ࡱ> nklm@=" ,+EpR],c(8MxZmlE~gࠡOKSk?" hlDF 9 (h"? !a?_P 6OٙgߝFD[QX*%+1JCmd"BKREw*@74'lg?ӶJͲmE2J$t|O$-uߌd,m&)_*VnZE?gtBSe~xx&|yLAu%rPms^le|1ܨgQDmEw5tu1;4b,]~Dہ87OD;QCesOxkyq`Q7ŋsfJ'=m{jܩ1c-W2}#Σr󢯓嘽.i?s7go@M6->pLC1 (?"8 \/沀..?*K_K/ePpYſ H7iX/.[&[XeźQpY@w1eO)ց2N t?NQClb-(slq?:6!}HsPpY@S%♢/ݭ; 9\.W#=cH<=1KAzlgK{Dk4/.SelȷV~`D"pmy[0A>Wn3*+:c7*  " rZ 7YI#9(Gp f./B/X J/Nb f am 1 5_ M  CPQ *s  , G lh7$ T k Zp)+  !Bn[P+SS  &s "#]U$4jRIo$$$$$"$" ,+EpR] F    A A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| -3f3@d g4KdKd )0 pp@ <42d2d 0ܺT<4!d!d 0ܺTg4dddd )0 pl pk ʚ;ʚ;<4ddddL 08r0___PPT10   2___PPT9/ 0? -O =/  rImplications of Federal Medicaid Reform on States, Beneficiaries, and Providers TrendWatch April 2005 Vol. 7 No. 1P ywD& and rising Medicaid expenditures& ##dZBHREnrollment in Medicaid continues to rise& **|e:& surpassing Medicare in 1999& rlZ& and to the elderly and disabled populations...RQClose to two-thirds of Medicaid spending is for  optional services and/or populations.XXtc  -Federal savings from Medicaid proposals vary...  LMedicaid spending growth remains high& '' o_b& which state tax revenues seem unlikely to cover& 22 x   /S!"#./ ` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 4, (  fB  0D"ppfB  0D"   0" +e B*(2H  0޽h ? ̙33 $Blank Presentation 0 T*(  T T 0K       X*  T 0X\   @    Z* d T c $ ?HP    T 0x   @0   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S T 6{      X*  T 6}   @   Z* H T 0j ? ̙3380___PPT10.n L8( \ef@ L L 0     >*  L 0܉  @   @*  L 6\    >*  L 6ĩ  @  @* H L 0j ? ̙3380___PPT10.Pvܿ 4,0,(    0̨  o`s    H  0޽h ? ̙33  j b @5m(    < ;C^ `Chart 1: Growth of Federal Deficit 2000  2010*11  6ؼ  r NPressure to reduce the federal deficit& &(':  H4 %e%e ZSource: CBO, The Budget and Economic Outlook: Fiscal Years 2006 to 2015, January 2005 and CBO, Preliminary Analysis of the President s Budget Request for 2006, March 4, 2005L 2  :  ?  F Y  m Y  : <, +  ? In Billions   H ; C  -.H < C  -;v = <??"6?@`NNN?NB > <??"6?@`NNN?NO  H ? C \  & H @ C c   H A C p  u H B C w  H C C  H D C  H E C   <B F # X<B G # <B H # <B I # <B J #   <B K #   <B L #   <B M # # $ <B N # * + <B O # 78<B P # DE<B Q # KL<B R # XY S <\ u N$236.G C  T <  e N$128.G C  U <T l  O-$158.G C  V <W   W  O-$378.G C  W <[  .  O-$412.G C  X <_ "  ~  O-$394.G C  Y <c + ~   O-$332.G C  Z <g 3  &x  O-$278.G C  [ <(l D 79  O-$250.G C  \ <p M @6  O-$246.G C  ] <8b X K  O-$229.G C  ^ < 3G   L00.G C  _ <$ @G   L01.G C  ` < EG   L02.G C  a < T G  L03.G C  b <H! ] G  L04.G C  c <$ f G  L05.G C  d <X( q G  L06.G C  e <, z G  L07.G C  f <0 G   L08.G C  g <4 G   L09.G C  h <9 G   L10.G C d k H  ?V *2005 - 2010 CBO s estimate of the president s budget, projected March 2005LL  :H  0޽h ? ̙33  O(    B0  xo   l  0A 8!??S+ 8!  0   f.Chart 2: Total Medicaid Spending* 2000 - 2010//  0l(  JSource: CMS, Form CMS-64   6, /  ? In Billions     H0  ?M3 `,* State and federal expenditures include medical services, DSH payments and administration, calculated using calendar year data; 2005  2010 projected H  0޽h ? ̙33! PF@0 M(  @ @ 0  3H KChart 3: Medicaid as a Percentage of Total Mandatory Federal Spending 2004LL  @ 6P  r n& have made Medicaid a target for federal spending cuts.88 @ 0  USource: CBO, The Budget and Economic Outlook: Fiscal Years 2006 to 2015, January 20050V  :    @ 0(k  <1 *Does not include offsetting receipts or net interest **Includes other programs (e.g., TRICARE, Student loans, SCHIP, Social Services) F  F@  1@ BC\DE0F" - :PA[f[\Mff:@   `S" 4 7  2@ BC:DE$F NMI: @  `S" f  3@ BC"DE$F - "M`" @  `S" a.  4@ BCDE$F :ZtZ @  `S"  v  5@ BCDEF3$ S'|Q$ @ ` . 