Pennsylvania Medicaid History and Facts

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Initial Medicaid Implementation: Pennsylvania began their Medicaid program on January 1, 1966, the first available opportunity for states to establish their Medicaid programs. Prior to the passage of the Medicaid program, Pennsylvania participated in the Kerr-Mills program. Collectively with four other states, Pennsylvania and these other large states accounted for nearly 2/3rds of the expenditures of the Kerr-Mills program. Pennsylvania set an annual income level of $4,000 for a family of four, making the program inaccessible to many low-income residents. The state’s Medicaid program was initially called “Pennsycare.” In the first year of the program’s implementation approximately 6% of the population or 583,000 people enrolled in Medicaid in the state. Following the reforms in 1967 that set a limit of 150% of AFDC levels for federal reimbursement, Pennsylvania decided to reduce eligibility to this level although Pennsylvania avoided that cutback by raising the AFDC levels in the state essentially maintaining eligibility levels and federal reimbursement. Under a proposed change that would have lowered the amount of federal reimbursement the state of Pennsylvania would have lost $30.5 million in the first year. One major change that Medicaid brought in the state was a reduction in the amount of uncompensated care. According to the Pennsylvania Medical Society, physicians provided more than $41 million in uncompensated care in 1960.

Key Medicaid Political Issues: Pennsylvania has had a generous benefit for children under their Children’s Health Insurance Program. The program would become a model for the federal legislation that would begin the CHIP program. In 1992 then Governor Robert P. Casey signed a law into the state that would provide health coverage to higher income families that are too wealthy to be eligible for Medicaid but uninsured because they do not make enough to afford health insurance. One sponsor of the bill in the state legislature included Alyson Schwartz who would later go on to become a Congresswoman in the US House and become an active leader in shaping CHIP policy in the House. Governor Corbett opposed changes to the CHIP program that would require certain income eligible enrollees to enroll in Medicaid rather than in the CHIP program. Ultimately, the governor conformed with the proposal and certain changes were made to the Medicaid and CHIP program to ensure that people who had received CHIP and moved to Medicaid benefits were not seeing a reduction in benefits. The state has also had a focus on providing wrap around services for psychiatric and substance use disorder. In 1997 the state implemented an integrated and coordinated care plan that carved out behavioral health services

Medicaid Expansion Implementation: When the Medicaid expansion went into effect and states were making decisions on whether or not to expand coverage, Pennsylvania had a Republican governor. Governor Corbett had been opposed to Medicaid expansion. He conceded in supporting Medicaid expansion, in part because his term was over in 2014 and several other Republican controlled states had expanded through a waiver. The early version of Corbett’s proposal included a work requirement that was later dropped after receiving a letter from the Obama Administration informing the governor that it would not approve a work requirement. The Republican governor nominee criticized Corbett in the general election for vetoing this policy. In August of 2014 the Centers for Medicare and Medicaid Services approved the state’s Medicaid expansion with a waiver that included benefit package changes for the expansion population and created new managed care options for Medicaid expansion enrollees. The plan would phase in premiums and additional cost-sharing in the second year of the plan. The expansion was implemented on January 1, 2015. Democratic governor Tom Wolf was elected in November of 2014 and on his first month in office, the Governor announced that the state would transition from the waiver expansion to an expansion without the complexities of the waiver. The plan would move the people who gained coverage from newly created managed care plans to managed care plans that existed through the Medicaid program prior to the implementation of the waiver.
General facts about Pennsylvania Medicaid:
Medicaid program name: Medical Assistance
CHIP Program name: CHIP
Separate or combined CHIP: Separate
Medicaid Enrollment: 2.9 million (2018 estimate)
Total Medicaid Spending: $28 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 19%
Share of Children covered by Medicaid: 37.5% (estimate)
Share of Medicaid that is Children and Adults: 62%
Share of Spending on Elderly and people with disabilities: 79%
Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)
FMAP: 52.25%
Expansion state: Yes
Number of people in expansion: 751,000
Work Requirement: No

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Oregon Medicaid History and Facts

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Initial Medicaid Implementation: Oregon implemented their Medicaid program in July of 1967.When the state began their Medicaid program the state did not offer benefits for the medically indigent. The Medicaid program was run under the Department of Human Resources’ Adult and Family Services Division until 1990. The Medical Consultant was first established in 1933 as part of the State Relief Commission. The duties were later transferred to the title of Administrator and control of regulation of hospitals and care for children with medical needs were added. The office was moved to be under the jurisdiction of the governor in 1971.

Key Medicaid Political Issues: Oregon has consistently been a leader in addressing coverage and expanding coverage prior to federal action. The movements began in 1987 under the leadership of then state Senator and future Governor John Kitzhaber. The legislature passed a series of laws known as the Oregon Health Plan. The plan extended coverage for people under the poverty level, instituted an employer mandate, create an insurance pool for people with pre-existing conditions, created a small business marketplace, regulated medical technology, add new programs for people with disabilities, and extend mental health coverage. In 1994 the state received the funding and approval to expanded Medicaid to all residents living below the poverty level enrolling 120,000 newly insured residents. The following year the state added mental health and substance use treatment services to the plan. The state also implemented a board to oversee drug utilization. The state’s reforms were extended through 2002 following a successful implementation. Some of these services were repealed in 2003 following economic constraints in the state. The state faced a number of constraints that led to enrollees being required to pay a premium to receive Medicaid services, Oregon implemented a waiver in 2008 that expanded Medicaid coverage to low-income childless residents in the Portland area that would have not otherwise been eligible for Medicaid coverage. There has been extensive research into the effects of this Medicaid expansion on the health of the population. Most notably it was found that newly insured were more likely to use the emergency room than people who did not gain Medicaid coverage and remained uninsured. The state has worked to improve care coordination and redirect people away from the emergency room. In 2012 the state began using Coordinated Care Organizations (CCOs) to improve the delivery of care by providing mental health, dental care, and other community based services and reimburse based on performance.

