Florida Medicaid Expansion Chartbook

How Medicaid Expansion Would Benefit Florida

A Guide for Understanding Florida’s Medicaid Program and How to Improve It

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Page 3

Section 1 : Understanding Florida’s Medicaid Program �� 4Who Gets Medicaid in Florida? ��5Who Qualifies for Medicaid in Florida? ��6How Restrictive is Florida’s Medicaid Program? ��7When the Economy is Down, Medicaid Enrollment Increases ��8Medicaid Controls Costs Better ��9Projected Increase in State Medicaid Spending for State Fiscal Year 2015 �� 10

Section 2 : Florida’s Opportunity to Close The Coverage Gap ��11Expansion Would Loosen Restrictions on Eligibility �� 12What is the Coverage Gap in Florida? �� 13Local Communities Stand to Benefit �� 14Coverage for Workers in Key Sectors �� 15Majorities and Minorities �� 16Florida’s Veterans and Medicaid Expansion �� 17Drastic Difference �� 18

Section 3 : Economic and Other Benefits of Closing the Coverage Gap �� 19Closing the Coverage Gap is a Great Deal For Florida �� 20Booster Shot to the Economy �� 21Key Sources for Savings �� 22Health Insurance Matters �� 23

Section 4 : We Should Not Delay �� 24We Can’t Afford to Wait �� 25Prescription for Access �� 26Florida Can Change Course �� 27

About the Florida Policy Institute �� 28

Table of Contents

Florida Policy Institute | www.fpi.institute


Section 1Understanding Florida’s

Medicaid Program


Who Gets Medicaid in Florida?

Nearly 2 out of every 10people in Florida

Four out of every �ve poor* kids in Florida

More than one in three poor* adults in Florida

*Poor is de�ned as families earning <100% of the Federal Poverty Level.Source: Kaiser Family Foundation


Who Qualifies for Medicaid in Florida?

0% 50% 100% 150% 200% 250%

Childless Adults

Parents of Dependent Children

Disabled Adults

Pregnant Women

Children (Ages 6-18)

Children (Ages 1-5)

Children (Ages 0-1)

Source: Medicaid.gov

Several groups are covered and each group has different thresholds.

206%

191%

140%

133%

88%

30%

0%

(Eligibility is determined by measuring income as a percentage of Federal Poverty Levels)

$49,955

$33,950

$32,253

$46,318

$21,340

$7,275

Dol

lar a

mou

nts

for i

ncom

e th

resh

olds

of a

fam

ily o

f fou

r


43If a family of four lives in Florida

$7,275

Only 7 states make it harder for working parents

to get Medicaid.

and has an annual income above

rd

The parents would be ineligible for Medicaid.

Source: Medicaid.gov

How Restrictive is Florida’s Medicaid Program?How Restrictive is Florida’s Medicaid Program?


When the Economy is Down, Medicaid Enrollment Increases

The number of Floridians covered by employer-sponsored health insurance decreased from 9.4 million to 8.9 million

Florida’s Medicaid/ CHIP enrollment increased from 2.3 million to 2.6 million

The number of uninsured people in Florida increased from 3.5 million to 4 million

The number of jobs in Florida decreased from 8.4 million to 8.1 million

330,000jobs

500,000people

300,000people

500,000 people

Sources: US Department of Labor, Bureau of Labor Statistics, US Census Bureau, and Agency for Health Care Administration

Between 2008 and 2009:


Medicaid Controls Costs Better

0%

1%

2%

3%

4%

5%

6%

7%

8%

Private InsuranceMedicaid Cost

4.6%

7.7%

Between 2000-2009, the growth in per-person cost was much lower in Medicaid than in the private insurance market.

