Five Medicaid Numbers in Five Days
October 21, 2011

Here’s a rundown of five Medicaid-related statistics released this week via several different official state sources…and why they matter as the Medicaid budget comes under fire once again:

1.92 million

What it is: The number of Florida Medicaid recipients currently enrolled either in managed care plans like HMOs (enrollment is mandatory in the five-county Medicaid Reform experiment) or the MediPass program, in which primary care providers perform that management function. These recipients are very low-income families with children and SSI recipients (both very low-income and disabled).

Why it’s significant:  This group is the portion (majority) of the Medicaid caseload that is most sensitive to changing economic conditions. The number of all such recipients peaked at 1.97 million in July and has decreased for 3 consecutive months.  Furthermore, current enrollment is only 1 percent higher than it was a year ago.

10.8 percent

What it is: The average increase for the coming year in capitated (per recipient) payments to be made to Medicaid HMOs for the care of recipients in the five-county Medicaid Reform experiment.

Why it’s significant: This compares with an average 1.3 percent rate increase throughout the rest of the state. HMOs explained the disproportionate increase as a function of hospital costs rising faster than actuaries had projected in the Reform counties.  More accurately, actuaries simply were not operating completely in the dark in Medicaid Reform for the first time since its 2006 launch, as “patient encounter data” that was to be used to set payment rates was at least available from hospitals. Even so, other types of encounter data aren’t available or aren’t ready, and the process for setting HMOs’ rates was once again an exercise in “sausage-making” that was completed months behind schedule. The upshot: the unknowns in Medicaid Reform continue to make statewide managed care expansion too risky.

$18

What it is: The average amount set aside for SSI recipients in Medicaid Reform (Broward County) to earn “enhanced benefit” credits as an incentive to perform healthy behaviors during the coming year.

Why it’s significant: One of the few pieces of the Medicaid Reform designed directly to benefit recipients rather than managed care plans was the provision allowing them to earn up to $125 worth of such credits each year. For the first time, the State is only reserving money to fund these credits based on past usage, taking millions of dollars that had been earmarked for recipients and giving them to managed care plans instead. Not only will this reduce opportunities for these patients with chronic health problems to earn credits, it creates a built-in incentive for plans to withhold credits when earned.

$933 million…

What it is:  The projected shortfall of state general revenue funds in Florida’s Medicaid program for 2012-13, according to state economists. The Legislature used short-term federal stimulus funds to replace far more long-term general revenue funding than necessary, putting the program and the Floridians who depend on it in a deep hole when those funds stopped flowing.

…and $135 million

What it is: The amount by which the state general revenue invested in Florida Medicaid four years ago exceeds the GR investment for this year.

Why they’re significant:  The Legislature has already warned that the shortfall will lead to another round of cuts to Medicaid in next year’s state budget. The appropriateness of such cuts as well as the continuing allegations that Medicaid spending remains out of control should be re-evaluated, not only in light of the fact that state GR funding for Medicaid is less in 2011-12 than in 2007-08, but also that that funding supports more than a million more recipients today than it did four years ago.

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New Census Estimates Provide Strong Testimonial for Medicaid
September 19, 2011

While newly released Census estimates painted a bleak picture for Floridians with respect to income levels and poverty rates in 2010, health insurance coverage rates, though still unacceptably low, actually improved slightly.  The difference-maker?  None other than public enemy No. 1 of the Florida Legislature: the Medicaid program.

Focusing on a few of the numbers:

·        The estimated percentage of Florida children who were uninsured in 2010 – 14.2 percent – was (statistically significantly) lower than in any other year since 2004.  In terms of raw numbers, the 2010 estimate of 576,000 uninsured kids came in 135,000 below 2009 levels, although Census  Bureau officials advise us not to make too much of single year comparisons. 

·        The estimated total number of uninsured Floridians decreased by a similar amount (142,000), from 4 million to 3.85 million. (As widely reported, that still left more than one in five - 20.7 percent – Floridians without coverage, the third highest rate of any state in the U.S.) 

Then, examining these numbers more closely:

·        Among children, the number covered by private health insurance coverage remained steady from 2009 to 2010, but nevertheless remained far below pre-recession levels. By contrast, the estimated number covered through Medicaid in 2010 jumped by 223,000.  This more than accounts for the decrease in the estimated number of uninsured kids.

