New York's Medicaid Expansion of 2000-2010: Implications for Other States under the ACA Michael Birnbaum Vice President United Hospital Fund June 14, 2011.

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Presentation transcript:

New York's Medicaid Expansion of : Implications for Other States under the ACA Michael Birnbaum Vice President United Hospital Fund June 14, 2011 Funded by the New York State Department of Health

Medicaid in New York: Looking Back (2000 – 2010)  Primer on NY Medicaid  Key roles and basic facts  Medicaid enrollment  Unprecedented growth  Medicaid spending  Beyond the headlines 2

Medicaid in New York: Key Roles  Cover nearly 5 million low-income New Yorkers  1.8 million children  1.9 million adults (under 65 and without disabilities)  1.2 million elderly or disabled beneficiaries  Deliver essential services  Half of all births  Three-fourths of all nursing home days  Finance one-third of state’s health care economy  Spending on services = $52.1 billion in FFY 2010 Source: United Hospital Fund analysis of NYS DOH enrollment reports, CMS 64, and NHE data. Note: Medicaid enrollment is from Sept and does not include about 400,000 children in CHIP. 3

$52.1 billion in 2010 $13.4 billion $10.6 billion Medicaid Spending by Service Area (2010) Source: United Hospital Fund analysis of CMS 64 data and NYS DOH MARS 72 data. Note:Data are for FFY $6.1 billion $9.3 billion $3.1 billion 4

Source:United Hospital Fund analysis of CMS 64 and MSIS data and NYS DOH enrollment reports. Note: Data are for FFY All beneficiaries covered at any point during the year are included. Spending does not include administration. Medicaid in New York: Enrollment and Spending (2010) $52.1 billion5.3 million 5

Medicaid Spending per Beneficiary (2010) Source: United Hospital Fund analysis of CMS 64 and MSIS data and NYS DOH enrollment reports. Note:Data are for FFY Spending does not include DSH payments or administration. 6

Medicaid Enrollment: The Decade in Review 7

Medicaid Enrollment (2000 – 2010) Source:United Hospital Fund analysis of NYS DOH enrollment reports. Note:Data are for September 2000 through September

Thousands of enrollees Source: United Hospital Fund analysis of NYS DOH enrollment reports. Note: Enrollment is for September of each year. Medicaid Enrollment by Eligibility Category (2000 – 2010) 9

Drivers of Medicaid Enrollment Growth (2000 – 2010)  Policy  Eligibility  Higher income limits (Family Health Plus, 2001)  Inclusion of immigrants (Aliessa v. Novello, 2001)  Enrollment  Simplification of initial enrollments and renewals  Economics  Cyclical  Recessions beginning March 2001 and December 2007  Structural  Decline in employer-based coverage 10

Medicaid Income Limits for Adults: Select States (2011) Source: Kaiser Family Foundation State Health Facts. Note:Some counties in California, Texas, and Florida provide health care services to some low-income childless adults. In some cases, Medicaid funds may be used; however, these states provide no statewide Medicaid eligibility for childless adults. In some states, earnings disregards slightly raise the effective eligibility limits for working parents. Income limit as share of FPL $10,890 $27,795← For a family of 3 ← For an individual 11

Select Enrollment Simplifications (2000 – 2010)  Streamlined applications and renewals  Uniform application (2001)  Adults and children  Medicaid and CHIP  Mail-in renewals (2003)  Elimination of face-to-face interviews  Pre-populated forms  Shift from documentation to data matching  Self-attestation of family assets and SSNs (2003)  “Facilitated Enrollment”  Community-based assistance for applicants (2000) 12

Participation in Medicaid and CHIP: Children (2002 – 2008) Source: United Hospital Fund analysis of CPS and NYS DOH enrollment data. Note:Estimates include eligibility for and enrollment in CHIP. Estimates consider only those eligible individuals without private coverage. 13

Participation in Medicaid: Adults (2002 – 2008) Source: United Hospital Fund analysis of CPS and NYS DOH enrollment data. Note:Estimates consider only those eligible individuals without private coverage. 14

