10.13.11.Medicaid.Doshi - Introduction to Medicaid HCMG 101...

Info iconThis preview shows pages 1–12. Sign up to view the full content.

View Full Document Right Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Introduction to Medicaid HCMG 101 Jalpa Doshi October 13, 2011 History Eligibility and Enrollment Coverage and Cost-sharing Expenditures and Payments Medicaid and Managed Care Dual-Eligibles Summary of Differences Medicaid vs. Medicare Medicaid Overview 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 Childrens Health Insurance Program) Brief History 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 Program Administration How is Medicaid Financed? 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) Growing Pressure on Government Spending 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 Health Insurance Coverage of the Nonelderly by Poverty Level, 2004 Medicaid is a Primary Source of Health Insurance For People Below Poverty Level 2010 Poverty Guidelines Persons in Family or Household 48 Contiguous States and D.C. Alaska Hawaii 1 $10,830 $13,530 $12,460 2 14,570 18,210 16,760 3 18,310 22,890 21,060 4 22,050 27,570 25,360 5 25,790 32,250 29,660 6 29,530 36,930 33,960 7 33,270 41,610 38,260 8 37,010 46,290 42,560 For each additional person, add 3,740 4,680 4,300 SOURCE: CMS. Medicaid Eligibility and Enrollment Eligibility Rules Mandatory Eligibility Certain pregnant women, children, and parents with...
View Full Document

Page1 / 52

10.13.11.Medicaid.Doshi - Introduction to Medicaid HCMG 101...

This preview shows document pages 1 - 12. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online