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Listen to a recording of Talking Medicaid, the May 4 webinar sponsored by the Alliance. The slide presentation is also available for downloading. …

Listen to a recording of Talking Medicaid, the May 4 webinar sponsored by the Alliance. The slide presentation is also available for downloading.


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  • [Rachel’s turn] Thank you, Lisa. So currently, there are about 62 million individuals enrolled in Medicaid. About 50% are children and 25% are elderly and disabled individuals. In 2009, the federal and state government spent around $338 billion on Medicaid and $17 billion alone on hospitals that serve the uninsured. By numbers alone, we see that Medicaid provides a fairly sizable budget for health care services for low-income individuals. In fact, as a comparison, the budgets for the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration combined is around $11 billion. Those are the agencies that administer programs targeted for chronically homeless people, as well as funding for mainstream safety net programs. This underlines how large Medicaid is and its overall scale in the parts of the health care system that are most relevant to us.
  • Rachel: Although Medicaid services can be reimbursed from the state directly to health care providers, many states have contracts with managed care plans to provide services in full or in part. 70% of Medicaid enrollees nationally are in managed care. In 2010, about a quarter of Medicaid spending on benefits went to managed care plans. Some states, like South Carolina and Tennessee, enroll all Medicaid participants in managed care while other states like Alaska and Wyoming, do not have Medicaid managed care at all. Under Medicaid managed care, instead of the state agency paying every provider separately for patient encounters, the state pays private plans a negotiated amount for each member-enrollee. The plans work with providers to assure access and coordinate care. Lisa: Managed care in Medicaid can be controversial. Managed care can result in better care coordination; or it can lead to “cherry picking” – which is what we call “creaming” – plans marketing themselves to the healthiest consumers so they have to spend less on care and can gain more in profit. Or, if they cannot avoid enrolling higher-cost members, plans might find ways to skimp on care, and save money for themselves that way. Some think that managed care systems can do a good job serving people with co-occurring conditions , using subcontracts with behavioral health providers. Researchers and policy analysts have a lot of questions about how Medicaid managed care works best in supportive housing. Mainstream health care advocates are generally not convinced that Medicaid managed care is good for people in Medicaid. … I’ll leave it at that for now.

