Hoping For Economic Recovery, Preparing for Health Reform: A Look - PowerPoint PPT Presentation

Figure 1 Hoping For Economic Recovery, Preparing for Health Reform: A Look at Medicaid Spending, Coverage and Policy Trends Presenting the Findings: Robin Rudowitz, Kaiser Family Foundation Vernon Smith, Health Management Associates Release: September 30, 2010 Report Authors: Vernon Smith, Kathleen Gifford and Eileen Ellis Health Management Associates Robin Rudowitz and Laura Snyder Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed

Figure 2 Medicaid Today Health Insurance Assistance to Long-Term Care Coverage Medicare Beneficiaries Assistance 29.5 million children & 15 8.8 million aged and disabled 1 million nursing home — 19% of Medicare million adults in low-income residents; 2.8 million families; 14 million elderly and community-based residents beneficiaries persons with disabilities MEDICAID Support for Health Care State Capacity for Health System and Safety-net Coverage 16% of national health spending; Federal share ranges 50% to 76%; 40% of long-term care services ARRA FMAP ranges 62% to 85% K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed

Figure 3 Medicaid Enrollees and Expenditures by Enrollment Group, FFY 2007 Elderly 10% Elderly 25% Disabled 15% Adults 25% Disabled 42% Children Adults 12% 49% Children 20% Enrollees Expenditures on benefits Total = 58 million Total = $300 billion K A I S E R C O M M I S S I O N O N SOURCE: KCMU and Urban Institute estimates based on 2007 MSIS and Medicaid edicaid and the and the Unins ninsur ured ed CMS64 data.

Figure 4 State Tax Revenue, 1999 – 2010 15.9% 15% 10% 5% 2.5% 0.9% 0% 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 -5% -10% -11.5% -9.4% -12.2% -15% -16.8% -20% K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed SOURCE: Percent change in quarterly state tax revenue, US Census Bureau

Figure 5 Medicaid Enrollment Has Increased by Nearly 6 Million Since the Start of the Recession Monthly Enrollment in Millions 48.5 44.8 42.8 42.6 42.3 41.9 40.4 Dec-03 Dec-04 Dec-05 Dec-06 Dec-07 Dec-08 Dec-09 K A I S E R C O M M I S S I O N O N SOURCE: Analysis for KCMU by Health Management Associates, using Medicaid edicaid and the and the Unins ninsur ured ed compiled state Medicaid enrollment reports

Figure 6 Enhanced Federal Medical Assistance Percentages (FMAP), FY 2011 VT WA ME MT ND NH MN MA OR NY WI SD ID MI RI WY CT PA NJ IA NE OH DE IN IL NV MD UT WV VA CO DC KS MO KY CA NC TN SC OK AR AZ NM GA AL MS LA TX FL AK HI 62 percent (14 states) 63 – 69 percent (7 states) 70 – 77 percent (18 states) 78 – 82 percent (10 states including DC) NOTE: Reflects the enhanced FMAPs granted to states under ARRA. K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed SOURCE: Federal Register, August 26, 2010

Figure 7 Medicaid Today and Tomorrow Minimum floor for Health Insurance Coverage Health Insurance Coverage for Certain Categories to 133% FPL Additional Shared Financing Federal Financing States and Federal Govt. for Coverage MEDICAID Additional Options Assistance for Long-Term Care / Duals / Long-Term Care Coordination for Duals Support for Health Care System K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed

Figure 8 About the Study • 10 th Annual Survey of Medicaid directors in all 50 states and DC • Conducted in July and August 2010 • Report focuses on actions implemented in FY 2010 and adopted for FY 2011 • Purpose: To track trends in state budgets, Medicaid spending, enrollment, policy initiatives and impact of federal policies such as ARRA • Establish a baseline for evaluating changes as states implement health reform K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed

Figure 9 How States Used ARRA Enhanced Medicaid Funding in FY 2009 and FY 2010 FY 2009 FY 2010 Closed or Reduced Medicaid 36 Budget Shortfall 43 Helped Pay for Increases in 33 Medicaid Enrollment 41 Closed or Reduced State General 44 Fund Shortfall 38 36 Avoided Benefit Cuts 37 Avoided or Reduced Provider Rate 38 Cuts 35 Avoided or Restored Eligibility 29 Cuts 28 K A I S E R C O M M I S S I O N O N SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Medicaid edicaid and the and the Unins ninsur ured ed Health Management Associates, 2009 and 2010.

