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George A. Ralls M.D.Health Services Department
December 1st, 2009
Medicaid Update 2009
• Brief History
• Florida Medicaid Program
• Medicaid & the Economy
• Current Situation
• Summary
Overview
• Brief History
• Florida Medicaid Program
• Medicaid & the Economy
• Current Situation
• Summary
Overview
• In 1965, the Federal Social Security Act was amended to establish two major national health care programs:– Title XVIII (Medicare)– Title XIX (Medicaid)
• Medicaid is an open-ended, means-tested entitlement program financed jointly by the Federal Government and States
Medicaid
• Federal Medicaid laws mandate certain benefits for certain populations
• To qualify for Federal funds states administer their programs under federally approved state plans:– A waiver is required is state plans
deviated from certain provisions of the Social Security Act
Medicaid
• Medicaid programs vary considerably from state to state, and within states over time– Optional services covered
differ– Limits on mandatory and
optional services differ– Level provider reimbursement
Medicaid
• Omnibus Budget Reconciliation Act 1989:– Mandates states to extend
Medicaid coverage to children & pregnant women
Medicaid
• Federal Medicaid Spending:– expected to be about $216
billion in FY 2009 (7% of federal spending), rising to $287 billion in 2013 (8.4% of the federal budget)
• 44 million people in low-income families
• 14 million elderly and disabled people
Medicaid
• Brief History
• Florida Medicaid Program
• Medicaid & the Economy
• Current Situation
• Summary
Overview
• Florida implemented the Medicaid program in 1970 to provide medical services to indigent people
• SOBRA greatly expanded services to include pregnant women and children
• Medicaid program administered by AHCA
Florida Medicaid
Florida Medicaid
2009
Florida Medicaid
• Primary Care• Screening & Preventative
care• Laboratory, X-ray & other
diagnostics• Specialist referrals• Inpatient
care/Hospitalization• Dental, Vision, Orthotics,
Ambulance Transports• Nursing home and long
term care
Florida Medicaid
Medicaid Eligibility Levels by Annual Income and FPL (2009)
Florida Medicaid
Federal
OtherState
$ 14.4 Billion
Florida Medicaid
FY07
Other
Florida Medicaid
FY07
• Local County funds
• Cigarette Taxes
F.S. 409.915: County contributions to Medicaid
Florida Medicaid
• F.S. 409.915– The Department of Financial Services shall
withhold from the cigarette tax receipts or any other funds to be distributed to the counties the individual county share that has not been remitted within 60 days after billing
Florida Medicaid
• Brief History
• Florida Medicaid Program
• Medicaid & the Economy
• Current Situation
• Summary
Overview
Medicaid & the Economy
Medicaid & the Economy
Kaiser Commission on the Uninsured & Medicaid 2008
1% in National Unemployment
Medicaid & the Economy
Kaiser Commission on the Uninsured & Medicaid 2008
Unemployment
GDP Decline
Medicaid & the Economy
7% 9%10%
16%
21%
28%
32%
97% Increase in Medicaid enrollment in 4 years
*Monthly case load in thousands
Medicaid & the Economy
Medicaid & the Economy
• Increase in unemployment since beginning of current recession expected to result in: – 4.8 million more
Medicaid/CHIP enrollees– 5 million more uninsured
• Improvement in unemployment rates & Medicaid will lag behind other economic indicators
• Brief History
• Florida Medicaid Program
• Medicaid & the Economy
• Current Situation
• Summary
Overview
126K
145K
2008 2009
Orange County Medicaid Eligible
FY08 = $9M
FY09 = ?FY09 = 12.4M
Current Situation
Current Situation
Shortfall covered by:• $ 1.9 million from PCAN• $ 700K from DJJ• $ 500K from Health Services
Current Situation
38% increase from 2008 to 2009
Orange County Medicaid Expenditure
Current Situation
13% in 1 year
10% in 5 months
*In thousands; AHCA
Current Situation
Current Situation
Current Situation
Current Situation
• Proposed an increase in county contribution for Medicaid nursing home care – From $ 55 to $ 202 per
month per person– $ 66 Million from counties– Has not changed in 39 years
AHCA
Current Situation
Additional $ 3M to Orange County Medicaid expenditure
Medicaid Expansion
Federal Match
Cost to State
Cost to Counties
Healthcare Reform
• Brief History
• Florida Medicaid Program
• Medicaid & the Economy
• Current Situation
• Summary
Overview
Summary
• Medicaid enrollment is increasing significantly
• Mandated expenditure for Medicaid was $3.1 Million over budgeted amount for FY2008-09
• Projected Medicaid expenditure for FY2009-10 is $15.8 Million– Adopted budget for Medicaid $9.3M
Summary
• Economic recovery may be on horizon but Medicaid improvements will lag behind
• Changes in State law may further exacerbate budget shortfall
• House and Senate Healthcare reform proposals advocate extending Medicaid to more individuals
George A. Ralls M.D.Health Services Department
December 1st, 2009
Medicaid Update 2009