Participation Rates for Public Coverage in New York (2008) Source: United Hospital Fund analysis of CPS and NYS DOH enrollment data. Note:Data are for Data for children include CHIP. Estimates consider only those eligible individuals without private coverage. 15

Adult Medicaid Enrollment per 100 Child Enrollees (2008) Source:United Hospital Fund analysis of CMS MSIS data. Note: Enrollment includes all beneficiaries enrolled at any point during FFY Data for TX was unavailable; data for CA is not included because enrollment reflects a substantial number of adults eligible only for family planning services under a waiver. 16

Recession Drove Many to Medicaid Last Year Thursday, September 30, 2010 “Joblessness and the accompanying loss of health benefits drove an additional 3.7 million people into the Medicaid program last year, the largest single-year increase since the early days of the government insurance plan...” 17

Share of Non-Elderly New Yorkers with Employer-Sponsored Insurance (2000 – 2009) Source: U.S. Current Population Survey. 18

2.6 Million Uninsured New Yorkers (2008) 2.6 million in 2008 Source: UHF analysis of Urban Institute estimates of Current Population Survey data, Pew Hispanic Center estimates, and NYS DOH enrollment data. 650 K 950 K 100 K 550 K 350 K 19

Medicaid Enrollment: The Decade in Review  73% increase since 2000  Elderly and disabled: incremental growth  Children: rapid growth that levels off  Adults: enrollment triples  About one million eligible but uninsured  Nearly one million will remain ineligible  Impact of national health reform on New York:  Eligibility levels will change very little  Enrollment efforts remain paramount 20

Medicaid Spending: The Decade in Review 21

Annual Medicaid Spending Growth in New York All Funds and All Services: 2000 – 2010 Source: United Hospital Fund analysis of CMS 64 data. Note: Spending is for federal fiscal years; administration is not included. *For 2006 and 2007, growth rates are adjusted to exclude a decline in Rx drug spending triggered by implementation of Medicare Part D. * * 22

NY Medicaid Spending Growth vs. NHE (2000 – 2010) Compound Growth Rates over 5-Year Periods Source: United Hospital Fund analysis of CMS 64 and CMS NHE data. Note: NY Medicaid spending is for FFYs and includes all funds; administration is not included. For the 2005 to 2010 period, the average growth rate for Medicaid is adjusted to exclude a decline in Rx drug spending triggered by implementation of Medicare Part D. 23

Medicaid Spending by Service Category (2000 – 2010) Compound Growth Rates over 5-Year Periods Source: United Hospital Fund analysis of CMS Form 64. Note:Mainstream LTC includes skilled nursing facilities, home health, and personal care; specialized LTC includes intermediate care facilities, and home and community-based services for the developmentally disabled; acute care includes managed care premiums, FFS payments to hospitals for inpatient and outpatient services, and FFS payments to clinics and community health centers. To ensure consistency among service categories and across time periods, outpatient prescription drugs are excluded due to implementation of Medicare Part D. 24

Increase of 2.0 million Source: United Hospital Fund analysis of NYS DOH enrollment reports. Note: Enrollment is from September 2000 to September Categories do not sum to total due to rounding. 1.2 million 0.5 million 0.2 million Increase in Enrollment by Eligibility Category (2000 – 2010) 25

Increase in Spending by Eligibility Category (2000 – 2010) Source: United Hospital Fund analysis of CMS 64, CMS MSIS, and NYS DOH data. Note:Spending is from FFY 2000 to FFY Increase of $22.2 billion $13.2 billion $5.5 billion $2.3 billion $1.2 b 26

Medicaid Spending: The Decade in Review  Overall Medicaid spending growth:  Lower than growth in national health expenditures  Despite substantial increases in enrollment  Higher than growth in NY State revenue  Growth concentrated among elderly and disabled  Despite small increases in enrollment  Impact of national health reform on New York:  Substantial new federal support starting in 2014  Fiscal stress and uncertainty before

New York's Medicaid Expansion of : Implications for Other States under the ACA Michael Birnbaum Vice President United Hospital Fund June 14, 2011 Funded by the New York State Department of Health