6@ BCDE$F (Emzn( @  `S"  N  7@ BCDEFY6 ;Y @ ` v  8@ B.CDEF3f-.- @ ` av  9@ 6p O  MSocial Security 36%  :@ 6  t  B Medicare 22%    ;@ 6h   B Medicaid 13%    <@ 68L  & [ W!Other Retirement & Disability 10%""  =@ 6DO  6  MIncome Security 14%  >@ 6Q  pV @ Other** 4%    ?@ 6U  j  YDiscretionary Spending 40% "0   @@ 6Y '   ZMandatory Spending* 60% &0  fB A@ 6 D?ne# fB B@ 6 D?n5 # t C@ N$]  ? : ^(Total Mandatory Spending* $1,346 billion)) D@ N`  ?E< STotal Spending $2,241 billionH @ 0޽h ? ̙33-  --^-( xZ   Bd  xo    D 0e   RChart 4: Medicaid Enrollees 1990  2004***  H\k T dSource: CMS. For 2002  2004 data, CBO s March Baseline, 2003  2005; Other Title XIX data  1990 = 1.1 million and 1995 = 0.6 million 2 $_TB  # C"? oo TB  # C"? ss TB  # C"? | } TB   # C"?  TB   # C"? TB   # C"?   . H0z  ?;h V"*Does not include SCHIP population##  : 6~ j  ? In Millions    ; 6́ H E  @Children  - < 6,v Ev >Adults  = 6 E IBlind & Disabled  > 6D> EG AElderly 3 ? 6  %  D24.1$G  @ 6 ) D35.6$G  A 6 7 D42.5$G  B 6 % " D46.2$G  C 60 /  D50.8$G  D 6H 3J D52.4$G  E 6` '< D57.3$G Z F 3  -C"?  Z G 3  -C"?%  Z H 3  -C"?  Z I 3  -C"?e  Z J 3  -C"? # Z K 3  -C"? - Z L 3  -C"? 1 Z M 3 C"?1  Z N 3 C"? % Z O 3 C"?d  Z P 3 C"? e Z Q 3 C"?P#  Z R 3 C"?2- Z S 3 C"?1 Z T 3 C"? 1 Z U 3 C"?F  Z V 3 C"?bd Z W 3 C"? Z X 3 C"?<# PZ Y 3 C"?-2Z Z 3 C"?v1Z [ 3 3C"?B  Z \ 3 3C"? F Z ] 3 3C"?bZ ^ 3 3C"?B Z _ 3 3C"?# <Z ` 3 3C"?j-Z a 3 3C"?1v.B b  bfg .B c   Hf .B d   Hf .B e  - Hf. .B f   Hf .B g   Hf .B h  $ Hf% .B i  v Hfw .B j  Hf.B k  Hf.B l  lHfm.B m  Hf.B n  Hf.B o  bHfc.B p   f .B q   fg .B r   pq .B s   tu .B t   ~  .B u   .B v   .B w    .B x     y 6 M   K0.G C  z 6\    K5.G C  { 6\  d  L10.G C  | 6 C   L15.G C  } 60    L20.G C  ~ 6|  [  L25.G C   6 :   L30.G C   6(  L35.G C   6\ Q L40.G C   6 0 L45.G C   64  L50.G C   6 G L55.G C   6 & L60.G C   6  J N1990.G C   6  J N1995.G C   6@  J N2000.G C   6,   J N2001.G C   6$  J N2002.G C   6 'J N2003.G C   6@  1J N2004.G C H  0޽h ? ̙33.  ..Gt*.(  t t B xo    t 0  nChart 5: Medicaid and Medicare Enrollment 1990  2010*88p t 08 Source: CBO, March 2005 Baseline; CMS, Medicare Enrollment, National Trends 1966-2003; and CMS, Medicaid Enrollment and Beneficiaries, Selected Fiscal YearsX    .  = : t H# ?  *1990  2003 historical CMS data; 2004  2010 projected CBO data&A@   Pt 6''? @Medicare   Qt 6+K; @Medicaid  - Rt 6t/v9  ? In Millions   4B St # i+y4 4B Tt # i+4 5 4B Ut # i+= > 4B Vt # i+F G 4B Wt # i+N O 4B Xt # i+^_4B Yt # i+gh4B Zt # i+pq4B [t # i+yz4B \t # i+4 N5 4B ]t # i+4 P 4B ^t # i+4 MNP 4B _t # i+4 P 4B `t # i+4 |}P 4B at # i+4 P 4B bt # i+4 P 4B ct # i+4 O P P 4B dt # i+4 P 4B et # i+4 ~  P 4B ft # i+4   P 4B gt # i+4 P 4B ht # i+4 J K P 4B it # i+4 P 4B jt # i+4 P 4B kt # i+4 P 4B lt # i+4 P 4B mt # i+4 LMP 4B nt # i+4 P 4B ot # i+4 P 4B pt # i+4 P 4B qt # i+4 P 4B rt # i+4 NOP h  st  0e0e     ?BC)DETF\ @  o 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||)&+#A!Wm1F \ r +,@ "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab tt  BC~DETF\ - -V}~+mAdW^mZZegFA4+$1 F \ r+,@"<  T  ut 6= S`  K0.G C  vt 6A Pi  L10.G C  wt 6? Pr  L20.G C  xt 6@I P{  L30.G C  yt 6LP L40.G C  zt 6P!P L50.G C  {t 6T*P L60.G C  |t 6X3P L70.G C  }t 6`\ 5  L90.G C  ~t 6` i  L91.G C  t 6d e  L92.G C  t 6g   L93.G C  t 6,l 4  L94.G C  t 6p 7  L95.G C  t 6s d  L96.G C  t 6w g  L97.G C  t 6{   L98.G C  t 6 6  L99.G C  t 6  9  L00.G C  t 6d f  L01.G C  t 6d&  i  L02.G C  t 6   L03.G C  t 6ԡ 8  L04.G C  t 6d 4  L05.G C  t 6왵 h  L06.G C  t 6 k  L07.G C  t 6    L08.G C  t 6 3  L09.G C  t 6 6  L10.G C H t 0޽h ? ̙33N MM`0 FM(    0\g  +Chart 6: Medicaid Spending by Service 2003:'H':  6D  :r & with the bulk of the dollars going to nursing home and hospital care....