Transcript Slide 1

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Texas Medicaid and CHIP Enrollment
Update
for
Children’s Hospital Association of Texas
October 24, 2006
Anne Dunkelberg, Associate Director
900 Lydia Street - Austin, Texas 78702
Phone (512) 320-0222 – fax (512) 320-0227 - www.cppp.org
Center for Public Policy Priorities
www.cppp.org
2
Texans and Health Insurance
US Census Bureau Statistics (March 2006 CPS):
• Approximately 5.5 million Texans uninsured in 2005
–24.6% of Texans of all ages were uninsured (versus 15.7% U.S.)
–26.9% of Texans under age of 65 were uninsured
• Another three million Texans covered by Medicaid or CHIP
(i.e., generally not insured through private coverage)
• Why are so many Texans uninsured?
Low percentage of employer-sponsored insurance (ESI)
–8% below national average for < age 65 (54.5%, vs. 62.8%)
–10.4% below national average for < age 18
–Only 12.0% of Texans below poverty have ESI
• Approximately 83% of Texas Medicaid recipients are below poverty (i.e.,
most are unlikely to be insured w/o Medicaid)
Center for Public Policy Priorities
www.cppp.org
Texas’ Uninsured by Income, 2005
Income, % of
Poverty
Uninsured
(millions)
As % of Group
All
5.5
24.6%
<100%
1.55
42.2%
$20,000
100-200%
1.92
37.5%
$40,000
200-300%
1.04
26.5%
$60,000
300-400%
0.446
14.8%
$80,000
400-500%
0.172
9.4%
$100,000
Above 500%
0.368
7.1%
More than
$100K
Center for Public Policy Priorities
Max income,
Family of 4
www.cppp.org
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How Does Immigration Factor In?
• Immigrants are NOT the primary cause of Texas’
last-place ranking
– Census Bureau reported 2.4 million non-citizens
(includes both legal residents and undocumented
persons); 1.3 million of them are uninsured (54.5% of
non-citizens)
– BUT! If you removed non-citizens from the equation,
Texas would still be tied with New Mexico for the
worst uninsured rate at 20.6% uninsured (4.2 million),
even if you left the non-citizens in the other state’s
counts
• Without immigrants, New Mexico’s rate would drop to 18.9%
Center for Public Policy Priorities
www.cppp.org
5
Texas Health Insurance Stats:
What They Tell Us About the Need for Outreach?
Texas Children who are Uninsured, 2004-05 – U.S. Census
All incomes, under age 19 (0-18*; 2-year
average 2004-05 Census CPS)
20.4%
1.367 million
< 200% FPL; under age 19 (0-18; 2-year
average 2004-05 Census CPS)
28% of
<200%;
13.4% of all
kids
919,000
•In other words, 2/3 of uninsured Texas children are below 200% of the
federal poverty line, despite Medicaid and CHIP.
•Texas is home to an estimated 230,000 undocumented kids, and another 160,000
legal immigrant (LPR) children under age 18 (Pew Hispanic Center).
•But, the LPR kids can participate in CHIP.
•Clearly, undocumented children are just a small part of our uninsured problem
•At least half of our uninsured kids (~689,000) could enroll in Medicaid or
CHIP!
Center for Public Policy Priorities
www.cppp.org
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Texas Medicaid: Who it Helps
August 2006, HHSC data.
Disabled,
360,974
Elderly,
362,953
Poor Parents,
60,445
TANF Parent,
25,411
Maternity,
97,161
Children,
1,784,302
Total enrolled 6/1/2006: 2,644,167
Center for Public Policy Priorities
www.cppp.org
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Income Caps for Texas Medicaid and CHIP, 2006
250%
200%
$21,708
$30,710/yr $30,710/yr
$22,078/yr
150%
100%
$16,600
$33,200
222%
200%
Long
Term
Care
CHIP
$7,476
185% 185%
133%
50%
100%
$2,256
$3,696
13.6% 22.3%
74%
0%
Pregnant Newborns Age 1-6 Age 6-18 TANF Working SSI (aged
Women
parent of Parent of
or
2, no
2
disabled)
income
Mandatory
Optional
Income Limit as Percentage of Federal Poverty Income
Annual Income is for a family of 3,
except Individual Incomes shown for SSI and Long Term Care
Center for Public Policy Priorities
www.cppp.org
Medicaid in Texas: Who it Helps
Medicaid:
As of September 2006, 2.6 million Texans were enrolled in Medicaid:
•1.75 million were children
–about 96,000 of these children, or 5.5%, were receiving disabilityrelated Medicaid (98% of these on SSI)
–about 13,100 were pregnant teens (0.8% of the kids; 0.5% of all
Medicaid)
–125,600 in TANF cash assistance families ( 7.2% of the kids;
4.8% of total caseload)
–OTHER 1.5 MILLION predominantly in WORKING POOR
FAMILIES
• About 1.2 million worker-headed families,
• Other 20% are headed by disabled parents; living on child
support from non-custodial parent, or both)
Center for Public Policy Priorities
www.cppp.org
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Medicaid in Texas: Who it Helps
Medicaid:
As of September 2006, 2.6 million Texans were enrolled in
Medicaid:
895,000 were adults:
– 691,000 (79% of the adults) were elderly or disabled.
