Medicaid The Programs Purpose, Patients, and Providers Nancy
Cooper Coordinator, Health Policy Fellowship OU-HCOM February 5,
2013 1 Slide 2 50% Private Insurance Employer-based group insurance
or Single policy or Out of Pocket 50% State/Federal Gov. Medicare
Medicaid CHIP Veterans Affairs Indian Health Service Federal
Employee Health Benefits Program 2 Slide 3 Health and Human
Services Centers for Medicare and Medicaid Services Medicare
(Entitlement >65) Medicaid (Eligibility - poor) CHIP
(Eligibility near poor kids) Indian Health Service Veterans
Affairs/TriCare Federal Employee Health Benefits Program (FEHBP) 3
Slide 4 Albany VFW - May 2 In March this year Randy was diagnosed
with stage four prostate cancer, His family and friends are having
a benefit for him to help him with medical expenses. There will be
a Chinese Auction and All You Can Eat for $7 from 5:00 7:00. If you
would like to donate but cant make the benefit, you can donate
money at the First National Bank of Athens under the Randy B Cancer
Fund. The Athens Messenger April 27, 2009 4 Slide 5 SSI 10
Congressional Research Service, Medicaid: A Primer July 2012 Slide
11 11 Medicaids Challenges Takes up >25% of state budgets in
unemployment = in eligibility (but less state revenue) Fairly
generous benefits (mental health, dental and vision) but access
problems due to low reimbursement Slide 12 12 Slide 13 Number of
boomers will grow from 42 to 73 million Number of elderly over age
80 will triple Highest number of divorcees (live alone) Half live
at or < FPL 1/3 retirees have NO savings 13 Congressional Budget
Office 2/1/12 Slide 14 14 Medicare 49 Million Medicaid 69 Million
9.2 M AARP, Integrating Care for Dual Eligibles, 2012 59% are over
65 41% disabled Most are very poor Fills in gaps: long term care,
glasses, dental, pays Medicare premiums and cost share Hospital
coverage, physician visits, drugs, some post hospital care Slide 15
17 million poor, childless men and women Affordable Care Act
expands Medicaid to this population 100% FMAP for newly eligible
for 3 years and 90% FMAP after 2017 SCOTUS ruling will leave
decision to expand up to the states Kaiser Health News July 2012 15
Slide 16 For those few that are slow to come in, they're going to
have to answer to people why they're turning this down and why
they're letting people go without coverage. Jack Lew, Chief of
Staff 6/30/12 As it stands now, theres no way we can afford to do
it. Tony Keck, South Carolinas Medicaid director July 2012 16 Slide
17 17 Washington Post, Medicaid expansion scorecard: 17 states say
yes, 9 say no, by Sarah Cliff 12/7/12 Slide 18 Set by the state NJ
lowest, WA highest Lower than Medicare Low fees affect access to
care 18 Slide 19 19 Health Policy Institute of Ohio, Ohio Medicaid
Basics 2011, May 2011 Gov. John KasichODJFS Director Michael
Colbert Slide 20 20 DD: developmental disabilities MH: mental
health ADAS: alcohol and drug addiction services Health Policy
Institute of Ohio, Ohio Medicaid Basics 2011, May 2011 Slide 21 CFC
mostly Managed Care: HMO gets capitated payment per person
Financial burden is on the HMO Does not cover long term care By
law, ABD long term and home based care are Fee for Service ($$$$$).
21 Health Policy Institute of Ohio, Ohio Medicaid Basics 2011, May
2011 Slide 22 22 Health Policy Institute of Ohio, Ohio Medicaid
Basics 2011, May 2011 Slide 23 Kids: 1,093,724 Parents: 435,742
Pregnant women: 26,195 Health Policy Institute of Ohio, Ohio
Medicaid Basics 2011, May 2011 23 Slide 24 112,019 seniors 242,091
adults with disabilities 37,989 children with disabilities 392,099
patients 24 Health Policy Institute of Ohio, Ohio Medicaid Basics
2011, May 2011 Slide 25 Mandatory Benefits Early and Periodic
Screening, Treatment and Diagnosis for kids (HEALTH-CHEK) Inpatient
Hospital Physician Lab and X Ray Outpatient (rural clinics and
FQHCs) Medical and surgical vision Medical and surgical dental
Transportation to services Nurse midwife, family nurse
practitioner, pediatric nurse practitioner Family planning services
and supplies Home health Nursing home care $$$$$ Medicare premium
assistance 25 Health Policy Institute of Ohio, Ohio Medicaid Basics
2011, May 2011 Slide 26 Facility based long-term care Nursing
facilities Intermediate care for mentally retarded (ICF-MR) State
developmental centers for mentally retarded (MR-DD) Home and
Community Based Services (HCBS) Personal care, homemaking, and
nursing Adult day care Delivered meals Transportation Respite care
Hospice and Program for All Inclusive Care for the Elderly (PACE)
Health Policy Institute of Ohio, Ohio Medicaid Basics 2011, May
2011 26 Slide 27 27 Ohio Department Job and Family Services web
site accessed 1/30/13 Slide 28 28 Ohio Department Job and Family
Services web site accessed 1/30/13 Slide 29 Physicians bill
reasonable and customary charge Providers cant charge the patient
for the difference between their bill and the Medicaid payment Ave.