Transcript

  • 1. Talking Medicaid: First Steps in Building Effective Homelessness-Health Care Partnerships May 4, 2011
  • 2. Health Care Reform in Context
    • The Affordable Care Act (ACA) – 2010
      • Significant Medicaid reforms
      • Expanded access to health care for low-income and vulnerable populations
    • Changes in Medicaid
      • Complicated
      • Promise and potential
    • Strategy for ending homelessness
  • 3. Agenda for Today’s Webinar
    • Topics to Cover
    • Introduction to Medicaid
    • Health Care Reform and Implications for Ending Chronic Homelessness
    • Getting Involved in Implementation
    • Next Steps
  • 4. Medicaid Essentials
    • Medicaid populations – Children and parents, pregnant women, elderly, people with disabilities, adults as states permit
    • Subject to financial qualifications
    • State-federal partnership
    • Federal matching funds
    • State flexibility
    • Health care services and long-term supports
    • More info about Medicaid, including state-specific data: The Kaiser Family Foundation, www.kff.org/medicaid
  • 5. Medicaid Essentials
    • Medicaid Today
    • 62 million enrollees
      • Around 50% are children
      • 25% elderly and disabled (14-15 million)
    • $338 billion federal and state expenditures
      • $17 billion to hospitals for otherwise uncompensated care
        • To compare, combined budget for SAMHSA and HRSA is around $11 billion
    • Medicaid is always a work in progress, always changing.
    • For states, Medicaid a major budget item but also a considerable part of their economies.
    MACPAC. “Report to the Congress on Medicaid and CHIP.” March 2011. http://www.macpac.gov/reports Kaiser Family Foundation- State health facts. “Distribution of Medicaid Spending by Servce, FY 2009.” Accessed on May 2, 2011. http:// www.statehealthfacts.org/comparetable.jsp?typ =2&ind=178&cat=4&sub=47
  • 6. Medicaid Essentials
    • Medicaid Managed Care
    • 70% of Medicaid enrollees, around 36 million nationally ,are in managed care
    • 75% of all child CHIP enrollees are in comprehensive managed care plans
    • Some states enroll all Medicaid participants in managed care while other states do not contract with plans at all.
    MACPAC. “Report to the Congress on Medicaid and CHIP.” March 2011. http://www.macpac.gov/reports CMS. “Medicaid Managed Care Enrollment as of June 30, 2009.” June 2009. https://www.cms.gov/MedicaidDataSourcesGenInfo/downloads /09June30f.pdf
  • 7. Medicaid Populations MACPAC. “Report to the Congress on Medicaid and CHIP.” March 2011. http://www.macpac.gov/reports For more information about Chronic Homelessness policy solutions, find our policy brief at http://www.endhomelessness.org/content/general/detail/2685
  • 8. Chronically Homeless Adults
    • 110,000 chronically homeless adults in 2010
    • Frequent system users: hospitals, jails, mental health, prison
    • Serious mental illness, substance use, poor physical health, co-occurring conditions
    • Permanent supportive housing is effective
      • Housing stability
      • Health services utilization
  • 9. How Medicaid Helps
    • Medical
    • Screening, prevention
    • Mental health and rehabilitation
    • Long-term services & supports
  • 10. Talking the Affordable Care Act
    • 1. Essential Health Benefits – Coming in 2014
    • Medicaid for new group: adult citizens up to 133% of federal poverty level
    • Basic coverage subject to federal and state definitions, under development
    • Mental health coverage is required
    • Additional Medicaid coverage subject to implementation
  • 11. Talking the Affordable Care Act
    • 2. Delivery System Changes
    • More options for states to provide home and community-based services
    • Quality improvements in primary care delivery – health homes, care coordination
    • Opportunities for future state Medicaid reforms to incorporate best practices for PSH in benefits and program designs.
  • 12. Talking the Affordable Care Act
    • Federal Incentives
    • Basic health care benefits for newly-eligible enrollees
      • Very significant federal commitment – enhanced match rate
    • Needs-based home and community-based services for all enrollees
      • Significantly more dependent on state priorities – usual match
  • 13. Implications for Housing Solutions
    • Medicaid Changes – New Tools to End Homelessness
    • Potential to boost supportive housing as strategy to end homelessness, especially for individuals with multiple co-occurring conditions
    • It is up to homelessness advocates to drive these policy changes and shape effective systems
    • Together we can end homelessness
  • 14.
    • Action Steps
    • Assign a health care “lead” in your organization or network
    • Tell your story, share your vision – concrete, visible, and compelling
    • Know your audience
    An Initial Agenda for Engagement
  • 15. An Initial Agenda for Engagement
    • Action Steps, cont’d
    • Know your audience:
      • Mainstream housing (for-profit developers, PHAs)
      • Healthcare partners (local reform coalitions, nonprofit hospitals, clinics)
      • Public agencies (health, housing, social services)
      • Safety net advocates and providers
      • Local and state legislators
    • Add your voice to support Medicaid funding
  • 16. An Initial Agenda for Engagement
    • Talking Points
    • Medicaid helps end homelessness by providing access to primary care and coordinating key services
    • PSH + Medicaid can be cost-effective for communities
    • Housing and health pieces can fit together to improve lives and make a stronger safety net
  • 17. Conclusion
    • Summary
    • Additional resources www.endhomelessness.org
    • Slides and other materials will be available
    • www.endhomelessness.org/section/issues/mental_physical_health/medicaid
    • Questions?
    • Contact us – lstand@naeh.org
  • 18. Bonus Points – Medicaid & Budgets Kaiser Family Foundation – Commission on Medicaid and the Uninsured. “Top 5 Things To Know About Medicaid.” February 25, 2011. http://www.kff.org/medicaid/8162.cfm