Adults on SSI account for 60% of the aged and disabled
recipients
– Other adults: 98,600 maternity coverage; 25,500 TANF
parents (1.0% of total caseload);
– NOTE: there are fewer than 85,000 total poor parents on
Texas Medicaid. 59,400 either TMA (Transitional
Medicaid Assistance) or parents who are at or below TANF
income, but not receiving TANF cash assistance
Children’s Health Insurance Program (CHIP):
• as of September 1, 2003 — 507,259 children
• as of October 1, 2006 — 300,685 (drop of 206,574, or 41%)
Center for Public Policy Priorities
www.cppp.org
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Texas Child Medicaid and CHIP
6,400,000
9/03: 2,150,543
2,100,000
6,300,000
2,000,000
6,200,000
10/06: 2,020,710
1,900,000
6,100,000
1,800,000
6,000,000
1,700,000
5,900,000
1,600,000
5,800,000
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Children Enrolled
2,200,000
(Jan. 2002-October 2006)
Child Population
Enrollment
Source: Enrollment from Texas Health and Human Services Commission; Texas
State Demographer's 0-17 Population Estimates
Center for Public Policy Priorities
www.cppp.org
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Texas Child Medicaid Enrollment
(February 2001-October 2006)
Simplified Enrollment
begins
High:
1,838,239
1,900,000
now:
1,720,025
1,600,000
1,300,000
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Source: Texas Health and Human Services Commission
Center for Public Policy Priorities
www.cppp.org
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Texas CHIP Enrollment
(May 2000-Oct. 2006)
Highest, 5/02:
529,271
600,000
9/03:
507,259
10/06:
300,685
400,000
200,000
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Source: All figures from Texas Health and Human Services Commission;
Compares most recent month with September 2003
Center for Public Policy Priorities
www.cppp.org
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CHIP Caseloads: Now and Projected
2006
2007
HHSC 2/05 enrollment projection, if 12month eligibility restored
386,110
467,404
SB 1 funded caseload, traditional CHIP
(6 month renewal)*
344,750
351,132
Additional caseload, perinatal coverage
17,425
47,498
Total, SB 1 projected CHIP caseload,
traditional & perinatal CHIP
362,175
398,630
September 2003 actual caseload
507,259
October 2006 actual caseload
300,685
decline, 9/03 to 10/06 (-40.7%)
(-206,574)
*Rider 57 HHSC (SB 1) requires agency to request more $$ for CHIP from LBB if
needed for enrollment and benefits.
•HHSC Budget Request for 2008-09 would allow enrollment to grow to 339,037 in
2009.
Center for Public Policy Priorities
www.cppp.org
Recent Declines in Texas Children’s Medicaid Enrollment
December
2005
October
2006
1,838,239
1,720,025
-118,214
-6.4%
139,682
134,021
-6,478
-4.6%
64,339
64,212
-1,347
-2.1%
182,954
172,030
-12,900
-7.1%
98,319
91,162
-9,054
-9.2%
316,896
301,042
-24,905
-7.9%
4,953
5,178
155
3.1%
Tarrant
97,908
91,296
-8,425
-8.6%
Travis
52,667
50,835
-3,400
-6.5%
Webb
36,473
33,347
-3,727
-10.2%
State total
Bexar
Cameron
Dallas
El Paso
Harris
Hays
Center for Public Policy Priorities
Decline, December to
October
Source: Texas Health and Human Services Commission
www.cppp.org
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Children’s Medicaid declines
• Drop of over 99,000 children statewide from December
2005 to April 2006 caused alarm.
• As of April, Travis and Hays showing much greater loss
since December than statewide loss (-11.4% and -16.8%,
vs. -5.4% statewide).
• However, caseloads improved June to September, and
Travis and Hays county child enrollment rebounded by
much larger margin than the statewide growth.
• Then dropped 35,607 from August to September; -28,670
from Sept. to Oct.
• Net decline since December now -118,214.
• Travis and Hays counties now doing BETTER than state
average (Due to extra State attention to them?).
