Medicaid Coverage and Spending

Medicaid Coverage and Spending

Diane Rowland, Sc.D.Executive Vice President,

Henry J. Kaiser Family Foundationand

Executive Director,Kaiser Commission on Medicaid and the Uninsured

forAlliance for Health Reform Briefing:

Inside Deficit Reduction: What it Means for MedicaidWashington, DC

November 10, 2011

FIGURE 2

Total = 300 million

Health CoverageOther Government

Programs4%

Total = $2.1 trillion

Health Spending

SOURCE: Health insurance coverage: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS. Health expenditures: KFF calculations using NHE data from CMS, Office of the Actuary

Health Care Coverage and Personal Health Care Expenditures in the U.S., 2009

FIGURE 3

Medicaid has many roles in our health care system.

Health Insurance Coverage

29 million children & 15 million adults in low-income families; 15 million elderly and persons with

disabilities

State Capacity for Health Coverage

Federal share can range from 50 - 83%;For FFY 2012, ranges from 50 - 74.2%

MEDICAID

Support for Health Care System and Safety-net

16% of national health spending; 40% of long-term care services

Assistance to Medicare Beneficiaries

8.9 million aged and disabled — 21% of Medicare beneficiaries

Long-Term Care Assistance

1 million nursing home residents; 2.8 million

community-based residents

FIGURE 4

Most beneficiaries are children, but the elderly and disabled account for the majority of Medicaid spending.

NOTE: Percentages may not add up to 100 due to rounding.SOURCE: KCMU/Urban Institute estimates based on data from FY 2008 MSIS and CMS Form-64, 2010.

Total = 59.5 million Total = $317.7 billion

FIGURE 5

Disability and long-term care drive higher per-enrollee spending.

SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on 2007 MSIS and CMS64 data.

$2,135 $2,541

$14,481

$12,499Long-Term Care

Acute Care

$5,163

FIGURE 6

Duals Account for 39% of Medicaid Spending.

SOURCE: Urban Institute estimates based on FFY 2007 data from MSIS and CMS Form 64, prepared for the Kaiser Commission on Medicaid and the Uninsured, 2010.

Total = 58 Million

Medicaid Enrollment Medicaid Spending

Total = $311 Billion

Duals 15%

Children 50%

Other Aged & Disabled

10%

Adults 25%

Non-Dual Spending

60%Long-Term Care 27%

Prescribed Drugs 0.4%

Premiums 4% Medicare

Acute 6%

Other Acute

2%

Dual Spending

39%

FIGURE 7

Medicaid spending growth per enrollee has been slower than growth in private health spending.

SOURCE: Urban Institute, 2010. Estimates based on data from Medicaid Financial Management Reports (HCFA/CMS Form 64), Medicaid Statistical Information System (MSIS), and KCMU/HMA enrollment data. Expenditures exclude prescription drug spending for dual eligibles to remove the effect of their transition to Medicare Part D in 2006.

FIGURE 8

Enrollment was the largest driver of Medicaid spending during this last recession.

SOURCE: Urban Institute, 2010. Estimates based on data from Medicaid Financial Management Reports (HCFA/CMS Form 64), Medicaid Statistical Information System (MSIS), and KCMU/HMA enrollment data. Expenditures exclude prescription drug spending for dual eligibles to remove the effect of their transition to Medicare Part D in 2006.

FIGURE 9

WY

WI

WV

WA

VA

VT

UT

TX

TN

SD

SC

RI PA

OR

OK

OH

ND

NC

NY

NM

NJ

NH

NV NE

MT

MO

MS

MN

MI

MA

MD

ME

LA

KY KS

IA

IN IL

ID

HI

GA

FL

DC

DE

CT

CO CA

ARAZ

AK

AL

NOTE: Rates are rounded to nearest percent. These rates will be in effect Oct. 1, 2011 – Sept. 30, 2012.SOURCE: Federal Register,, Nov, 10, 2010 (Vol. 75, No. 217), pp. 69082-69083. http://edocket.access.gpo.gov/2010/pdf/2010-28319.pdf

Federal share of Medicaid spending (FMAP) varies by state.

60 – 66 percent (13 states)51 – 59 percent (11 states)50 percent (15 states)

67 – 74 percent (12 states including DC)

Statutory Federal Medical Assistance Percentages , FY 2012