Source: Center on Budget and Policy Priorities Analysis

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0%

1%

2%

3%

4%

5%

6%

7%

8%

NonExpansion

States

Medicaid Expansion

States

4.4% 6.8%

Source: Center on Budget and Policy Priorities Note: Projected increase in state Medicaid spending for state fiscal year 2015

Florida Policy Institute | www.fpi.institute

Projected Increase in State Medicaid Spending for State Fiscal Year 2015


Section 2Florida’s Opportunity

to Close The Coverage Gap


0% 30% 60% 90% 120% 150%

Newly EligibleCurrently Eligible

Childless Adults

Working Parents

Disabled Adults

138%

138%

88%

30%

138%

Childless adults would be eligble and eligibility thresholds would increase to 138% of the Federal Poverty Level for other adults.

Income as Percentage of Federal Poverty Level

Expansion Would Loosen Restrictions on Eligibility Expansion Would Loosen Restrictions on Eligibility


What is the Coverage Gap in Florida? 567,000 people in Florida fall into the coverage gap.

$24,250*

Current FLMedicaid Program

Health Insurance

MarketplaceSubsidies

$7,275*

Under Florida’s current Medicaid program, working parents must have incomes

below 30 percent of the Fed-eral Poverty Level (FPL) to be

eligible for Medicaid.

*$7,275 represents 30% of the Federal Poverty Level for

a family of four.

*$24,250 represents 100% of FPL for a family of four.This is the lower threshold for receiv-ing subsidies to buy health-

care in the marketplace.

Childless adults are not eligible for Medicaid no matter

how poor they are, unless they are elderly, disabled, or

pregnant.

Sources: Medicaid.gov, US Department of Health and Human Services, and the Kaiser Family Foundation.


Local Communities Stand to Benefit

Percent of uninsured who could gain coverage

22.3% 45.0%Percentage of uninsured people who could gain coverage

Source: U.S Census Bureau, FPI Analysis of United States Census Bureau Data.[i]; County-by-county data provided upon request


0 20000 40000 60000 80000 100000CHILD DAY CARE SERVICES

HOTELS / MOTELS

PRIVATE HOUSEHOLDS

AGRICULTURE

GROCERY STORES

DEPARTMENT & DISCOUNT STORES

SERVICES TO BUILDINGS & DWELLINGS

LANDSCAPING SERVICES

CONSTRUCTION

RESTAURANTS & OTHER FOOD SERVICES

Workers in 10 of the state's top largest employment sectors have the most to gain under an expanded Medicaid program.

Coverage for Workers in Key Sectors

95,360

87,490

25,430

24,230

21,790

21,250

21,070

18,790

13,570

10,840

Source: FPI analysis of the U.S Census Bureau Data using IPUMS. American Community Survey 2014.

Coverage for Workers in Key Sectors


Majorities and Minorities

Minorities represent 44.4% of Florida’s total population.

Minorities represent 64.2% of Florida’s uninsured population.

Minorities make up almost two thirds of Florida’s uninsured population, although they make up less than half of the general population.

Source: FPI analysis of the U.S Census Bureau Data using IPUMS. American Community Survey 2014.


Florida’s Veterans and Medicaid Expansion54,600 military veterans and their spouses could get quality, a�ordable health care coverage through Medicaid expansion.

41,200 uninsured veterans

13,400 uninsured spouses of veterans

Source: Haley, Jennifer, and Genevieve M Kinney. Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA.


Drastic Difference

0%

10%

20%

30%

40%

Did notClosed the gap

States that closed their coverage gaps have seen the number of adults without health coverage drop by 37.7 percent. Compare that with a just 9 percent drop in states like Florida that did not close the coverage gap.

Percent reduction in uninsured nonelderly adults

Source: Urban Institute survey results released July 10, 2014

37.7%

9.0%


Section 3Economic and Other Benefits of

Closing the Coverage Gap


Closing the Coverage Gap is a Great Deal For Florida

0%

20%

40%

60%

80%

100%

Closing the coverage gap beyond 2020

Closing the coverage gap

under ACA 2016

KidcareCurrent Medicaid

The federal government will cover the vast majority of the costs of closing the coverage gap. Other public health programs require far more state funds.

