Economics Exam 1- Medicaid

Front 1

when was medicaid enacted?

Back 1

enacted in 1965 to cover medical care costs of the poor (Title XIX of the Social Security Act).

Front 2

date of medicaid expansion- what was expanded?

what is dual eligibility?

Back 2

Medicaid was expanded to include Supplemental Security Income (SSI) recipients (low income elderly and disabled). These people are “dually eligible” for Medicare and Medicaid (1972)

Front 3

medicaid funding

Back 3

funded jointly by the federal and state governments via an open-ended matching program.

Front 4

what does open ended matching program mean?

Back 4

fed govt pays a certain percent of cost, open ended refers to fed govt continuously contributing to funds as long as state govt keeps spending

Front 5

administration of medicaid- fed or state?

Back 5

States administer the program but must follow federal guidelines. States have some flexibility so Medicaid is different across states.

Front 6

what is FMAP?

is it same across stateS? depends on what?

Back 6

federal share of funding

Depends on per capita income of states- if states are more poor, they get higher FMAP

Front 7

give example of how the FMAP is used (say, 60% FMAP in a state)

Back 7

in a state with a 60% FMAP, the federal government pays $60 and the state pays $40 of every $100 spent.

Front 8

state participation in medicaid- involuntary?

Back 8

-state participation is voluntary but they all participate due to fed govt helping out- if you pull out of medicaid, then fed won't help insure poor people

Front 9

what type of program is medicaid in terms of enrollment?

Back 9

entitlement

Front 10

what does entitlement program mean?

Back 10

means there are certain eligibility criteria for medicaid- if person meets it, they must enroll you (no waiting lists)

Front 11

federal funding of medicaid during recessions (more people on medicaid)

Back 11

sometimes will increase funding

Front 12

states- 2 different ways they can offer medicaid to population

most states are moving towards what model?

Back 12

States can purchase private insurance for Medicaid beneficiaries

or they can act as the insurer and directly pay the health care providers for care used by the beneficiaries.

historically states have been insurer, but recently states have been moving their Medicaid beneficiaries into managed care plans (private)

Front 13

medicaid is an entitlement program with what type of eligibility? what does that mean?

Back 13

categorical- meaning that you must be poor AND in certain categories to be eligible.

Front 14

eligible for medicaid categories- (4)

then on top of that what do you need?

Back 14

SSI recipients (dual eligibles), pregnant women, children, and adults with dependent children are eligible categories

If you are in one of the approved categories, you must meet income/asset requirements to be eligible

Front 15

NOT eligible for medicaid categories (2)

Back 15

Childless, non-disabled adults and illegal immigrants are not eligible

Front 16

what happens to low income people not eligible for medicaid? (2) specifically what do we have in iowa to help?

Back 16

Often are uninsured.
Some receive help from a patchwork of different state and county level programs.
In Iowa, we have the IowaCare program

Front 17

% of nursing home residents on medicaid. why?

Back 17

70%

nursing homes make you poor

Front 18

optional categories that state medicaid can choose to cover (2)

Back 18

but states may cover pregnant women at higher income levels

“medically needy,” people who are in an eligible category, but whose incomes are too high to meet categorically needy income standards (as in, they spend down their income to meet poverty level because they are so sick)

Front 19

% of federal poverty lvl required to meet conditions for medicaid i don't think we have to know this

Back 19

133%

Front 20

% of children covered under medicaid

Back 20

30% of children covered under medicaid

Front 21

reasons for gaps in medicaid (2)

Back 21

-eligibility thresholds (% of poverty line)
-childless adults not eligible for medicaid

Front 22

do medicaid plans have to cover Rx drugs?

Back 22

do NOT have to cover Rx drugs though most do

Front 23

2 populations in medicaid that incur the most cost

Back 23

disabled
elderly (dual eligible)

Front 24

does medicaid cover rx drugs for dual eligibles?

Back 24

no Dual eligibles receive their prescription drug coverage through Medicare Part D.

Front 25

About 1/3 of Medicaid expenditures are for ...

Back 25

long term care.

Front 26

For dual eligibles, who is the primary payer.

