Government Involvement in Health Care

Part Two

StateGovt

FedGovtMedicaid

• Title XIX of the Social Security Act

• Health Care program for certain low income persons (NEED based program)

• Administered by each state– Federal mandates– State options

• Funded by Federal and State Government

Medicaid

• Groups Eligible – Mandatory– Children < 6, pregnant women, family income ≤ 133%

FPL (FPL on next slide)

– Supplemental security income (SSI)• Aged Needy, Blind Needy, Disabled Needy

– Children <19, income ≤ FLP

– Some foster care children

– Certain Medicare beneficiaries, ≤ 74% FPL

• Many states are expanding eligibility (SCHIP)

StateGovt

FedGovt

2006 HHS Poverty Guidelines

Size of Family Unit

48 States

Alaska

Hawaii

1 $9,800 $12,250 $11,270

2 13,200 16,500 15,180

3 16,600 20,750 19,090

4 20,000 25,000 23,000

5 23,400 29,250 26,910

6 26,800 33,500 30,820

7 30,200 37,750 34,730

8 33,600 42,000 38,640

FedGovt

Medicaid

• Mandatory Services– Hospital services (inpatient

and outpatient)

– Physician services

– Diagnostic services

– Skilled nursing facility services

– Rural Health Clinic services

– Prenatal care/vaccines-child

– Family planning

– Nurse practitioner services

• Optional Services– Clinic services

– Dental

– Eye glasses

– Intermediate care facilities-mentally retarded

– Physical therapy

– Prescription drugs

– Rehabilitation services

– Transportation services

– Some home/community services

StateGovt

FedGovt

Medicaid

• Federal Government pays 50-83% of costs depending on the state

• Federal Match in Nebraska is ~ 60% (59.7% for fiscal year 2006)

• For other states, please see the following web-site:http://www.kff.org/mfs/index.jsp

StateGovt

FedGovt

In Nebraska:

• 64.5% of recipients are children and pregnant women, low incomes– < 26% of the dollars go here

• 27% of recipients are aged or disabled– Consume 66% of the dollars

• Largest Medicaid expenditure–long term care

StateGovt

FedGovtMedicaid

NE Medicaid Expenditures2003

8%

26%

37%

29%Age>/= 65 Blind/DisabledChildrenAdults

www.hhs.state.ne.us/med/reform/expenditures.htm (Accessed 9/3/06)

StateGovt

12%

19%

43%

26%

Age>/= 65 Blind/DisabledChildrenAdults

U.S. Medicaid Expenditures2003

www.kff.org/medicaid/upload/7334%20Medicaid%20Primer_Final%20for%20posting-3.pdf (Accessed 9/3/06)

Fed.Govt.

U.S. Expenditures Compared to Number of Enrollees- Medicaid (2003)

0%10%20%30%40%50%60%70%80%90%

100%

Expenditures Enrollees

AdultsChildrenBlind/DisabledAge >/= 65

www.kff.org/medicaid/upload/7334%20Medicaid%20Primer_Final%20for%20posting-3.pdf (Accessed 9/3/06)

Fed.Govt.

Fed.Govt.

Other major Federal Health Coverage Plans

• Veterans Administration

• Dept. of Defense (Military Services) & Tri-Care [Formerly CHAMPUS] (Military Dependents)

• Federal Employee Plan

• Indian Health Service / U.S. Public Health Service

• State & Local Plans for poor and uninsured.

Government Involvement in Health Care

This concludes Part Two