Medicaid Expansion Implementation: Oregon was one of a handful of states to implement policies to allow people to enroll in coverage more quickly if they were already proven to be eligible for another state run program. In January 23 of 2018 an initiative was brought before Oregon voters on how to fund the Medicaid expansion and where the tax revenue for the expansion would come from. The initiative was approved by the public. In 2017 the state moved to cover undocumented children in their Medicaid program. In 2016 the state added long-acting birth control as part of the covered benefits for the Medicaid expansion population.

General facts about Oregon Medicaid:

Medicaid program name: Oregon Health Plan

CHIP Program name: Healthy Kids

Separate or combined CHIP: Separate

Medicaid Enrollment: 962,000 (2018 estimate)

Total Medicaid Spending: $8.4 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 24%

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

Share of Medicaid that is Children and Adults: 83%

Share of Spending on Elderly and people with disabilities: 41%

Share of Nursing Facility Residents covered by Medicaid: 57% (estimate)

FMAP: 62.56%

Expansion state: Yes

Number of people in expansion: 557,000 (2018 estimate)

Work Requirement: No

Oklahoma Medicaid History and Facts

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Initial Medicaid Implementation: Oklahoma began their Medicaid program in January of 1966, the first available time that states could participate. Senator Kerr of the Kerr-Mills legislation represented Oklahoma. It was estimated that approximately 16% of the population would be eligible for Medicaid when the program began. After Medicaid was implemented an estimated 8% of the population had signed up within a year of the program beginning or approximately 195,000 people. When the program began, the state offered generous eligibility levels. In 1967 when the federal matching rate was restricted to only people earning under 150% of AFDC levels the state decided to reduce eligibility levels instead of pay state funds to maintain levels at the same rate. In 1968 the state was facing fiscal pressures as the Medicaid program spending was running ahead of expectations. The state continued to face financial pressure and in 1968 the cash reserves of the state’s welfare program were so low that the state was forced to ask for federal funds in advance of the payments in order to meet the needs of the Department. At that time the state reduced payment rates to hospitals and physicians and reduced eligibility levels. Medicaid beneficiaries were also encouraged to reduce or “carefully use” the amount of benefits that they used.

Key Medicaid Political Issues: Oklahoma faces issues around rural access to health care and low reimbursement rates for providers. In 1993 the state created the Oklahoma Health Care Authority to oversee the Medicaid program. Before that point the state had seen a rise in the number of beneficiaries in the late 1980s and early 1990s, in part due to the economic conditions at that time. The growth in enrollment was coupled with a growth in spending that nearly doubled the state’s budget. The state had proposed an increase on providers to fund the increase in spending but the proposal was defeated. Instead the state cut provider payments by approximately 5% and instituted limits on beneficiary use and adult dental benefits were eliminated. As part of these reforms, the state also began transferring the Medicaid system from a largely fee-for-service based approach to begin contracting with managed care companies. By 2004 there were not enough providers to operate the managed care program and the state was forced to terminate the program. The state has considered restoring their managed care program several times but remains one of the few states in the country without a managed care program to administer their Medicaid program. The state instituted broad tax increases on oil and natural gas to fund increasing costs in the Medicaid program in 2005. The state has been focused on updating their IT system for the last decade. The state has had a premium assistance program since 2005. The state has the highest proportion of Native American residents. While Native residents often receive their health care services through the Indian Health Service, many low-income residents are dependent on Medicaid coverage to pay for their health care outside of the IHS network or to receive services not available at IHS facilities.

Medicaid Expansion Implementation: Oklahoma has not expanded Medicaid as of January 1, 2019. Legislators in the state had made several attempts to expand. In 2016 there was a suggestion to use cigarette taxes to fund the Medicaid expansion. Instead, the state made cuts to their existing Medicaid program that impacted approximately 111,000 residents. In May of 2018 the legislature passed a work requirement bill that would impact the adults and parents currently covered by the Oklahoma Medicaid program. As of January 1, 2019 the Trump Administration has not yet approved their waiver or any state who has not extended coverage to individuals making at least 100% of the federal poverty level.

General facts about Oklahoma Medicaid:

Medicaid program name: SoonerCare

CHIP Program name: SoonerCare

Separate or combined CHIP: Combination

Medicaid Enrollment: 803,600 (November 2016 enrollment)

Total Medicaid Spending: $5 billion (FY 2015 estimate)

Share of total population covered by Medicaid: 17%

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

Share of Medicaid that is Children and Adults: 78%

Share of Spending on Elderly and people with disabilities: 57%

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

FMAP: 59.9%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: Under review