10.13.11.Medicaid.Doshi - HCMG 101 Jalpa Doshi History...

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HCMG 101 Jalpa Doshi October 13, 2011
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History Eligibility and Enrollment Coverage and Cost-sharing Expenditures and Payments Medicaid and Managed Care Dual-Eligibles Summary of Differences Medicaid vs. Medicare
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1965: Medicaid bill (Title 19; Social Security Act) Low-income families with dependent children (AFDC) Low-income elderly, blind, and individuals with disabilities Late 1980s: Expansion to pregnant women and infants Coverage for women and children <6 years of age (<=133% of FPL) Phase-in of children ages 6-18 years (<=100% of FPL) Mid 1990s: Medicaid HMOs & Welfare Reform Many states choose mandatory Medicaid enrollment with HMOs 1996 Clinton replaces AFDC with TANF (no welfare link to Medicaid) 1997: BBA creates expanded access for children SCHIP (State Children’s Health Insurance Program)
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Administered by each State within broad national guidelines established by Federal statutes, regulations, and policies. Each State: establishes its own eligibility standards; determines the type, amount, duration, and scope of services; sets the rate of payment for services; and administers its own program. Medicaid policies for eligibility, services, and payment are complex and vary considerably across States
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State Budgets (15-30% of budget) Federal Matching (50-76% rates) Medicaid is a top budget item for state governments (education, public works) States qualify for federal match if they agree to provide coverage for: Low-income families Poor elderly, disabled Children, pregnant women Match based on state per capita income Mississippi (76% rate: $1:$3.17) NJ, NY, CT, DE (50% rate: $1:$1)
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SOURCE: CBO, Baseline Budget Outlook , January 2005; National Association of State Budget Officers, 2003 State Expenditure Report, 2004. State General Fund Spending Total = $499 Billion Total = $2.3 Trillion Federal Outlays
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Medicaid is a Primary Source of Health Insurance For People Below Poverty Level
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