1. Government Involvement in Health Care Part Two

2. State Govt Fed Govt Medicaid Title XIX of the Social Security Act Health Care program for certain low income persons (NEED based program) Administered by each state –Federal mandates –State options Funded by Federal and State Government

3. Medicaid Groups Eligible – Mandatory –Children < 6, pregnant women, family income ≤ 133% FPL (FPL on next slide) –Supplemental security income (SSI) Aged Needy, Blind Needy, Disabled Needy –Children <19, income ≤ FLP –Some foster care children –Certain Medicare beneficiaries, ≤ 74% FPL Many states are expanding eligibility (SCHIP) State Govt Fed Govt

4. 2006 HHS Poverty Guidelines Size of Family Unit 48 States Alaska Hawaii 1$9,800$12,250$11,270 213,20016,50015,180 316,60020,75019,090 420,00025,00023,000 523,40029,25026,910 626,80033,50030,820 730,20037,75034,730 833,60042,00038,640 Fed Gov t

5. Medicaid Mandatory Services –Hospital services (inpatient and outpatient) –Physician services –Diagnostic services –Skilled nursing facility services –Rural Health Clinic services –Prenatal care/vaccines-child –Family planning –Nurse practitioner services Optional Services –Clinic services –Dental –Eye glasses –Intermediate care facilities- mentally retarded –Physical therapy –Prescription drugs –Rehabilitation services –Transportation services –Some home/community services State Govt Fed Govt

6. Medicaid Federal Government pays 50-83% of costs depending on the state Federal Match in Nebraska is ~ 60% (59.7% for fiscal year 2006) For other states, please see the following web-site: http://www.kff.org/mfs/index.jsp State Govt Fed Govt

7. In Nebraska: 64.5% of recipients are children and pregnant women, low incomes –< 26% of the dollars go here 27% of recipients are aged or disabled –Consume 66% of the dollars Largest Medicaid expenditure–long term care State Govt Fed Govt Medicaid

8. NE Medicaid Expenditures 2003 www.hhs.state.ne.us/med/reform/expenditures.htmwww.hhs.state.ne.us/med/reform/expenditures.htm (Accessed 9/3/06) State Govt

9. U.S. Medicaid Expenditures 2003 www.kff.org/medicaid/upload/7334%20Medicaid%20Primer_Final%20for%20posting-3.pdf (Accessed 9/3/06) Fed. Govt.

10. U.S. Expenditures Compared to Number of Enrollees- Medicaid (2003) www.kff.org/medicaid/upload/7334%20Medicaid%20Primer_Final%20for%20posting-3.pdf (Accessed 9/3/06) Fed. Govt.

11. Fed. Govt. Other major Federal Health Coverage Plans Veterans Administration Dept. of Defense (Military Services) & Tri- Care [Formerly CHAMPUS] (Military Dependents) Federal Employee Plan Indian Health Service / U.S. Public Health Service State & Local Plans for poor and uninsured.

12. Government Involvement in Health Care This concludes Part Two