY 2008 – FY 2011

48 35 27 31 46 47 24 19 29 37 36 18 8 22 26 36 21 8 20 22

Any Provider Inpatient Hospital MCOs Nursing Homes Physicians States with Rate Increases States with Rate Restrictions

NOTE: Rate restrictions include rate cuts for any provider and also frozen rates for inpatient hospitals and nursing homes. SOURCE: KCMU survey of Medicaid

• fficials in 50 states and DC conducted by Health Management Associates,

September 2008 - 2010

FY 2009 FY 2008 FY 2010 Adopted FY 2011

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States With Eligibility Expansions / Enhancements FY 2008 – FY 2011

33 27 23 30 15 25 41 32 26 27 17 17

Total Changes Eligibility Standards Application and Renewal

SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2008 – 2010.

FY 2009 FY 2008 FY 2010 Adopted FY 2011

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States Cutting or Restricting Benefits FY 2008 – FY 2011

3 10 20 14

2008 2009 2010 Adopted 2011

Number of States

SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2008 – 2010.

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Medicaid Long-Term Care Expansions, Implemented in FY 2008 – FY 2011

5 12 8 22 6 12 5 23 3 6 12 27 1 10 8 38

Enhanced Institutional Services Added Additional Services to HCBS Waiver Implemented or Expanded PACE New or Expanded HCBS Waiver

SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2009 and 2010.

FY 2008 FY 2009 FY 2010 Adopted FY 2011

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Delivery System Changes

• States continue to broaden use of managed care
• ACA includes provisions to improve care delivery

– Health Home Option - enhanced funding for care coordination for individuals with chronic care needs – CMS Innovation Center to test payment and delivery models, – Federal Coordinated Health Care Office within CMS to improve coordination for dual eligibles – Funding for demonstrations and grants

• States focused on initiatives to improve quality using

HEDIS and CAHPS, P4P and other strategies

• States continue to expand the use of HIT

– Focus on adoption and meaningful use of electronic health records (EHRs) and health information exchanges (HIEs)

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Outlook for FY 2011 and Beyond

• Even though the recession is over, states are still

feeling the impact and will for the next few years

• Few options left for significant Medicaid savings
• Major concerns about the end of ARRA funds in 2012
• Health reform presents new opportunities and

challenges

– Estimates show large declines in the uninsured in 2019 and increased federal funds for Medicaid expansion – Biggest challenges: staff capacity, implementing Medicaid expansion, establishing Exchanges, transitioning to MAGI, designing new eligibility systems