Medicaid 101

1
Medicaid 101
Diane Rowland, Sc.D. Executive Director The
Kaiser Commission on Medicaid and the
Uninsured Andy Schneider Principal Medicaid
Policy LLC for Alliance for Health
Reform/ Kaiser Commission on Medicaid and the
Uninsured Washington, DC March 9, 2001
2
Medicaids Role
Figure 1

• Coverage of the Low-Income Population
• Covers 1 in 10 nonelderly Americans
• Covers 1 in 5 children
• Pays for nearly 40 of births
• Supplements Medicare for 6 million beneficiaries
• Access to care
• Improves access to physician services and
  preventive care
• Facilitates access to prenatal care for
  low-income women
• Long-Term Care Safety Net
• Pays for nearly half of all national nursing home
  spending
• Established nationwide nursing home quality
  standards
• Pioneered community-based long-term care
  innovations

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Medicaids Role for Selected Populations, 1999
Figure 2
Note Non-elderly population. Federal Poverty
Level is 13,880 for a family of three in
1999. SOURCE Urban Institute estimates based on
the March 2000 Current Population Survey.
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Medicaid Enrollees and Expendituresby Enrollment
Group, 1998
Figure 3
Elderly 10.1
Blind Disabled 17.3
Adults 21.4
Children 51.2
Total 40.4 million people
Total 169.3 billion
Total expenditures exclude administrative
expenses. Disproportionate Share Hospital
payments. Source Urban Institute estimates,
based on HCFA-2082 and HCFA-64 Reports.
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Medicaid Expenditures by Service, 1998
Figure 4
DSH Payments 8.8
Inpatient 14.4
Personal Care 3.5
Home Health 6.9
Physician 4.1
Mental Health 1.8
Outpatient/Clinic 7.1
ICF/MR 5.9
Drugs 6.9
Other Acute 6.2
Nursing Facilities 20.3
Payments to Medicare 2.6
Payments to MCOs 11.6
Total 169.3 billion
SOURCE Urban Institute estimates, based on
HCFA-2082 and HCFA-64 Reports.
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Medicaid Expenditures Per Enrolleeby Acute and
Long-Term Care, 1998
Figure 5
11,235
9,558
1,892
1,225
Note Expenditures do not include DSH,
adjustments, or administrative costs. SOURCE
Urban Institute estimates based on HCFA-2082 and
HCFA-64 Reports.
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Medicaid Spending Growth by EligibilityGroup,
1990-1998
Figure 6
169.3
Dollars (in billions)
161.2
155.4
151.9
137.8
128.0
115.4
89.2
70.6
Disproportionate Share Hospital payments. Note
Total expenditures excludes administrative
expenses. SOURCE Urban Institute estimates based
on HCFA-2082 and HCFA-64 Reports.
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Health Insurance Coverageby Poverty Level, 1999
Figure 7
Other
Employer
Medicaid
Uninsured
Other includes individually-purchased private
insurance and other public coverage. Note The
federal poverty level for a family of three in
1999 was 13,290. SOURCE Urban Institute and
Kaiser Commission on Medicaid and the Uninsured,
analysis of March 2000 Current Population Survey,
2000.
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Access to Health Care by Insurance Status
Figure 8
Percent Reporting
Did Not Receive Needed Care
No Pap Test
Did Not See a Doctor
Adults
Women
Children
SOURCES The 1997 Kaiser/Commonwealth National
Survey of Health Insurance Womens Health, The
Commonwealth Fund Survey, 1996.
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Medicaid Eligibility Milestones, 1965-1997
Figure 9
Millions of Medicaid Beneficiaries
(35 Million Beneficiaries)
AFDC Repealed (1996)
1965 1970 1975 1980 1985
1990 1995 2000
SOURCE Health Care Financing Administration,
1998 Rosenbaum S., 1993 Rowland, D., 1992.
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Medicaid Minimum Income Eligibility Standards,
2001
Figure 10
Percent of Federal Poverty Level
Federal Minimum
National AFDC Average
0
Pregnant Women/ Infants
Nonelderly Adults without Children
Preschool 1 to 5
School-age 6 to 18
Adults with Children
Note 18-year-olds phased in by September 2002.
Based on AFDC average for 1996, the standard
used for Section 1931 eligibility. The Federal
Poverty Level is 14,630 for a family of three
for 2001.
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Figure 11
Medicaid/CHIP Income Eligibility Levels for
Children, 2000
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
DE
NV
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
OK
SC
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
Medicaid/CHIP Income Levels
lt 150 FPL (8 states)
151 - 199 FPL (7 states)
gt 200 FPL (36 states)
NOTE The Federal Poverty Level (FPL) is 14,150
for a family of three in 2000. SOURCE Center
on Budget and Policy Priorities, 2000.
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Figure 12
Strategies for Simplifying Medicaid and CHIP
Eligibility and Enrollment for Children
Number of States Reporting
NOTE State counts include only states that have
adopted the enrollment simplification strategy
for both their Medicaid for children and CHIP
programs. SOURCE Center on Budget and Policy
Priorities for the Kaiser Commission on Medicaid
and the Uninsured, 2000.
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Figure 13
Medicaid Income Eligibility Levels for Parents,
2000
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
DE
NV
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
OK
SC
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
Medicaid Income Eligibility Levels
(US Median 67 FPL)
lt 50 FPL (14 states)
50 - 99 FPL (19 states)
gt 100 FPL (18 states)
Connecticut, New Jersey, and New York have
enacted but have not yet implemented their
Medicaid expansion for parents. SOURCE Center
on Budget and Policy Priorities and Families USA,
