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Medicaid Solutions

Medicaid Solutions

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Medicaid Solutions:
Florida’s Medicaid cure for Illinois’ ailing program
Medicaid Solutions:
Florida’s Medicaid cure for Illinois’ ailing program

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Published by: Illinois Policy Institute on Mar 06, 2013
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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.
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.
illinoispolicy.org | 2
Children and nondisabled adults make up amajority of Medicaid patients in Illinois
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.
That numberalmost doubled to 3.1 million Illinoisans by 2011.
To put thisin perspective, the state’s population grew by only 3.5 percentduring that same time period.
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.
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.
Most people on Medicaid are not in poverty
Enrollment in Illinois’ Medicaid program by poverty level in 2012
Below poverty level
Above poverty level
Source: U.S. Census Bureau
1999 2001 2003 2005 2007 2009 20111.
i, v w  Mdd p,  mb d  i d  mb.
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.
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 1.92002 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.
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.
t dd  d  Mdd w  m m k pv d p  b dd  ppm   p.
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.
t m b w kg w pm  p d gw-p .
a mj  d  kg w   wMdd p.
idd, Mdd p   k    p  d p, v   .
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.
t   dg, mp, d  Mdd m w  vg  103d, m  w  g  pv d p.
F p,  vg w  Mdd p  22 dg  pv d p.
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

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