Figure 2
Health Status of the Population
MEDICAID IN THEAdults
UNITED
in the US STATES
reporting:
January 2017
Overweight or obese
64.5%
Medicaid and the Children’s Health Insurance Program (CHIP) provide health and long-term care coverage to more than
Poor
mental
health with
status disabilities in the
34.3%United States. Medicaid
74 million low-income children, pregnant women, adults, seniors,
and
people
is a major source of funding for safety-net hospitals and nursing Fair
homes.
Federal policy proposals
could fundamentally
or poor health status
17.5%
change the scope and financing of the program. Figure 2
Exhibit 1
Diabetes
10.4%
Health Status of the Population
Adults in the US reporting:
32% of the US population
is low-income
318.9 million
Overweight or obese
Poor mental health status
people live
in the US
Figure 3
16.5
Opioid Deaths
HIV Diagnoses
Per 100,000 population in 2014
10%
Figure 6
Figure 5
9.0DC have expanded
16.5
32 states including
Since implementation of the
Affordable Care Act (ACA),
Medicaid/CHIP enrollment
has increased in the US.
Uninsured
9%
18%
Diabetes
Figure 4
In 2015, 20% of people in the US
were covered by Medicaid/CHIP.
9.0
34%
Fair or poor health status
Low-income: <200% FPL or
$40,320 for a family of 3 in 2016
Other Public
2%
65%
Medicaid through the ACA.
Opioid Deaths
OR
Monthly Medicaid/CHIP
enrollment
Employer
49%
VT
ND
CA
AZ
56.4
MI
IL
KS
KY
WV VA
9%
SC
GA
AL
LA
TX
AK
Medicaid/
CHIP
20%
13%
DC
NC
TN
AR
MS
NJ
DE
MD
OH
IN
MO
OK
NM
PA
IA
NE
CO
Uninsured rate
NH
MA
CT RI
NY
WI
WY
UT
ME
Per 100,000
population in 2014
MN
SD
ID
NV
(in millions)
74.4
Medicare
14%
HIV Diagnoses
WA
MT
The uninsured rate in the
US has decreased.
FL
HI
14.4 million adults
Pre-ACA
(2013)
Non-Group
7%
Figure 9
November
2016
in the expansion group
in Q1 of 2016
In the US, Medicaid/CHIP covers:
Nationally, Medicaid is comparable to private insurance for
access and satisfaction – the uninsured fare far less well.
Percent reporting in the last year:
1 in 7 adults <65
Medicaid
85%
ESI
87%
74%
69%
77%
of adult and child
Medicaid enrollees in
the US are in families
with a worker.
Medicaid coverage contributes
to positive outcomes:
53%
And…
44%
36%
30%
>85%
24%
3 in 5 nursing home residents
of the public would enroll
themselves or a child in
Medicaid if uninsured.
9%
2 in 5 people with disabilities
2015
• Declines in infant and child mortality
rates
• Long-term health and educational gains
for children
• Improvements in health and financial
security
Uninsured
85%
86%
1 in 2 low-income individuals
2 in 5 children
2013
Not Adopting At This Time (19 States)
NOTES: Current status for each state is based on KCMU tracking and analysis of state executive activity. *AR, AZ, IA, IN, MI, MT, and NH have
approved Section 1115 waivers. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion.
Figure 10
SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated October 14, 2016.
http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
Figure 9
Figure 10
Adopted (32 States including DC)
Well-Child Checkup
Doctor Visit Among Adults
Specialist Visit Among
Adults
Adults Satisfied With Their
Health Care
NOTES: Access measures reflect experience in past 12 months. Respondents who said usual source of care was the emergency
room are not counted as having a usual source of care. *Difference from ESI is statistically significant (p<.05)
SOURCE: KCMU analysis of 2015 NHIS data.
Figure 11
Figure 12
Each Medicaid program is unique:
Medicaid/CHIP eligibility levels are highest for children and
pregnant women.
Eligibility - All states have taken up options to expand coverage for
children; many have opted to expand coverage for other groups.
Benefits – All states offer optional benefits, including prescription
drugs and long-term care in the community.
Federal
government
sets core
requirements,
but states have
flexibility
regarding:
Median Eligibility Level in the US as a Percent of FPL, as of January 1, 2017
255%
($51,408)
205%
($41,328)
Delivery system & provider payment– States choose what type of
delivery system to use and how they will pay providers; many are
testing new payment models to better integrate and coordinate care
to improve health outcomes.
