BPF is publishing a multipart series on the Medicaid program. This being the first in the series, our goal is awareness and education regarding a large part of the state’s budget.Medicaid 101: Part I
The rising cost of healthcare in the United States is a concern not only for individual citizens, but also for the business community and the state and federal governments as well. One of the major issues that will be addressed during the 2018 legislative session is the reauthorization of the Medicaid program in Mississippi. Most people, legislators included, roll their eyes when they hear the term Medicaid. It is a complicated program but it might be worth deconstructing it a little bit to help folks understand it maybe just a little better.
Both Medicaid and Medicare began in 1965 with an amendment to the social security act. Both are health insurance programs that cover the cost of healthcare services such as doctors’ visits, diagnostic procedures and hospitalizations. Medicare covers the healthcare needs of individuals 65 and older. Medicaid covers the healthcare needs of families and children, pregnant women and individuals needing long-term care services (think nursing homes). To receive healthcare coverage by Medicare, there is no means test to qualify for the program. Just reach the age of 65, and you’re in. For Medicaid, there is a means test based on the federal poverty level (FPL). Those at a certain percentage of, or below the federal poverty level might qualify. This coverage depends on factors such as age and family status. The current FPL is an income level of $12,060 for a single individual, and $20,420 for a family of three.
The various categories of eligibility for the Medicaid program are based on family size and income relative to the FPL. Single individuals with no children are not eligible for the Medicaid program in Mississippi (unless they are disabled). For example, dependent children between the ages of 1-6 who live with a caretaker relative are covered up to 143% of FPL. That means for a single mom with two children (a family of three) could have an income up to $29,201 and her children would receive healthcare coverage through the Medicaid program. Children 6-19 in a similar family situation would be covered up to 133% of FPL. That income level would need to be less than $27,159.
Pregnant women receive Medicaid coverage up to 194% of FPL. If you are pregnant, you are considered a two-person family. So, a pregnant women with one child at home, again a family of three, would have the cost of her pregnancy, delivery and two months of post-delivery care covered if her income did not exceed $39,614. In addition, her newborn child would receive healthcare coverage during their first year of life. Because of the income levels for covering the pregnancy and the continuous coverage of the child up to one year of age, the Medicaid program in Mississippi covers approximately 65% of the pregnancies and births in the state.
The other major difference between Medicare and Medicaid is the percentage of federal involvement. Medicare is funded almost entirely by the federal government. Medicaid is a state and federal partnership where the federal government matches dollars contributed by the states. The match rate, known as the federal medical assistance percentage (FMAP), depends on the economic conditions prevalent in the state. Those states with higher economic indicators are matched at a lower rate than states with lower economic indicators. The lowest match rate is 50% (think of states like New York, Massachusetts and California). That means that when these states spend one dollar on the program the federal government contributes one dollar to make a total of two dollars.
Because Mississippi has such poor economic indicators and a high level of poverty, it receives the highest FMAP in the country at 75.65%. That means for every dollar Mississippi spends on the Medicaid program the federal government contributes three dollars to make a total of four dollars. The state with the next highest FMAP is West Virginia at 73.24%. The average FMAP for the southeastern states is 68.6%
Medicaid covers the healthcare needs of about one in four people in Mississippi. Therefore, it is an important component of the healthcare industry in Mississippi and a critical funding component for almost all the hospitals in the state. Last year, total Medicaid spending in the state was just over $6.1 billion. That is almost the entire amount of the state’s general funds. It is critically important that the Mississippi Legislature and Governor consider any changes to the program during this legislative session with great caution and care. It’s not just about the money, it’s about the health and well-being of about 755,000 citizens of this state.
Monday, January 15, 2018
Bigger Pie Forum: A Medicaid Primer
This post is sponsored content provided by Bigger Pie Forum.
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13 comments:
I hope Mississippi legislators will take advantage of the Trump Administrations allowance to require able bodied adults to work as part of being in the program. So far our state isn't one of the 10 that have asked for this. And if they can't find a job then require an alternative like community service or volunteer, or go to school or get in a job training course at WIN Center. Anything.
Hmmm...... so how many able-bodied adults to you think are on Medicaid in Mississippi? Think before you answer.
So Medicaid considers a pregnant woman a family of two, but liberals and progressives advocate for abortion on demand and would encourage this woman to kill her unborn child...this kind of siloed thinking defies logic. It's either a child or it's not - I'll wait for your poorly constructed explanation.
Feel said he's for a workforce requirement for Medicaid recipients in his State of the State. I don't care if there are only 10 able bodied Mississippians. If they can work, they should.
Interesting timing on your part, KF, to post the salaries of MHA and the primer on Medicaid funding.
MHA just started its assault on Medicaid reimbursement rates for providers and facilities. They scream it's too low to make any money.
They're lying but don't expect our gummit leaders to call them on it.
And having the fox guard the henhouse has to be one the dumber ideas to come out of our legislature in years. A provider sponsored health plan is hysterical.
