Even as Congress is trying to expand SCHIP/Medicaid coverage by $35 billion, the Kaiser Foundation just released a study indicating that Medicaid enrollment rates are growing more slowly than in past years. Among other things, the decline was driven by strong economic growth (gee, imagine that — economic growth as the solution to poverty); cost-containment measures (expect more of that if Hillary gets her way); and new requirements that prevent illegal aliens (or is that undocumented workers? foreign nationals? unauthorized persons?) from getting Medicaid benefits.
Indeed, as a result of the Deficit Reduction Act (DRA) passed by Congress in February 2006, three out of four states reported that “the new citizenship and identity documentation requirements have contributed to slowing enrollment growth.” As Kaiser notes, the DRA did not change eligibility requirements, but merely required states to verify citizenship using approved documentation — instead of, as was the practice in 47 states, allowing applicants to self-declare citizenship status.
Here in North Carolina, the state implemented several cost-containment measures over the past year, including: reducing provider payments (in some areas, with increases in others) and implementing pharmacy controls. The state also expanded eligibility in some categories (for foster children up to age 21, for instance). The state also continued to move from a capitated or per person managed care model (MCO or HMO) to a primary care case management (i.e., fee for service) system.
All that being said, don’t confuse an enrollment decline with a cut in spending. As Kaiser reports, states responded to the enrollment decline by adding additional services. Thus North Carolina’s budget for the Division of Medical Assistance (DMA), which administers Medicaid and NC Health Choice for the state, increased by $300 million, going from $2.6 billion for FY2007 to $2.9 billion for FY2008.