K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicaid: The Essentials Diane Rowland, Sc.D. Executive Vice President, Henry J. Kaiser Family Foundation and Executive Director, Kaiser Commission on Medicaid and the Uninsured for Alliance for Health Reform Washington, DC February 13, 2009

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 1 Medicaids Origins Enacted in 1965 as companion legislation to Medicare Parts A and B (Title XIX) Entitles eligible individuals to defined set of benefits Entitles participating states to federal matching funds on open-ended basis Means-tested, with focus on welfare population: -- single parents with dependent children -- aged, blind, and disabled Mandatory services and populations for participating states with options for broader coverage

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 2 Medicaid Today Health Insurance Coverage 29.5 million children & 15 million adults in low-income families; 6 million elderly & 8 million persons with disabilities State Capacity for Health Coverage Federal share ranges 50% to 76%; 44% of all federal funds to states MEDICAID Support for Health Care System and Safety-net 16% of national health spending; 42% of long-term care services Assistance to Medicare Beneficiaries 8.8 million aged and disabled 19% of Medicare beneficiaries Long-Term Care Assistance 1 million nursing home residents; 2.8 million community-based residents

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 3 Medicaids Role for Selected Populations Note: Poor is defined as living below the federal poverty level, which was $17,600 for a family of 3 in SOURCE: KCMU, KFF, and Urban Institute estimates; Birth data: NGA, MCH Update. Percent with Medicaid Coverage: Families Aged & Disabled

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 4 IL Percent of Nonelderly Residents Covered by Medicaid, by State, AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA SOURCE: Urban Institute and KCMU analysis of the March 2006 and 2007 Current Population Survey. Two-year pooled estimates for states and the US ( ). TX FL AL 10-12% (12 states) 13-15% (16 states) < 10% (8 states) US Average = 13% NE >15% (15 states including DC)

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 5 Medicaid Enrollees and Expenditures by Enrollment Group, 2005 Children 18% Elderly 28% Disabled 42% Adults 12% Children 50% Elderly 10% Disabled 14% Adults 26% Total = 59 millionTotal = $275 billion SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on 2005 MSIS data.

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 6 Medicaid Payments Per Enrollee by Acute and Long-Term Care, 2005 $1,617 $2,102 $13,524 $11,839 SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on 2005 MSIS data.

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 7 Median Medicaid/SCHIP Income Eligibility Thresholds, 2008 Federal Poverty Line (For a family of four is $21,200 per year in 2008) SOURCE: KCMU/Urban Institute analysis of March 2008 CPS.

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 8 Childrens Eligibility for Medicaid/SCHIP by Income, January 2009 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA *The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year. ***IL uses state funds to cover children above 200% FPL.; MA uses state funds to cover children above 300% FPL; NY uses state funds to cover children from 250% to 400% FPL; WI uses state funds to cover children from 250% to 300% FPL. SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, TX IL FL AL < 200% FPL (7 states) >250% FPL (11 states & DC) % FPL (33 states)

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 9 Medicaid Eligibility for Working Parents by Income, January 2009 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA TX IL FL AL % FPL (20 states) 20-49% FPL (13 states) > 100% FPL (18 states including DC) US Median Eligibility = 68% FPL: $11,968 per year *The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year. SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2009.

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 10 Poor Near-Poor (<100% Poverty) ( % Poverty) Poor Near-Poor Poor Near-Poor Children Parents Adults without Children Medicaid also includes SCHIP and other state programs, Medicare and military-related coverage. SOURCE: KCMU and Urban Institute analysis of March 2008 CPS. Health Insurance Coverage of Low-Income Adults and Children, 2007