&JI  0h> \ j8Source: CMS, Form CMS-64; Payments to Managed Care entities have been allocated among providers receiving MCO payments per CMS methodology; Hospital services include inpatient hospital services, outpatient hospital and clinic services, payments made to rural health clinics and federally qualified health centers99   <0I  ?6 c* Includes medical services and DSH payments, not administration, calculated using fiscal year datadd   BCDE$F - M` @  `S" 3 @C    0e0e     ?BCDEF @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||p~xjYp @ ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab- 3 K    0e0e     ?BCDE$F @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| "4]4 @  ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab- ;   0e0e     ?BCDEF3 @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||Ft;kF @ ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab- ~3    0e0e     ?BCzDE$F @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| "3Ldz4 @  ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab3    0e0e     ?BClDEF @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||$8l @ ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abO3 -    0e0e     ?BCDEF @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||+ &+ @ ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab3 -    0e0e     ?B_CDEF @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||  _ @ ` "" ?@  `     @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abx3 -   BJCDEF̙I0JI @ `S" y 3 -   0s <4 QTotal = $266.1 billion*XB  0 D?   0 b  KIntermediate Care Facility for People with Mental Retardation (ICF/MR) 6.2%LL   0 : QPhysician, Lab & X-Ray 5.5%   0 )  LMedicare Payments 2.3%   0} .  @ Other 7.4%     0 h 5 =  aHospital Services 30.1%.    0l  u  iNursing Facility Services 16.9%.     0lM 8 P w  W!Home Health & Personal Care 14.2%""   0H  T   SPrescription Drugs 12.0%   0  S  SDSH Payments 5.4%&  H  0޽h ? ̙33`  @%j(    <(ӯ7F^ \Chart 7: Percentage of Medicaid Enrollees vs. Medical Expenditures by Enrollment Group 2003"]\  6\ׯ r   ]   HXٯ%e%e Source: Kaiser Commission on Medicaid and the Uninsured, The Medicaid Program at a Glance, January 2005, estimates based on CMS, CBO and OMB data, 20042 29  ?  I <ޯJ s  VMedicaid Enrollees( J <\J   XMedical Expenditures( K <L %  @Children  - L <D9   >Adults  M <' 1  IBlind & Disabled  N <$E ?Elderly 3 O <` 1 k VTotal = 52 million(   P <|  }k YTotal = $252 billion*(   Q <? -?"6?@`NNN?N 6 &  R <? -?"6?@`NNN?N ] 9& 4B S #   ]  T H?1?"6?@`NNN?N6  U H?1?"6?@`NNN?N ] 9 4B V #  ] "  W <??"6?@`NNN?N6  X <??"6?@`NNN?N] 9 4B Y #  ]  Z <?3?"6?@`NNN?N:6  [ <?3?"6?