medicaid in rural missouri april 7, 2006 amy lake community policy analysis center university of...

Medicaid in Rural MissouriApril 7, 2006

Amy LakeCommunity Policy Analysis Center

University of Missouri-Columbia230 Middlebush HallColumbia MO 65202

[email protected] or 573-882-5412http://www.cpac.missouri.edu/

mailto:[email protected]

http://www.cpac.missouri.edu/

2©2005 Medicaid Work Group, University of Missouri--Columbia

Missouri Medicaid Chartbook

Missouri Medicaid Chart Book

The Missouri Medicaid Program:The Missouri Medicaid Program: A Graphical Profile A Graphical Profile

Medicaid Work Group, University of Missouri--Columbia

August 2005

http://oseda.missouri.edu/medicaid/





Missouri Medicaid ChartbookTotal Medicaid Enrollment, FY2001

More than a million people were enrolled in Missouri Medicaid in 2001

NATIONAL MAPS


Missouri Medicaid ChartbookPercent of the Population Enrolled in Medicaid, 2001

Almost one-fifth of Missourians were enrolled in Medicaid in 2001

NATIONAL MAPS

Federal and State Medicaid Expenditures 2004

• $5.7 billion = Total Medicaid Expenditures in Missouri (SFY 2004)

• $3.7 billion in Federal Funds

• $2.0 billion in Missouri funds (GR and other)

Source: Kaiser Foundation


Missouri Medicaid ChartbookMissouri Medicaid Expenditures by Enrollment Group, FY2005

Source: MoDSS Summary Table 5, FY2005.

Children accounted for 55% of enrollees, but only 20% of expenditures

MISSOURI CHARTS

Total Enrollees992,622

Total Expenditures$5,557,804,149

Note: Other includes Medicaid Assistance to Pregnant Women and the Breast or Cervical Cancer Program.



Source: MoDSS Summary Table 5, FY2005.

Missouri Medicaid Expenditures by Type of Service, FY2005

Pharmacy is the largest category of costs to Missouri Medicaid

Note: All other includes rehabilitation & specialty care, EPSDT, buy-in premiums, and dental services.

(in billions of $)

MISSOURI CHARTS


Missouri Medicaid ChartbookPercentage of Missouri Population in Poverty, 2002

Poverty is concentrated in the southeast, south central, northeast regions of the state and in St. Louis City

MISSOURI MAPS

Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Metro and Non Metro Missouri Counties Medicaid Enrollees as Percentage of Total Population January 2006

06 Non Metro County 40.6% 12.7% 16.0% 13.5% 20.9%

06 Metro County 30.2% 8.6% 11.4% 9.1% 15.2%

Under 20

20-6465 and older

20 and older

All ages


28%-40% of the populations in 12 NON-METRO counties are enrolled in Medicaid

The 2 METRO areas with the highest Medicaid enrollment are Washington Co and St. Louis City with 28% of overall population enrolled


For 17 NON-METRO counties, 50%-78% of children enrolled in Medicaid

For METRO areas, only St. Louis City has over 50% of children enrolled in Medicaid


55 NON-METRO counties had over 10% of population aged 20-64 enrolled in Medicaid. 11 rural counties had over 19% of adults enrolled.

8 METRO areas had over 10% of adults enrolled, with a high of 19%.


15 NON-METRO counties had over 20% of elderly enrolled in Medicaid, and 56 had over 12.8%

Only 1 METRO area (Washington Co.) had over 20% of elderly population enrolled in Medicaid. 8 METRO counties over 12.8 %


24 NON-METRO counties had over 5% of overall population enrolled in Blind/ Disabled Medicaid

Only 1 METRO area (Washington Co.) had this level of enrollment



Total Medicaid Expenditures by County, FY2004

Total expenditures were $4.8 billion in 2004

MISSOURI MAPS


Missouri Medicaid ChartbookMedicaid Expenditures per Capita by County, FY2004

Per capita expenditures ranged from $326 to $2,425, reflecting the relative need of the population

