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Medicaid and CHIP: On the Road to Reform

Cindy Mann, JDCMS Deputy Administrator

Director

Center for Medicaid, CHIP & Survey & Certification

Centers for Medicare & Medicaid Services

National Conference of  State Legislatures National Conference of  State Legislatures July 26, 2010July 26, 2010

CMCS: Our Mission

To help States make Medicaid andTo help States make Medicaid and CHIP the best programs they can be

Partnerships are critical to success

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2014BeginsNow!Now!

A System of Coverage

ExchangeEmployer Coverage

Medicaid/CHIP

Medicaid/CHIP

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Projected Changes in Coverage by 2019

0

5

10

15

20

25

Exchanges

Medicaid & CHIP

Employer

Nongroup & Other

-5

0

Total new coverage = 32 million

Sources of Coverage by 2019

Medicaid & CHIP

Employer

Nongroup & Other

Uninsured

Exchanges

25m

22m24m 51m

159m

(For All Individuals under 65)

Source:  Congressional Budget Office, March 2010

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Eligibility Changes

Medicaid coverage for adults under 133% of the povertyMedicaid coverage for adults under 133% of the poverty line

CHIP and Medicaid coverage for children at higher incomes (State March 23, 2010 levels)

Simpler rules

Increased federal funding across the board

Estimated Distribution of Costs for Medicaid Coverage Changes: 2014 2019

Who Pays?

Coverage Changes: 2014‐2019 (in billions)

Total $464.7 billion

Source: Medicaid Coverage and Spending in Health ReformJohn Holahan and Irene Headen/ Kaiser Commission, May 26, 2010

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Significant increase in federal support for Medicaid/CHIP

State Financial Impacts

Medicaid/CHIP100% match for “newly eligible” group for 3 years and 95100% match for “newly eligible” group for 3 years and 95--90% match thereafter90% match thereafter

Increased match for “childless adults” in “expansion” states Increased match for “childless adults” in “expansion” states (reaches 93%/90% in 2019/2020)(reaches 93%/90% in 2019/2020)

Increased match for CHIP in 2016 (enhanced plus 23 Increased match for CHIP in 2016 (enhanced plus 23 percentage points)percentage points)

Regular federal match for remaining currently eligible Regular federal match for remaining currently eligible groupsgroups

Certain state-funded, Medicaid-funded

Other State Financial Impacts

Certain state funded, Medicaid funded coverage/services may no longer be neededReductions in uncompensated care/cost shiftingGreater efficienciesDSH funding declines (as will state contributions)

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New Paradigm

Not a “safety net” but a full partner in assuring coverage for all

Eligible = enrolled

Essential to make a system out of different components to achieve coverage, quality and cost containment objectivesj

Top 5%

Elderly 16.80 %

Top 5% of Enrollees Accounted for More than Half of Medicaid Spending in 

FY 2008

Bottom 95% Bottom 95% of Enrolleesof Enrollees

Elderly 16.80 %

Disabled 31.79%

Adults 1.75%Children 3.72%

Top 5%

Elderly    1.82%

Disabled 2.61%

Adult         .21%

Children    .36%

Bottom 95% Bottom 95% of Enrolleesof Enrollees

5%54%

of Enrolleesof Enrollees

EnrolleesTotal = 60.6 million

ExpendituresTotal = $292.9 billion

Source: FY MSIS 2008, FY MSIS 2007 for AZ, NC, ND, HI, UT, VT, WI

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No payment for HACs

Payment & Delivery System Reforms

Medical and health homes

Global payment demonstrations

Pediatric ACOs

Primary care provider increase (2013)

Preventive care incentives

FMAP increase for preventive services & immunizations for adults (2013)

Eligibility Rules

BenefitDesigns

Systems Support

Basic Option

DataPerformanceStandards

FMAP Rules …

Collaboration with States is Essential

2010201020102010

Adopt NewLaws/

Provider Networks

StaffingTrainin

Federal Actions

2014201420142014

System NewRules/

Exchange/Medicaid EnrollmeLaws/

Budgets /ContractsTrainin

gChangesRules/FormsOrg Structure

State Actions

Enrollment …

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Uninsurance rates for Percentage of Children Without H lth I B P t

Building on Success

children have steadily dropped due to Medicaid/CHIP

Disparities are narrowing

In general, access is

Health Insurance, By Poverty Level, 1998‐2007

Children below 200% of poverty

Children above 200% of poverty

28%

17%

15%

8%7% 6%In general, access is

strong1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Children’s Coverage Does Not Need to WaitConnecting Kids to Coverage Challenge:  Enroll the 5 million uninsured children who are currently eligible 

for Medicaid or CHIP over the next five years

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K R hiK R hiKey to Reaching Key to Reaching Our Goals:Our Goals:

Assuring that all Assuring that all Partners are at Partners are at 

the Tablethe Table