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Maryland How Do Premiums Affect Enrollment?. Tricia Roddy Maryland Department of Health and Mental Hygiene June 28, 2004. Maryland’s HealthChoice Program Provides Services To 75% Of All Medicaid Recipients. Managed Care Program – HealthChoice. Based on January 2004 enrollment. - PowerPoint PPT Presentation
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1
Maryland
How Do Premiums Affect Enrollment?
Tricia RoddyMaryland Department of Health and
Mental Hygiene
June 28, 2004
2
92,000
291,000
11,000
111,000
19,000 17,000
77,000
0
100,000
200,000
300,000
400,000
Adults Children MCHPChildren
MCHPPremiumChildren
Fee-For-Service -
Adults
Fee-For-Service -Children
NursingHome
Managed Care Program – HealthChoice
Maryland’s HealthChoice Program Provides Services To 75% Of All Medicaid Recipients
Based on January 2004 enrollment
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Budgetary Language Expanded Premium Requirements To More Recipients Prior to FY 2004
The income standard for MCHP Premium was between 200% and 300% of FPL
Premiums are set at 2% of the annual income of a family of two, regardless of the actual number of children
$41 for incomes between 200% and 250% of FPL
$52 for incomes between 250% and 300% of FPL
FY 2004 - General Assembly Budgetary Language
The income standard for MCHP Premium was expanded to include children with family income of 185% to 200% of FPL for FY 2004 only
Premiums were set at 2% of the annual income of a family of two at 185% of FPL, regardless of the actual number of children ($37 per family per month)
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The Number Who Disenrolled Was Lower Than Expected
An Urban Institute study estimated declines in enrollment of 16% when participants are charged premiums that equal 1% of family income, enrollment declines of about 49% if premiums equal three percent
In Maryland, the decline in enrollment (28%) was lower than expected for this population group
Source: Leighton Ku. “Charging The Poor More For Health Care: Cost-Sharing in Medicaid.” Center on Budget and Policy Priorities. May 7, 2003.
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Premium’s Impact On Enrollment Was Immediate and Somewhat Temporary
• Since December 2003, enrollment has been steadily growing
Between November 2003 and January 2004, enrollment grew by 10%
In a comparable period last year, enrollment was relatively static
As of March 31, 2004, 158 (or 9%) disenrollees have re-enrolled
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Department Conducted Survey To Study The Premium Expansion
• Determine the impact of the premium on enrollment
• Determine whether families had obtained other
health coverage since their children disenrolled • Determine whether there were differences
between enrollees and disenrollees in terms of utilization, family size, age, race/ethnicity, and geography
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Premium Not The Main Reason For Why Children Disenrolled
• 360 parents/guardians were surveyed in February 2004
• Key Findings
- A majority said the premium was not the main reason their child left MCHP
- 63% thought $37/month per family was affordable
- Over half said they had obtained other health insurance for their child
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While Enrolled, Children Who Disenrolled Were Less Likely to Access Services
83
.0%
69
.4%
52
.1%
33
.6%
34
.2%
29
.6%
43
.2%
76
.1% 8
1.7
%
60
.5%
44
.2%
40
.5%
33
.3%
49
.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
0 - <1 1 - 2 3 - 5 6 - 9 10 - 14 15 - 18 All
Disenrolled
Enrolled
Percentage of the Population Accessing Well-Child Services by Age, CY 2002
Source: Maryland encounter data
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Distribution of Family Size for Children in 185-200% FPL Families
Time Period One Two Three Four FivePrior to Premium 63.3% 27.0% 7.7% 1.7% 0.2%After Premium 54.3% 34.0% 9.5% 1.9% 0.3%Disenrolled Population 78.5% 16.2% 3.9% 1.3% 0.1%
Number of Children Enrolled per Family
Families with 1 child accounted for the majority of disenrollment between Sept. 03
and Jan. 04
Families With More Than One Child Were More Likely To Stay On The Program
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Racial/Ethnic Distribution of Children who Disenrolled Compared to Children who Remained Enrolled (12/31/03)
52%
32%
9%
3% 4%
44%
39%
11%
3% 4%
0%
20%
40%
60%
80%
100%
African-American Caucasian Hispanic Asian Other
Disenrolled
Enrolled
A Slightly Larger Proportion Of African-Americans Disenrolled
Source: Maryland encounter data
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Age Distribution of Children who Disenrolled Compared to Children Who Remained Enrolled (12/31/03)
5%
13
% 18
%
20
% 25
%
20
%
2%
12
% 19
%
22
% 27
%
19
%
0%
20%
40%
60%
80%
100%
0-1 1-2 3-5 6-9 10-14 15-18
Disenrolled
Enrolled
Very Little Difference With Regard To Age Distribution
Source: Maryland encounter data
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Regional Distribution of Children Who Disenrolled Compared to Children who Remained Enrolled (12/31/03)
18%
32%
8% 5%
34%
4%
18%
27%
10%
6%
32%
6%
0%
20%
40%
60%
80%
100%
Baltimore City BaltimoreSuburban
Eastern Shore SouthernMaryland
WashingtonSuburban
WesternMaryland
Disenrolled
Enrolled
Little Differences Among Geographic Regions
Source: Maryland encounter data
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Lessons Learned
Survey findings indicate that the premium did not cause the majority of disenrollments
Most of the disenrolled had obtained other insuranceDisenrolled children used fewer services while
enrolledDisenrolled children were more likely to be in families
with only one child enrolledThere were few differences between enrolled and
disenrolled children with regard to age, race/ethnicity, or region
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What Does This Mean For Maryland?
Cost sharing should be explored before making more serious cuts, such as reductions in services and eligibility
CMS should reevaluate its cost sharing policies
Cost sharing should be explored when designing new programs to cover more of the uninsured