@`NNN?N:] 94B \ # : ] ;4B ] # & a' 4B ^ # & > 4B _ # & < < > 4B ` # & ab>  a <lJJ 2  M48%.G C  b <eS Z   M19%.G C  c < 2  M27%.G C  d <S Z   M12%.G C  e <hH2 Q16%2G G  f <d Z   Q43%2G G  g <aL H9%*C C  h <Z O I26%*C C  j <tz ?6 c* Includes medical services, not DSH payments and administration, calculated using fiscal year datadd H  0޽h ? ̙33  `"r&( xZ   BL o   j  H3 Source: Kaiser Commission on Medicaid and the Uninsured, Key Facts, May 2003; Urban Institute estimates based on data from 1998 HCFA 2082 and HCFA 64 reports, 20012 2:  b   0  Chart 8: Distribution of Medicaid Mandatory and Optional Spending (Length of bar is proportional to amount of Medicaid spending) 1998F A S  -" B << %Optional Services / Population Groups(&%  hh88 C <  'Mandatory Services for Mandatory Groups(('  hh88F D S " @ T C  -3f3 # @ U C  -3f > @ V C  -3fzN W C  -3f"`8(@ X C ̙3  # @ Y C ̙ > @ Z C ̙z@ [ C ̙8(.B \   .B ]    .B ^    .B _  ( ) .B `  .B a   b 6 1nq   I65%*   c 6bn   I45%*   d 6gn9 I34%*   e 6Xenns I17%*   f 64dnq = *  I35%*   g 68rn   I55%*   h 6@vnB / 9 I66%*   i 6ynn  I83%*   j 6~ni 2  LChildren(    k 6n \  KParents(   l 6@n,9 LDisabled(    m 6\ntt KElderly(  H  0޽h ? ̙33& %%JghT%(  h h 0Тn^ _Chart 9: Number of States & District of Columbia with Selected Types of Optional Services 2003``& h 6n q Many  optional services are viewed by states as medically necessary.FF h 6\n \Source: The Lewin Group, Opportunities and Observations for Indiana Medicaid, September 20040] 3   "h 6n  LOccupational Therapy  #h 0$n o MChiropractic Services  $h 0\nz u  TPhysical Therapy(   %h 0n } <  KEyewear(   &h 07nE   THospice Services(   'h 0n N  ]%Non-Emergency Transportation Services&&  (h 0Dn  s  q-Mental Health & Other Rehabilitative Services(.-   )h 0n} S  a)Inpatient Psychiatric Services (> age 65)**  *h 0Ln!   SDental Services(   +h 0Hn x ]Durable Medical Equipment(   ,h 0n  e!Targeted Case Management Services("!   -h 0nQ I j&Optometric Services (excludes eyewear)('&   .h 0nN  JICF/MR(   /h 0n  f"Emergency Transportation Services (#"   0h 0 n  A  a)Inpatient Psychiatric Services (< age 21)**  1h 0dnL   GClinic Services  2h 0PnS  UPharmacy Benefits(  : 3h 3  -? : 4h 3  -? b: 5h 3  - ? u : 6h 3  - ? 3 : 7h 3  -P ?  : 8h 3  - ?  : 9h 3  - ? f : :h 3  - ?  : ;h 3  - ? 7 : h 3  -"? Sm: ?h 3  -? S: @h 3  -? m>: Ah 3  -Y? : Bh 3  -?  : Ch 3  -)? t4B Dh # ? @ $4B Eh # $) ? %4B Fh # ) ? 4B Gh #  ) ? 4B Hh # [ ) ? \ 4B Ih #  ) ? 4B Jh # ( ) ? ) 4B Kh #  ) ? 4B Lh #  ) ? 4B Mh # ^ ) ? _ 4B Nh #  ) ? 4B Oh # / ) ? 0 4B Ph # ) ? 4B Qh # ) ? 4B Rh # e) ? f4B Sh # ) ? 4B Th # 1) ? 24B Uh # ) ? 4B Vh # ) ?  Wh 6Ht An J25,G C  Xh 6 <  J41,G C  Yh 64D >  J44,G C  Zh 6 >  J44,G C  [h 6 ;t  J44,G C  \h 6} ;  J44,G C  ]h 6t U@  J45,G C  ^h 6K U  J45,G C  _h 68t  J46,G C  `h 6fy J49,G C  ah 6f J49,G C  bh 6lJ J50,G C  ch 6M J51,G C  dh 6 J51,G C  eh 6  J51,G C  fh 6 A  J25,G C  gh 6`z   J31,G C H h 0޽h ? 33___PPT10i.f p+D='  = @B + . +TZ(    B<7 xo     0;  wChart 10: Estimated Federal Savings from Selected Medicaid Reform Options and Cost Containment Measures FY 2006 - 2010xx  0 (Source: CBO, Budget Options, February 2005; CRS Report for Congress, Medicaid and SCHIP: The President s FY 2006 Budget Proposals, February 15, 2005J   * <  w8 .U  Tm . 0ؖ"`)   m#Block Grant for Acute Care Services.$#G C  / 0"`3   j Allotment for State Admin. Costs.! G C  0 04"`  y/Increase the Flat Rebate for Prescription Drugs.0/G C  1 0̡"`   iReduce Spending on Admin. Costs. G C  2 0T"` I  gIncrease Allowable Copayments.G C  3 0"` \  t*Restrict Allocation of Common Admin. Costs.+*G C  4 0"` .j  l"Asset Transfers for Long-term Care.#"G C  5 6l]  ? In Billions   z 6  J0e0e    B CDEF @  5% 8c8c     ?A)BCD|E||  @$P 7 3  -"`nt 6B 8  & L 6B 9  & ' 6B :     6B ;    6B <   6B =   6B >   6B ?    6B @  i j  A 6h. O$60.7.G C  B 0"`  #Restructure Pharmacy Reimburse-ment.