MISSOURI MAPS

MO Medicaid Changes

• Estimated 120,000 people affected by changes since July 1, 2005 (and Sept. 1, 2005)

• Medicaid eligibility changes/ reductions:– People with disabilities (working, transitional,

Permanently and Totally Disabled) and Old Age– Low income parents (eligibility reduced from 75%

Federal Poverty Level to 22% FPL)– Medical services and equipment reduced– Increased cost sharing for recipients = increased

monthly premiums and increased “spend downs”



Percent of County Population Affected by Changes in Medicaid

Provisions, FY2006 Missouri’s poorest regions will have the highest percent of population impacted by the recent changes in Medicaid provisions

MISSOURI MAPS

Change in Medicaid Enrollment for Blind / Disabled from 2/05 and 1/ 06 was 4,391 decrease

Total change Medicaid Enrollment approximately 117,000 decrease

Change in MO Medicaid Enrollment by Age between Feb 2005 and January 2006

-80000

-60000

-40000

-20000

0

20000

Series1 420 -49771 -64654 -2907

Age 0-1 Age 1 - 19 Age 20-64 Age 65 and

Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA),

The concentration of health and social services firms that employ less than 10 people is highest in Missouri’s rural counties

72% of health and social services firms in rural counties and 70% in urban counties have less than 10 employees

Source: 2003 County Business Patterns and Federal Office of Rural Health Policy

Firms with less than 20 employees made up 90-100% of all health and social services employers in 15 rural Missouri counties

84% of health and social services firms in both rural and urban counties have less than 20 employees

Source: 2003 County Business Patterns and Federal Office of Rural Health Policy

Things to consider…

• Rural areas tend to have fewer options for employer-based health insurance

• Health insurance companies tend to levy high premiums, deductibles, exclusions on farmers and small businesses

• Rural health care providers tend to be small businesses themselves. They may be paying high costs for health insurance and/or sharing the high cost with employees


• Significant program changes are happening both in Medicaid in MO and in Medicare Part D (prescription drug program) nationally– Rural populations tend to be older and sicker than

urban counter parts– Health care providers are spending time and

resources helping individuals find ways to pay– Pharmacies in rural areas are more often

independently owned than in urban areas – Medicaid and Medicare Part D have been challenging for all pharmacies


• Rural providers are currently being called on to provide more free / un-reimbursed /discounted care

• Rural providers may depend heavily on Medicare and Medicaid

• Rural providers may have smaller total profit margins so they may have less ability to absorb significant financial losses

Source: DHSS Primary and Rural Health

Health Professional Shortage Areas HPSAs

Other Resources

• Medicaid Reform Commission http://www.senate.mo.gov/medicaidreform/

• Missouri Hospital Association– http://web.mhanet.com/asp/Governmental_Relations/Medicaid.asp

• Dept of Social Services Reading Room Statistics http://www.dss.mo.gov/rr_stats.htm

• Dept of Social Services http://www.dss.mo.gov/pr_health.htm• MU Center for Health Policy

http://healthpolicy.missouri.edu/publications.htm• MO Information For Community Assessment (MICA) DHSS

http://www.dhss.mo.gov/MICA/nojava.html• Missouri Foundation For Health

http://www.mffh.org/policy_medbasics.html• Centers for Medicare and Medicaid Services

– http://www.cms.hhs.gov/

http://www.senate.mo.gov/medicaidreform/



http://web.mhanet.com/asp/Governmental_Relations/Medicaid.asp

http://www.dss.mo.gov/rr_stats.htm

http://www.dss.mo.gov/pr_health.htm

http://healthpolicy.missouri.edu/publications.htm

http://www.dhss.mo.gov/MICA/nojava.html

http://www.mffh.org/policy_medbasics.html

http://www.cms.hhs.gov/



medicaid in rural missouri april 7, 2006 amy lake community policy analysis center university of...

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