Well 7:50, your concern for the well-being of the “henhouse” is correct, your targeted “Fox” is the wrong culprit.
Government mandates Medicaid healthcare policy and practices. Providers ie doctors and hospitals actually provide care to the Medicaid recipients. The Managed Care Organizations theoretically purport to manage healthcare outcomes by promoting good health practices such as educating the largely “uninformed” Medicaid population on the importance of wellness checkups, preventative care, guidance for healthcare issues, etc. they are the administrative middleman.
Check the MCO’s, United and Magnolia, and their rising stock prices for the 5 years operating in MS, yet our beloved state remains the fattest, most diabetic, etc, and our emergency rooms are crowded with Medicaid patients with the “sniffles” - so much for “managed care”, huh! 5 years should be long enough to show healthier Medicaid recipients!
With their lobbyists paid hundreds of thousands over the years and the hundreds of thousands in campaign contributions, they ARE the Fox in the henhouse! The doctors and hospital groups haven’t matched the mco’s at this game.
For the sake of MS, let us hope that the new Medicaid director, with the aid of newly informed legistors, will actually research and validate the numbers and rein in the MCO’s.
Kingfish:
Good job on your description of Medicaid eligibility. Too many people don't have an even basic understanding of this, and it's important. Likewise, there are NOT many people who would be working (even if required) who are currently receiving Medicaid in Mississippi. This may not be true in other states, but because of our eligibility rules, most of the people on Medicaid in MS now are children, pregnant women, and disabled adults. That was true before the PPACA (Obamacare) and even though the eligibility expanded, they are still the large majority.
Another item folks should remember about Medicaid: about half of ALL of Medicaid's budget (In MS) goes to NURSING HOMES. This is because when folks get old and go into the nursing home, they give away all their stuff (known at Medicaid as the "spend down") to become Medicaid eligible. Medicaid is supposed to have a "look back" provision to try and eliminate this, with varying degrees of success.
Also, folks should understand this about Medicaid: it's basically a totally free credit card for medical services. No copay, no deductible, basically no limits. You can call the Ambulance to take you to the ER for your toe fungus or menstrual cramps or fake seizures EVERY SINGLE DAY OF YOUR LIFE and the taxpayers have to pay the bill. Does this happen? yes. While most people with Medicaid don't "abuse" it, large numbers do, and it skyrockets the cost to hospitals, taxpayers, and chokes emergency departments to the point where they can't function in many places. (Go to any local ER and see if there are people checking their four kids in to the EMERGENCY DEPT for "a cold." No one with Blue Cross is doing that. Even folks with no insurance are doing it. Why? Because it's too dang expensive, that's why.)
Supposedly these "managed care organizations" such as Unitedhealthcare and Magnolia were going to address this, but surprise, they have not. They are just giant vacuums, sucking millions out of $$$$ out of our state to go to giant corporations in other places.
This is why there is a battle over Medicaid. It costs taxpayers LOTS of money, and that tax money has to come from taxPAYERs. The argument that somewhere, the federal government has golden geese pumping out solid golden eggs, so that Medicaid is not any sort of burden on the States is false. The feds get their money the same place the states do, which is MY WALLET.
Likewise, expanding Medicaid is akin to giving people free crack cocaine. Obama figured this out right away. Give it away FREEE for a while, then YOU get to pay all the costs later. This is why the feds covered 99% of the Medicaid expansions but ONLY INITIALLY, now the states are having to foot greater % of the Medicaid bills. Kudos to our state leadership for not falling into that trap.
Thanks but Bigger Pie explained it, not me.
There are so many "facts" about who is on Medicaid being thrown around. I can't find any source online that breaks down the demographics. Can anyone help me with that? What percentage are able bodied? What percentage are children, disabled, elderly, or pregnant? Surely that is publicly available.
I like the idea that the feds are allowing states to manage their programs with fewer mandates/strings attached. Even if the number of adults who physically can work is only 10%, that is 70,000+ Mississippians. If only half of them are employed then the other half (35,000 people) should be doing whatever is reasonable to contribute to society and the federal government should not tell us we can't ask them to do that.
You're adorable, 1:08.
If the ER's are choked with Medicaid pts that just have a cold or some other non-emergency complaint, why wouldn't those facilities setup a "clinic" conveniently located inside or near the ER for those pts? You know, a true after-hours clinic that takes Medicaid?
I'll tell you why.
Money. They can make higher reimbursement rates on an unnecessary ER visit vs an after hours clinic.
"...with the aid of newly informed legislators". Nice work there. I read that as bought and paid for by MHA.
Great thing about Medicare and Medicaid is when you got it you can smoke, drink, dope and eat all the sugar you want, no matter your diabetes, bad heart or host of other problems you have. Not having to be responsible for yourself is great.
10:51 you won't find 70 people who can work, I agree they should if they are able, but this isn't going to have any impact.
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