wait of 41 days for reimbursement Fee schedule available on ODJFS
website Health Affairs Do Reimbursement Delays Discourage Medicaid
Participation By Physicians? by Cunningham and OMalley Feb 2009 29
Slide 30 30 % Increase in Medicaid fees 2003-2008 OHUS All
services15.9%15.1% Primary Care13.6%20% Obstetrics6.8%8.8% Other
services28.4%8.7% Kaiser State Health Facts/Ohio accessed 1/30/13
The good news Slide 31 Medicaid to Medicare Fee Index 2008 OHUS All
services.69.72 Primary care.66 Obstetrics.84.93 Other
services.65.72 31 Kaiser State Health Facts/Ohio accessed 1/30/13
More good news ACA will pay Medicaid primary care providers 100% of
the Medicare rate for evaluation, management an immunizations in
2013 and 2014 (after that reimbursement rate will be up to the
state). Slide 32 Enroll via ODJFS website: Medicaid Information
Technology Provider link Ohio Department Job and Family Services
web site 32 Slide 33 ACA Maintenance of Effort limits states
ability to control costs by changing eligibility or benefits Have
to maintain eligibility till 2014... Or lose FMAP 33 Health Policy
Institute of Ohio, Ohio Medicaid Basics 2011, May 2011 Slide 34
Individual-Centered Integrated Care Delivery System (CDS)
Coordinate care for dual eligibles Promote the use of health homes
Promote use of home-based long term care instead of nursing home
care Change hospital payments Adjust nursing home payment formula
link $ to outcomes 34 Health Policy Institute of Ohio, Ohio
Medicaid Basics 2011, May 2011 Slide 35 Medicaid is a vital source
of health care for 69 million vulnerable Americans BUT... 35 Slide
36 ALBANY Randy Dewaine B., 52, of Albany, passed away at his
residence Thursday, Dec. 30, 2010, after a hard-fought battle with
cancer. Born Aug. 8, 1958, in Athens, he was the son of Sharon
Michael B. of Athens, and the late Robert B. Sr. He was retired
from the Southeast Psychiatric Hospital and an avid sports fan,
having played basketball and softball, and loved playing music with
family. The Athens Messenger, December, 2010 36 Slide 37 37
WWW.Kaiserhealthnews.org WWW.healthaffairs.org Slide 38 38 Slide 39
1. Covering all people below the poverty line 2. Covering just low
income children 3. Covering certain groups of low income people 39
Slide 40 1. Less than 10% 2. About 20% 3. More than 30% 40 Slide 41
1. True 2. False 3. Dont know 41 Slide 42 1. One quarter 2. One
half 3. Three-quarters 42 Slide 43 1. Children under 19 2.
Unemployed adults 3. Elderly and disabled 43 Slide 44 1. Medicaid
spending grew faster 2. Medicaid spending grew slower 3. Medicaid
spending grew at the same rate as private insurance 44 Slide 45 1.
Medicare 2. Medicaid 3. Private insurance 45 Slide 46 1. Medicaid
pays for premiums and co-pays for low-income beneficiaries 2.
Medicaid pays for health care services not covered by Medicare,
such as home and community based care 3. Both are true 46 Slide 47
1. Yes 2. No 3. Dont know 47 Slide 48 1. Children up to age 26 2.
Many low income adults 3. Undocumented immigrants 48 Slide 49 1. 3
2. 2 about 20% 3. False 4. 2 Half 5. 3 elderly and disabled 6. 2
Medicaid spending grew slower 7. 2 Medicaid 8. 3 - Both are true 9.
2 No 10. 2 many low income adults 49
