What Does a Debate on National Health Care Reform Mean for Medicaid in New York James R. Tallon, Jr. - PowerPoint PPT Presentation

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What Does a Debate on National Health Care Reform Mean for Medicaid in New York James R. Tallon, Jr.

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Medicare and Medicaid: one-fifth of the federal budget ... Supplementing Medicare coverage for duals accounts for more than 40 percent of ... – PowerPoint PPT presentation

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Title: What Does a Debate on National Health Care Reform Mean for Medicaid in New York James R. Tallon, Jr.


1
What Does a Debate on National Health Care
Reform Mean for Medicaid in New York?James R.
Tallon, Jr. PresidentUnited Hospital Fund
July 10, 2008
2
Outline
  • Medicaids key roles
  • The national health care reform debate
  • Medicaid in the coverage debate

3
Medicare and Medicaid one-fifth of the federal
budget
2,655 billion in gross federal outlays, 2006
4
Medicaids key roles
  • Health insurance for low-income families
  • Health and long term care for people with
    physical and mental disabilities
  • Supplement to Medicare for duals
  • Major source of long term care financing
  • Support for safety net providers

5
Health insurance for low-income families
  • About one in four New Yorkers (24 percent) are
    enrolled in Medicaid (and SCHIP).
  • 2.0 million children
  • 45 of all children in New York State
  • 1.5 million (non-elderly, non-disabled) adults
  • Only 600,000 were enrolled in 2001
  • In addition, over 1 million elderly and disabled
    enrollees

6
Medicaid spending is heavily concentrated on a
small minority of beneficiaries the vast
majority of enrollees are low-cost.
Persons using long term care 59,000
Persons with high costs (no long term care)
20,000
23 b
Annual Medicaid costs per person
Persons with low costs (no long term care)
1,700
9 b
400 K
450 K
4 million beneficiaries, 7 billion
1 2
3 4 5
6
Medicaid beneficiaries (in millions)
7
Health and long term care for people
withphysical and mental disabilities
  • Prevalence of chronic conditions
  • Multiple chronic conditions
  • Mental illness
  • Absence of private resources
  • Very low incomes and very few assets
  • Medicaid has different rules
  • No waiting periods
  • No exclusions for pre-existing conditions
  • Few benefit limits for medically necessary
    services

8
Supplement to Medicare for duals
  • For duals, Medicaid is responsible for the
    services and costs not covered by Medicare.
  • Medicare covers almost no long term care.
  • Medicare has a more limited acute care benefit.
  • Medicare requires significant cost-sharing.

9
Supplementing Medicare coverage for duals
accounts for more than 40 percent of Medicaid
spending in New York.
35
FFY 2004 spending 12.4 billion LTC 5.3
billion Acute 17.7 billion Total
10
Major source of long term care financing
  • Medicaid payments account for the majority of
    nursing home revenue in New York.
  • 6.9 billion in annual payments
  • 78 of patient days statewide
  • Apart from family resources, Medicaid is the only
    major source of financing for intermediate care
    facilities and home-based services for
    individuals with mental retardation.

11
Support for safety net providers
  • 13.9 billion in total annual payments to
    hospitals
  • 23 of hospitals net patient revenue statewide
  • 33 in NYC
  • 3.1 billion in disproportionate share hospital
    (DSH) paymentswhich help offset the cost of
    caring for the uninsuredaccount for 23 of
    Medicaids total support for hospitals.

12
National health care reform debate
  • Substantial (and continuing) federal budget
    deficits
  • Insurance coverage
  • Employer or individual
  • National or state
  • Emerging cost and quality debate
  • Medicare reimbursement changes
  • Systemness in health care
  • The Federal Reserve Board model
  • Medicaid reform as an afterthought

13
Medicaid in the coverage debate
  • Resolve proposed regulatory changes
  • Reduce state variation
  • Broaden eligibility, especially for adults
  • Improve enrollment and retention
  • Transitions between public and private coverage
  • Countercyclical financing challenge

14
Conclusions
  • National health reform does not focus on
    Medicaids special roles.
  • New York is at the upper end of state variation
    in Medicaid spending.
  • New York is entering a period of growing budget
    deficits.
  • New York has begunbut not completedrenewal and
    reform of its Medicaid program.
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