Medicaid Funding and Policies Is There a Medicaid Crisis? A - - PowerPoint PPT Presentation

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May 18, 2023 200 likes •305 views

Medicaid Funding and Policies Is There a Medicaid Crisis? A Financial Diagnosis for State and Local Government Matt Powers Health Management Associates March 15, 2007 Main Points Medicaid Remains a Workhorse - has Evolved into a Very

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Medicaid Funding and Policies

Is There a Medicaid Crisis? A Financial Diagnosis for State and Local Government Matt Powers Health Management Associates March 15, 2007

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Main Points

Medicaid Remains a Workhorse - has Evolved into a Very Different Program States & Health Reform – leading the charge, balancing public/private Early lessons learned in state-based health reform initiatives Hard Questions

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Medicaid Remains the “Utility Man” …

Mental health: over half of publicly financed care Public health and schools Hospitals that serve the safety net: special Medicaid “DSH”

payments $16 billion in 2007

Community Health Centers: Medicaid averages 40% of

CHC revenues

7 million low-income elderly and disabled are “dual

eligibles”– on both Medicaid and Medicare

“Duals” account for 40% of Medicaid spending

Smith, V. Medicaid in 2007 and Beyond: Context for Medi-Cal Policy Development. Presentation for The Working Committee on Waiver Development and Medi-Cal Expansion, February 2007.

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….But Medicaid Has Fundamentally Changed

Coverage @ much higher income levels Entitlement has changed with Waivers - Florida Match for Preventive/Wellness/Enhanced Benefits Government subsidized commercial insurance SCHIP

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40% 45% 50% 55% 60% 65% 70% 75% 1 987 1 989 1 991 1 993 1 995 1 997 1 999 2001 2003 2005 0% 2% 4% 6% 8% 1 0% 1 2% 1 4%

Is this a Business Cycle or is the “Defined Contribution” Having an Impact?

Me dic aid

mploye r

Sponsor

e d He alth Insur anc e

So urc e : US Ce nsus Bure a u, Smith, V., NCSL Pre se nta tio n; F e d e ra l Re se rve Ba nk o f Da lla s; Sc o tt, J. 2005 NASMD Pre se nta tio n. 1985 1.8 Million E mploye e s 1995 709,000 E mploye e s 2005 1.3 Million E mploye e s

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

2007 State Coverage Initiatives

Current State Coverage Initiatives

Comprehensive Reform Medicaid/SCHIP Expansion Premium Support/HSA Currently No Major Initiative

Non-Elderly Population 257,442,650 Employer Sponsored Coverage 61% Medicaid/SCHIP Coverage 16% Uninsured 18% Individual/High-Risk Pool/Other Coverage 5% Uninsured Population 46,118,230 Uninsured Population 18-30 15,068,735 Population Undocumented 11,100,000 Uninsured Eligible for Medicaid/SCHIP 11,391,203 2007 Total Health Care Spending $2,325,700,000,000 Employer Sponsored Coverage Spending 2007 Medicaid Spending $347,300,000,000 All numbers represent the non-elderly population, age 0-64.

United States - Statistical Perspective

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Early Lessons Learned

Do We Nearly Have Universal Access, Only Delivered

in a Very Inefficient Way Given the Roles of EMTALA, FQHC, Charity Hospitals?

Is This a Crisis or Several Sub-Crises? Voluntary (e.g. Maine) Helps but Individual and

Business Components Help Affordable Rates and Level Playing Field

Concept to Implementation Issues

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My Case for Coverage Issues Being Less of a Partisan Issue than in Past

Government routinely subsidizes commercial insurance Individual and Business mandate are a unique blend

f “big government” and “personal responsibility”

Bipartisan blend leading charge from Executive branches Broad recognition that uninsured shift costs

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Hard Questions

Ultimate Juggling–Assessment, NPRM, Payment Methodology, Cook Pressures, Community Benefit, Uninsured Plan The Stomach to Tolerate Set-Backs and Tweaks? Will the Beltway Trump this with a Big Plan? [Be nice to

ur guests – Wisconsin]