1. Florida’s Medicaid Reform Joan Alker and Jack Hoadley Georgetown Health Policy Institute, Duval County Medical Society Forum 2/23/07

2. 2 The role of Medicaid in Florida Medicaid serves over 2.1 million Floridians -- children, parents, pregnant women, people with disabilities, and seniors. 27% of Florida’s children are enrolled in Medicaid; slightly higher than national average. Also covers 51% of all deliveries. Pays for 63% of nursing home days. Federal-state matching program – feds pick up 58.76% of the cost.

3. 3 Trends in state Medicaid activity

4. 4 What trends do we see in state Medicaid policy? Post Deficit Reduction Act 2006: Some movement away from Medicaid waivers that included limiting benefits in different ways States opting for DRA changes rather than waivers include KY, WV, SC?, Budget pressures have eased somewhat which were the driving force behind many state actions 3-5 years ago including FL

5. 5 State Tax Revenue and Medicaid Spending Growth, 1997-2006 NOTE: State Tax Revenue data is adjusted for inflation and legislative changes. Preliminary estimate for 2006. SOURCE: Kaiser Commission on Medicaid and the Uninsured Analysis of CMS Form 64 Data for Historic Medicaid Growth Rates and KCMU / HMA Survey for 2006 Medicaid Growth Estimates; Analysis by the Rockefeller Institute of Government for State Tax Revenue.

6. 6 Florida’s Medicaid Growth versus Growth in Cost of Private Insurance Source: Georgetown Health Policy Institute analysis based on Kaiser HRET 2006 Annual Survey; “Growth in Medicaid Average Monthly Caseload” and “Growth in Medicaid Service Expenditures,” Thomas W. Arnold, Florida Medicaid Program: An Overview, 01/09/07. * Based on projections from the 2006 Medicaid Expenditure Social Services Estimating Conference.

7. 7 Public opinion Growing unease about our health care system. The number of uninsured Americans continues to rise (46.6 million in 2005), last year for the first time an increase in the number of uninsured kids (8.3 million in US; 800,236 in Florida) Source: Census Bureau 2005 CPS survey.

8. 8 A marked shift in political climate towards focus on the uninsured Federal level this year there will be a focus on reauthorizing the SCHIP program in the context of broader discussion of uninsured issue; Presidential race promises to have lots of candidates with health proposals; This coincides with a number of states that are looking to cover “all” children And there is a growing number of states looking to move towards universal coverage

9. 9 State proposals States that have or are looking to cover “all” or “more” children include: IL, PA, AZ, NY, OK, OR, WA, WI, UT Governors considering or moving forward on universal coverage proposals: MA, VT, CA, CT, IL, PA, AZ Medicaid waivers and public coverage are the foundation for many of these efforts.

10. 10 Our project Two-year independent evaluation of pilots in Duval and Broward counties. Funded by Jessie Ball DuPont Fund, with additional support from the Community Foundation in Jacksonville and the United Way of Northeast Florida. Project period, April 2006 – March 2008

11. 11 Our project, cont. Goal is to address how changes affect the experiences of children, parents, people with disabilities and others who receive their health care through Medicaid First brief, released September 2006, provides an overview of some of the key issues Lack of awareness of changes is widespread Some different issues for children and adults

12. 12 What are the issues we are looking at? How do beneficiaries respond to the use of market-based concepts, such as consumer choice and plan competition? Are providers participating with reform plans? How are benefits changing? Do enhanced benefit accounts result in healthy choices? Does reform have an impact on the cost and quality of care?

13. 13 What are our study methods? Site visits to Broward and Duval before reform and after one year Interviews with key stakeholders Focus groups with beneficiaries Survey of physicians in both counties Additional focus groups during initial enrollment period Review and analysis of written materials

14. 14 How are we looking at choice? Analysis of choices available to beneficiaries Benefit variations Added benefits Preferred drug lists Provider networks Analysis of other information Enrollment materials Enrollment numbers Plan contracts