Transcript Medicaid and Health Reform: How Will They Work Together? Jocelyn Guyer Center for Children and Families http://ccf.georgetown.edu.

Medicaid and Health Reform:
How Will They Work Together?
Jocelyn Guyer
Center for Children and Families
http://ccf.georgetown.edu
Medicaid’s Coverage Role Today
Children = 78.6 million
Uninsured
11%
EmployerSponsored
Insurance
Medicaid/Other
Public
29%
55%
Individual
Coverage
4%
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.
Medicaid Provides Coverage for
Half of Low-Income Children
Percent with Medicaid Coverage
All Children
Low-Income
Children
27%
51%
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.
Decline in the Rate of Uninsured LowIncome Children is Attributable to
Enrollment in Medicaid and CHIP
60%
47.8%
50%
40%
30%
20%
53.1%
50.9% 51.9%
56.2%
43.2%
37.0% 35.9% 37.7%
39.1%
23.3% 22.7%
21.7% 21.4%
19.1% 16.6% 16.5%
15.9% 15.6% 15.4%
10%
0%
1997
1998
1999
2000
Uninsured
2001
2002
2003
2004
2005
2006
Public 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).
70% of Uninsured Children
are Below 200% FPL
Children = 8.9 million
15%
300% +
15%
200-299%
28%
100-199%
42%
Under 100%
70% below
200% FPL
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.
Children Currently
Eligible but Unenrolled
9 Million Uninsured Children
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
Medicaid Income Eligibility Levels
51 states cover children above
the minimum eligibility level
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).
Medicaid and SCHIP Eligibility
Levels for Children, January 2009
WA*
MT*
VT
ND
OR
MN
ID
WY
NV
UT
AZ
CO*
IL
OK*
TX
IN*
MO
PA
OH*
KY
WV*
TN
AR
MS
AL
VA
NJ
DE
MD
NC*
DC
RI
CT
SC
GA
LA*
FL
HI
< 200% FPL
(4 states)
MA
NY
IA*
KS*
NM
AK
ME
MI
NE
CA
WI
SD
NH
200% FPL
(16 states)
201%-250% FPL
(9 states)
> 250% FPL
(21 states)
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.
Medicaid/CHIP Coverage
Improves Access to Care
Employer/Other Private
M edicaid/Othe r Public
Uninsure d
32%
28%
24%
18%
17%
13%
3% 4%
No Us ual Souce
of Care
2% 3%
1% 2%
13%
3% 3%
12%
4%
6%
Pos tpone d Ne e de d Car e butLas t MD Contact Unm e t De ntal Las t Dental Vis it
Se e k ing C ar e
Did Not Ge t it
>2 Ye ars Ago
Ne e d Due to
>2 Ye ars Ago
Due to Cos t*
Due to Cos t*
Cos t*
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.
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-IVE 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
Health Care Reform Proposals
Obama plan maintains Medicaid
and SCHIP, but no details yet.
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