Examining Implications for Medicare Beneficiaries April 10, 2017 - PowerPoint PPT Presentation

Medicaid Per-Capita Allotments: Examining Implications for Medicare Beneficiaries April 10, 2017 Hashtag: #PerCapitaCaps

Medicaid Financing Basics  Nearly 1 in 4 Americans are served by Medicaid;  For 2015, $509 billion in expenditures shared by state & federal government - 62% federal/38% state (Source: Kaiser Family Fdn)  For each state, the state & federal share are set by a statutory formula, named the Federal Medical Assistance Percentage or FMAP

Base FMAP in FY 2017  Varies by state from 50% to 74.63% (Source: CRS)  Based on each state’s per capita income relative to per capita income nationwide  OPEN-ENDED : For each dollar spent by state Medicaid program (for allowable purposes), the federal government covers the FMAP percentage

Enhanced FMAPs for Specific Purposes 1. Medicaid eligibility and enrollment systems: a. 90% for establishment b. 75% for maintenance 2. ACA Medicaid expansion Enhanced FMAP : 90-100% 3. Certain other populations, services and provider types

Per Capita Cap Concept # of enrollees X avg. per person cost set from a base year X a trending factor (based on CPI or GDP +x%) = Cap on federal contribution for any given year

Impact Can Vary by Design - Which populations are included in the cap - Each population’s trending factor - Base year coverage & spending patterns - Which Medicaid spending (e.g. DSH or MSPs) is excluded from cap? - Cap established via statute or waiver What changes are permitted to Medicaid standards and requirements (flexibility)

Further Details Kaiser Family Foundation: Medicaid Enrollment and Spending Growth: FY 2016 and 2017 – Oct. 13, 2016 CRS: Federal Medical Assistance Percentage - Febuary 9, 2016 GAO: MEDICAID: Key Policy and Data Considerations for the Establishment of a Per Capita Cap on Federal Funding – August 2016