K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 1

Medicaid: The Essentials

Diane Rowland, Sc.D.Executive Vice President,

Henry J. Kaiser Family Foundationand

Executive Director, Kaiser Commission on Medicaid and the Uninsured

for

Alliance for Health ReformWashington, DC

February 13, 2009

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 2

Medicaid’s Origins

• Enacted in 1965 as companion legislation to Medicare Parts A and B (Title XIX)

• Entitles eligible individuals to defined set of benefits

• Entitles participating states to federal matching funds on open-ended basis

• Means-tested, with focus on welfare population:

-- single parents with dependent children

-- aged, blind, and disabled

• Mandatory services and populations for participating states with options for broader coverage

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 3

Medicaid Today

Health Insurance Coverage

29.5 million children & 15 million adults in low-income families; 6 million elderly & 8

million persons with disabilities

State Capacity for Health Coverage

Federal share ranges 50% to 76%; 44% of all federal funds to states

MEDICAID

Support for Health Care System and Safety-net

16% of national health spending; 42% of long-term care services

Assistance to Medicare Beneficiaries

8.8 million aged and disabled — 19% of Medicare

beneficiaries

Long-Term Care Assistance

1 million nursing home residents; 2.8 million

community-based residents

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 4

Medicaid’s Role for Selected Populations

Note: “Poor” is defined as living below the federal poverty level, which was $17,600 for a family of 3 in 2008. SOURCE: KCMU, KFF, and Urban Institute estimates; Birth data: NGA, MCH Update.

65%

44%

20%

51%

23%

40%

19%

20%

27%

27%

41%

24%

Nursing Home Residents

People Living with HIV/AIDS

People with Severe Disabilities

Medicare Beneficiaries

Births (Pregnant Women)

Low-Income Parents

Low-Income Children

All Children

Hispanics

African-Americans

Near Poor

Poor

Percent with Medicaid Coverage:

Families

Aged & Disabled

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 5

IL

Percent of Nonelderly Residents Covered by Medicaid, by State, 2006-2007

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

SOURCE: Urban Institute and KCMU analysis of the March 2006 and 2007 Current Population Survey. Two-year pooled estimates for states and the US (2006-2007).

TX

FL

AL

10-12% (12 states)

13-15% (16 states)

< 10% (8 states)

US Average = 13%

NE

>15% (15 states including DC)

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 6

Enrollees Expenditures on benefits

Medicaid Enrollees and Expendituresby Enrollment Group, 2005

Children 18%

Elderly28%

Disabled42%

Adults 12%Children50%

Elderly10%

Disabled14%

Adults26%

Total = 59 million Total = $275 billion

SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on 2005 MSIS data.

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 7

Medicaid Payments Per Enrolleeby Acute and Long-Term Care, 2005

Children Adults Disabled Elderly

Long-Term Care

Acute Care

$1,617 $2,102

$13,524

$11,839

SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on 2005 MSIS data.

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 8

200%185%

41%

0%

68%74%

Children PregnantWomen

Elderly andIndividuals

withDisabilities

WorkingParents

Non-WorkingParents

ChildlessAdults

Median Medicaid/SCHIP Income Eligibility Thresholds, 2008

Federal Poverty Line (For a family of four is

$21,200 per year in 2008)

SOURCE: KCMU/Urban Institute analysis of March 2008 CPS.

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 9

Children’s Eligibility for Medicaid/SCHIP by Income, January 2009

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

*The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year.***IL uses state funds to cover children above 200% FPL.; MA uses state funds to cover children above 300% FPL; NY uses state funds to cover children from 250% to 400% FPL; WI uses state funds to cover children from 250% to 300% FPL.SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2009.

TX

IL

FL

AL

< 200% FPL (7 states)

>250% FPL (11 states & DC)

200-250% FPL (33 states)

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 10

Medicaid Eligibility for Working Parents by Income, January 2009

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

TX

IL

FL

AL

50- 99% FPL (20 states)

20-49% FPL (13 states)

> 100% FPL (18 states including DC)US Median Eligibility = 68% FPL: $11,968 per year

*The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year.SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2009.

K A I S E R C O M M I S S I O N O N

Medicaid and the Uninsured

Figure 11

44%

25%

50%

18%

41%

16%

37%

46%

33%

43%

16%

20%

17%

39%

43%

64%

19%

29%

Medicaid/Other Public Employer/Other Private Uninsured

Poor

Near-Poor

(<100% Poverty)

(100-199% Poverty)

Poor

Near-Poor

Poor

Near-Poor

Children

Parents

Adults without Children

Medicaid also includes SCHIP and other state programs, Medicare and military-related coverage.SOURCE: KCMU and Urban Institute analysis of March 2008 CPS.

Health Insurance Coverage of Low-Income Adults and Children, 2007