US Healthcare--Feb 21
On average, ___ in ___ americans are getting coverage via a medicaid program, but there are more than ___ people in medicare who are dually eligible for medicaid
1 in 5 10 million (qualified for medicare by age but qualify for medicaid by assets/income)
There are 3 options given for each state to administer CHIP in different ways. What are they?
1) As part of medicaid expansion --using CHIP $$ to expand eligibility to those children that didn't qualify before 2) Design a separate program 3) Hybrid approach of the two above (Illinois = "all kids")
Medicaid programs: Trump-era approved ACA era waivers focused on?
1) Eligibility conditional on meeting work requirements 2) Coverage loss and lock-outs for failure to pay premiums 3) Premium surcharge for tobacco users 4) Health behavior incentives
What are states preparing to do ahead of the unwinding of the continuous enrollment principle to medicaid in March 2023?
1) Further streamline the renewal process --make it easier for people to stay in the program 2) Issue temp waivers --slow unwinding process 3) Expand outreach services --consider social determinants of health + behavioral services 4) Partner w/ medicare manage programs to identify those who will be kicked out
Medicaid programs: Biden-era approved ACA era waivers focused on?
1) Got rid of work requirements 2) Expanded coverage, social determinants of health and behavioral health
What was the key impact on Medicaid via ACA?
1) Increase outreach and simplify enrollment process --make those aware of their coverage in medicaid 2) Increased fees paid to PCP 3) Changes in premium amounts and copayment limits 4) Increased innovations --> Changes in health care delivery & demonstration projects --i.e. medical homes, ACOs 5) Expansion to non-elderly adults
What are some of the MANDATORY covered services under medicaid?
1) Inpatient & outpatient hospital services 2) Family planning & nurse midwife services --a lot are for pregnant women or children 5) etc.
What was the impact/outcomes from the ACA expanding medicaid?
1) Larger increase in medicaid enrollment --more eligible for program = reduction in uninsured rates 2) Coverage gain in specific vulnerable populations --young adults, people with HIV, parents, mothers, children, rural areas 3) Improvements in self-reported health
Medicaid has implemented a few programs to help states with their drug expenditures. What are these?
1) Mandatory drug rebate program --requires that manufacturers give $$ back to medicaid programs + provide rebates 2) Manufacturers have to be included in state medicaid formularies --greater access for them to beneficiaries
How is medicaid delivered?
1) Medicaid fee for service --providers are reimbursed for services they provide 2) Medicaid managed care --insurance firm is provided a pot of $$ per individual beneficiary to deliver medicaid benefits to those beneficiaries note: most states have large proportion enrolled in managed care plans (70% are covered ACROSS the COUNTRY in managed)
What are some of the OPTIONAL covered services under medicaid?
1) RX drugs --every state has chosen to cover these! may differ in how much or which ones... 2) etc...
What is the responsibility of the state and federal governments for financing the Medicaid program?
1) State treasury --state income tax 2) Federal matching --federal income tax 3) Premiums and cost sharing --Charges must be <5% of family income --cost sharing 10-20% depending on income level + state
Medicaid spending and enrollment changes upon 2 major factors: _____ and _____
1) The health of the economy 2) The policy changes that may have been implemented to expand benefits or those covered
_____% of national health care expenditures in 2021 were for Medicaid spending
17
About _____% of those in medicaid are responsible for _____% of the entire expenditures
20% (aged+disabled) responsible for 80% of total costs
There are almost ______ people enrolled in the prescription medicaid benefits
3 million (81% of these are enrolled in managed care)
How many kids were enrolled in CHIP in July 2022
7.1 million
There were more than ______ individuals enrolled in medicare and CHIP programs
91.3 million (~80 in Medicare--eligibility can change from month to month...changes #'s!)
What is Medicaid?
A joint state AND federal program for providing health insurance for those w/ LIMITED INCOME and ASSETS --safety net system --> expanded access to individuals who did not have it before --gives ability to tailor needs per state
Why was ACA used to modify legislations on the original medicaid covered groups?