Figure 10 Projected and Actual Total Medicaid Spending and Enrollment Growth for FY 2010 Projected for FY 2010 Actual for FY 2010 8.8% 8.5% 6.6% 6.3% Total Spending Growth Enrollment Growth K A I S E R C O M M I S S I O N O N SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Medicaid edicaid and the and the Unins ninsur ured ed Health Management Associates, September 2009 and September 2010.

Figure 11 Percent Change in Total Medicaid Spending and Enrollment, FY 1998 – FY 2011 Spending Growth Enrollment Growth 12.7% 10.4% 8.8% 8.7% 8.5% 7.7% 7.6% 7.4% 6.8% 9.3% 6.4% 5.8% 8.5% 4.7% 7.5% 3.8% 7.5% 6.1% 5.6% 4.3% 1.3% 3.2% 3.2% 3.1% 0.4% 0.2% -0.7% -1.9% 2011 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Adopted NOTE: Enrollment percentage changes from June to June of each year. Spending growth percentages in state fiscal year. SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by K A I S E R C O M M I S S I O N O N Health Management Associates, September 2010. Medicaid edicaid and the and the Unins ninsur ured ed

Figure 12 Change in State Share of Medicaid Spending, FY 2009 – FY 2011 25.6% 13.1% First Decreases Ever in State Spending for Medicaid, Due to ARRA FMAP (2009 and 2010) 5.3% Average Did Not Assumed for 2011 Assume ARRA ARRA Extension for Extension for 2011 2011 -7.1% (24 States) (27 States) -10.9% 2010 2009 SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by K A I S E R C O M M I S S I O N O N Health Management Associates, September 2010. Medicaid edicaid and the and the Unins ninsur ured ed

Figure 13 State Policy Actions Implemented in FY 2010 and Adopted for FY 2011 FY 2010 Adopted FY 2011 States with Expansions / Enhancements 41 36 36 32 32 27 16 15 Provider Payments Eligibility Benefits Long Term Care 1 1 10 14 18 20 37 39 States with Program Restrictions NOTE: Provider payment restrictions include rate cuts for any provider or freezes for nursing facilities or hospitals. SOURCE: KCMU survey of Medicaid officials in 50 K A I S E R C O M M I S S I O N O N Medicaid edicaid and the and the Unins ninsur ured ed states and DC conducted by Health Management Associates, September 2010.

Figure 14 States with Provider Rate Changes FY 2008 – FY 2011 FY 2008 FY 2009 FY 2010 Adopted FY 2011 48 47 States with Rate Increases 46 37 36 36 35 31 29 27 26 24 22 22 21 20 19 18 8 8 Any Provider Inpatient Hospital Physicians MCOs Nursing Homes 1 1 5 5 8 9 10 12 14 16 20 20 25 27 30 21 33 29 37 39 States with Rate Restrictions NOTE: Rate restrictions include rate cuts for any provider and also frozen rates for inpatient hospitals and nursing homes. SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, K A I S E R C O M M I S S I O N O N September 2008 - 2010 Medicaid edicaid and the and the Unins ninsur ured ed

Figure 15 States With Eligibility Expansions / Enhancements FY 2008 – FY 2011 FY 2008 FY 2009 FY 2010 Adopted FY 2011 41 33 32 30 27 27 26 25 23 17 17 15 Total Changes Eligibility Standards Application and Renewal SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by K A I S E R C O M M I S S I O N O N Health Management Associates, September 2008 – 2010. Medicaid edicaid and the and the Unins ninsur ured ed

Figure 16 States Cutting or Restricting Benefits FY 2008 – FY 2011 Number of States 20 14 10 3 2008 2009 2010 Adopted 2011 SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by K A I S E R C O M M I S S I O N O N Health Management Associates, September 2008 – 2010. Medicaid edicaid and the and the Unins ninsur ured ed

Figure 17 Medicaid Long-Term Care Expansions, Implemented in FY 2008 – FY 2011 FY 2008 FY 2009 FY 2010 Adopted FY 2011 New or 38 27 Expanded HCBS 23 Waiver 22 8 Implemented or 12 5 Expanded PACE 8 10 Added Additional 6 Services to 12 HCBS Waiver 12 1 Enhanced 3 Institutional 6 Services 5 K A I S E R C O M M I S S I O N O N SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted Medicaid edicaid and the and the Unins ninsur ured ed by Health Management Associates, September 2009 and 2010.