Spending and enrollment growth in Medicaid, a health-care program for poor and disabled people, slowed “substantially” in the 2011-12 fiscal year across the country as states continued their work to control costs and the economy started to improve, according to a new study by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.
Average spending increased by an average of 2 percent in the 2011-12 fiscal year, compared to 9.7 percent the previous year. The spending growth was among the lowest recorded; it was 1.3 percent in 2006. Medicaid enrollment increased by an average of 3.2 percent nationwide, down from 4.4 percent in the 2010-11 fiscal year. The end of American Recovery and Reinvestment Act funding in the 2011-12 fiscal year likely contributed to the slower spending growth, according to the report, which was conducted with Health Management Associates.
“After several economically depressed years in which high demand for public programs and slumping tax revenue created intense pressure on state Medicaid programs, last year saw total Medicaid spending growth hit a near record low,” said Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Commission on Medicaid and the Uninsured.
Medicaid spending in New York (federal, state and local) was $54.2 billion in the 2011-12 state fiscal year and is $54 billion in the current fiscal year. Gov. Andrew Cuomo created a Medicaid Redesign Team that worked in 2011 and this year to reduce costs and improve care.
Enrollment in the 2012-13 fiscal year nationwide is expected to increase an average of 2.7 percent, a slower rate than this year, according to the commission’s survey of states. State lawmakers have authorized state and federal spending growth of 3.8 percent for the 2012-13 fiscal years. Average enrollment in New York for the 2011 calendar year was 4.9 million, according to the state Health Department.
The report noted that the financing role of counties has become an issue in some states, such as New York, Iowa and North Carolina, as the fiscal burden for Medicaid has increased. Lawmakers in those states have adopted measures to reduce the local financial obligation for Medicaid. Most states don’t require counties to pay for a portion of Medicaid.
As the fiscal burden has increased, the financing role of counties has become an issue in some states—such as Iowa, New York, and North Carolina—where legislatures have enacted measures to phase down the local financial obligation for Medicaid.
Changes New York implemented in the 2011-12 fiscal year included expanding coverage of podiatry services for adults with diabetes; adding coverage of obesity counseling, home lead investigations and environmental asthma investigations; expanding language interpretation services; adding coverage for counseling of eligible pregnant women; and expanding coverage of Nurse Family Partnership home visits for pregnant women and new mothers.
New York’s Medicaid program eliminated coverage of certain arthroscopy for osteoarthritis of the knee; ended coverage of treatments for lower-back pain when there is no benefit or evidence of benefit; and stopped covering growth hormones for idiopathic short stature.
Other survey findings include:
—Forty-eight states implemented at least one cost-control measure and 47 planned to do so in the 2012-13 fiscal year. New York was one of seven states that enacted new dosage or quantity limits for prescription drugs. Others were Alaska, Georgia, Indiana, Maine, Tennessee and Vermont.
—Twenty states said they expanded Medicaid managed care in the 2011-12 fiscal year, and more than two-thirds planned to do that in the 2012-13 fiscal year. Other strategies states are using include care coordination for people with chronic conditions. Seven states, including New York, had created health-home initiatives to improve care for people with complex health needs.
—Nineteen states, including New York, are applying for a waiver from Medicaid regulations as they seek to provide care that is innovative and more efficient. The report notes the approval process can be lengthy. New York has submitted its application Aug. 6.