By Tara Mancini
Earlier this month, the Medicaid and CHIP Payment and Access Commission (MACPAC) released the Excel-friendly version of MACStats, the state-specific information on Medicaid and CHIP programs that accompanies the Commission’s semi-annual reports to Congress. Containing many items of interest, such as: Medicaid and CHIP enrollment by state, Medicaid benefit spending by state and category, CHIP spending by state, and an exclusive first look at CHIP allotments for FY 2013, its always fun to peruse MACStats. Of course, having the Excel version makes analysis much easier.
The data on spending and enrollment indicates that the growth rate for each continues to slow down; not surprising given other recent reports. In FY 2012, total Medicaid spending grew by about 1% and CHIP grew by less than 2%, to reach $435.5 billion and $12.2 billion, respectively. The number of individuals who were ever-enrolled during the year in Medicaid (even if for a single month) reached 72.6 million, an increase of less than 2%. CHIP enrollment reached 8.4 million, and increase of less than 3%.
Aside from the report’s statistics, Say Ahhh! readers are likely to be interested in MACPAC’s recommendations to Congress regarding Medicaid and CHIP eligibility. Raising concerns that some provisions of the ACA may have unintended consequences for beneficiaries of Medicaid and CHIP, the Commission’s recommendations serve to mitigate churning and maximize continuity of coverage. They recommend that Congress create a statutory option that allows states to implement 12-month continuous eligibility for children enrolled in CHIP, and adults enrolled in Medicaid; and permanently fund Transitional Medical Assistance (TMA), while allowing states that expand Medicaid to opt-out.
For instance, allowing states flexibility to extend 12-month continuous eligibility to adults in Medicaid and children in CHIP may alleviate churn that results from changes to income that affect program eligibility. (One study cited by the Commission indicated that within a six-month period, as many as 35% of adults in low-income families will experience such a change in income.) Twelve-month continuous eligibility is available as a statutory option only for children in Medicaid; however, 33 states are currently using it in CHIP. CMS is said be considering codification of 12-month continuous eligibility for CHIP so that it can continue as an option in 2014. States have implemented this option for adults through waivers or through the use of state-flexibility in disregarding changes in income. Reasoning that waivers create an administrative burden for states, and that state-flexibility in counting income will not be available once MAGI is implemented in 2014, MACPAC advocates that 12-month continuous eligibility be made available as a state plan option.
The recommendation to permanently fund TMA will finally end the uncertainty that is created by the program’s need for annual appropriations. In addition, in states that do not expand Medicaid, TMA will help prevent uninsurance for Medicaid enrollees that experience increases in income. Yet, allowing states that extend Medicaid to the newly eligible to opt-out of TMA can save states money. Last week, President Obama included this recommendation in his FY 2014 budget proposal.