• Of concern and unexplained: Webb and El Paso counties
drop more than Travis (-10.2, -9.2%)
Center for Public Policy Priorities
www.cppp.org
16
Adult Medicaid Trends - Statewide
Dec-05
Sept.-06
Dec 05 to
Sept. 06
Change
Aged and
Disabled
687,177
710,131
22,954
3.3%
Cash
Assistance
31,876
25,527
-6,349
-19.9%
Maternity
93,617
98,614
4,997
5.3%
Other
Parents
64,656
59,412
-5,244
-8.1%
877,326
894,585
17,259
2.0%
Total
•CAVEAT: Travis and Hays County Medicaid enrollment have DECLINED for
adults from December 2005 to September 2006.
•Points to problems with the IE&E pilot and TIERS
Center for Public Policy Priorities
www.cppp.org
Adult Medicaid Trends – Travis County
Dec-05
Sept.-06
Dec 05 to
Sept. 06
Change
Aged and
Disabled
17,435
16,846
-589
-3.4%
Cash
Assistance
4,089
4,352
263
6.4%
Maternity
1828
1,967
139
7.6%
Other
Parents
1,692
1,596
-96
-5.7%
25,044
24,761
-283
-1.1%
Total
• From December 2005 to July 2006, Statewide Adult Medicaid enrollment
grew by 1%, but Travis County enrollment DECLINED for adults, including
aged and disabled and maternity (-6.5% overall)
• Enrollment since then shows some recovery; Statewide growth 2% since
December, but Travis County enrollment dropped -1.1%
• Points to problems with the IE&E pilot and TIERS.
Center for Public Policy Priorities
www.cppp.org
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Adult Medicaid Trends – Hays County
Dec-05
Sept.-06
Dec 05 to
Sept. 06
Change
1,956
1,658
-298
-15.2%
Cash
Assistance
348
456
108
31.0%
Maternity
261
273
12
4.6%
Other
Parents
119
106
-13
-10.9%
2,684
2,493
-191
-7.1%
Aged and
Disabled
Total
•From Dec. 2005 to Sept. 2006, Statewide Adult Medicaid enrollment grew by
2%, but Hays County enrollment DECLINED for aged and disabled and nonTANF parents (-7.1% overall)
•Hays County decline as of July was -10.1% (vs. +1.1% statewide), so some
improvement over summer.
• Points to problems with the IE&E pilot and TIERS
Center for Public Policy Priorities
www.cppp.org
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Recent Declines in Texas CHIP Enrollment
December
2005
September
2006
322,898
291,530
-31,368
-9.7%
20,915
18,443
-2,472
-11.8%
7,814
7,770
-44
-0.6%
Dallas
33,325
30,470
-2,855
-8.6%
El Paso
13,628
11,571
-2,057
-15.1%
Harris
65,465
56,211
-9,254
-14.1%
Hays
1,489
1,342
-147
-9.9%
Tarrant
19,754
19,039
-715
-3.6%
Travis
8,550
8,847
297
3.5%
Webb
5,279
5,153
-126
-2.4%
State total
Bexar
Cameron
Center for Public Policy Priorities
Decline, December to
September
Source: Texas Health and Human Services Commission
www.cppp.org
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CHIP Declines
• September ’06 county numbers show slight
improvement in SOME counties, while most
remain well below December ’05 enrollment.
• Renewal rates ARE improved: back above 70%
for June-Sept.-- compared to 50%-57% from
January through May .
• However, thru September statewide enrollment
continues to drop, new enrollment is low. Thus,
too early to claim recovery trend for CHIP.
Center for Public Policy Priorities
www.cppp.org
21
What Texas Spends
and how much more it would cost to “Be Average”
State "Own Source" Budget, 2006-07: $90 Billion
K-12 Education,
$28.6 b, 31%
Medicaid,
$14.1 b, 16%
All Other,
$7.0 b, 8%
Business/
Econ Devel.,
$9.2 b, 10%
Higher
Education,
$17.7 b, 20%
Criminal Justice,
$8.3 b, 9%
If State
Spending
per Texan
were equal
to the U.S.
