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Expansion of Public Insurance for Adults: SCHIP and Medicaid/QUEST

Expansion of Public Insurance for Adults: SCHIP and Medicaid/QUEST. Gerard Russo Sang-Hyop Lee Lawrence Nitz University of Hawai `i at M ānoa Hawai`i Coverage for All Project Technical Workshop III 23 May 2003. POLICY SCENARIO: SCHIP Adults.

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Expansion of Public Insurance for Adults: SCHIP and Medicaid/QUEST

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  1. Expansion of Public Insurance for Adults: SCHIP and Medicaid/QUEST Gerard Russo Sang-Hyop Lee Lawrence Nitz University of Hawai`i at Mānoa Hawai`i Coverage for All Project Technical Workshop III 23 May 2003 This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation.

  2. POLICY SCENARIO:SCHIP Adults Extend State Children’s Health Insurance Program eligibility to the parents of children aged 0-18 years residing in households with incomes less than or equal to 200% of the Federal Poverty Line. This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation.

  3. Social Security Amendments • Medicare: Title XVIII of the Social Security Act 1965 • Medicaid: Title XIX of the Social Security Act 1965 • SCHIP: Title XXI of the Social Security Act 1997 Preliminary results. Not for quotation, citation nor further dissemination.

  4. SCHIP FMAP • Federal Medical Assistance Percentage (FMAP) • FFY 2002 69.44% • FFY 2003 71.14% Preliminary results. Not for quotation, citation nor further dissemination.

  5. Adult SCHIP Demonstration States • Arizona • Minnesota • New Jersey • Rhode Island • Wisconsin Preliminary results. Not for quotation, citation nor further dissemination.

  6. Econometric Model: Multinomial Logit • Mutinomial Logit to Estimate the Probability of Coverage • Three Categories • Uninsured • Private Insurance & Other • Medicaid QUEST • Predictor Variables • Age • Sex • Income • County • Race/Ethnicity • Health Status (some models) • Employment Status (some models) Preliminary results. Not for quotation, citation nor further dissemination.

  7. Methodology for Predicting the Effect of Changing Eligibility • Step I: Estimate multinomial logit model on a sample of adults with eligible children where the adults are also eligible (i.e., 0-100% FPL). • Step II: Estimate multinomial logit model on a sample of adults with eligible children where the adults are ineligible (i.e., 100-200% FPL). • Step III: Predict with Model I and Model II with the characteristics of the target population (i.e., adults with SCHIP children 100-200% FPL). Preliminary results. Not for quotation, citation nor further dissemination.

  8. Economic-Demographic Analysis of Adult SCHIP Expansion • How many additional adults are potentially eligible for free medical assistance under the SCHIP Expansion from 100% to 200% FPL? • 35,756 adults based on CPS 1996-2002 • Of the newly eligible adults, how many are expected to be enrolled in SCHIP? (Take-Up) • 7831 adults based on model estimate CPS 1996-2002 • Of the newly enrolled SCHIP beneficiaries, how many are expected to have switched from private to public insurance? (Crowd-Out) • 4255 adults based on model estimates CPS 1996-2002 • How many adults will become newly insured? • 3576 adults based on model estimates CPS 1996-2002 Preliminary results. Not for quotation, citation nor further dissemination.

  9. Econometric Prediction of Insurance Coverage Change due to Adult SCHIP Expansion: CPS 1996-2002 Preliminary results. Not for quotation, citation nor further dissemination.

  10. Econometric Prediction of Insurance Coverage Change due to Adult SCHIP Expansion: CPS 1996-2002 Preliminary results. Not for quotation, citation nor further dissemination.

  11. Incurred Per Capita Expenses 2001: Uninsured SCHIP Adults Age 19-64, 100-200% FPL Preliminary results. Not for quotation, citation nor further dissemination.

  12. Economic Cost Analysis • What is the expected direct expenditure per newly enrolled beneficiary? $3000 • Burden to Federal Taxpayers $2134 • Burden to State Taxpayers $866 • What is the current total medical expenditure by all sources per uninsured adult residing in SCHIP households 100-200% of FPL? • $388 Preliminary results. Not for quotation, citation nor further dissemination.

  13. Economic Cost Analysis (cont.) • What is the cost per newly insured adult? • Cost to Federal Taxpayers • Cost to State Taxpayers • Cost to Society as a Whole • What is the total cost of the SCHIP expansion? • Cost to Federal Taxpayers • Cost to State Taxpayers • Cost to Society as a Whole Preliminary results. Not for quotation, citation nor further dissemination.

  14. Burden to Federal and State Taxpayers • Direct Cost of SCHIP Expansion $3000*7831=$24,493,000 • Federal Share 71.14%: $2134*7831=$16,711,354 • State Share 28.86%: $866*7831=$6,781,646 • Direct Cost per Newly Insured Adult $6849 • Federal Cost per Newly Insured Adult $4873 • State Cost per Newly Insured Adult $1976 Preliminary results. Not for quotation, citation nor further dissemination.

  15. Net Cost to Society as a Whole Preliminary results. Not for quotation, citation nor further dissemination.

  16. Policy Scenario:Medicaid/QUEST Adults Extend Quest eligibility to adults with incomes less than or equal to 200% of the Federal Poverty Line This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation.

  17. Medicaid/QUEST FMAP • Federal Medical Assistance Percentage (FMAP) • FFY 2003 58.77% Preliminary results. Not for quotation, citation nor further dissemination.

  18. Where we are now: Distribution of Insurance in 2001, BRFSS Survey Preliminary results. Not for quotation, citation nor further dissemination.

  19. Two models • Test Case: Compute a predictive equation on the 0% to 100% FPL population • Estimate the distribution of insured among the 100%-200% FPL population using this equation • Base Case: Compute a predictive Equation on the entire sample • Estimate the distribution of insured among the 100% -200% FPL population Preliminary results. Not for quotation, citation nor further dissemination.

  20. Predictions of changing Medicaid ceiling to 200% of FPL Preliminary results. Not for quotation, citation nor further dissemination.

  21. Implications for Changing Adult Eligibility • From the ideal base case, raising the eligibility floor to 200% FPL brings the Medicaid coverage from 5% to 9.9% • The same change in eligibility also raises the percentage of uninsured from 3% to 8.9% • 10.8% of the target population will switch from private or other health insurance to Medicaid Preliminary results. Not for quotation, citation nor further dissemination.

  22. Problematic Issues • The whole population model may not be the best indicator of the base case for the 100% to 200% FPL household’s insurance decision • The multivariate logistic regression for the 0% to 100% FPL population may identify behavioral patterns unrelated to the policy difference—the zero monetary cost of Medicaid coverage Preliminary results. Not for quotation, citation nor further dissemination.

  23. Open Questions • How can we more cleanly separate the economic decision to acquire a particular health insurance coverage from other motivations or experiences in the target population? • Do systematic differences in the underlying surveys lead to different results in the CPS and BRFSS? Preliminary results. Not for quotation, citation nor further dissemination.

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