$#G C P C 3  -"`wB D 3  -d B E 3  -G B F 3  -k  / B G 3  -S g  B H 3  -5  B I 3  -+  B J 3  -7  6B K  . T 6B L  T U  M 6|Yc N$7.1.G C  N 6=A  N$6.1.G C  O 6k y$  N$5.4.G C  P 6S  E  N$4.2.G C  Q 6$5   N$2.0.G C  R 6h   N$1.7.G C  S 6H   N$1.5.G C H  0޽h ? ̙33/!    !i/ (  Rx Tc)  i #"*yiiiicT) . c B  ?"`i h)!  X" Enrollees may lack means to pay higher cost sharing " Narrow benefits for expansion group may not adequately meet health care needs of enrollees (e.g., no inpatient care)`  @` a B  ?"`hi !  " Covers more people " Provides states more flexibility in benefit design for various populationsb`b  @` _ B   ?"`Th!  rTiered Programs (e.g., UT)&   @`I ] B   ?"`i ! )  sEnrollees may lack the knowledge to make informed decisions Weakens safety net if private providers deny coveraget`t  @`v [ BL   ?"`! i  " Provides choice to enrollees " Enrollees would go into mainstream health plansQ`Q  @` Y B   ?"`T!   kVouchers (e.g., FL)&    @`x U B\   ?"`i )h " States may limit or eliminate medically necessary services to fit under the capR`R  @` S B   ?"`i h ^" States not at risk for fluctuations in enrollment growth " Re-investment of savings can be used for expanded coverage of the uninsured`  @` Q B   ?"`Th [Per Capita Caps  @`H   BX  ?i )  " Shifts some financial risk to Medicaid consumer increasing the likelihood that care may be delayed due to increased cost sharing " Enrollees may lack the knowledge to make informed decisions`  @`   BT  ? i  ," Enrollees manage a portion of own health care dollars " Creates incentives for patients to help control costsp`p  @`   BT  ?T   {#Health Spending Accounts (e.g., NH)&$   @`   B  ?i F) ~0" Shifts financial risk for eligibility & cost growth solely to states " States may limit or eliminate medically necessary services to fit under the cap`  @`   B4  ?Fi  D" Provides incentives to states to spend cost-effectively " Encourages state innovation and flexibility in program design {`{ DD@`  Bܤ  ?TF fGlobal Caps (Block Grants)  @`  H\  ?i c)F RCons  @`  H  ?ci F RPros m @`  H  ?TcF \Reform Efforts  @`fB  6 o ?Tc)c`B  0 1 ?T)fB  6 o ?T ) fB  6 o ?TcT `B  0 1 ?c `B  0 1 ?i ci fB  6 o ?)c) fB  6 o ?TF)F`B R 0 1 ?Th)h`B Z 0 1 ?T ) `B ` 0 1 ?T! )!   0 ) VChart 11: Medicaid Reform Proposals Focusing on State Flexibility and Enrollee ChoiceWW  0  ISource: The Lewin Group H  0޽h ? ̙3380___PPT10. $aJ / wo Q(    <  "`p   j  0 "`  Source: Rockefeller Institute of Government analysis of data from the Bureau of Census, Bureau of Economic Analysis, and the National Association of State Budget Officers. 2004 is a preliminary estimate   0p "` s=Chart 12: Percentage Growth in Medicaid Spending 1997 - 2004>>8 c  Q0h 6B 6  < b= 6B 7  < Z 6B 8  < Z 6B 9  < Z 6B :  r < s Z 6B ;  9 < : Z 6B <   <  Z 6B =  < Z 6B >  < Z 6B ?  b< cZ  @ BCDE F(oMd_H2!98@S" ~ A 6l O2K L6.8%,G C  B 6   L7.1%,G C  C 6   [ L8.5%,G C  D 6   A M10.9%,G C  E 6$ Z q M12.9%,G C  F 6   L9.5%,G C  G 6 y L9.4%,G C  H 6t e3 L3.9%,G C  I 6 Y  L1997,G C  J 6쳵V &  L1998,G C  K 6    L1999,G C  L 6  L2000,G C  M 6  L2001,G C  N 6pĵ P  L2002,G C  O 6PȵG   L2003,G C  P 6d̵   L2004,G C H  0޽h ? ̙3380___PPT10./7 ! )kX0 y(  X~ Xs *ٵ p    X 0ڵ"`  FSource: Rockefeller Institute of Government analysis of data from the Bureau of Census, Bureau of Economic Analysis, and the National Association of State Budget Officers. State tax revenue data is adjusted for inflation and legislative changes. 2004 is a preliminary estimate  X 0ݵ"` s=Chart 13: Percentage Growth in State Tax Revenue 1997 - 2004>>F 0h  kX 0h T Z < A  EX# _ Fh B FX 3  -Z < t B GX 3  -!