Illinois Medicaid History and Facts

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Initial Medicaid Implementation: Illinois implemented Medicaid in January of 1966, five months after the Medicaid program was signed into law. Initially, Medicaid medical dependency levels were set at $3,600 for a family of four. The state imposed cutbacks to its program by January 1969 due to the high costs associated with their initial welfare eligibility levels. Additionally in 1969 the state transitioned from a closed panel system where only physicians that served welfare beneficiaries to one that allowed all beneficiaries to accept Medicaid. This increased the participation in the Medicaid program from 3,228 physicians in 1967 to over 6,000 physicians in 1969. An early audit in the program found that the state had used a significant amount of funds improperly in the first year that the program was open.

Key Medicaid Political Issues: The state has had a history of expansions and contractions of services following changes in the party in charge of the governor’s office and fluctuations in the state’s budget. For example, the state provided adult dental benefits and in the mid 1990’s the program was cut and then quickly restored until these were eliminated through a set of further reductions in 2012 and later restored in 2014. The current programs that have seen greater cuts in recent years are programs that assist the developmentally disabled community. Illinois has provided fairly generous benefits to residents and has worked to establish greater availability of birth control and Hep C treatment in recent years with mixed results. Illinois was also the first state to provide coverage to children.

 Medicaid Expansion Implementation: Illinois began their expansion of Medicaid on January 1, 2014 and opened enrollment the preceding October along with the state’s separately run Marketplace. As of August 2018, Illinois is the most recent state to pass Medicaid expansion through the legislature without a waiver or other modifications made to the Medicaid expansion, passing on July 22, 2013.

General facts about Illinois Medicaid:

Medicaid program name: Medicaid

CHIP Program name: ALL Kids

Separate or combined CHIP: Combination

Medicaid Enrollment: 3.1 million (2017 estimate)

Total Medicaid Spending: $19.3 billion (FY 16 estimate)

Share of total population covered by Medicaid: 19%

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 60%

FMAP: 51.3%

Expansion state: Yes

Number of people in expansion: 681,000

Work Requirement: No

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Idaho Medicaid History and Facts

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Initial Medicaid Implementation: Idaho initially implemented Medicaid in July 1966, one year after the establishment of the Medicaid program. The state was likely an early adopter of the Medicaid program because it had a more robust existing infrastructure. Prior to the establishment of Medicaid, Idaho paid doctors through “usual and customary” charging structure and this practice continued during the initial establishment of the program. The state’s Medicaid program is divided into three programs- Basic Medicaid Plan which is the MAGI population (pregnant women, adults, and children that qualify based on income), Enhanced Medicaid Plan (people with disabilities or other individuals with special needs), and the Coordinated Medicaid Plan (which serves people who are jointly eligible for Medicare and Medicaid). 

Key Medicaid Political Issues: Idaho has a small and largely rural population so issues surrounding coverage for these groups have been key in the program’s development. Like many states, Idaho responded to the growth of the role of the state in providing health coverage by consolidating services (public health, environmental, Medicaid, etc.) into the Board of Health and Welfare. 

Medicaid Expansion Implementation: Idaho has not expanded Medicaid and attempts to expand have failed in the legislature. Idaho is one of three states that will have voters decide whether the state should expand Medicaid through an initiative process. The signature gathering campaign has been active over the course of 2017 and 2018. In 2016 governor Butch Otter proposed a plan that would provide primary care services to people that fall in the coverage gap (do not qualify for Medicaid but fall below the 100% poverty level to receive subsidies. This plan ultimately failed to pass and died in committee. The governor is retiring so Otter’s proposal is not currently being discussed. Democratic and Republican legislative leaders have signaled support for the ballot initiative.

General facts about Idaho Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Idaho Health Plan

Separate or combined CHIP: Combination

Medicaid Enrollment: 294,500 (estimate 2017)

Total Medicaid Spending: $1.7 billion (FY 2016 estimate)

Share of total population covered by Medicaid: 18% (2015)

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 77%

Share of Spending on Elderly and people with disabilities: 61%

Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)

FMAP: 71.5%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: No

Hawaii Medicaid History and Facts

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Initial Medicaid Implementation: Hawaii implemented Medicaid in January 1966 which was the first opportunity that states had to implement the program and less than six months after the program was passed in Congress.