138%
($27,821)
138%
($16,394)
74%
Long-term care – States have expanded eligibility for people who
need long-term care and are increasingly shifting spending away
from institutions and towards community-based care.
State health priorities – States can use Medicaid to address issues
such as the opioid epidemic, HIV, Zika, autism, dementia,
environmental health emergencies, etc.
($8,820)
Children
Pregnant Women
Parents
Childless Adults
Seniors & People
w/ Disabilities
Eligibility levels are based on the FPL for a family of three for children, pregnant women, and parents, and for an individual for
childless adults and seniors & people w/ disabilities. Seniors & people w/ disabilities eligibility may include an asset limit.
Figure 14
Figure 13
Per enrollee spending growth in the US,
2007-2013
$1 in $6 dollars spent overall in
the health care system
Medicaid plays a key role
in the U.S. health care
system, accounting for:
4.6%
On a per enrollee basis,
Medicaid spending growth is
slower than private health
care spending, in part due to
lower provider payments.
More than $1 in $3 dollars provided to
safety-net hospitals and health centers
$1 in $2 dollars spent on
long-term care
Medicaid Acute Care
Private Health
Insurance
Figure 15
Figure 18
In FY 2015, Medicaid spending in the
US was $532.2 billion.
In 2011, most Medicaid beneficiaries in the US Federal funding to states is guaranteed with no
cap and fluctuates depending on program needs.
were children and adults, but most spending
was for the elderly and people with disabilities. The federal share (FMAP) for states ranges from 50% to
Payments to
Medicare
3%
Disproportionate
Share Hospital
Payments
3%
Rx Drugs*
2%
Expansion states receive an increased FMAP for the
expansion population. The federal government provided
$99.3 billion to states for expansion adults from Jan 2014 –
Sept 2015.
Adults &
Children 75%
Figure 21
Elderly &
Disabled 63%
Figure 21
Long-term Care*
22%
74.6%. For every $1 spent by the state, the Federal
government matches $1 to $2.94.
Adults &
Children 36%
Other*
8%
Managed Care
43%
Figure 20
Figure 17
Physician &
Outpatient*
8%
Hospital*
11%
Elderly &
Disabled 24%
*Fee-for-service
Enrollees
28%
Expenditures
of total state spending in in
the US is for Medicaid.
0.66
10 million
19%
is the Medicaid-to-Medicare
physician fee ratio in the US.
Medicare beneficiaries (21%)
in the US rely on Medicaid for
assistance with Medicare
premiums and cost-sharing
and services not covered by
Medicare, particularly longterm care.
of state general fund spending
in the US is for Medicaid.
53%
of long-term care spending
in the US is for home and
community-based care.
39
36%
states including DC have
Medicaid managed care.
of Medicaid spending in the US
is for Medicare beneficiaries.
Figure 22
57%
of all federal funds received
by states is for Medicaid.
Figure 25
Figure 23
Congress may soon debate proposals to
reduce federal
reduceMedicaid
federal Medicaid funding
ugh ACA repeal
and
through
ACAfederal
repeal and federal caps.
The impact of a block grant or per capita
cap will depend on funding levels, but could
include:
debated in
TheCongress.
March 2016 Budget Resolution would reduce federal
Medicaid
by 41% nationally over the 2017-2026
udget Resolution
wouldspending
cut Medicaid
A per capita cap could lock in historical
state differences or redistribute federal
funds across states.
Per capita spending by enrollment group
$33,808 (NY)
Increases in the number of uninsured
$32,199
(WY)
period.
the 2017-2026 period.
al Cut:
lion (32%)
3.1%
Total reduction in federal funds:
$2.1 trillion
Reduced access and service utilization,
decreased provider revenues (to hospitals,
nursing homes, etc.), and increased
uncompensated care costs
Increased pressure on state budgets
Decreased economic activity
SOURCE: L. Antonisse, R. Garfield, R. Rudowitz, and S. Artiga, The Effects of Medicaid
Expansion under the ACA: Findings from a Literature Review (Washington, DC: Kaiser Commission on
Medicaid and the Uninsured, June 2016), http://kff.org/medicaid/issue-brief/the-effects-of-medicaidexpansion-under-the-aca-findings-from-a-literature-review/
US
$5,214 (VT)
$6,928 (NM)
US
$1,656 (WI)
US
$2,056 (IA)
Children
Adults
US
$10,142
(AL)
$10,518
(NC)
Individuals with
Disabilities
Aged