< A &T d<  HX# i  P IX 3  -"`dP< B JX 3  -1K< B KX 3  -P < B LX 3  - V < B MX 3  - < B NX 3  -< <B OX #  g <B PX #   <B QX #   <B RX #   <B SX # w x <B TX # > ? <B UX #  <B VX #   <B WX #   <B XX # g h  YX <dxu <5.0%C  ZX 6x00P <5.9%C  [X <(x  <5.0%C  \X < x  <4.9%C  ]X <   =-6.8%C  ^X <00@ K  =-3.4%C  _X 6$ PH <3.4%C  `X <    @1.0% G  aX <    L1997,G C  bX < x H  L1998,G C  cX < (   L1999,G C  dX <   L2000,G C  eX <h   L2001,G C  fX <t    L2002,G C  gX < x H  L2003,G C  hX <L (   L2004,G C H X 0޽h ? ̙3380___PPT10./7" A(    0, p Source: Division of Research, Moore School of Business, University of South Carolina. Economic Impact of Medicaid on South Carolina, January 2002; Ferber JD, et al., The County Level Impact of Medicaid and SCHIP in Missouri, February 2, 2005T0 2V - # 9  Y>  05 B & potentially forcing states to make cuts, leading to weakened state economies.&O0 2O  09 "` t>Chart 14: Potential Impact of Cuts to State Medicaid Programs??, 8 I!\  A h 4 s *"`D ( 5 0=  `{  C6,181"0( 2h 6 s *"` w ( 7 0A  ` d$150 million in lost wages 0 2m: 8 04I KT  ~Missouri: If State Medicaid and SCHIP funding by $43 million 8@0 .h 9 s *"`D $ : 0M  T  D2,049 "0( 2h ; s *"` w $< < 0Q  T\  b$73 million in lost wages $150 million in lost economic activity $5.4 million in lost tax revenueHc0@ O m = 0(U I` ^South Carolina: If State Medicaid funding 10%,00 * > Hl`  ?# = Cuts Made  ? HPT  ? !  = Jobs Lost  @ Hf  ? !s CEconomic ImpactH  0޽h ? 33___PPT10i.p+D='  = @B +;%# $$p(o$(  ( ( B8C\DE0F" - !CT[[\888M@   `c"$ `VI ( BCkDEFFS _kF @ `S" k }6  (  0e0e     ?BCDE$F A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| 7Y @  ` "" ?@  `     @ABC DEEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN E5%  N E5%  N F   5%    !"?N@ABC DEFFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abt6   (  0e0e     ?B*CDEF A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| * @ ` "" ?@  `     @ABC DEEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN E5%  N E5%  N F   5%    !"?N@ABC DEFFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab\: 6 k  (  0e0e     ?BCDEF A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||  @ ` "" ?@  `     @ABC DEEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN E5%  N E5%  N F   5%    !"?N@ABC DEFFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abV 6 k  ( 0  pChart 15: Distribution of Transitions from Medicaid to Other Sources of Coverage (Under Age 65) During 1996-1999qq ( 6  r hLoss of Medicaid coverage has led to more uninsured& 55, ( 0,  ^Source: Short, PF, Graefe, D, and Schoen, C, Churn, Churn, Churn: How Instability of Health Insurance Shapes America s Uninsured Problem, The Commonwealth Fund, November 2003 0- [ (  ( 0 c M 4I  G Uninsured 65%   ( 0#  iw  F Employer 28%     ( 0! J 0 >Other 2%     ( 0D+  s C Individual 2%  ( 0T. l <KR  A Medicare 4%   H ( 0޽h ? ̙33v. -- =v-(  - 8 0 ySource: Adapted from Kaiser Commission on Medicaid and the Uninsured, Overview of the Utah Section 1115 Waiver, July 20048z0 F (   9 0$gf^ \Chart 16: Examples of Benefits Covered and Not Covered Under Utah's Three Medicaid Programs"]0 ]. ~ 6Tk  j & while program cuts have decreased benefits, increased beneficiary costs& JJ) Qjv  # #":. x*3Lv  6/? j ]Waiver Coverage  @`  <X -?Q bCovered Services   @`  B?Q* v  q%Mental Health and Chemical Dependency&&  @`  B?Qw *  ^Prescription Drugs  @`  B?Q w  ZLong-term Care  @`  Bw?QW   ZSpecialty Care  @`  Bt`?QaW  ^Physician Services  @`  B\?Qka ZEmergency Room  @` ¬ Bܢ?Qk _Outpatient Hospital  @` ì B?Q ^Inpatient Hospital  @` Ĭ B?!