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Native Americans and Medicaid: Coverage and Financing Issues

Native Americans and Medicaid:Coverage and Financing Issues

Prepared by Andy Schneider and JoAnn Martinez, The Center on Budget and Policy Priorities for The Kaiser Commission on the Future of Medicaid

December 1997

Table 1: Medicaid Eligibility Thresholds

Pregnant Women, Infants and Children (Effective October 1997) Other Eligibility Categories State Pregnant Women and Infants Children Under Age Six Children Ages Six and Older Upper Age Limit Asset Test Required Supplemental Security Income, 1996 Max. AFDC Payments (7/16/96) Medically Needy, 1996 (Percent of Federal Poverty Level) (Percent of Federal Poverty Level) Alabama 133 133 100 14 No 75 15 N/A Alaska 133 133 100 14 No 75 76 N/A Arizona 140 133 100 14 No 75 32 N/A Arkansas (a) (133) (200) 200 200 17 Yes 75 19 25 California 200 133 100 14 No 75 56 86 Colorado (b) 133 133 100 14 No 75 39 N/A Connecticut 185 185 185 16 No 75 81 71 Delaware 185 133 100 18 No 75 31 N/A District of Columbia N/A N/A N/A N/A No 75 N/A N/A Florida 185 133 100 14 No 75 28 28 Georgia 185 133 100 19 No 75 39 35 Hawaii (c,d) 300 300 300 19 No 67 57 57 Idaho 133 133 100 14 No 75 29 N/A Illinois (c) 133 133 100 14 No 48 35 45 Indiana (c,e) 150 133 100 18 No 73 27 N/A Iowa 185 133 100 14 Yes 75 39 52 Kansas 150 133 100 17 No 75 40 44 Kentucky 185 133 100 14 No 75 49 28 Louisiana 133 133 100 18 No 75 18 N/A Maine 185 133 125 19 No 75 51 42 Maryland (d) 185 185 185 14 No 75 34 40 Massachusetts 185 133 133 17 No 75 52 72 Michigan 185 150 150 16 No 75 45 52 Minnesota (c,d) 275 275 275 20 No 71 49 86 Mississippi 185 133 100 14 No 75 34 N/A Missouri (c) 185 133 100 18 No 71 27 N/A Montana 133 133 100 14 No 75 41 46 Nebraska 150 133 100 14 No 75 34 45 Nevada 133 133 100 14 Yes 75 32 N/A New Hampshire (c) 185 185 185 19 No 74 51 60 New Jersey 185 133 100 14 No 75 41 52 New Mexico 185 185 185 19 No 75 36 N/A New York (f) 185 133 100 14 No 75 61 76 North Carolina (c) 185 133 100 18 No 41 50 34 North Dakota (c) 13 133 100 18 Yes 62 40 47 Ohio (c) 133 133 100 14 No 63 32 N/A Oklahoma 150 133 100 14 Yes 75 28 42 Oregon 133 133 100 19 No 75 43 57 Pennsylvania 185 133 100 14 No 75 39 43 Rhode Island (d) 250 250 250 17 No 75 51 69 South Carolina 185 150 150 18 No 75 18 N/A South Dakota 133 133 100 19 No 75 47 N/A Tennessee (d) 400 400 400 17 No 75 54 23 Texas 185 133 100 14 No 75 17 25 Utah 133 133 100 18 No 75 53 53 Vermont (g) (200) (225) 225 225 17 No 75 59 81 Virginia 133 133 100 19 No 75 22 33 Washington (g) (185) (200) 200 200 19 No 75 50 62 West Virginia 150 133 100 19 No 75 24 27 Wisconsin 185 185 100 14 No 75 48 64 Wyoming 133 133 100 14 No 75 55 N/A

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Source: National Governors’ Association.Washington, DC. 1996 and 1997.

N/A Not applicable.

Note: The 1997 Federal poverty guideline for a family of three was $13,330; for Alaska $16,670 and Hawaii $15,330.

(a) In Arkansas pregnant women are covered up to 133 percent and infants are covered up to 200 percent of poverty.

(b) Colorado has dropped the asset test for pregnant women only.

(c) indicates state with a 209 (b) waiver, which permits it have different eligibility criteria for the Supplemental Security Income program.

(d) Hawaii, Maryland, Minnesota, Rhode Island, and Tennessee operate under 1115 waivers. Some populations receive fully

subsidized premiums while others are required to pay a portion of the premium and may have a different benefits package.

(e) Indiana is planning to reinstate the asset test for pregnant women.

(f) Payment standards in New York state vary across counties. The figures shown are for New York City.

(g) In Vermont pregnant women are covered up to 185 percent of poverty and infants are covered to 225 percent of poverty.

In Washington pregnant women are covered up to 185 percent of poverty and infants to 200 percent.