Federal Florida Federal Florida Federal Florida Federal Florida

Source: Federal Register: https://aspe.hhs.gov/sites/default/�les/pdf/106641/fmap16.pdf

100%

90%

60.67%

39.33%

72.47%

27.53%

0%

10%


New Jobs58,400

New Tax Revenues $1.8 Billion

New Federal resources would bring new jobs and revenues to the state

Source: Hodges, Alan W. and Mohammad Rahmani. 2012.The Economic Impact of the Patient Protection and Affordable Care Act in Florida.

$16.7 Billion in new federal funding (2016-2023)

+

$

Booster Shot to the Economy


State Michigan Kentucky Arkansas

% Decrease in uncompensated

care

85% decrease*

*in the Detroit area 59.7% decrease 56.4% decrease

State savings due to additional

federal funding

$35 million $33.3 million $68 million

Mental health savings

$190 million $21 million $7.1 million

Sources: Bachrach, Deborah et al., 2016. “States Expanding Medicaid See Significant Budget Savings and Revenue Gains. Early Data Shows Consistent Economic Benefits Across Expansion States” and Bachrach, Deborah et al., 2015. “The Impact of Medicaid Expansion on Uncompensated Care Costs: Early Results and Policy Implications for States.”

Key Sources for Savings


Health Insurance Matters

Improves Financial

Health

ControlsCosts

ReducesDeath Rate

Results compare uninsured people who gained coverage in Oregon versus those who did not gain coverage.

Affordable health care delivers great value for individuals and communities.

Sources: Baicker, Katherine et al. 2013. The Oregon Experiment- Effects of Medicaid on Clinical Outcomes. Bradley, Cathy J. et al. 2012. Health Affairs- At the Intersection of health, Healthcare and Policy. Dickman, Sam et al. 2014. Opting Out of Medicaid Expansion: The Health and Financial Impacts.


Section 4We Should Not Delay


We Can’t Afford to Wait

•$16.7 billion* in federal funds could be injected into Florida’s economy •$1.8 billion* in new tax revenues • Support for 58,000* new jobs• guaranteed budget savings from using federal funds, rather than state dollars, for existing healthcare programs such as mental health services and uncompensated care costs.

Florida could have closed the coverage gap on January 1, 2014.

The state is losing money every day that it fails to do so. January 1, 2014

Sources: Hodges, Alan W. and Mohammad Rahmani. 2012. Economic Impacts of the Patient Protection and Affordable Care Act in Florida. and Bachrach, Deborah et al. 2015. Medicaid expansion States See Significant Budget Savings and Revenue Gains.

*These are cumulative total estimates for the years 2016-2023, if Florida were to close the coverage gap by expanding Medicaid.


Prescription for AccessPrescription for Access

Three out of five doctors in Florida are accepting new Medicaid Patients.

Source: Galewitz, Phil. “Nearly a Third of Doctors Won’t See New Medicaid Patients” Kaiser Health News, 6 August 2012. http://khn.org/news/third-of-medicaid-doctors-say-no-new-patients/


Florida Can Change CoursePrescription for Access

Three out of five doctors in Florida are accepting new Medicaid Patients.

Source: Galewitz, Phil. “Nearly a Third of Doctors Won’t See New Medicaid Patients” Kaiser Health News, 6 August 2012. http://khn.org/news/third-of-medicaid-doctors-say-no-new-patients/

Florida Can Change Course If Congress lowers the enhanced federal match rate (of 90%) for covering low-income adults, Florida can exit the new program


About the Florida Policy Institute This guidebook was produced by staff of The Florida Policy Institute. The Florida Policy Institute is an independent, nonpartisan and nonprofit organization dedicated to promoting widespread prosperity through timely, thoughtful and objective analysis of state policy issues affecting economic opportunity. The Institute provides analysis of state budget and revenue trends and proposes common-sense policy options with the aim of encouraging broad public education, discussion, and informed action. The Institute advances fiscal policies that expand economic opportunity for all Florida residents. Our goal is to be an accurate, trusted source of information for policymakers, advocates, the media, and the public at large.

For more information, contact:

Joseph F. PennisiExecutive Director [email protected] 407.459.8658