* jv  ] Not Covered    @` Ŭ Bq? * !v  v*X (30 outpatient & 30 inpatient days/year)++  @` Ƭ B;?* v  MX  @`7 Ǭ B?!w j*  OX (limited to 4 drugs/month, no exceptions $5 copayment/prescription, generics)PP .  @`0 Ȭ B ? w !*  HX (limited to 7 drugs/ month, with exceptions $2 copayment/prescription)II 1  @` ɬ B ?w *  X ($1 copayment/ prescription)   @` ʬ B?! jw  ] Not Covered    @` ˬ B? !w  ] Not Covered    @` ̬ Bt? w  MX  @` ͬ B܂?!W j  ] Not Covered    @` ά BĊ? W !  MX  @` Ϭ Bh?W  MX  @` Ь B^?!ajW  ~X ($5 copayment)   @` Ѭ BU? a!W  ~X ($3 copayment)   @` Ҭ BS?a W  ~X ($2 copayment)   @` Ӭ B:?!kja X ($30 copayment)   @` Ԭ B@? k!a ~X ($6 copayment)   @` լ Bx?k a ~X ($6 copayment)   @` ֬ B1?!jk ] Not Covered    @` ׬ Bx3? !k MX  @` ج B? k MX  @` ٬ Bd?!j ] Not Covered    @` ڬ B-? ! o#X ($220 coinsurance per admission)$$  @` ۬ Bv ?  o#X ($220 coinsurance per admission)$$  @` ܬ < ?!j o!Utah's Primary Care Network (PCN)""  @` ݬ < ? ! mUtah's Non-traditional Medicaid    @` ެ <  -?  fTraditional Medicaid   @`ZB ߬ s *o ?QjZB  s *1 ?QjZB  s *1 ?QjZB  s *1 ?QkjkZB  s *1 ?QajaZB  s *1 ?QW jW ZB  s *1 ?Q j ZB  s *1 ?Qw jw ZB  s *1 ?Q* j* `B  0o ?Qv jv ZB  s *o ?QQZB  s *1 ?  v ZB  s *o ?jjZB  s *1 ?ZB  s *1 ?!!v ZB  s *o ? j`B  0o ?QQv ZB  s *1 ?v `B  0o ?jjv H  0޽h ? 3380___PPT10.Vϴ  E=@33(  ^B  6 D?   <py ?"`N<  IPremiums Implemented* :  3 Tf :  3 nf :  3 f :  3 y)f :  3 B f :   3 JU f :   3 i f :   3  f :   3  f :   3 N f :  3  .f :  3  Gf :  3  [f .B   f g .B   f  .B   f  .B   f  .B   f  .B   f  .B   f   .B   f   .B   f . / .B   f B C .B   f UV .B   f no .B   f  .B   f  .B   f     6 p P98,828.G C  ! 6؈ X   P50,938.G C  " 6؆ ; 9  P95,701.G C  # 64  T POct 02.G C  $ 6   PNov 02.G C  % 6藤   PDec 02.G C  & 6̛   PJan 03.G C  ' 6  /  PFeb 03.G C  ( 6T  <  PMar 03.G C  ) 6|  V  PApr 03.G C  * 6  c   PMay 03.G C  + 6   PJun 03.G C  , 6Ȳ   PJul 03.G C  - 6$  H PAug 03.G C  . 6<  Z PSep 03.G C  / 6  l POct 03.G C  0 0¤ f &Chart 17: Oregon Health Plan, Number of Medicaid Enrollees, Before & After Premiums Implemented October 2002  2003"u0 u 1 64Ǥ   j r& and reduced access to care for the neediest populations.::I 2 0ˤ  Source: McConnell, J and Wallace, N, Impact of Premium Changes in the Oregon Health Plan, Office for Oregon Health Policy and Research, February 200480 % 3 >  3 <Ф ?"` e*The state also implemented a policy where people were disenrolled if they missed one premium paymentff H  0޽h ? ̙33R Q 0   p(  ^  S THP   n  c $nT @0  n >Story A crucial factor in helping to narrow gaps within the safety net has been expanding the use of  optional eligibility and coverage categories under Medicaid. Although labeled  optional by statue, some of the sickest and poorest Medicaid beneficiaries often fall into this category. Overall, two-thirds of Medicaid spending is for  optional populations or services. In fact every state covers some set of optional services and populations, devoting most of their resources to prescription drugs or low-income seniors. The Bush Administration (Leavitt) has indicated that states should have the ability to offer less comprehensive Medicaid benefits to optional populations or those not required to be covered under federal law (NYT, 2/17/05) But of Nursing home patients are optional Medicaid beneficiaries, according to Janet Wells, National Citizens Coalition for Nursing Home Reform (cited in NYT 2/17/05). > H  0j ? ̙332y 0 ,B(  ,^ , S THP    , c $T @0   8Story  H , 0j ? ̙3380___PPT10.