Transcript Figure 0 Medicaid: The Essentials Diane Rowland, Sc.D. Executive Vice President, Henry J. Kaiser Family Foundation and Executive Director, Kaiser Commission on Medicaid and the Uninsured for Alliance for.

Figure 0
Medicaid: The Essentials
Diane Rowland, Sc.D.
Executive Vice President,
Henry J. Kaiser Family Foundation
and
Executive Director,
Kaiser Commission on Medicaid and the Uninsured
for
Alliance for Health Reform
Washington, DC
February 13, 2009
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 1
Medicaid’s Origins
• Enacted in 1965 as companion legislation to Medicare
Parts A and B (Title XIX)
• Entitles eligible individuals to defined set of benefits
• Entitles participating states to federal matching funds on
open-ended basis
• Means-tested, with focus on welfare population:
-- single parents with dependent children
-- aged, blind, and disabled
• Mandatory services and populations for participating
states with options for broader coverage
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 2
Medicaid Today
Health Insurance
Coverage
Assistance to
Medicare Beneficiaries
Long-Term Care
Assistance
29.5 million children & 15
million adults in low-income
families; 6 million elderly & 8
million persons with disabilities
8.8 million aged and disabled
— 19% of Medicare
beneficiaries
1 million nursing home
residents; 2.8 million
community-based residents
MEDICAID
Support for Health Care
System and Safety-net
State Capacity for Health
Coverage
16% of national health spending;
42% of long-term care services
Federal share ranges 50% to 76%;
44% of all federal funds to states
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 3
Medicaid’s Role for Selected Populations
Percent with Medicaid Coverage:
Poor
Near Poor
African-Americans
Hispanics
40%
23%
27%
24%
Families
All Children
27%
Low-Income Children
Low-Income Parents
51%
20%
Births (Pregnant Women)
41%
Aged & Disabled
Medicare Beneficiaries
19%
People with Severe Disabilities
20%
People Living with HIV/AIDS
44%
Nursing Home Residents
Note: “Poor” is defined as living below the federal poverty level, which was
$17,600 for a family of 3 in 2008. SOURCE: KCMU, KFF, and Urban
Institute estimates; Birth data: NGA, MCH Update.
65%
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 4
Percent of Nonelderly Residents Covered
by Medicaid, by State, 2006-2007
NH
VT
WA
MT
ME
ND
MN
OR
ID
SD
MI
RI
WY
PA
IA
NE
NE
NV
UT
CA
KS
WV
VA
NC
OK
AZ
NM
TN
TX
AL
DC
SC
AR
MS
DE
MD
KY
MO
CT
NJ
OH
IN
IL
CO
MA
NY
WI
GA
LA
AK
FL
HI
>15% (15 states including DC)
13-15% (16 states)
US Average = 13%
10-12% (12 states)
< 10% (8 states)
K A I S E R C O M M I S S I O N O N
SOURCE: Urban Institute and KCMU analysis of the March 2006 and 2007 Current
Population Survey. Two-year pooled estimates for states and the US (2006-2007).
Medicaid and the Uninsured
Figure 5
Medicaid Enrollees and Expenditures
by Enrollment Group, 2005
Elderly
10%
Disabled
14%
Elderly
28%
Adults
26%
Disabled
42%
Children
50%
Adults 12%
Children 18%
Enrollees
Expenditures on benefits
Total = 59 million
SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban
Institute estimates based on 2005 MSIS data.
Total = $275 billion
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 6
Medicaid Payments Per Enrollee
by Acute and Long-Term Care, 2005
$13,524
$11,839
Long-Term Care
Acute Care
$1,617
Children
$2,102
Adults
Disabled
SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban
Institute estimates based on 2005 MSIS data.
Elderly
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 7
Median Medicaid/SCHIP Income Eligibility
Thresholds, 2008
200%
185%
Federal Poverty Line
(For a family of four is
$21,200 per year in 2008)
74%
68%
41%
0%
Children
Pregnant
Women
Elderly and
Individuals
with
Disabilities
SOURCE: KCMU/Urban Institute analysis of March 2008 CPS.
Working
Parents
NonWorking
Parents
Childless
Adults
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 8
Children’s Eligibility for Medicaid/SCHIP by Income,
January 2009
NH
VT
WA
MT
ND
MA
MN
OR
ID
NY
SD
WI
RI
MI
WY
PA
IA
NE
NV
ILIL
UT
CA
ME
CO
OH
IN
WV
DE
VA
KS
MO
KY
NC
TN
OK
AZ
NM
AK
MD
DC
SC
AR
MS
TX
CT
NJ
AL
GA
LA
FL
HI
< 200% FPL (7 states)
*The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year.
***IL uses state funds to cover children above 200% FPL.; MA uses state funds to
cover children above 300% FPL; NY uses state funds to cover children from 250%
to 400% FPL; WI uses state funds to cover children from 250% to 300% FPL.
SOURCE: Based on a national survey conducted by the Center on
Budget and Policy Priorities for KCMU, 2009.
200-250% FPL (33 states)
>250% FPL (11 states & DC)
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 9
Medicaid Eligibility for Working Parents by Income,
January 2009
NH
VT
WA
MT
ND
MN
OR
ID
WI
RI
MI
WY
PA
IA
NE
NV
ILIL
CA
CO
MO
DE
WV
KY
NC
TN
OK
AZ
NM
MD
DC
SC
AR
MS
TX
CT
NJ
OH
IN
VA
KS
MA
NY
SD
UT
ME
AL
GA
LA
AK
FL
HI
20-49% FPL (13 states)
50- 99% FPL (20 states)
US Median Eligibility = 68% FPL: $11,968 per year
> 100% FPL (18 states including DC)
*The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year.
SOURCE: Based on a national survey conducted by the Center on Budget and
Policy Priorities for KCMU, 2009.
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 10
Health Insurance Coverage of Low-Income
Adults and Children, 2007
Medicaid/Other Public
Poor
Children
64%
(<100% Poverty)
Near-Poor
Poor
Adults
without
Children
Near-Poor
Poor
Near-Poor
16%
43%
(100-199% Poverty)
Parents
Employer/Other Private
39%
17%
29%
19%
20%
41%
18%
50%
25%
44%
Uninsured
16%
43%
33%
46%
37%
Medicaid also includes SCHIP and other state programs, Medicare and military-related coverage.
K A I S E R C O M M I S S I O N O N
SOURCE: KCMU and Urban Institute analysis of March 2008 CPS.
Medicaid and the Uninsured