Key Medicaid Political Issues: Hawaii faces a unique challenge to its Medicaid program because of the law that requires the state provide Medicaid services to people living in territories and the island’s unique location near territories. In addition, the island’s geography makes its medical system more dependent on air transportation which drives up costs in the system. In 1974 Hawaii became the first state to implement an employer mandate which requires employers to offer health coverage plans to all employees working over 20 hours per a week. This lower requirement on number of hours worked has an impact on the state’s Medicaid expansion population with many Medicaid eligible individuals having the choice between employer plans and the state’s Medicaid program. Hawaii implemented one of the country’s first Medicaid 1115 waivers in 1994 to expand coverage for its State Health Insurance Program (SHIP) which covers uninsured residents. The state has a large portion of managed care participants.

 Medicaid Expansion Implementation: Hawaii expanded Medicaid with coverage beginning in January of 2014. The state has begun making some changes to its Medicaid expansion program to expand service for people lacking sustainable housing. The supportive housing plan would provide wrap around services to homeless residents and would focus on behavioral health and services for substance abuse and mental health. The state has limited availability of dentists that serve expansion enrollees. This means that low-income adult residents in the state have harder times seeing dentists and potentially worse health outcomes.

General facts about Hawaii Medicaid:

Medicaid program name: Med-QUEST, QUEST (MMCO) and Medicaid (FFS)

CHIP Program name: QUEST

Separate or combined CHIP: Medicaid Expansion

Medicaid Enrollment: 348,400 (March 2017 estimate)

Total Medicaid Spending: $2.2 billion

Share of total population covered by Medicaid: 18%

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 83%

Share of Spending on Elderly and people with disabilities: 52%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 54.9%

Expansion state: Yes

Number of people in expansion: 110,000 (2016 estimate)

Work Requirement: No

Georgia Medicaid History and Facts

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Initial Medicaid Implementation: Georgia was one of several states that did not take advantage of medical coverage provided by the Kerr-Mills bill, the program that provided reimbursement for low-income elderly medical costs. While Georgia established a program in 1961 it never drew down funds. Georgia initially implemented Medicaid in October of 1967, earlier than many of its neighbor states. The state did not initially establish a medically needy program, perhaps on the concern that the program would expand similar to Kerr-Mills programs in other states.

 Key Medicaid Political Issues: The state has been an early adopter of managed care with initially bringing in managed care programs into the state in 1993 and establishing the program statewide in 2006. The state has historically kept their cost per a beneficiary low in part because of the limitations on eligibility among certain high cost patients, potentially the high managed care penetration, and low Medicaid reimbursement rates. .

Medicaid Expansion Implementation: Georgia has faced little action surrounding the Medicaid expansion debate. The state legislature and governor’s office has been run by Republicans since 2012. There are a number of individual legislators that have introduced bills in recent years to expand Medicaid but they have largely failed to garner support. The Democratic nominee for governor, Stacey Abrams, is running on Medicaid expansion but it is unclear whether she has the authority to expand without legislative approval in the state. In 2014 the legislature prohibited the state from taking action on Medicaid expansion without the legislature’s approval and they also passed a law preventing state employees from advocating for Medicaid expansion.

General facts about Georgia Medicaid:

Medicaid program name:

CHIP Program name: PeachCare for Kids

Separate or combined CHIP: Separate CHIP

Medicaid Enrollment: 1.7 million

Total Medicaid Spending: $9.8 billion (FY2016)

Share of total population covered by Medicaid: 19%

Share of Children covered by Medicaid: 50% (estimate)

Share of Medicaid that is Children and Adults: 75%

Share of Spending on Elderly and people with disabilities: 45%

Share of Nursing Facility Residents covered by Medicaid: 75% (estimate)

FMAP: 67.9%

Expansion state: No

Number of people in expansion: NA

Work Requirement: No, proposal died in legislature

Florida Medicaid History and Facts

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Initial Medicaid Implementation: Florida initially implemented Medicaid in January 1970, the day following the federally imposed “deadline” to implement Medicaid, or the day after previous programs that paid for low-income populations would end. Florida had a fear that implementing Medicaid would lead to the state covering “indigent” care and the state initially did not include a program that would provide coverage to the medically needy population. The state later implemented this program.