·        Among all Floridians, the overall level of private health insurance coverage was statistically unchanged from the previous year.  At the same time, Census estimates show 330,000 more Floridians had to rely on (and be poor enough to qualify for) Medicaid coverage in 2010 than in 2009. Actual Medicaid enrollment figures are not inconsistent with these estimates.

The Census estimates therefore bring several important issues to light:

·        The resource that almost single-handedly prevented the “un-insurance” crisis to which we are “accustomed” from exploding into an even more dire threat to Florida and Floridians is Medicaid.  As families continued to lose income and coverage options, the Medicaid safety net caught them.

·        When legislative leaders lamented (incorrectly) that Medicaid is spiraling out of control, it is the fact that Medicaid has served as a safety net that they lamented.  And when they demanded flexibility from “oppressive” federal Medicaid requirements, it is the flexibility to cut Medicaid eligibility they sought.  For instance, the Senate’s version of last year’s Medicaid bill called for automatic eligibility cuts.

·        The Affordable Care Act (ACA) is key to Medicaid’s ability to prevent growth in the ranks of uninsured Floridians in the shorter term as well as to its ability to make a significant dent in un-insurance in Florida in the longer term. Specifically, it is the ACA’s “Maintenance of Effort” requirement that prevents Medicaid eligibility cuts, and it is the ACA’s Medicaid coverage expansion that will significantly reduce un-insurance among the lowest-income Floridians starting in 2014.

 

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Florida Jobs Fell in July, With Government Leading the Way
August 25, 2011

The loss of government jobs due to reduced budgets significantly impacted the Florida economy in July, highlighting a decline in total jobs in Florida of 22,100 from June to July.

Job losses in government made up half of the monthly decrease, with local governments leading the way.

The job backtracking in July dropped job growth since January to 64,300 – down from the 85,400 pointed to last month as significant progress against unemployment.  Jobs in leisure and hospitality – among the lowest-paid business sectors – account for a third of job growth since in 2011.

The 64,300 gain in jobs so far in 2011 is offset by a decline since January of 58,000 Floridians actively participating in the workforce.  These workers may have given up looking for work, at least temporarily, due to bleak job prospects.  By way of contrast, Floridians in the labor force increased by about 49,000 in 2010.

Elimination of more state and local government jobs in the months ahead will provide an additional drag on the overall number of jobs in the state.

The table below shows the number of jobs by business sector in March 2007, the peak before the recession, compared to jobs in January, June, and July numbers.  Total jobs gained or lost in 2011 are shown in the right column.

(Data from Agency for Workforce Innovation, Labor Market Statistics, Current Employment Survey, in cooperation with the U.S. Department of Labor, Bureau of Labor Statistics, nonagricultural employment, seasonally adjusted.  Sums may not add up to totals because some small industries are excluded.)  http://www.labormarketinfo.com/Library/CES.htm

 

Jobs in Florida

 

Job Sector

July 2011p

June 2011

January 2011

March 2007

2011 Gain/Loss

Total

7,225,800

7,247,900

7,161,500

8,142,900

64,300

Construction

330,700

336,500

332,500

650,800

- 1,800

Manufacturing

308,500

308,500

301,700

406,800

   6,800

Trade, Transportation, and Utilities

1,466,100

1,464,200

1,459,500

1,629,200

  6,600

Information

129,700

130,900

132,300

161,800

- 2,600

Financial Activities

467,800

469,200

465,900

552,300

  1,900

Professional, Business Services

1,043,900

1,045,400

1,024,200

1,226,600

19,700

Priivate Education Services

152,500

148,700

151,400

136,200

  1,100

Health Services

950,900

951,000

934,500

885,900

16,400

Leisure/Hospitality

957,500

962,300

936,100

1,100,100

21,400

Other Services

311,400

313,200

309,100

351,900

  2,300

Total Government

1,101,300

1,112,500

1,108,800

1,140,600

- 7,500

Federal

132,200

132,200

132,600

127,000

  - 400

State

215,800

217,300

220,000

219,800

- 4,200

Local

753,300

763,000

756,200

793,800

- 2,900

 

 

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