Transcript Strengthening Medicaid - Center For Children and Families

Georgetown Center for
Children and Families
Strengthening Medicaid Project
Vikki Wachino
Consultant
http://ccf.georgetown.edu/index/strengthening-medicaid
May 29, 2008
The Council of State Governments
Figure 1
Medicaid’s Role in the
Health Care System
Health Insurance
Coverage
Assistance to
Medicare Beneficiaries
Long-Term Care
Assistance
29 million children & 15
million adults in low-income
families; 14 million elderly
and persons with disabilities
7.5 million aged and disabled
— 18% of Medicare
beneficiaries
1 million nursing home
residents; 43% of long-term
care services
MEDICAID
Support for Health Care
System and Safety-net
State Capacity for Health
Coverage
15% of national health spending
43% of federal funds to states
Source: Kaiser Commission on Medicaid and the Uninsured.
Figure 2
Medicaid Enrollees and Expenditures
by Enrollment Group, 2007
Elderly
9%
Disabled
16%
Adults
26%
Elderly
22%
Disabled
44%
Children
49%
Adults 14%
Children 20%
Enrollees
Expenditures
Total = 60.5 million
Total = $169.6 billion
SOURCE: Center for Children and Families analysis of March 2008 CBO Medicaid Baseline.
Figure 3
Trends in the Uninsured Rate of LowIncome Children, 1997 - 2005
Uninsured rate of children under19
22.3%
21.5%
20.1%
20.0%
18.0%
15.8%
15.9%
15.2%
1997
1998
1999
2000
2001
2002
2003
2004
14.9%
2005
Source: Georgetown CCF analysis based on data from the National Health Interview Survey, November 2006. Beginning in 2004,
the NHIS changed its methodology for counting the uninsured. This results in the data for 2004 and later years not being directly
comparable to the data for 1997 – 2003.
Figure 4
States Are Moving Forward
(2006-2007)
WA
NH
VT
MT
ND
OR
ME
MN
ID
WY
NV
UT
NY
MI
IA
NE
CA
MA
WI
SD
PA
IL
CO
KS
OH
IN
WV
MO
VA
KY
NC
AZ
OK
NM
TN
AR
NJ
DE
MD
DC
SC
MS
TX
RI
CT
AL
GA
LA
AK
FL
HI
Implemented or Recently Adopted
Legislation to Improve Children’s Coverage
(29 states including DC)
Source: As of January 31, 2008 based on a review by the Center for Children and Families of state initiatives in 2006 and 2007.
Figure 5
More Than 25 States Project or Expect
Budget Shortfalls
WA
MT
VT
ND
OR
MN
ID
WY
AZ
CO
IL
KS
OK
NM
TX
IN
MO
PA
OH
WV
KY
AR
AL
VA
NJ
DE
MD
NC
TN
MS
AK
MA
NY
IA
NE
UT
ME
MI
NV
CA
WI
SD
NH
RI
CT
DC
SC
GA
LA
FL
HI
Projected Gap in FY 2009
Expect Gap in FY 2009, Size Unknown
Expect Gap in FY 2010
Source: E. McNichol and I. Lav, “22 States Face Total Budget Shortfall of At Least $39 Billion in 2009; 6 Others Expect Budget
Problems.” Center on Budget and Policy Priorities, revised March 14, 2008.
Figure 6
Key Themes: Public
Opinion about Medicaid
• Voters believe that the
government should play a role
in helping to provide coverage
for low-income, uninsured
children and parents, seniors,
and people with disabilities.
• Voters perceive that the nation
faces a health care crisis, not
a Medicaid crisis.
• While we reform the system
as a whole, we need to keep
Medicaid strong for those who
need it.
Figure 7
The Medicaid Program Enjoys
Strong Public Support
• 78% voters
consider
Medicaid to be
very important
Figure 8
Public Views on Key Medicaid
Policy Issues
% Saying
“Excellent Idea”
Make sure all states provide the same basic health
care coverage for children, as recommended by
leading pediatricians.
62%
Simplify eligibility rules and cut down on paperwork
for families applying to Medicaid.
