Medicaid and CHIP: On the Road to Reform Cindy Mann, JD CMS Deputy Administrator Director Center for Medicaid, CHIP and Survey & Certification Centers for Medicare & Medicaid Services Alliance for Health Reform/Kaiser Family Alliance for Health Reform/Kaiser Family Foundation Foundation March 4, 2011 March 4, 2011
17
Embed
Medicaid and CHIP: On the Road to Reform Cindy Mann, JD CMS Deputy Administrator Director Center for Medicaid, CHIP and Survey & Certification Centers.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Medicaid and CHIP: On the Road to Reform
Cindy Mann, JDCMS Deputy Administrator
DirectorCenter for Medicaid, CHIP and Survey & Certification
Centers for Medicare & Medicaid Services
Alliance for Health Reform/Kaiser Family FoundationAlliance for Health Reform/Kaiser Family FoundationMarch 4, 2011March 4, 2011
Implementing the Affordable Care Act
Working with States (Governor’s offices, Medicaid, CHIP, Insurance Commissioners)
Coordinating with the Center for Consumer Information and Insurance Oversight (CCIIO), IRS/Treasury, other federal agencies
Listening to what reform means to a broad array of stakeholders
Promulgating regulations and guidance; providing technical assistance
2
Source: Congressional Budget Office, March 2010Source: Congressional Budget Office, March 2010Source: Congressional Budget Office, March 2010Source: Congressional Budget Office, March 2010
Sources of Coverage by 2019 for Individuals Under 65
25m23m
24m 51m
159m
Not a safety net but a full partner in assuring coverage, quality and cost containment
Simplified rules and process (eligible = enrolled)
A system of coverage and care
New Paradigm
ExchangeExchangeEmployer Coverag
e
Medicaid/CHIP
Medicaid/CHIP
Percentage of Population Under 133% of the FPL
Uninsured vs. Medicaid Covered
66%
17%
35%
42%
23%
43%
Source: HHS ASPE analysis of the 2010 Annual Social and Economic Supplement to the Current Population Survey
Minimum Medicaid Eligibility Levels
Now and 2014Population Current Minimum
Eligibility Levels(average)
2014 MinimumEligibility Levels
Children 100%/133%(241%)
241%
Parents 41%(64%)
133%
Disabled Adults 74%(SSI-related)
133%
Other Adults 0%* 133%* 5 States provide Medicaid or Medicaid look-alike coverage to certain childless adults; 15 States provide a limited benefit package to certain childless adults.
Average - Will vary by State
2014 Health Insurance Subsidies
Medicaid/CHIP Children
0
133% FPL
241%FPL
400%FPL
Exchange Subsidies
Adults Children
Medicaid Adults
Varies by State
First Steps:Modernized, Efficient Systems
IT Guidance 1.0 for Medicaid and the ExchangeNPRM on Medicaid Eligibility Systems
90% FFP for eligibility and enrollment system design and development until 12/31/15
75% FFP for system maintenance
Established 7 Conditions & Standards
7 Exchange Innovator Grants and Collaborative8
Estimated Distribution of Costs for Medicaid Coverage Changes: 2014-2019
(in billions)
Total $464.7 billion
Who Pays?
Source: Congressional Budget Office and Medicaid Coverage and Spending in Health Reform, John Holahan and Irene Headen/Kaiser Commission, May 26, 2010
Current Fiscal Pressures
Enrollment among families and children has grown sharply due to the recession Medicaid is intended to be a countercyclical program
Despite enrollment growth, state Medicaid spending declined during the recession The Recovery countercyclical FMAP increase resulted in a 10% drop in
state spending on Medicaid in 2009
While enrollment growth explains recent growth in costs, the real cost drivers lie elsewhere
10
Concentration of Medicaid Spending
Source: Medicaid Statistical Information System Claims Data for FY 2008
1%
5 %54%
10%
95%
50%5%
Percentile of Medicaid Population (Ranked by Spending)
Percent of Total Medicaid Spending
0% 20% 40% 60% 80% 100%
Coverage: Pathway to Better Care, Better Health, Lower Costs
Per CapitaCost
ExperienceOf Care
PopulationHealth
Focus on Medicaid Cost DriversExisting Authority & New Initiatives
Benefits & Cost-Sharing
Integrated Care for High-Cost Beneficiaries; improving care transitions; reducing unnecessary hospitalizations
Purchasing Drugs More Efficiently
Assuring Program Integrity
Working individually with States (“MSTAT”)
What CMS is Doing to Help States Reduce Costs Now
Health Care Expenditures
$2,541
$7,464
Average Cost of One Hospital Admission for a Non-Dual Disabled
Medicaid Enrollee
Annual Cost of Providing Health Coverage to One Parent under
Medicaid
Source: CMS data analysis and Urban Institute analysis of data from MSIS and CMS Form 64, prepared for Kaiser Commission on Medicaid and the Uninsured, 2010. Kaiser Family Foundation-State Health Facts, FY 2007.
Source: CMS data analysis and Urban Institute analysis of data from MSIS and CMS Form 64, prepared for Kaiser Commission on Medicaid and the Uninsured, 2010. Kaiser Family Foundation-State Health Facts, FY 2007.
Focus on Dual Eligibles
Source: CMS data and Urban Institute analysis of data from MSIS and CMS Form 64, prepared for Kaiser Commission on Medicaid and the Uninsured, 2010. Kaiser Family Foundation-State Health Facts, FY 2007.
Source: CMS data and Urban Institute analysis of data from MSIS and CMS Form 64, prepared for Kaiser Commission on Medicaid and the Uninsured, 2010. Kaiser Family Foundation-State Health Facts, FY 2007.
Total Spending = $311 billion
Duals as Share of Medicaid Spending
Dual EligiblesNon-Duals39%
61%
Children Adults Duals
Medicaid Spending by Population Group
$2,541$2,135
$14,972
Non-Disabled Adults
Children Duals
Achieving a High Performing Medicaid Program
States and the Federal Government working together to achieve:Simplified, accurate, customer-friendly, data driven
eligibility/renewal processes that are fully coordinated with the Exchange
Eligible = Enrolled
Access to person-centered, high quality, integrated care with options for continuity of coverage with plans on the Exchange
Continuing quality and cost improvement in our health care system, based on consumer and other stakeholder input, data, and collaboration.