America's Children Health Insurance and Access to Care (1998) / Chapter Skim
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5 Medicaid
5 Medicaid
Pages 81-101
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From page 81... ...
The EPSDT program is a comprehensive package of chilciren's medical, ancillary, anc3 support services with an emphasis on regular screenings anc3 preventive services. As cliscussec3 later in this chapter, the scope of EPSDT benefits is quite comprehensive compared to the scope of most commercial benefit packages.
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From page 82... ...
Data are from the Urban Institute analysis of the HCFA 2082 and 64 Statistical Reports. CHILDREN'S MEDICAID EXPANSIONS RESULTED IN INCREASED ENROLLMENT 20 T 18 16 ~14 a_ I c 12 ·~ 10 1 ~l 8 it- 8 E 6, ~_ Z 4 2 _' Children, 0-21 AFDC Adults · - Blind and - -~ Di~hl~d 1 987 1 988 1989 1 990 1 991 Fiscal Year Elderly 1992 1993 1994 1995 FIGURE 5.2 Trends in the number of Medicaid recipients, by enrollment group, United States, 1987-1995.
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From page 83... ...
By 1997, Meclicaic3 cost increases seemed to have leveled Off, in part because of the shift to Meclicaic3 managed care, anc3 also because of declining welfare enrollment clue to welfare reform anc3 the growth in the nation's economy. However, chilciren's enrollment in Meclicaic3 is expected to continue to increase through 2002, when phasec3-in coverage for older children is complete, anc3 as some states choose to use Meclicaic3 to cover groups of previously uninsured children uncier the State Chilciren's Health Insurance Program (SCHIP)
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From page 84... ...
· Chilclren who receive adoption assistance or foster care. · Pregnant women whose incomes are up to 133 percent of the federal poverty level.
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From page 85... ...
MEDICAID 85 States have the option of expanding Meclicaic3 coverage to pregnant women and children beyond the minimum federal requirements. In 1997, 26 states had expanciec3 Meclicaic3 eligibility for children by increasing the age criteria, the income criteria, or both (Gauthier and Schroclel, 1997~.
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From page 86... ...
Family income may fluctuate seasonally, particularly for those below 150 percent of the Federal Poverty Level. It may fluctuate on the basis of periods of employment and unemployment.
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From page 87... ...
. Data were provided by the Division of Information Distribution and were derived from the HCFA 2082 Statistical Report on Medical Care: Eligibles, Recipients, Payments and Services.
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From page 88... ...
. The SCHIP program will pay a limited amount for outreach activities anc3 also includes a "presumptive eligibility" option that will allow states to immediately enroll Meclicaic3-eligible children in the program, pencling the results of the determination process.
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From page 89... ...
The reduction of Disproportionate Share Hospitals (DSH) funding in the Balancec3 Budget Act of 1997 could have an inciepencient impact on hospitals that serve relatively large numbers of Meclicaic3 anc3 uninsured patients.
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From page 90... ...
As a matter of public policy, maybe we are going to have to create global budgets for poor people, but give those poor people an opportunity to get into a better system. John Goodman National Center for Policy Analysis, Dallas, TX Public Workshop June 2, ~ 997 SCOPE OF SERVICES As a condition for receiving federal Medicaid matching funds, Medicaid coverage and services must be in effect statewide and must be comparable for everyone within a particular eligibility group.
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From page 92... ...
Second, the EPSDT program emphasizes age-appropriate preventive strategies and not simply the treatment of acute illnesses and injuries. Third, the EPSDT benefit package was intended to address the needs of chronically and congenitally ill children, including those who need to improve their age-appropriate functioning as well as those who have congenital conditions, need to maintain their limited functional capacity, but who are not ~ , 1 .
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From page 93... ...
Department of Health and Human Services found that only 28 percent of the children enrolled in Meclicaic3 managed care received all of the EPSDT program screens called for in their state, and 60 percent of the children in the study received none of the services called for in their states' perioclicity schedules (DHHS, 1997a)
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From page 94... ...
These services are typically not provided by health care plans, and as more states move toward managed care, some groups are concerned that children may not get the comprehensive services included in the EPSDT program. MEDICAID MANAGED CARE The number of Medicaid beneficiaries enrolled in managed care plans increased fourfold between 1991 and 1996 (see Figure 5.6 and Table 5.11.
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From page 95... ...
. 1991 1 992 1 993 Year 1 994 1 995 Managed Care Fee-for-Service 1 996 FIGURE 5.6 Percentage of Medicaid recipients enrolled in fee-for-service and managed care plans, United States, 1991-1996.
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From page 96... ...
The welfare reform law required states to provide ~ year of transitional Medicaid coverage for those individuals who lost their eligibility as a result of beginning to receive child support payments or beginning emnlovment. To further address the chances of welfare reform, the Balanced Budget Act of - -o -- -- -- -- o -- -- I -- I -- -- -- -- - - -- -- -- -- - -- -- -- -- -- -- -- -- -- -- -lo -- -- -- -- -- -- - -- -- -- -- a -- -- -- -- -- -- -- -- -- -- -to -- - -- - 1 BY ~ provided funding to allow states to continue to provide Medicaid coverage for these individuals for a transitional i~year period.
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From page 97... ...
[* Balanced Budget Act of 1997 restores Medicaid coverage to those SSI recipients who lost coverage because of change in definitions.]
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From page 98... ...
. A new option in the Balanced Budget Act of 1997 allows states to create a Meclicaic3 "buy- in" program for inclivicluals whose incomes are uncier 250 percent of the federal poverty level anc3 who would otherwise meet the medical eligibility criteria for SSI.
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From page 99... ...
The Medicaid program continues to change rapidly. Eligibility requirements are changing in many states as a result of the implementation of new state children's health insurance programs under the Balanced Budget Act of 1997, and managed care is expected to play a major role in the delivery of care 1 it_ _~*
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From page 100... ...
1996. Medicaid Managed Care Encounter Data: What, Why and Where Next?
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From page 101... ...
1997. Overview of Medicaid Provisions ire the Balanced Budget Act of 1997, P
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