Presentation to the House Appropriations Subcommittee on Health

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Presentation to the House AppropriationsSubcommi
ttee on Health Human Services

Medicaid and CHIP Caseloads April 17, 2006
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Medicaid and CHIP Caseloads

• Medicaid Caseload
• Historical caseload from September 1977 to
  present
• Caseload history by risk group and fiscal year
• Recent caseload by risk group
• Childrens Health Insurance Program Caseload
• Historical caseload from September 2003

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Medicaid Acute Care Historical Caseload
September 1977 March 2006
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Medicaid Historical Caseload

• Medicaid caseloads have grown historically as a
  result of the expansion of eligibility groups,
  most notably Childrens groups
• Historical declines were seen in the Medicaid
  caseload overall after sustained growth from 1977
  forward, beginning fiscal year 1997, following
  federal welfare reform
• By the end of fiscal year 2000, caseloads had
  stabilized and were beginning to increase
• Currently, caseloads have declined since November
  2005, however not all risk groups are declining

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Medicaid Historical Caseload
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Medicaid Historical Caseload

• Total Medicaid caseload grew 54 percent from
  fiscal year 2000 to 2005, by close to 1 million
  clients
• In that same time, the non-disabled Children
  served by Medicaid grew by 80 percent, from
  slightly over 1 million Children to slightly less
  than 2 million.
• Non-disabled Children currently comprise 70
  percent of the Medicaid caseload
• Adding CHIP Children to that picture brings the
  growth since fiscal year 2000 to 105 percent,
  with over 1.1 additional Children served by
  Medicaid or CHIP from 2000 to 2005.

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Medicaid Historical Caseload
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Medicaid Acute Care Caseload

• Medicaid caseload trends, which averaged
  approximately 8 percent in fiscal year 2004 after
  double-digit growth in both fiscal years 2002 and
  2003, began to stabilize at approximately 4
  percent overall beginning December 2004.
• At that time, trends for the two largest
  Childrens Medicaid groups (non-TANF,
  non-disabled ages 1 to 18) dropped below 10
  percent for the first time in many years.
• From March 2005 through October 2005, the growth
  trend for this group of Children stabilized at 6
  percent.
• For comparison, from March 2004 through October
  2004, the growth trend for this group of Children
  averaged 15 percent.
• The slowed growth beginning December 2004 may be
  a result of changes in the economy and outside
  forces impacting client behavior. However, the
  more recent declines may be driven by a number of
  interacting factors in the short-term.

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Medicaid Acute Care Caseload

• Medicaid caseload (overall) continued to increase
  until November 2005, at which point began the
  first sustained caseload decline since FY1999.
• Caseload growth or decline differs by risk group
• Newborns and Disabled and Blind are increasing
  steadily
• Aged and Medicare related are increasing at a
  rate of 1.5 (slightly lower than population)
• Pregnant Women remain mostly stable, with some
  very recent growth
• All other groups are declining

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Medicaid Caseload October 2005 March 2006
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CHIP Caseload
9,107
78.9
81.7
6.8
Mar-05
328,350
19,163
33,223
6,982
21,206
8,230
80.1
83.0
6.5
Apr-05
326,836
20,379
37,171
8,031
21,875
8,398
81.6
84.3
6.7
May-05
326,809
21,278
39,088
7,248
21,288
8,087
82.9
85.1
6.5
Jun-05
326,473
19,623
37,899
6,156
19,955
8,062
82.5
84.5
6.1
Jul-05
327,267
20,404
35,735
6,625
19,609
7,517
82.6
84.9
6.0
Aug-05
326,770
18,998
35,195
6,029
19,493
7,142
83.1
85.2
6.0
Sep-05
326,557
18,624
34,128
5,693
18,832
6,892
83.2
85.2
5.8
Oct-05
323,343
17,176
37,059
7,070
20,360
7,914
82.4
84.8
6.3
Nov-05
321,562
19,129
39,485
6,527
20,902
8,024
83.1
85.2
6.5
Dec-05
322,898
20,385
37,964
6,297
19,048
7,428
83.6
85.6
5.9
Jan-06
317,408
11,591
18,460
1,227
20,303
17,290
51.6
53.2
6.4
Feb-06
310,981
23,937
25,285
4,387
26,553
20,097
55.7
59.6
8.5
Mar-06
302,020
23,728
19,482
10,370
31,220
19,298
50.2
60.7
10.3
Apr-06
294,189
29,479
19,081
10,065
37,167
19,740
49.2
59.6
12.7
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CHIP Caseload

• Total CHIP caseload began declining in October
  2003 as a result of policy changes, after having
  stabilized for most of fiscal year 2003 at
  approximately 507,000.
• CHIP caseload stabilized to approximately 326,500
  from April September 2005 (within 500 of the
  average each month), with a decline of 3,000
  holding steady through December 2005
• Beginning January 2006, CHIP caseload declined by
  almost 6,000 to 317,408, with similar declines in
  the following months.
• Currently, CHIP caseload is 294,189 for April
  2006.

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CHIP Caseload

• Beginning November 28, 2005, the eligibility for
  the CHIP program changed from Affiliated Computer
  Services (ACS) to Texas Access Alliance (TAA).
  The first clients processed by TAA were seen in
  the January 2006 caseload.
• March 2006 is the first month that new enrollment
  fees were to be paid by clients.
• In addition to changing vendors, new business
  rules were implemented, including requiring
  verification of income status upon renewal for
  CHIP, rather than only a statement that income
  had not changed.
• The decline in the CHIP caseload, like the
  decline in the Medicaid caseload, may be driven
  by a number of factors.