Issues and Challenges in State Medicaid Programs

1
Issues and Challenges in State Medicaid Programs

• Ann Clemency Kohler, Director of Health Services
• National Association of State Medicaid Directors
• American Public Human Services Association
• Ann.Kohler_at_aphsa.org
• 202.682.0100

2
States - Laboratory For Health Care Reform

• ? Fifty states, Puerto Rico, and the territories
  are working on health care solutions
• ? The States are in a unique position to address
  a variety of health care reform ideas
• ? Through Medicaid waivers, states have tested
  various health care initiatives
• ? States have significant experience with long-
  term care and community-based models
• ? States are in the best position to implement
  innovative ideas and strategies

3
Federal - State Relationship

• ? CMS and states need to rebuild partnership
• ? Relationship needs to be more collaborative
• ? Partnership is critical with current economy,
  budget constraints, and plans for healthcare
  reform
• ? Interim head at CMSO committed to working with
  NASMD

4
Impact of Recession on State Budgets

• ? Economic downturn and massive job losses are
  contributing to significant shortfalls in state
  budgets and increases in Medicaid enrollment
• ? States must have balanced budgets
• ? Many states forced to cut funding to Medicaid
  and other crucial programs
• ? Every 1 increase in unemployment 1 million
  additional Medicaid clients

5
The American Recovery and Reinvestment Act

• ? Provides temporary FMAP increase of 6.2
  percentage points for 27 months
• ? Allows additional 5.5 percent, 8.5 percent, or
  11.5 percent reduction in the State share of
  Medicaid costs determined by unemployment rate
• ? Creates State Fiscal Stabilization Fund
• ? Extends Transitional Medical Assistance

6
The American Recovery and Reinvestment Act

• ? Increases Supplemental Nutrition Assistance
  Program funding by 20 billion
• ? Places a moratorium on a regulation for
  outpatient hospital services and
• ? Extends existing moratoria on selected Medicaid
  regulations, including targeted case management
  provider taxes and school based administration
  and transportation services

7
SCHIP Reauthorization

• ? Signed into law February 4, 2009
• ? Expands coverage to additional 4 million
  children
• ? Requires states to offer dental care through
  SCHIP, and allows them to extend dental benefits
  to children who have private coverage that does
  not include dental coverage
• ? Requires Mental Health Parity
• ? Eliminates the five-year waiting period for
  documented immigrant children and pregnant women
  to become eligible

8
Ready for Reform

• ? Medicaid waivers and SCHIP programs show
• states can develop high quality affordable
  health
• care with low administrative costs
• ? They can be models to build upon for reform
• efforts

9
Dual Eligibles

• ? Any solution must address the dual eligibles
• ? Over 7 million duals, 5 million over the age of
  65 years
• ? They represent 29 of Medicare spending and 40
  of Medicaid spending
• ? Much of the Medicaid spending is for long-term
  care- too often institutional care