Key Facts: Medicaid & CHIP

Medicaid: Holes in the Low-Income Safety Net?

Utah’s Medicaid program is “minimalist” in several respects…

…The percent of the population that is covered by Medicaid is very low:

Percent of Population Covered by Medicaid
RANK ORDER: 1=lowest proportion of population covered by Medicaid

State	% Covered by Medicaid	Rank
New Hampshire	6	1
Colorado	7	2
Nevada	7	2
New Jersey	8	4
North Dakota	8	4
Virginia	8	4
Maryland	9	7
Minnesota	9	7
Delaware	10	9
Hawaii	10	9
Illinois	10	9
Kansas	10	9
Nebraska	10	9
Utah	10	9
Connecticut	11	15
Florida	11	15
Iowa	11	15
Montana	11	15
Pennsylvania	11	15
Wyoming	11	15
Idaho	12	21
Indiana	12	21
Ohio	12	21
Oregon	12	21
South Dakota	12	21
Texas	12	21
Washington	12	21
Wisconsin	12	21
Michigan	13	29
Missouri	13	29
North Carolina	13	29
Oklahoma	13	29
Georgia	14	34
Massachusetts	14	34
West Virginia	14	34
Alabama	15	37
Arkansas	15	37
Kentucky	15	37
Louisiana	15	37
South Carolina	15	37
Alaska	16	42
Arizona	16	42
California	16	42
New Mexico	17	45
Rhode Island	17	45
Tennessee	17	45
New York	18	48
Vermont	19	49
Maine	20	50
Mississippi	20	50
District of Columbia	21	51

Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey (CPS: Annual Social and Economic Supplements).

 One-third of Utah’s uninsured are eligible for Medicaid (or CHIP) but not enrolled. Efforts to retain enrollees or simplify enrollment are minimal at best.

Percent Reporting Lost Medicaid or CHIP as Reason for Being Uninsured


Source: Utah Department of Health (2001-06) Utah Health Status Survey.

Medicaid Minimalism…the portion of state funds devoted to Utah’s Medicaid program is one third the national average.  Utah may have the lowest per pupil funding in the nation, but the portion of state funds devoted K-12 public education is very high. This certainly leaves less funding for Medicaid, though there is more to the story.     

Distribution of State General Fund Expenditures, Utah vs. U.S.

Source: Kaiser Commission on Medicaid and the Uninsured. statehealthfacts.org

 

Medicaid Minimalism… Utah Medicaid pays very low reimbursements to providers—even providers of cost-effective primary care.  As one unfortunate result, Medicaid patients do not have timely access to primary and preventive care.  In fact, Medicaid enrollees are slightly more likely than the uninsured to make inappropriate (and expensive) visits to the E.R. The reasons for their visits to the E.R. should have been addressed in a less expensive primary care setting.

 

Primary Care Sensitive Visits to
Utah Emergency Rooms by Payer, 2001


Source: Utah Office of Health Care Statistics (2004). Primary Care Sensitive Emergency Department Visits in Utah, 2001. Salt Lake City, UT: Utah Department of Health.

 

Medicaid-to-Medicare Fee Index, 2003

Rank		Primary Care	Obstetric Care	Other Services
	United States	0.62	0.84	0.73
1	New Jersey	0.34	0.31	0.43
2	Rhode Island	0.34	0.50	0.50
3	New York	0.40	0.65	0.31
4	District of Columbia	0.35	0.94	0.41
5	Pennsylvania	0.43	0.90	0.61
6	Missouri	0.50	0.71	0.56
7	California	0.51	0.65	0.74
8	Michigan	0.63	0.60	0.60
9	Illinois	0.54	0.84	0.68
10	Florida	0.60	0.82	0.58
11	Maine	0.54	0.84	0.71
12	Indiana	0.60	0.77	0.79
13	Ohio	0.66	0.79	0.66
14	Texas	0.62	0.82	0.82
15	New Hampshire	0.67	0.96	0.54
16	Oklahoma	0.67	0.81	0.73
17	Louisiana	0.70	0.89	0.75
18	Utah	0.66	0.86	0.75
19	Colorado	0.68	0.86	0.75
20	Hawaii	0.71	0.79	0.76
21	Kansas	0.63	0.92	0.86
22	Kentucky	0.63	1.11	0.83
23	Virginia	0.73	0.84	0.77
24	Minnesota	0.64	0.82	1.14
25	Maryland	0.76	1.03	0.72
26	Massachusetts	0.72	0.98	0.75

Medicaid Enrollment by County, December 2006

County	Count	% Enrolled	% In poverty
BEAVER	896	13.9
BOX ELDER	4,008	8.7
CACHE	9,518	9.0
CARBON	3,114	15.9
DAGGETT	22	2.3
DAVIS	17,293	6.0
DUCHESNE	2,243	14.3
EMERY	1,277	12.2
GARFIELD	538	11.2
GRAND	1,400	15.5
IRON	6,013	13.8
JUAB	1,035	11.1
KANE	692	11.0
MILLARD	1,722	13.0
MORGAN	338	3.8
OUT OF STATE	70
PIUTE	297	21.6
RICH	125	5.9
SALT LAKE	77,716	7.8
SAN JUAN	3,119	21.3
SANPETE	3,612	14.0
SEVIER	3,067	15.3
SUMMIT	1,217	3.3
TOOELE	4,075	7.5
UINTAH	2,346	8.5
UTAH	35,138	7.4
WASATCH	1,144	5.4
WASHINGTON	12,156	9.0
WAYNE	288	11.4
WEBER	20,660	9.6
Total (state Average)	215,139	8.2

Source: Division of Health Care Financing, Utah Department of Health, 2006.

 

 

Assuming the need for Medicaid should reflect a community’s poverty burden more than it should reflect its share of the general population, Utah’s communities of color are under-enrolled in public programs.