Table 2: Medicaid Managed Care Enrollment, by State (As of June 1996)

Total Medicaid Enrollment Medicaid Managed Care Managed Care Penetration Approved Medicaid Births, 1995 (b) State Enrollment Total Full-Risk PCCM (a) Full-Risk PCCM 1115 Waiver Number of Medicaid Births Percent of Total Births United States 32,176,785 11,721,807 7,711,275 4,010,532 24 12 19
states
1,213,943 39 Alabama 498,006 56,929 0 56,929 0 11 Yes 27,867 46 Alaska 87,550 0 0 0 0 3,282 32 Arizona 443,302 381,485 381,485 0 86 0 Yes 31,567 44 Arkansas 371,047 143,232 0 143,232 0 39 16,606 47 California 5,415,207 1,141,857 1,141,857 0 21 0 Yes 229,158 42 Colorado 259,949 136,462 71,419 65,043 27 25 17,277 32 Connecticut 311,884 186,837 186,837 0 60 0 10,931 25 Delaware 73,798 57,256 57,256 0 78 0 Yes 3,145 31 District of Columbia 125,000 69,200 37,650 31,550 30 25 n/a n/a Florida 1,538,007 980,371 390,286 590,085 25 38 Yes 79,969 45 Georgia 968,008 309,503 3,363 306,140 0 32 58,680 52 Hawaii 163,000 131,000 131,000 0 80 0 Yes n/a n/a Idaho 84,618 31,049 0 31,049 0 37 6,608 37 Illinois 1,399,372 179,863 179,863 0 13 0 Yes 65,000 35 Indiana 432,558 135,510 51,171 84,339 12 19 32,686 39 Iowa 226,701 93,791 27,293 66,498 12 29 11,892 32 Kansas 192,188 60,863 8,539 52,324 4 27 n/a n/a Kentucky 531,728 282,813 0 282,813 0 53 Yes n/a n/a Louisiana 801,930 44,772 0 44,772 0 6 34,863 53 Maine 157,881 1,316 0 1,316 0 1 n/a n/a Maryland 466,114 274,276 96,666 177,610 21 38 Yes 23,000 32 Massachusetts 654,000 378,183 87,288 290,895 13 44 Yes 17,335 21 Michigan 1,148,115 790,388 288,889 501,499 25 44 43,986 33 Minnesota 477,000 158,449 158,449 0 33 0 Yes 20,645 33 Mississippi 510,226 35,137 0 35,137 0 7 25,184 61 Missouri 637,897 214,896 207,701 7,195 33 1 29,318 42 Montana 79,000 46,891 635 46,256 1 59 4,266 38 Nebraska 144,305 39,651 22,129 17,522 15 12 6,819 29 Nevada 64,712 0 0 0 0 0 6,890 27 New Hampshire 72,158 11,828 11,828 0 16 0 2,099 21 New Jersey 706,812 302,618 302,618 0 43 0 n/a n/a New Mexico 331,808 147,767 0 147,767 0 45 14,276 53 New York 2,750,000 629,093 625,365 3,728 23 0 Yes 103,516 38 North Carolina 818,364 264,272 3,724 260,548 0 32 44,756 44 North Dakota 46,566 25,442 0 25,442 0 55 1,913 23 Ohio 741,910 239,306 239,306 0 32 0 Yes 56,940 40 Oklahoma 333,613 64,631 64,631 0 19 0 Yes 19,103 42 Oregon 383,334 290,479 290,479 0 76 0 Yes 14,865 35 Pennsylvania 1,612,905 852,265 516,299 335,966 32 21 n/a n/a Rhode Island 113,891 71,367 71,367 0 63 0 Yes 4,170 33 South Carolina 390,561 0 0 0 0 0 Yes 21,859 47 South Dakota 62,539 40,636 0 40,636 0 65 3,581 34 Tennessee 1,180,449 1,180,449 1,180,449 0 100 0 Yes 34,639 47 Texas 1,985,550 71,606 23,914 47,692 1 2 151,614 47 Utah 113,000 88,177 75,087 13,090 66 12 12,306 31 Vermont 82,650 0 0 0 0 0 Yes 2,615 39 Virginia 681,313 461,720 258,952 202,768 38 30 n/a n/a Washington 696,658 377,085 377,085 0 54 0 31,978 42 West Virginia 307,503 93,619 0 93,619 0 30 21,158 55 Wisconsin 463,142 147,218 140,395 6,823 30 1 24,025 36 Wyoming 38,956 249 0 249 0 1 2,737 44

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Sources: Urban Institute analysis of data from Health Care Financing Administration’s website.

Liska, D et al. “Medicaid Expenditures and Beneficiaries, 1990-1995.” Kaiser Commission on the Future of Medicaid. Washington, DC. 1997.

(a) PCCM refers to primary care case management plans.

Note: Includes managed care for a full-range of acute care services only. Does not include limited service plans such as mental health or dental only plans.

n/a Data not available.

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Native Americans and Medicaid: Coverage and Financing Issues
Report Part Four Report One Report Two Report Three