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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