View
215
Download
0
Category
Tags:
Preview:
Citation preview
Florida’s Florida’s Medicaid ReformMedicaid Reform
What’s the Right Prescription
For Floridians?
Understanding MedicaidUnderstanding Medicaid
• Medicaid is the nations “health insurance ” program for the poor.
• Differs from Medicare - which provides health insurance to the elderly
Understanding MedicaidUnderstanding Medicaid
• Medicaid program serves over 2 million Floridians
• 1 in 8 people in the State participant in Medicaid for nursing home care, prenatal for the uninsured during pregnancy, people with disabilities, and people with catastrophic health crises
Understanding MedicaidUnderstanding Medicaid
• Medicaid is funded both by the State and Federal Government▪ In 2004, the federal government is anticipated
to provide 6.7 billion dollars in funding.▪ The state will contribute 4.6 billion dollars.
Who Participates in Who Participates in Medicaid?Medicaid?
• Currently serves over 2.1 million Floridians▪ Over 1.2 million are children▪ 582,395 are persons with disabilities▪ 304,122 are seniors
Who Participates in Who Participates in Medicaid?Medicaid?
• Medicaid plays a vital role in Florida’s Health Care system▪ Finances over 43% of births in the state▪ Serves 52% of people with AIDS▪ Pays for 66% of all nursing home days
UnderstandingUnderstandingMedicaid WaiversMedicaid Waivers
• “Waivers” allow states to modify the Federal requirements of the Social Security Act which established Medicaid.
• Florida has successfully submitted and operates 13 “waiver programs.”
UnderstandingUnderstandingMedicaid WaiversMedicaid Waivers
• On March 30, 2004, the Agency for Health Care Administration announced their intent to restructure Florida’s Medicaid program by submitting a waiver to “modernize the program and test a new model that leads to a sustained and affordable program in the decades to come.”
What are the Issues?What are the Issues?
• Cost▪ Proponents claim Florida’s rising costs of
Medicaid are too high-overwhelming the state’s ability to meet the need.
CostsCosts
• Analysis of costs trends over time suggest that Medicaid expenditures are cyclical▪ When the economy slows-enrollment into
Medicaid increases.▪ During the recent recession, Medicaid and the
State Children’s Health Insurance Program picked up 4.1 million children and their parents nationally.
Why AreWhy AreMedicaid Cost Rising?Medicaid Cost Rising?
• In recent years, health care costs have been rising for both public and private health insurance.
• This increase in health care cost is due to a number of factors, most prominently prescription drug and hospital costs.
Florida’s Medicaid Budget: Why are Costs Going Up? Winter Park Health Foundation Policy Brief, July 2004.
Why AreWhy AreMedicaid Cost Rising?Medicaid Cost Rising?
• Children coming from families living below the poverty level increased 45% since 2000-2001.
• Florida’s low income elderly population is increasing at a rate eight times the national average.
Florida’s Medicaid Budget: Why are Costs Going Up? Winter Park Health Foundation Policy Brief, July 2004.
Why AreWhy AreMedicaid Cost RisingMedicaid Cost Rising
• Over the past 5 years, analysis documents that enrollment increase account for on average, 62% of Florida’ Medicaid cost increase
• The remaining 38% can be attributed to increase in health care cost.
Florida’s Medicaid Budget: Why are Costs Going Up? Winter Park Health Foundation Policy Brief, July 2004.
Why AreWhy AreMedicaid Cost Rising?Medicaid Cost Rising?
• During this same time, the private insurance market cost rose even more.
• “Despite the fact that Medicaid serves a sicker and older population, Florida’s Medicaid cost, when look at on a per capita basis to account for increases in enrollment, have been increasing much more slowly that private insurance premiums.”
Florida’s Medicaid Budget: Why are Costs Going Up? Winter Park Health Foundation Policy Brief, July 2004.
What are the Issues?What are the Issues?
• Modernizing the program▪ Proponents want to “modernize” Medicaid by
charging nominal co-pays, increasing consumer choice and privatizing operations.
““Modernizing” MedicaidModernizing” Medicaid
• Other states have undertaken similar initiatives
• Some have experience “unintended consequences” of massive overhauls of their Medicaid system.
Modernizing MedicaidModernizing Medicaid
• Tennessee initiated “TENNCARE about 10 years ago.▪ Unintended consequences include fewer
physicians▪ Co-pays created barriers-people didn’t get
health care▪ Changes resulted in series of class action law
suits.
Modernizing MedicaidModernizing Medicaid
• The combination of a low per person expenditure and rising enrollment needs places Floridians at risk for a number of unintended consequences.
• Some proponents want to “cap” the funds coming from Federal Sources
Modernizing MedicaidModernizing Medicaid• Under cap scenarios-if the state
underestimates both costs and enrollment growth by 1 percent, it loses 3.38 billion dollars. Floridians will either have to cover those cost (taxes) or cut the services or number of people served.
• Critics argue it won’t decrease health care costs-just shift the cost to Florida tax payers.
Other Unintended Other Unintended ConsequencesConsequences
• Studies document a potential “domino” effect in response to massive health system overhauls.
• For example, Medicaid expenditures inject a huge flow of revenue into the general economy.
Other Unintended Other Unintended ConsequencesConsequences
• Medicaid cuts impact jobs, income and business activity. Economic models show that at the state level, Medicaid match supports 120,950jobs, $4.3 billion in income and 8.7 billion in business activity.
Penny Wise and Pound Foolish. Why Cuts to Medicaid Hurt Florida Economy. October 2003 Human Services Council, Produced by CHAIN
SummarySummary
• Florida’s Medicaid Program is cost effective▪ Florida spends less on Medicaid that most
states▪ Our recent rising cost are likely the result of a a
slight economic downturn, from which we are already recovering
▪ Cost in Medicaid have risen at a slower pace that cost in the private insurance market
SummarySummary
• Under many of the proposed changes, the State assumes risk of future cost.▪ Any proposal that includes limiting the Federal
funds to support Medicaid will likely be insufficient to meet the growing health care needs of Floridians.
Summary Summary
• We can do better▪ Reforms which provide for more efficient
delivery of services and encourage preventative care should be given priority consideration.
▪ Reform initiatives should not shift costs to other pockets.
Recommended