Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
Medicaid Solutions

Medicaid Solutions

Ratings:
(0)
|Views: 833|Likes:
Medicaid Solutions:
Florida’s Medicaid cure for Illinois’ ailing program
Medicaid Solutions:
Florida’s Medicaid cure for Illinois’ ailing program

More info:

Published by: Illinois Policy Institute on Mar 06, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

10/29/2013

pdf

text

original

 
illinois Policy instituteMarch 4, 2013research rePorthealth care
Medicaid Solutions:Florida’s Medicaid cure for Illinois’ ailing program
Jonathan Ingram, Director of Health Policy and Pension Reform
For more than a decade, Illinois’ Medicaid program has ailed tomeet the needs o the state’s most vulnerable residents. Accessto high-quality care has deteriorated, even as record amountso taxpayer dollars are spent on the ballooning program.Over the years, eligibility standards have loosened toincreasingly include amilies earning ever-higher incomes.Today, only 40 percent o Medicaid patients are in poverty,meaning that scarce budget money is being siphoned awayrom those most in need. To cope with ballooning enrollmentand higher costs, the state has opted to ration the ees it paysor each service.Sadly, the state’s mismanagement o the Medicaid programhas orced many doctors to opt out o the Medicaid programaltogether. These actors have created an environment in whichMedicaid enrollees are given a medical card, but very littleaccess to care.In many cases, Medicaid patients have a more dicult timending a doctor and suer worse health outcomes than eventhe uninsured. The problems were so bad that a ederal judgeordered state ocials to study them. The results o that study,detailed more thoroughly later in this report, were published inthe New England Journal o Medicine.Illinois’ Medicaid program is a one-size-ts-all model that’sbroken, and it’s ailing Illinoisans on three ronts: costs, accessto quality care and health outcomes. Illinois should ollow thelead o states such as Florida and Louisiana and undamentallytransorm how the program operates. To address theseproblems, Illinois should:
•
Give Medicaid patients meaningul choices or their healthplans rom a variety o provider service networks andmanaged care organizations.
•
Allow plan providers to customize their plans to meet theindividual needs o their enrollees, which will help ensureplans compete on value.
•
Pay plan providers a xed, risk-adjusted monthly rate basedon enrollment in a particular plan.
Additional resources: illinoispolicy.org
190 s. ls s., s 1630, cg, il 60603 | 312.346.5700 | 802 s. 2d s., spgd, il 62704 | 217.528.8800
Florida’s reorm pilot is a proven success. It has improvedaccess to quality care and delivered better health outcomesto its patients than the traditional Medicaid program. Betteryet, the reorm pilot has seen average annual savings o morethan 20 percent when compared to per-person spending inFlorida’s traditional program.These reorms can be implemented without a waiver rom theederal government, and similar reorms have already beenimplemented in Florida and Louisiana.Transorming how Medicaid operates is the only solution thatdoes right by both patients and taxpayers.
The Medicaid program was created asa temporary safety net for the poor anddisadvantaged
Medicaid is a joint state and ederal program that aimsto provide medical care to the poor and disadvantaged.It is nanced by ederal, state and local taxes and isadministered by state governments. Each state receivesederal reimbursement o Medicaid expenditures accordingto their Federal Medical Assistance Percentage, or FMAP,rate. This rate can range rom 50 percent to 83 percento expenditures, depending upon the state’s per capitapersonal income. Historically, hal o all Medicaid spendingin Illinois has been paid or with ederal money.
1
In Illinois, Medicaid serves both the nondisabled low-incomepopulation and the elderly, blind and disabled populations.While there might be some overlap between these twogroups, each might require dierent policies tailored to theirspecic needs. Children and nondisabled adults account or84 percent o enrollees in Illinois.
2
 
illinoispolicy.org | 2
Children and nondisabled adults make up amajority of Medicaid patients in Illinois
61%23%6%10%
 
Elderly
 
Disabled adults
 
Nondisabled adults Children
Source: Illinois Department of Healthcare and Family Services
The size of Illinois’ Medicaid program hasalmost doubled since 2000
The number o people in Illinois’ Medicaid program hasincreased signicantly in recent years. In 2000, about 1.7million people were enrolled in the program.
3
That numberalmost doubled to 3.1 million Illinoisans by 2011.
4
To put thisin perspective, the state’s population grew by only 3.5 percentduring that same time period.
5
Medicaid enrollment almost doubled duringthe course of a decade
Total number o Medicaid enrollees in Illinois by year, in millions
Source: Medicaid Statistical Information System
Additionally, as Medicaid grew, the composition o Medicaidenrollees changed. Medicaid historically has ocused onindividuals and amilies in poverty. As recently as 2003, amajority o Medicaid patients in Illinois had incomes at orbelow the ederal poverty level.
6
But, over the years, eligibilitystandards were loosened to include amilies with ever-higher incomes than previously allowed. Today, ater years oexpanding eligibility, almost 60 percent o Medicaid enrolleesare above the ederal poverty level.
7
Most people on Medicaid are not in poverty
Enrollment in Illinois’ Medicaid program by poverty level in 2012
59%41%
 
Below poverty level
 
Above poverty level
Source: U.S. Census Bureau
1999 2001 2003 2005 2007 2009 20111.71.82.22.42.92.43.1
i, v w  Mdd p,  mb d  i d  mb.
8
t gg   vg pv d dvd, Mddp v wdd  pv  vg,vg  d pp g d.
9-10
sd,gb p v dvd m Mdd w m  p d wd m mdd- m w  pv .
 
illinoispolicy.org | 3
Medicaid expansions have not reduced thenumber of uninsured
Number o uninsured people in Illinois, in millions
1.6 1.61.71.51.9 1.92002 2004 2006 2008 2010 2012
Source: U.S. Census Bureau
Medicaid patients often have ‘coverage,’ butlack access to quality care
t Mdd pgm  i p   --vb.
11
a --v m,   m mp, m   mb d d p   pd   v  pvd.B bg m   Mdd pgm  dvdm  m  m vb d wd mdd- m w   pv . t p wg m d g ,    g   p   v.t --v  vz md pvd pm m v, gd  w   ,  w    w mbm  d b . a  , p    dd w pvd d  d   mgd.sd,  ’ mmgm   Mdd pgm d m d  p-   Mdd pgmg. t  v d  vm  wMdd   gv  md d, b v   .i’ pbm w  dd   2005  d jdgdd    d   b  Mddpgm  d. t    d w pbd  nw egd J  Md  2011.
12
t dd  d  Mdd w  m m k pv d p  b dd  ppm   p.
13
F m p,  b  v w.Mdd p  v  --v   g pd p, w pv d p  ddppm  2 p   m.
14
t m b w kg w pm  p d gw-p .
15
a mj  d  kg w   wMdd p.
16
idd, Mdd p   k    p  d p, v   .
17-18
Otolaryngology Endocrinology Neurology100%37%91%57%89%46%
Medicaid patients are far less likely to see a specialist
Likelihood o scheduling appointment, by insurance status and specialist type
Private insuranceMedicaid
Source: Bisgaier and Rhodes
ev w d g   m, Mdd p w g  v.
19
t   dg, mp, d  Mdd m w  vg  103d, m  w  g  pv d p.
20
F p,  vg w  Mdd p  22 dg  pv d p.
21
Medicaid patients must wait longer toreceive care
Length o wait times (days), by insurance status and specialty type
Otolaryngology Endocrinology NeurologyPrivate insuranceMedicaid
Source: Bisgaier and Rhodes
5.852.747.3103.423.338.8

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->