One in 5 million Americans now covered by Medicaid

By Claire Thayer, July 7, 2014

The Affordable Care Act (ACA) has had a huge impact on Medicaid enrollment and spending since the expansion of Medicaid eligibility to include almost all adults with incomes at or below 138% of the federal poverty level effective January 1, 2014. The Kaiser Family Foundation recently released, Medicaid Moving Forward, a concise fact sheet summarizing current enrollment, spending and other trends for the Medicaid program.  Lots of data is packed into this fact sheet, here are a few of the important highlights:

Who Does Medicaid Cover?

• Over 66 million Americans now receive their health coverage through the Medicaid

• Medicaid and Children’s Health Insurance Program (CHIP) cover more than 1 in every 3 children

• In June 2013, over 28 million children were enrolled in Medicaid and 5.7 million were enrolled in CHIP

• The ACA expanded Medicaid to nearly all adults under age 65 with income at or below 138% FPL, effective January 1, 2014.

• As of June 2014, 27 states, including DC, were expanding Medicaid, three states were actively debating the issue, and 21 states were not moving forward

What does Medicaid Cover?

• inpatient and outpatient hospital services;

• physician, midwife, and nurse practitioner services;

• early and periodic screening, diagnosis, and treatment (EPSDT) for children up to age 21;

• laboratory and x-ray services;

• family planning services and supplies;

• federally qualified health center (FQHC) and rural health clinic (RHC) services;

• freestanding birth center services (added by ACA);

• nursing facility (NF) services for individuals age 21+;

• home health services for individuals entitled to NF care;

• tobacco cessation counseling and pharmacotherapy for pregnant women (added by ACA);

• non-emergency transportation to medical care

How do Medicaid Beneficiaries Get Care?

• Most Medicaid beneficiaries obtain care from private office-based physicians & other health professionals.

• Safety-net health centers and hospitals also play a major role in serving the Medicaid population.

• Over half of Medicaid beneficiaries nationally, mostly, children and parents, are enrolled in comprehensive managed care organizations (MCO) that contract with states on a capitation, or risk, basis to deliver Medicaid services

• A smaller but still significant number of beneficiaries are enrolled in Primary Care Case Management (PCCM) programs

How much does Medicaid cost and how is it financed?

• In FY 2012, Medicaid spending on services totaled about $415 billion

• Administrative costs accounted for 5% of overall program spending.

• Two-thirds of all spending on services was attributable to acute care

• 30% of all spending on services was associated with long-term care.

• Supplemental payments to hospitals that serve a disproportionate share of Medicaid and uninsured patients, known as “DSH,” accounted for about 4% of spending

• Medicaid payments for Medicare premiums and cost-sharing on behalf of dual eligible beneficiaries totaled 3.5%.

Source: Medicaid Moving Forward, The Henry J. Kaiser Family Foundation, June 17, 2014.

Additional Issue Briefs that might be of interest:

Katherine Young and Lisa Clemans-Cope and Emily Lawton and John Holahan, Medicaid Spending Growth in the Great Recession and Its Aftermath, FY 2007-2012, The Henry J. Kaiser Family Foundation, Issue Brief, July 3, 2014.

Samantha Artiga and Robin Rudowitz, Medicaid Enrollment Under the Affordable Care Act: Understanding the Numbers, The Henry J. Kaiser Family Foundation, Issue Brief, January 29, 2014.

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