50%
Allow people with Medicaid to choose from a number
of private plans, as people do in the private market.
This will create competition among health insurers and
lower costs.
46%
Provide vouchers to people with Medicaid so they can
choose from a number of private coverage plans. This
will create competition among health insurers and
lower costs.
39%
Figure 9
Key Public Messages on
Medicaid
• We have a health care crisis, not a Medicaid crisis,
and need to keep Medicaid strong
• The federal government should take more financial
responsibility for Medicaid
– Reflects public awareness that growing health care costs, an
aging population, and uncertain economic conditions
challenge states
• Medicaid is the primary health program for children,
and we need to invest more to make sure children
get the services they need
• With more employers reducing or dropping health
benefits, Medicaid needs to cover more low-income
working families who lose health coverage
Figure 10
• Keeping Medicaid strong is central to achieving key
health care reform goals like expanding coverage
and controlling costs
• Project develops fresh approaches and
recommendations to strengthen the program,
focusing on:
– Maintaining and improving access to high-quality,
cost effective care for all Medicaid beneficiaries
– Putting Medicaid on sound financial footing while
ensuring that resources are used as efficiently as
possible
– Covering more uninsured low-income Americans
Figure 11
Advancing Efficient Management and
Purchasing of Prescription Drugs
State Recommendations from Policy Paper No. 4
Improve management of prescription
drugs:
• Rely on clinical evidence to manage the
pharmacy benefit
• Adopt best practices for managing high-cost
patients and high prescribers
• Strengthen drug utilization review programs
Figure 12
Advancing Efficient Management and
Purchasing of Prescription Drugs
State Recommendations from Policy Paper No. 4
Use Medicaid’s purchasing power to
get the best possible price:
• Obtain supplemental rebates to maintain
clinically sound preferred drug lists
• Require manufacturers, pharmacies, etc. to
report actual sales prices and/or acquisition
costs
Figure 13
Measuring and Improving Quality
of Care in Medicaid
State Recommendations from Policy Paper No. 3
• For health care to be high quality, it
must be safe, effective, timely, patientcentered, equitable, and efficient,
according to the Institute of Medicine
• Maintaining stable enrollment is key
– Lack of coverage negatively effects access
and makes quality hard to manage
Figure 14
Key Approaches to Measuring and
Improving Quality
State Recommendations from Policy Paper No. 3
• Develop core quality measures through a
state/federal and public/private consensus
development process
• Federal development and reporting of quality
performance across states is needed
• Create state quality improvement advisory councils to
coordinate across programs, develop measures, and
monitor impact
• States can also establish quality partnerships with
providers, purchasers, and experts
• Test specific pay-for-performance incentives for
quality and evaluate their impact on beneficiaries,
providers, and quality of care
Figure 15
Apply Innovative Health Information
Technology Approaches to Medicaid
State Recommendations from Policy Paper No. 1
Refocus Medicaid IT systems on sharing health
information to promote patient health:
• Use electronic prescribing to reduce errors and increase
efficiency
• Convey health information to beneficiaries through automated
telephone systems
• Expand the use of electronic health records to increase
coordination across providers
• Improve access to electronic personal health records to give
beneficiaries access to their own health information
Figure 16
Federal Action That Could Strengthen
Medicaid
• Strengthen Medicaid drug rebate policies to help both
states and the federal government get better prices
on prescription drugs
• Play a leadership role in developing quality
measures, with active state participation
• Stabilize Medicaid financing during economic
downturns, through an automatic increase in the
federal matching rate
• Over the long term, realign fiscal responsibilities
between the federal government and the states
Figure 18
Georgetown Center for Children and
Families Strengthening Medicaid Project
• Additional issue briefs to be released this year:
– Promoting good health and healthy behaviors
– Premium assistance: Integrating Medicaid with private
coverage
– Maintaining access and improving provider payments
– Simplifying coverage and reducing complexity for
beneficiaries and states
– Streamlining program management
• Visit the Strengthening Medicaid web site:
http://ccf.georgetown.edu/index/strengtheningmedicaid.