Average,
this budget
would
increase to
$142
Billion
Other Health &
Human Services,
$5.1 b, 6%
"Own Source" = Excludes Federal Funds
Center
for Public
Priorities
www.cppp.org
Source:
LBBPolicy
Fiscal
Size Up 2006-07; NASBO State Expenditure Report 2004 (Jan
2006)
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2008-09 Budget Will Be Very Tight
State Own-Source Spending and Revenue
$116 billion
$120
$94 billion
$100
$80
$114 billion
Other: $8.1
Other: $7.0
Eco. Dev.: $9.2
Eco. Dev: $9.2
Prisons: $8.7
GR Dedicated: $1.3 b
Rainy Day Fund: $3.3 b
HHS: $22.8
Prisons: $8.3
$60
HHS: $19.2
Higher Ed: $19.4
$40
Higher Ed: $17.7
$13.5 (tax swap)
$2.1 (tax swap)
$20
$6.6 b ending balance
$8 b rev growth
$-
2006-07 Spending
Center for Public Policy Priorities
2008-09 Needs
2008-09 Revenue
www.cppp.org
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HHS Needs in 2008-09
“Above Baseline” Requests
• Restore 10% Cuts: HHSC $72 million/550 workers; Aging
& Disability, $112 million/298 workers; Family & Protective
Services, $40 million/Eliminate Prevention services; State
Health Services, $236 million/693 workers; Assistive &
Rehabilitative Services, $13 million/168 employees
• HHSC needs $1.8 billion GR ABOVE “base” to maintain
caseload growth and inflation/cost increases in Medicaid and
CHIP
– $1.7 billion for Medicaid (allows for modest caseload growth)
– $14.7 million for CHIP; Enrollment assumed to cap at 339,000 in
2009
Center for Public Policy Priorities
www.cppp.org
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HHS Needs in 2008-09 (continued)
“Above Baseline” Requests
• Other HHSC: $254 million for community care waiting lists;
$237 million to restore Medicaid and CHIP rate cuts from 2003
• State Health Services: $116 million for Mental Health and
Substance Abuse programs
• Dept. Aging and Disability: $84 million to MAINTAIN
community care: $10.7 million to restore 2003 rate cuts
• Family and Protective Services: $79.6 million to continue
APS/CPS reform; $590 million to replace Rainy Day funds;
$51.3 million for caseload growth
Center for Public Policy Priorities
www.cppp.org
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Texas Unspent CHIP Funds Lost
to Other States
•
•
•
•
•
•
FFY 1998 Federal SCHIP Funds Lost - $170 million
FFY 1999 Federal SCHIP Funds Lost - $324.5 million
FFY 2000 Federal SCHIP Funds Lost - $123.7 million
FFY 2001 Federal SCHIP Funds Lost - $85.3 million
FFY 2002 Federal SCHIP Funds Lost - $104.6 million
FFY 2003 Federal SCHIP Funds Lost - $23.8 million
• Total lapsed to date (2000-2005): $831.9 million
• For perspective, TOTAL Texas CHIP spending in FY 2005 was
$401.6 million, of which $110 million was state dollars
• Expected to soon lapse another $26.5 million from the 2004
allocation, based on state estimates as of 8/2006.
Source: Center on Budget and Policy Priorities, analysis of CMS data.
Center for Public Policy Priorities
www.cppp.org
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History/Context of Texas CHIP and our
Federal CHIP Funding Allocation
• BEFORE 2003 CHIP cuts, Texas was projecting a
CHIP federal funding shortfall by late 2006.
• Had spending held flat at Texas’ fiscal year 2002 high (i.e., no
inflation and no enrollment growth) we’d still have had a federal
shortfall at least by 2008.
• Now, state is assuming (in current state budget and in official reports
to CMS) that CHIP enrollment will rebound, PLUS a perinatal option
is scheduled to begin in January 2007.
• The latest (unofficial) state projection for federal
CHIP shortfall in Texas is 2010.
• Texas projects 24% growth in CHIP spending from 2006 to 2007;
based on this projected (but as yet non-existent) enrollment rebound
PLUS new perinatal program
• Additional Texas CHIP spending planned (pending approval), but not
included in current state projections:
– SCHIP premium assistance waiver; Galveston regional “3-share”
waiver which will include SCHIP
Center for Public Policy Priorities
www.cppp.org
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Federal SCHIP Reauthorization, 2007
• Other states want Texas’ lapsed funds (Other
states have used all their and need more…)
• Texas’ CHIP allocation (share of the pie) will
be targeted to be reduced based on our lower
enrollment
• WILL Congress add money to CHIP to allow
for population growth, inflation, or expansion?
• This is a cautionary example of the problems
with block grants
Center for Public Policy Priorities
www.cppp.org
28
Federal SCHIP Reauthorization, 2007
Priorities:
• No loss of SCHIP ground in enrollment or benefits
(Need $12-$14 b/5 yrs new $$ to sustain)
• Enough growth to cover all eligible/not enrolled @
current eligibility thresholds
• Room to cover more uninsured kids
• NO cuts to Medicaid to offset SCHIP
Other issues:
• Fair treatment of states that did more prior to CHIP
Center for Public Policy Priorities
www.cppp.org
29
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