Medicaid and Health Reform: How Will They Work Together?

Jocelyn GuyerCenter for Children and Families http://ccf

.georgetown.edu

Medicaid’s Coverage Role Today

Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.

Children = 78.6 million

Employer-Sponsored Insurance

55%

Uninsured

11%

Medicaid/Other Public

29%

Individual Coverage

4%

Medicaid Provides Coverage for Half of Low-Income Children

Source: Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, and Urban Institute estimates; Birth data: NGA, MCH Update. Note that “poor” is defined as living below the federal poverty level, which was $17,600 for a family of 3 in 2008.

51%

27%

Low-IncomeChildren

All Children

Percent with Medicaid Coverage

Source: Data reflects low-income (<200% FPL) children. Johns Hopkins University Bloomberg School of Public Health analysis of the National Health Interview Survey for the Center for Children and Families (March 1, 2008).

Decline in the Rate of Uninsured Low-Income Children is Attributable to Enrollment in Medicaid and CHIP

39.1%43.2%

47.8%50.9% 51.9% 53.1%

56.2%

19.1%21.4%

15.4%15.6%15.9%16.5%

22.7%23.3%

16.6%

21.7%

37.7%35.9%37.0%

0%

10%

20%

30%

40%

50%

60%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Uninsured Public Coverage

42%

28%

15%

15%

70% of Uninsured Children are Below 200% FPL

Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.

Children = 8.9 million

Under 100%

100-199%

200-299%

300% +

70% below 200% FPL

Children Currently Eligible but Unenrolled

4.4 Million are Eligible for Medicaid

1.7 Million are Eligible for SCHIP

Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules

9 Million Uninsured Children

Medicaid Income Eligibility Levels

200%

133%

100%

Median Eligibility Level Minimum Eligibility Level(0-5)

Minimum Eligibility Level(6-19)

Source: D. Cohen Ross and C. Marks, “Challenges of Providing Health Coverage for Children and Parents in a Recession,” Kaiser Commission on Medicaid and the Uninsured (January 2009).

51 states cover children above the minimum eligibility level

Source: D. Cohen Ross, A. Horn, & C. Marks, “Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,” Kaiser Commission on Medicaid and the Uninsured (January 2008);updated by the Center for Children and Families. Note: States with asterisks (*) have enacted, but not yet implemented to the levels shown.

FL

NC*

SC

GALA*TX

AL

AR

KS*

OK*AZ TN

MS

NVUT

NM

CA

WYID

WA*

ORND

SD

NE

MT*

MO

IN*

MI

WI

IL

ME

OH*

KY

HI

AK

PA

WV* VA

CTNJ

DEMD

RI

NHVT

DC

MA

CO*

IA*

NYMN

Medicaid and SCHIP Eligibility Levels for Children, January 2009

> 250% FPL (21 states)

200% FPL (16 states)

201%-250% FPL (9 states)

< 200% FPL (4 states)

Medicaid/CHIP Coverage Improves Access to Care

Source: Kaiser Commission on Medicaid and the Uninsured analysis of National Center for Health Statistics, CDC. 2007. Summary of Health Statistics for U.S. Children: NHIS, 2007. Note: Questions about dental care were analyzed for children age 2-17. Respondents who said usual source of care was the emergency room were included among those not having a usual source of care. An asterisk (*) means in the past 12 months.

1%4%

2% 3%

13%

28%

4%3% 3%2%

12%

6%3%

18%17%

32%

24%

13%

No Usual Souceof Care

PostponedSeeking CareDue to Cost*

Needed Care butDid Not Get itDue to Cost*

Last MD Contact>2 Years Ago

Unmet DentalNeed Due to

Cost*

Last Dental Visit>2 Years Ago

Employer/Other Private Medicaid/Other Public Uninsured

Medicaid’s BIG Role in Covering Foster Children

• All IV-E foster care children are eligible for Medicaid

• States have the option to cover non-IV-E foster care children - All do

• All children receiving federal adoption subsidies are eligible for Mediciad

• Most states (50) provide Medicaid coverage to adopted children receiving state subsidies

Foster Children Covered by Medicaid

In 2001:

• 869,087 foster care children were covered under Medicaid– Estimates suggest, this reflects only 853%

of those eligible for care

• Foster children represent 3.7% of the non-disabled children on Medicaid

Source: R. Geen, A. Sommers, M. Cohen, “Medicaid Spending on Foster Children,” Urban Institute (August 2005)

Medicaid Spending on Foster Children

In 2001:• $3.8 billion was spent by states to

provide coverage for foster children• On average, states spent more on

foster children ($4,336 per child) than on all non-disabled children ($1,315)

• Foster children accounted for 12.3% of expenditures

Source: R. Geen, A. Sommers, M. Cohen, “Medicaid Spending on Foster Children,” Urban Institute (August 2005)

The Importance of Medicaid for Foster Children

Foster children tend to have significant health problems - Medicaid is there to help.

What About Health Reform?

But First . . . CHIP Reauthorization

• New funding levels and formula

• New incentives to enroll Medicaid children

• Eligibility changes• Benefit changes• Significant new emphasis

on quality, access

Obama plan maintains Medicaid and SCHIP, but no details yet.

Health Care Reform Proposals

Baucus plan extends Medicaid to all below 100% FPL and requires states to cover children in CHIP up to 250% of FPL; higher levels required/permitted.

Broader Health Reform – What Do Children Need?

• Access to affordable coverage for all children

• Stronger financing structure• A benefit package designed for

children and their unique developmental needs

• High quality care with access to needed providers

• Family-based coverage

Broader Health Reform – Risk Points for Children

• Failure to acknowledge and address the unique needs of children

• Politicians using mandates to claim victory on enrollment issues

• Poor coordination between existing programs and new initiatives

• Fracturing of coverage within families

• Criticism of Medicaid/CHIP as “failed” programs