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Medicaid and Health Reform: How Will They Work Together?

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Title: Medicaid and Health Reform: How Will They Work Together?


1
Medicaid and Health Reform How Will They Work
Together?
Jocelyn Guyer Center for Children and Families
http//ccf.georgetown.edu
2
Medicaids Coverage Role Today
Children 78.6 million
Uninsured 11
Employer-Sponsored Insurance 55
Medicaid/Other Public 29
Individual Coverage 4
Source Kaiser Commission on Medicaid and the
Uninsured/Urban Institute analysis of 2008 ASEC
Supplement to the CPS.
3
Medicaid Provides Coverage for Half of Low-Income
Children
Percent with Medicaid Coverage
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.
4
Decline in the Rate of Uninsured Low-Income
Children is Attributable to Enrollment in
Medicaid and CHIP
Source Data reflects low-income (lt200 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).
5
70 of Uninsured Children are Below 200 FPL
Children 8.9 million
300
200-299
100-199
70 below 200 FPL
Under 100
Source Kaiser Commission on Medicaid and the
Uninsured/Urban Institute analysis of 2008 ASEC
Supplement to the CPS.
6
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
7
Medicaid Income Eligibility Levels
51 states cover children above the minimum
eligibility level
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).
8
Medicaid and SCHIP Eligibility Levels for
Children, January 2009
WA
NH
VT
MT
ME
ND
OR
MN
MA
ID
WI
SD
NY
WY
MI
RI
CT
PA
IA
NV
NE
NJ
OH
IL
UT
IN
DE
CO
CA
WV
KS
VA
MD
MO
KY
NC
DC
TN
OK
AZ
SC
AR
NM
GA
AL
MS
LA
TX
AK
FL
HI
gt 250 FPL (21 states)
200 FPL (16 states)
201-250 FPL (9 states)
lt 200 FPL (4 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.
9
Medicaid/CHIP Coverage Improves Access to Care
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.
10
Medicaids BIG Role in Covering Foster Children
  • All IV-E foster care children are eligible for
    Medicaid
  • States have the option to cover non-IV-E 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

11
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)
12
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)
13
The Importance of Medicaid for Foster Children
  • Foster children tend to have significant health
    problems - Medicaid is there to help.

14
What About Health Reform?
15
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

16
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.
17
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

18
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
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