 Key Medicaid Political Issues: Florida has continued to wrestle with the problem of a high number of people without insurance in the state. In 2005 the state developed a financing arrangement with the federal government to fund uncompensated care costs through a waiver, known as the Low-Income Pool (LIP) program. Part of this waiver also expanded the use of managed care in the state, beginning in select counties and expanding statewide starting in 2014.

Medicaid Expansion Implementation: Florida Governor Rick Scott has been at the center of the Medicaid expansion debate. A former health care executive, Rick Scott’s political career began in earnest through forming an organization to fight the Affordable Care Act. Once in office, Scott helped lead the charge to bring the court case to the Supreme Court and even prior to the decision to allow states to determine whether or not to take the Medicaid expansion he decided to reject any federal funding from the Affordable Care Act, even programs that had been in existence for many years. Scott initially opposed the expansion of Medicaid but prior to his re-election as governor he declared his support for Medicaid expansion. The bill ultimately failed in the state legislature. The state and the Obama Administration spent several years debating, both in court and through policy, the future of the LIP program. The state sued the Obama Administration to maintain the federal matching of the program. The two parties came to an eventual agreement to decrease funding for the LIP program over time. This deal, however, was overturned when the Trump Administration came into office. The LIP program was scheduled to be terminated after 2017 and under the latest waiver, funding will continue through 2022.

General facts about Florida Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Florida KidCare

Separate or combined CHIP: Combination

Medicaid Enrollment: 4.4 million (2016 estimate)

Total Medicaid Spending: $21.8 billion (FY2016)

Share of total population covered by Medicaid: 18%

Share of Children covered by Medicaid: 50% estimate

Share of Medicaid that is Children and Adults: 71%

Share of Spending on Elderly and people with disabilities: 64%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 61.1%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: No

District of Columbia Medicaid Facts and History

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Initial Medicaid Implementation: The District of Columbia began its Medicaid program in July 1968. The initial implementation faced a difficult beginning as only two of the ten hospitals in the district decided to join the Medicaid program. The hospitals objected to the low payment rates as the District proposed paying 80% of the costs initially. This dispute continued for a year until a deal was reached and coverage was available in all hospitals.

Key Medicaid Political Issues: The unique state and federal relationship of the district as well as the urban dynamic of the city have presented exceptional challenges for the District’s Medicaid program. In 1996 the District and Congress came to an agreement on how the District would finance its Medicaid program. The District has the most generous eligibility in the nation with the income eligibility levels often being above 200-300% of the poverty level. The District also has several programs adjacent to their Medicaid program that provides coverage for undocumented immigrants and people at higher incomes. The FMAP is set into federal law at 70% as a result of an agreement with the federal government in 1996. For the most part, DC is treated like a state in Medicaid law with the exception of some financing rules which are complex in part because of the complex nature of the role of Congress in the District’s budget.

Medicaid Expansion Implementation: The District expanded Medicaid early beginning enrollment in 2011. The state had an existing program that did not receive federal matching levels. The early expansion of the Medicaid program allowed the District to take advantage of federal funds, greatly reducing the financial burden to the District. DC later expanded Medicaid under the Affordable Care Act with the higher federal match and integration with the state’s individual market.

General facts about Medicaid in the District of Columbia:

Medicaid program name: Medicaid

CHIP Program name: DC Healthy Families

Separate or combined CHIP: Medicaid Expansion

Medicaid Enrollment: 271,500 (2017 estimate)

Total Medicaid Spending: $2.8 billion (FY 2016)

Share of total population covered by Medicaid: 26% (2016)

Share of Children covered by Medicaid: 50% (estimate)

Share of Medicaid that is Children and Adults: 73% (2014)

Share of Spending on Elderly and people with disabilities: 59% (2014)

Share of Nursing Facility Residents covered by Medicaid: 80% (estimate)

FMAP: 70%

Expansion state: Yes

Number of people in expansion: 62,600 (2016)

Work Requirement: No