Back 26

medicare (medicare pays first- medicaid pays for things that medicare does not cover)

Front 27

why are dual eligibles such a challenging population to cover? (2)

what is ACA doing to address this

Back 27

-tough pop to manage- very poor and significant health care needs
-coordination of care b/t medicare/medicaid is challenging

The 2010 health care reform law establishes two new federal entities to try and improve coordination and care for dual eligibles.

Front 28

relative amount of medicaid payments per enrollee (4- 2 cheap to insure, 2 not)

Back 28

-kids cheap to insure
-adults (healthier ones)- also pretty cheap
-disabled- 14k/yr wtf (long term care makes up decent chunk)
-elderly (not disabled)- 12k per year, bulk of it is nursing home

Front 29

issues with medicaid (7)

Back 29

Categorical eligibility is issue because it leaves a bunch of people ineligible for medicaid no matter how poor they are

Abrupt discontinuation of Medicaid
benefits after income threshold is reached.

Difficulty in enrolling eligible individuals- varies from state to state but lot of hoops to jump thru (like have to go month to month to prove eligibility)

Difficulty in coordinating care for dual eligibles.

Burden on states when the economy is bad.
Variation across states means that eligibility and benefits vary by where you live.

Poor access to some types of providers in some states.

Front 30

Current Issues trending in Medicaid (3)

Back 30

ACA 2010

Medicaid reform – issue in upcoming presidential election, although does not get as much political attention as Medicare reform.
Long term care financing

Front 31

purpose of CHIP

Back 31

to provide health insurance coverage for low income children who are ineligible for Medicaid.

Front 32

state participation in CHIP- do they have to?

Back 32

Participation by the states is voluntary,

Front 33

CHIP funding

Back 33

the program is jointly funded by the federal government and participating states

Front 34

fed matching rate of CHIP vs. medicaid

Back 34

The federal matching rate is higher for CHIP than for Medicaid (on average 70% vs 57% for Medicaid).

Front 35

federal funding for CHIP- capping?

how does the funding work yearly?

Back 35

Federal funds are capped for each state.

Each state receives a yearly allotment determined based on the number of low income uninsured children in the state and state health care costs.

Front 36

CHIP vs. Medicaid enrollment- how is CHIP different?

Back 36

CHIP is not an entitlement program like Medicaid and therefore states may cap enrollment and have waiting lists.

Front 37

CHIP coverage other than children

Back 37

A few states have obtained special approval to use CHIP funds to insure low income parents.

Front 38

ways states can provide CHIP coverage (3)

Back 38

existing Medicaid program
creating a new program
using a combination approach.

Front 39

benefits for expanded medicaid CHIP vs. separate CHIP programs- what standards must each one meet?

Back 39

Benefits for expanded Medicaid programs must meet Medicaid benefit standards.

Benefits for separate CHIP programs are flexible, but must be equivalent to a benchmark package (e.g. state employee plan).

Front 40

cost sharing and premiums of CHIP

Back 40

Plans have minimal cost-sharing and premiums.

Front 41

2 parts of CHIP in iowa

Back 41

Expanded Medicaid program.
Healthy and Well Kids in Iowa (HAWK-I) program.

Front 42

Coverage in HAWK-I is via

Back 42

private insurers

Front 43

Premiums for HAWK-I

Back 43

Nothing or $10 per child up to a household maximum of $20, depending on income.

Front 44

Once a child qualifies, they are eligible for how long?

Back 44

one year even if their family’s income rises above the eligible level

Front 45

4 current issues with CHIP

Back 45

-getting eligible children enrolled (Iowa has done well making it easy and having more marketing)

-waiting lists issue in some states

-capped fed funding-as opposed to medicaid has no capped funding

-has to be reauthorized by congress periodically

Front 46

2 acts/laws that have reauthorized CHIP

Back 46

CHIPRA of 2009 expanded CHIP and reauthorized it until 2013.

2010 Health Care Reform law reauthorized CHIP until 2019 (funding authorized until 2015).

Front 47

CHIPRA reauthorized CHIP and added what 2 things?

Back 47

Incentives for states to enroll eligible kids.
Option to cover pregnant women through CHIP