Hot Issues in Health Care. Focus on Medicaid & SCHIP April 2, 2005 Martha King National Conference of State Legislatures (NCSL) Health Program Director 303/856-1448 email@example.com. Medicaid “Experts”.
Focus on Medicaid & SCHIP
April 2, 2005
National Conference of State Legislatures (NCSL)
Health Program Director
“While I can explain the meaning of life, I don’t dare try to explain how the Medicaid system works.”
Source: Milbank Memorial Fund, National Association of State Budget Officers and The Reforming States Group,
2000-2001 State Health Care Expenditure Report (New York: Milbank Memorial Fund, April 2003),
(16.5% of state general funds)
SOURCE: Heffler, S. et al., 2002. Based on National Health Care Expenditure
Date, Centers for Medicare and Medicaid Services, Office of the Actuary.
(Dollar for dollar match)
Three programs in one:
“Medicaid makes Medicare work”
A black hole
A cash cow
Entitlement: all who qualify are eligible
PEOPLE: Mandatory “categories” (e.g., children & PG women to 133% of poverty; SSI recipients)
Optional (e.g., additional children & PG women; “medically needy”)
SERVICES: Mandatory (e.g., hospital, nursing facility,physician, rural health clinics)
Optional (e.g., Prescription drugs, hospice)
Everybody else . . .
Anyone not in a “category”
SOURCE: Kaiser Commission on Medicaid and the Uninsured, January 2004
(e.g., DE, HI, MA, MN, OR, TN)
150% of poverty
HIFA (Health Insurance Flexibility & Accountability initiative) —6 approved
Most typical cuts
E.g., prescription drugs, hospice care, rehabilitative services, case management, etc.
Other reform options
Elderly & people with disabilities
(Source: Harrington & Kitchener, NCSL Annual Meeting, 2003)
Minnesota’s Long-term Care Task Force:
LTC spending decreased by an average of $198/person/mo.
(9.6% less per Family Care enrollee than a similar population in a fee-for-service environment)
Family Care Program: www.dhfs.state.wi.us/LTCare/index.htm
Managed LTC and integrated acute/LTC programs
How much could be prevented/reduced?
(Source: Scott Leitz, Economist, Minnesota Department of Health)
Appropriate preventive & acute care for Medicaid enrollees
(North Carolina Pilot Project)
(90% of 2003 drug costs in ’06 & ’07)
visit http://www.ncsl.org/programs/health/buyin03.htm for a list of the states and few details of the programs.
Arkansas saved about $30 million in 17 months:
Arkansas Medicaid: http://www.medicaid.state.ar.us
State Children’s Health Insurance Program