2000.
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Distribution of the Low-Income Uninsured
Figure 14
Total 24.5 million
NOTE Low-income refers to families with incomes
less than 200 of the federal poverty
level. SOURCE Urban Institute simulations, 2001.
Based on the March 1997 Current Population
Survey, projected to 1998.
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Growth in the Share of Medicaid Beneficiaries
Enrolled in Managed Care, 1991-1999
Figure 15
Percent enrolled in managed care
Millions of People
2.7
3.6
4.8
7.8
9.8
13.3
15.3
16.6
17.8
Note Includes full-risk and PCCM
arrangements. SOURCE HCFA, 2000.
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Figure 16
Medicaid Managed Care Enrollment, by State, 1999
lt25 percent (8 states)
National Average 55.6
75 percent (14 states)
Note Includes full-risk and PCCM
arrangements. SOURCE HCFA, 2000.
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Number of Commercial Plans Entering and Exiting
the National Medicaid Market, 1994-1997
Figure 17
Number of Plans
SOURCE Mathematica Policy Research, Inc.
analysis of InterStudy (1996-1997), GHAA
(1993-1995), and HCFA data.
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Access and Satisfaction Problems for Medicaid
Beneficiaries by Care Arrangement, 1995-1996
Figure 18
Percent of Adults Reporting
SOURCE Based on an analysis of the
Kaiser/Commonwealth Five-State Survey,
Lillie-Blanton and Lyons, 1998.
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The Non-Institutionalized Medicare Population by
Poverty Level, 1999
Figure 19
40 of beneficiaries
Total 36 Million Medicare Beneficiaries
Note Reflects income from all household family
members. 1999 federal poverty was 8,240 for
individuals 11,060 for couples. Source Urban
Institute estimates based on 2000 Current
Population Survey.
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Supplemental Health Insurance Coverage of
Medicare Beneficiaries, 1997
Figure 20
Note Columns may not sum to 100 other sources
of public coverage not shown. Source Urban
Institute analysis of 1997 Medicare Current
Beneficiary Survey.
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Figure 21
Medicaids Protections for Medicare Beneficiaries
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Health Status of Medicare Beneficiaries by Dual
Eligibility Status, 1997
Figure 22
Note ADLs Number of limitations in Activities
of Daily Living SOURCE Medicare Current
Beneficiary Survey, 1997.
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Figure 23
Medicaid Eligibility Levels for Disabled
Beneficiaries, 2000
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Medicaid Expenditures for the Disabled, by Type
of Service, 1998
Figure 24
Personal Care 5
Inpatient Hospital 17
Home Health 13
Mental Health 2
Acute Care (57)
Long Term Care (43)
ICFs/MR 14
Ambulatory Care 13
Prescription Drugs 10
Nursing Facilities 9
Payments to MCOs 8
Payments to Medicare 3
Other 6
Total Expenditures 66.7 Billion
SOURCEUrban Institute estimates based on data
from HCFA-2082 and HCFA-64 reports.
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Medicaid Spending Growth by Service,1990-1998
Figure 25
Dollars (in billions)
176.3
167.6
161.0
157.4
142.7
132.3
119.2
92.7
73.7
Includes Medicare and HMO payments. SOURCE
Urban Institute estimates based on HCFA-2082 and
HCFA-64 Reports.
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Average Annual Growth of Medicaid Spending for
Selected Services, 1995-1998
Figure 26
Total Medicaid Spending
Prescribed Drugs
Other Acute Care
Long-Term Care
Includes both fee-for-service expenditures and
estimated drug spending by managed care
organizations. SOURCE Urban Institute estimates
based on HCFA-2082 and HCFA-64 reports.
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Medicaid Prescription Drug Spending, 1998
Figure 27
Expenditures per Enrollee
Expenditures by Eligibility Group
All
Children
Adults
Blind Disabled
Aged
Total 14.5 billion
8.2 of total Medicaid spending on
services. SOURCE Urban Institute Estimates, 2000.
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Long-Term Care Spending, 1998
Figure 28
Medicaid LTC Spending, by Type of Service
Total National LTC Expenditures, by Source of
Funds
Total 65 billion
Total 117 billion
Source Urban Institute estimates based on
HCFA-2082 and HCFA-64 reports HCFA, National
Health Accounts, 2000.
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Federal Budget Outlays, FY 2000
Figure 29
Total 1.8 trillion
SOURCE CBO, January 2001.
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Figure 30
Federal Medical Assistance Percentage (FMAP), FY
2001
50 percent (9 states)
51 to lt60 percent (15 states)
60 to lt70 percent (15 states)
70 percent (11 states DC)
SOURCE Federal Register, February 23, 2000.
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Medicaid Spending as a Percentage of State
General Fund Expenditures, FY 1999
Figure 31
Higher Education 13
Elementary Secondary Education 35
Public Assistance 3
Medicaid 15
Corrections 7
All Other 27
Transportation lt1
Total 420 Billion
SOURCE National Association of State Budget
Officers, 1999 State Expenditure Report, June
2000.
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Medicaid as a Share of Total Federal Grants to
States, 1987 and 1999
Figure 32
Cash Assistance 10
Public Assistance 4.2
Federal Medicaid 26
Federal Medicaid 43.6
Education 13.8
Education 18
Transportation 9.2
Transportation 14
All other 30.1
All other 32
Total 222 billion 1999
Total 108 billion 1987
SOURCE National Association of State Budget
Officers, 1999 State Expenditure Report, June
2000.
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