Medicaid in Rural Missouri April 7, 2006

1. Medicaid in Rural MissouriApril 7, 2006 Amy Lake Community Policy Analysis Center University of Missouri-Columbia 230 Middlebush Hall Columbia MO 65202 lakea@missouri.edu or 573-882-5412 http://www.cpac.missouri.edu/

2. Missouri Medicaid Chart Book The Missouri Medicaid Program: A Graphical Profile Medicaid Work Group, University of Missouri--Columbia August 2005 http://oseda.missouri.edu/medicaid/

3. Total Medicaid Enrollment, FY2001 NATIONAL MAPS More than a million people were enrolled in Missouri Medicaid in 2001

4. Percent of the Population Enrolled in Medicaid, 2001 NATIONAL MAPS Almost one-fifth of Missourians were enrolled in Medicaid in 2001

5. $5.7 billion = Total Medicaid Expenditures in Missouri (SFY 2004) $3.7 billion in Federal Funds $2.0 billion in Missouri funds (GR and other) Federal and State Medicaid Expenditures 2004 Source: Kaiser Foundation

6. Missouri Medicaid Expenditures by Enrollment Group, FY2005 MISSOURI CHARTS Total Enrollees992,622 Total Expenditures$5,557,804,149 Children accounted for 55% of enrollees, but only 20% of expenditures Note: Other includes Medicaid Assistance to Pregnant Women and the Breast or Cervical Cancer Program. Source: MoDSS Summary Table 5, FY2005.

7. Missouri Medicaid Expenditures by Type of Service, FY2005 MISSOURI CHARTS (in billions of $) Pharmacy is the largest category of costs to Missouri Medicaid Note: All other includes rehabilitation & specialty care, EPSDT, buy-in premiums, and dental services. Source: MoDSS Summary Table 5, FY2005.

8. Percentage of Missouri Population in Poverty, 2002 MISSOURI MAPS Poverty is concentrated in the southeast, south central, northeast regions of the state and in St. Louis City

9. Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

10. 28%-40% of the populations in 12 NON-METRO counties are enrolled in Medicaid The 2 METRO areas with the highest Medicaid enrollment are Washington Co and St. Louis City with 28% of overall population enrolled Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

11. For 17 NON-METRO counties, 50%-78% of children enrolled in Medicaid For METRO areas, only St. Louis City has over 50% of children enrolled in Medicaid Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

12. 55 NON-METRO counties had over 10% of population aged 20-64 enrolled in Medicaid. 11 rural counties had over 19% of adults enrolled. 8 METRO areas had over 10% of adults enrolled, with a high of 19%. Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

13. 15 NON-METRO counties had over 20% of elderly enrolled in Medicaid, and 56 had over 12.8% Only 1 METRO area (Washington Co.) had over 20% of elderly population enrolled in Medicaid. 8 METRO counties over 12.8 % Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

14. 24 NON-METRO counties had over 5% of overall population enrolled in Blind/ Disabled Medicaid Only 1 METRO area (Washington Co.) had this level of enrollment Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA), USDC Bureau of the Census, Federal Office of Rural Health Policy

15. Total Medicaid Expenditures by County, FY2004 MISSOURI MAPS Total expenditures were $4.8 billion in 2004

16. Medicaid Expenditures per Capita by County, FY2004 MISSOURI MAPS Per capita expenditures ranged from $326 to $2,425, reflecting the relative need of the population

17. Estimated 120,000 people affected by changes since July 1, 2005 (and Sept. 1, 2005) Medicaid eligibility changes/ reductions: People with disabilities (working, transitional, Permanently and Totally Disabled) and Old Age Low income parents (eligibility reduced from 75% Federal Poverty Level to 22% FPL) Medical services and equipment reduced Increased cost sharing for recipients = increased monthly premiums and increased “spend downs” MO Medicaid Changes

18. Percent of County Population Affected by Changes in Medicaid Provisions, FY2006 MISSOURI MAPS Missouri’s poorest regions will have the highest percent of population impacted by the recent changes in Medicaid provisions

19. Change in Medicaid Enrollment for Blind / Disabled from 2/05 and 1/ 06 was 4,391 decrease Total change Medicaid Enrollmentapproximately 117,000 decrease Source: Dept of Health and Senior Services, Missouri Information for Community Assessment (MICA),

20. The concentration of health and social services firms that employ less than 10 people is highest in Missouri’s rural counties 72% of health and social services firms in rural counties and 70% in urban counties have less than 10 employees Source: 2003 County Business Patterns and Federal Office of Rural Health Policy

21. Firms with less than 20 employees made up 90-100% of all health and social services employers in 15 rural Missouri counties 84% of health and social services firms in both rural and urban counties have less than 20 employees Source: 2003 County Business Patterns and Federal Office of Rural Health Policy

22. Rural areas tend to have fewer options for employer-based health insurance Health insurance companies tend to levy high premiums, deductibles, exclusions on farmers and small businesses Rural health care providers tend to be small businesses themselves. They may be paying high costs for health insurance and/or sharing the high cost with employees Things to consider…

23. Significant program changes are happening both in Medicaid in MO and in Medicare Part D (prescription drug program) nationally Rural populations tend to be older and sicker than urban counter parts Health care providers are spending time and resources helping individuals find ways to pay Pharmacies in rural areas are more often independently owned than in urban areas – Medicaid and Medicare Part D have been challenging for all pharmacies Things to consider…

24. Rural providers are currently being called on to provide more free / un-reimbursed /discounted care Rural providers may depend heavily on Medicare and Medicaid Rural providers may have smaller total profit margins so they may have less ability to absorb significant financial losses Things to consider…

25. Health Professional Shortage Areas HPSAs Source: DHSS Primary and Rural Health

26. Medicaid Reform Commission http://www.senate.mo.gov/medicaidreform/ Missouri Hospital Association http://web.mhanet.com/asp/Governmental_Relations/Medicaid.asp Dept of Social Services Reading Room Statistics http://www.dss.mo.gov/rr_stats.htm Dept of Social Services http://www.dss.mo.gov/pr_health.htm MU Center for Health Policy http://healthpolicy.missouri.edu/publications.htm MO Information For Community Assessment (MICA) DHSS http://www.dhss.mo.gov/MICA/nojava.html Missouri Foundation For Health http://www.mffh.org/policy_medbasics.html Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/ Other Resources