A large majority of people who qualified for the income minimums were NOT qualified b/c they did not meet the "specified categories" = remained uninsured --i.e. those without kids were not qualified even if they met the financial baseline of <=133% of FPL (~$20K/yr)
What are the groups covered by Medicaid after the ACA? ON EXAM
After ACA: Expanded coverage to ALL adults who make <=138% of the federal poverty level (FPL) in MOST states (= ~21K) --note: resistance against expansion across all the states
The amount that the federal government funds for each state is dependent upon?
Dependent on the state's per capita income --i.e. states w/ lower per capita income = received larger percentage of funds for support (IL rate = 56%--lowest rate)
Medicaid/CHIP enrollment has increased GREATLY since the start of the pandemic (from 2020-now). Why is this?
During the period of the pandemic = continuous enrollment requirements were established --i.e. if you became eligible for medicaid the states could NOT kick you out = mandatory retention note: this requirement is ending March 2023 --> may soon see a lot more uninsured people
Veterans Health Administration: What is it?
Health services branch of the department of veterans affairs (VA) --services to US veterans with varying levels of service eligibility
Who is enrolled in medicaid? Majority vs minority
Majority = children (41%) + adults (18% post ACA + 21% originally) --these spend LOWEST $$ although majority! Minority = aged (8%) + disabled (12%)
What are some differences b/t medicare, medicaid, and CHIP?
Medicare = federal program where eligibility and benefits = uniform (no matter where you live) Medicaid and CHIP = 50 separate insurance programs that vary from state-to-state --got some more uniformity AFTER ACA...
Medicaid vs. Medicare premiums and cost sharing
Medicare = fixed costs and patient cost sharing Medicaid = sliding scale; some states require cost shares and others don't...
_____% of national health care expenditures in 2021 were for CHIP spending
ONLY 1%
What are some similarities b/t medicare, medicaid, and CHIP?
Provide insurance for a clearly defined population group
Medicaid is financed through _________
Shared b/t state and federal government
What are some overlaps b/t medicare, medicaid, and CHIP?
Some individuals can be eligible for >1 program (if poor elderly, disabled, or kids)
What are the groups covered by the original Medicaid legislation--before ACA? ON EXAM
Specified categories of low-income individuals --children --pregnant women --parents of dependent children --individuals with disabilities --individuals 65+yrs
What is CHIP?
Stands for: Children's Health Insurance Program --federally and state funded (more federal money) --administered by the state to include children who do not qualify for medicaid
Eligibility for Medicaid via State
States have option to more generous for defining eligibility but MUST meet at least the baseline as defined in the original medicaid proposal I.e. some chose to expand the federal minimum income threshold while others did NOT
ACA era waivers (section 15): What do they allow?
States to get around some mandatory services --tests new ideas on who is covered and what services they have to cover
Who is covered by CHIP?
Targeted low income children up to age 19 and pregnant women --states have flexibility to determine eligibility level --federal matching limited to those in families with incomes <300% of FPL (~$40,770)
In Medicaid, the formula for financing is related to state per capita income which means that _____
The bigger the area, the more funding
Medicaid is part of the title ______ of the ______ Act of 1965
Title XIX (19); Social Security Act of 1965 note: sister legislation to medicare! Same time!
CHIP is a part of the title _______ of the _______ Act of 1997
Title XXI (21) of the Balanced Budget Act of 1997
What benefits does CHIP cover?
Varies by state but includes the following: 1) Mirrors medicaid services 2) Things important to kids! = covers well-baby and well-child care, immunizations, emergency services, & dental care 3) Substantially equal to the standard benefit plan offered to Federal or State employees
What is one of the largest integrated health services systems in the US?
Veterans Health Administration
Describe the trend for: Year to year, how much medicaid spending changes vs how much medicaid enrollment changes
When the economy is healthy and we have low unemployment rates, medicaid spending and enrollment drops! --Why? B/c individuals are able to find job opportunities --> now do NOT qualify for medicaid b/c income is higher
Medicaid per enrollee spending is significantly greater for the ________ compared to ________
elderly and individuals with disabilities >> children and adults note: more long term care for elderly and the disabled
most states have large proportion enrolled in ________ plans
managed care (70% are covered ACROSS the COUNTRY in managed care program)
Difference b/t medicaid and medicare financing
medicare = federal program medicaid= joint partnership b/t state and federal governments (feds give state $ to implement state programs on their behalf!)
