Missouri's 2005 medicaid cuts: How did they affect enrollees and providers?

Health Affairs

Volumn 28, Issue 2, 2009, Pages

  Zuckerman, Stephen ^b   Miller, Dawn M ^b   Pape, Emily Shelton ^a  

^a Health Policy Center   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

AMBULATORY SURGERY; ARTICLE; BUDGET; COST CONTROL; DISABLED PERSON; EMERGENCY WARD; HEALTH CARE FINANCING; HEALTH CENTER; HEALTH INSURANCE; HEALTH SURVEY; HOSPITAL UTILIZATION; MEDICAID; MEDICAL CARE; REIMBURSEMENT; STRUCTURED INTERVIEW; UNITED STATES; WORKER WITH DISABILITY;

COMMUNITY HEALTH CENTERS; COST SHARING; DATA COLLECTION; ECONOMIC COMPETITION; HEALTH SERVICES NEEDS AND DEMAND; INSURANCE COVERAGE; MEDICAID; MEDICALLY UNINSURED; MISSOURI; UNITED STATES;

EID: 66149168577     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.2.w335     Document Type: Article

References (32)

1. A. Blouin et al., "Missouri's Budget Crisis: The Impact on Access to Health Care Cuts, Consequences, and Policy Options to Restore Health" (St. Louis: Missouri Budget Project, February 2005).
2. T.A. Coughlin and S. Zuckerman, "Three Years of State Fiscal Struggles: How Did Medicaid and SCHIP Fare?" Health Affairs 24 (2005): w385-w398 (published online 16 August 2005; 10.1377/hlthaff.w4.385).
3. J. Ferber, "Summary of Medicaid Cuts Adopted in the 2005 Legislative Session," 23 May 2005, http://www.mfhc.org/downloadfile.php?id=115 (accessed 26 January 2009).
4. J. Ferber, "Summary of Medicaid Cuts Adopted in the 2005 Legislative Session," 2005, http://www.mfhc.org/downloadfile.php?id=115 Ibid.
5. For an overview of mandatory and optional coverage under the Medicaid program, see Henry J. Kaiser Family Foundation, "The Latest Data on Mandatory and Optional Populations and Benefits in Medicaid," 7 June 2005, http://www.kff.org/medicaid/kcmu060705pkg.cfm (accessed 26 January 2009).
6. Ferber, "Summary of Medicaid Cuts."
7. A. Smoucha et al., "The 2005 Missouri Medicaid Cuts: A Guide for Consumers, Families and Advocates," 22 August 2005, http://www.namistl.org/ images/pdf/Support/Missouri-Medicaid.pdf (accessed 26 January 2009).
8. Ferber, "Summary of Medicaid Cuts."
9. For enrollment by state 2000-2004, see Exhibit III.2 in S. Liu and H.T. Ireys, "Participation in the Medicaid Buy-In Program: A Statistical Profile from Integrated Data" (Washington: Mathematica Policy Research, May 2006).
10. Ferber, "Summary of Medicaid Cuts."
11. As a federal requirement, pregnant women, children, nursing facility residents, and people who are blind were exempt from both copayments and service coverage reductions. Ferber, "Summary of Medicaid Cuts." Ibid.
12. Ferber, "Summary of Medicaid Cuts." Ibid.
13. Unborn children are included in the Medicaid beneficiary count because they are used to establish household size when determining income eligibility.
14. This report uses a hierarchy inwhich employer coverage is first, followed by Medicaid and state coverage, TRICARE/Medicare coverage, private nongroup coverage, and uninsured. Based on this hierarchy, a person who reports having both Medicaid and employer-sponsored coverage in a single year would be categorized as having employer-sponsored coverage.
15. As compared to household income, HIU income more accurately reflects the income available when purchasing private insurance or determining eligibility for public programs. J. Holahan, C. Hoffman, and M. Wang, "The New Middle Class of Insured Americans - Is it Real?" (Washington: Kaiser Commission on Medicaid and the Uninsured, March 2003).
16. Missouri Primary Care Association, "About Us," http://www.mo-pca.org/about.htm (accessed 15 May 2008).
17. We also excluded three hospitals for which we lacked data that were comparable across 2004 and 2006.
18. E.R Ellis et al., "Medicaid Enrollment in Fifty States: June 2006 Data Update," January 2008, http://www.kff.org/medicaid/upload/7606-03.pdf (accessed 26 January 2009).
19. G. Kenney et al., "Effects of Premium Increases on Enrollment in SCHIP: Findings from Three States," Inquiry 43, no. 4 (2006/2007): 378-392. (Pubitemid 46340086)
20. S. Watson et al., "HB 1742: Medicaid Buy-in for Workers with Disabilities,"Missouri State Health Policy Brief no.2 (St. Louis: Missouri Foundation for Health, March 2006).
21. Qualified Medicare Beneficiaries (QMBs) are beneficiaries with incomes up to 100 percent of poverty for whom Medicaid pays Part B premiums as well as all cost sharing required by Medicare.
22. American Hospital Association, "Uncompensated Hospital Care Cost Fact Sheet," October 2006, http://www.aha.org/aha/content/2006/pdf/ uncompensatedcarefs2006.pdf (accessed 21 October 2008).
23. Supplemental payments, predominantly disproportionate-share hospital (DSH) payments, are made to hospitals in addition to reimbursement for direct service provision. Hospitals designated to receive DSH payments serve a disproportionate number of low-income or uninsured patients.
24. CHC expenses were not available for 2006. We estimated 2006 total expenses per patient by extrapolating from the 2005 and 2007 figures ($154 million and $179 million, respectively).
25. V. Smith et al., "Low Medicaid Spending Growth Amid Rebounding State Revenues: Results from a Fifty-State Medicaid Budget Survey, State Fiscal Years 2006 and 2007," October 2006, http://www.kff.org/medicaid/upload/7569.pdf (accessed 26 January 2009).
26. V. Young and J. Mannie, "Healthcare Stance a Liability for Blunt," St. Louis Post-Dispatch, 19 November 2007.
27. S. Peterson and R. Ehresman, "Medicaid Becomes MO Health Net: A Tiny Step on the Road to Real Reform" (Springfield: Missouri Budget Project, 11 June 2007).
28. The Ticket to Work Program and dental and optometric care are both subject to state appropriation. S. Peterson and R. Ehresman, "Missouri Medicaid Becomes MOHealth Net: A Summary of the Truly Agreed to and Finally Passed SB577," 23 May 2007, http://www.mobudget.org/MO%20Health%20Net%20 Summary%20May%20-07.pdf (accessed 15May 2008).
29. T. Kruckmeyer, "Missouri's 2007 Budget Falls Short of Adequately Funding Education, Healthcare" (Springfield: Missouri Budget Project, 22 May 2006).
30. There was more enthusiasm for a proposal called Insure Missouri, but there is doubt that this will play out now that Gov. Matt Blunt (R) has left office. J. Ferber "Insure Missouri: Early Observations" (St. Louis: Legal Services of Eastern Missouri, 11 October 2007).
31. V. Smith et al. "Headed for a Crunch: An Update on Medicaid Coverage, Spending and Policy Heading into an Economic Downturn: Results from a Fifty-State Medicaid Budget Survey for State Fiscal Years 2008 and 2009," September 2008, http://www.kff.org/medicaid/upload/7815.pdf (accessed 26 January 2009).
32. After growing by more than 11 percent annually between 2000 and 2005, Missouri's Medicaid spending growth slowed to less than 4 percent the following two years, according to data reported to the Centers for Medicare and Medicaid Services on Medicaid spending reports.