`0Cw 0 bZ0(  0^ 0 S THP   T 0 c $lM T @0   @Story Data Issues We could use either CMS or CBO data for this chart. However in order to project this data, we run into the following difficulties CMS Data In order to show total Medicaid spending from 1997 to 2010 or 2014, we could use CMS historical and projected data from the National Health Accounts. These data show the combined total for Medicaid and SCHIP spending. The data currently in the chart shows only total historical data on Medicaid spending. If AHA could get the breakdown of spending for Medicaid and SCHIP separately from CMS, then we could create the chart using the same source, showing only Medicaid spending from 1997-2014. CBO Data CBO shows projections for Medicaid without SCHIP to 2014, but only shows federal spending, not state and federal together. !     !   &  J  H 0 0j ? ̙3380___PPT10.B 0 <((  <^ < S THP    < c $E T @0    H < 0j ? ̙3380___PPT10.H8Z 0 @H(  @^ @ S THP    @ c $t_ T @0   >Story H @ 0j ? ̙3380___PPT10.}8H 0 DH(  D^ D S THP    D c $|T @0   >Story H D 0j ? ̙3380___PPT10.67'8e 0  HH(  H^ H S THP    H c $ƯT @0   >Story H H 0j ? ̙3380___PPT10.08r 0 0LH(  L^ L S THP    L c $`ͯT @0   >Story H L 0j ? ̙3380___PPT10.`"38l 0 PPH(  P^ P S THP    P c $vT @0   >Story H P 0j ? ̙3380___PPT10.p58c 0 XH(  X^ X S THP    X c $@ T @0   >Story H X 0j ? ̙3380___PPT10.L69/_ 0 t?(  t^ t S THP    t c $' T @0   5StoryH t 0j ? ̙3380___PPT10.U/x 0  x?(  x^ x S THP    x c $m T @0   5StoryH x 0j ? ̙3380___PPT10.EW/ 0 0|?(  |^ | S THP    | c $s T @0   5StoryH | 0j ? ̙3380___PPT10.l 0 nf(  d  c $THP   Z  s *T @0   @Story Data Issues We could use either CMS or CBO data for this chart. However in order to project this data, we run into the following difficulties CMS Data In order to show total Medicaid spending from 1997 to 2010 or 2014, we could use CMS historical and projected data from the National Health Accounts. These data show the combined total for Medicaid and SCHIP spending. The data currently in the chart shows only total historical data on Medicaid spending. If AHA could get the breakdown of spending for Medicaid and SCHIP separately from CMS, then we could create the chart using the same source, showing only Medicaid spending from 1997-2014. CBO Data CBO shows projections for Medicaid without SCHIP to 2014, but only shows federal spending, not state and federal together. !     !   &  J  H  0j ? ̙3380___PPT10.B; 0 K(  d  c $THP     s *ԵT @0   5StoryH  0j ? ̙3380___PPT10.U Vx[klT>s\c0Y;6`N; %1ۈ6d҈*钴5UTEE<*?*OQޞ33w0{f̜3gμ} pH, !iFDpJl$@aZЉO`+t&˜\^a!C"y5IߙOJg3;G&U5dEZH#H3I? 4Fc3$ރ@MEꟴCrwlbd]6 AD*xH| a"v ݏi R )T~;v[2r4ϓ0e uL'0_~߇oHƿ)i)2`Ư lhdrH _dO4L!2?B:euuzh'!k$*'XĮqd k7'z:{;|{Z|[zwؾ;]<'VJ4jy'o8Ő!v;K?\&lo~N)vOB%W|ur#Es1};gcJ|0N'J&C~>fݿձմʞZՏEѩְDѳTqɲ-2FQĜa%N/:#<)PLs&ThbޓF.V錟zi+dϝdRl7~,8 N/9PMz^hB ᾡiP?_90H'G#B@CCC(B0<AQhXGy>|c0&G!JeX6o0☛(Ԍ웣p)Q!m3k) +| ))ԝ4B^Da,5t>a.ljˇ懇|18S- uUPT;I Auhe\D=2QVhVh]4VCѨ뭩HȡꜴǰ=23Z !^^VR OK)6bAO5\eQakM9 Jϋ[,[t1:&'в{ 9-myykfrDmN m5:68 o΋fM{My!/F>d.Kb)Kw~.>gtFg2aCyqR̶XwbAp-qnpYrb)Z:?:wGQm~GBY`OU4+i7gܪBZjpXzLi,}& D2ހyRMA/ ?Vo.i*eX b1RDd.jD?3 m^-#pМRS=39}j'}e)qCeL!1f5QծI;06y!@W3.wAb4Ϳho_P=$KyXd- ٯD~|?МTl=fhoiˏnr;H~#JJbfd=8\g8*m\>Nae2 f/sz[}_NTZNa)v)vp:1xSs:.S]ԣn0K# JԶC0]ukA8)̺9e/$1 5N}eSf%!gcĐIgfN,󼢉܏a)!=vQavKa"Wa {Sao*s}f`%AT+)oJI?`Uc7Vx5gr{X?J.4ۛ>%/Iʉ{ܿ&;H?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRTUVWXYZ\]^_`abdefghijoRoot EntrydO)PicturesCurrent UsercSummaryInformation(SPowerPoint Document(DocumentSummaryInformation8[