Medicaid Update - SCHA


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  • Subsidies are available to individuals from 100% of the federal poverty level (FPL) to 400% FPL if their state does not opt in to Medicaid expansion; from 138% to 400% FPL if their state opts in to the Medicaid expansion
  • We’ve been here before…. Back when the Medicaid program was originally created.
  • The “woodwork” are individuals who will choose to enroll in Medicaid who are eligible under the current Medicaid guidelines.
  • Florida’s Governor, Rick Scott, dropped his staunch opposition after the presidential election. "The election is over and President Obama won… I'm responsible for the families of Florida. … If I can get to yes, I want to get to yes… I don't think anyone involved in trying to improve health care should say 'no, no, no,’.. Let's have a conversation."
  • The states standing to benefit the most from theexpansion are likely to not opt in to the expansion, but states standing to benefit the least are likely to opt in.
  • The state cost estimate above does not include SC DHHS’s estimate of average administrative cost of $27 million per year. That average annual estimate contains cost elements that would exist even if SC were not to opt in to the Medicaid expansion.
  • SCHA commissioned the University of South Carolina Darla Moore School of Business to study the economic impact of new dollars the Medicaid expansion would bring into SC.
  • The USC study uses estimates from the April 2012 Milliman ACA impact study commissioned by SCDHHS.Newly eligible enrollees include those who are uninsured and currently insured who would become newly eligible if SC were to opt in to the Medicaid expansion.
  • Medicaid Update - SCHA

    1. 1. Medicaid Expansion
    2. 2. Well, now we know.
    3. 3. Repeal is a long shot.
    4. 4. The debate isn’t over.
    5. 5. supreme court Ruled 5-4 on June 28, 2012 to uphold law Individual mandate, exchanges, insurance rules and other programs still stand Medicaid expansion is now optional for each state Subsidies are available to individuals from 100% FPL and above if a state does not opt in
    6. 6. The political question: what will states do?
    7. 7. some background January 1966. Only six states originally participated when the program launched: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma, Pennsylvania 20 states signed on later that year 11 states joined in 1967 13 more states (southern) joined in 1968-1972 Arizona last to join in 1982 Eventually all states participated in basic program and SCHIP (enacted in 1997)
    8. 8. why are states reluctant? Oppose Obama…… Oppose ObamaCare States Rights Administrative burden 10 percent is still a big commitment Fear the federal government will not keep its financial commitment The “woodwork” effect
    9. 9. who isn’t participating?
    10. 10. who will benefit?
    11. 11. how much will the medicaid expansion cost sc? Year State Federal 2014 0 $796m 2015 0 $1.64b 2016 0 $1.69b 2017 $44m $1.72b 2018 $101m $1.74b 2019 $125m $1.80b 2020 $171m $1.84b Totals $442m $11.24b
    12. 12. state impact reports$2,038,205,270 No matter what decision the state makes on Medicaid expansion, our state will see this reduction in Medicare reimbursement from 2014 to 2020.$735,400,000 Hospitals in South Carolina will also see this reduction in Medicaid DSH funds from 2014 to 2020 with or without Medicaid expansion.$2,773,605,270 The total cost of statewide cuts in Medicare reimbursement and Medicaid and Medicare DSH funds to South Carolinas hospitals from 2014-2020 with or without Medicaid expansion.$11,682,500,000 The total amount our state would receive in federal funding from 2014 to 2020 if South Carolina decides to expand Medicaid.
    13. 13. economic impact in sc
    14. 14. USC economic impact report SCDHHS estimates $11.2 billion in new federal funding will be generated between 2014 and 2020 due to newly eligible enrollees. By 2020, the annual economic impact will total $3.3 billion in annual economic output, nearly 44,000 jobs, and approximately $1.5 billion in labor income. This will translate into additional spending, leading to increases in SC general funds totaling $105.6 million by 2020.
    15. 15. USC economic impact report This increased tax revenue will completely offset the required state costs over the first seven years and generate a $9 million net surplus. From 2020 forward after the federal match rate caps at $9 federal to every $1 state, new tax dollars will generate enough to cover 53% of the state required Medicaid match.
    16. 16. what you can do? Communicate with legislators Engage local chambers of commerce, businesses and civic organizations Write letters to editor
    17. 17. despite the concerns, these facts remain: SC hospitals will continue to care for uninsured patients; federal law requires them to do so. The cost of that care must be paid by someone, and there are two options:  We can let the other states help pay 90% of it (they are offering to do so through Medicaid), or  We can absorb 100% of the costs within our borders. Which strategy will make SC more competitive?
    18. 18. Strategic imperative: Enhance South Carolina’s economic competitiveness by improving healthstatus, improving health care delivery, and lowering the per capita cost of care
    19. 19. In order tolower healthcare costs,SC needsbetter healthand betterhealth care
    20. 20. America ranks dead last in health statusSource: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 bythe Institute of Medicine
    21. 21. America ranks dead last, continuedSource: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 bythe Institute of Medicine
    22. 22. In the least healthy developed nation: South Carolina ranked 46th out of 50 states in 2012 (The Palmetto State ranked 45th in 2011)Source: America’s Health Rankings, published by the United Health Foundation
    23. 23. What’s driving our low health status?Factor Rank Weight1. Diabetes 49 Low2. Children in Poverty 48 Medium3. Low Birth weight 47 Medium4. High School Graduation Rate 47 Medium5. Violent Crime 46 Medium6. Lack of Health Insurance 45 Medium7. Obesity 42 Medium8. Premature Death 42 Medium9. Infant Mortality 40 Medium10.Smoking 39 HighSource: America’s Health Rankings, published by the United Health Foundation
    24. 24. Better Health  Health is the result of our behaviors, genetics, and environment combined with the clinical care we receive and the policies of our health care, government, and other prevention systems.  SC is one of the least healthy states in the least healthy developed nation. We need a comprehensive, data-driven plan to make SC one of the healthiest states in America.  Our plan must address the primary factors driving our poor health status.
    25. 25. Better Health Care  We all care about quality of life. One of the major contributors to a high quality of life is access to excellent health care.  SC has been recognized in recent years as a national leader in patient safety and quality of care, but there’s much more to be done.  Health care in America must become as reliable as commercial aviation and nuclear power; SC is poised to be the lead state in building highly reliable systems of care.
    26. 26. Lower Cost  The fundamental complaint about America’s health care system is the high (and ever-increasing) cost of care.  There are two contributing factors, both of which must be addressed simultaneously. The first is the cost of health services, and the second is the frequency with which those services are utilized.  It’s not enough to reduce the cost of health care; we must improve our health so we won’t have to purchase so many health care services.