Medicaid. (Title XIX and Title XXI) STATE REPORTS FY 2008 TEXAS. Text7:

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1 Medicaid STATE REPORTS FY 2008 (Title XIX and Title XXI) Text7:

2 General Information about CMS/MSIS2082, main data source of this report: [Based on Center for Medicare and Medicaid Services(CM) description of Medical Statistical Information System(MSIS) data] CMS/MSIS2082 data represent people on the Medicaid rolls, recipients of Medicaid services and the payments for claims adjudicated during the year. The data reflected bills adjudicated, or processed, during the year rather than the services used during the year. States submit individual eligibility and claims data tapes to CMS on a quarterly basis via MSIS (the Medicaid Statistical Information System). Starting FFY1999, CMS started reporting Title XXI funded Medicaid expansion enrollment and expenditures data on MSIS2082 reports. As a result, use caution when comparing FFY1999 and later Medicaid State Reports to prior years. Caveats: The general quality of the data is only as reliable as the data submitted to CMS by States. Federal edits are performed to validate individual data elements, check consistency between data elements and verify reasonableness of distributions between reporting periods. Payments, or vendor payments, from MSIS include dollars for all claims adjudicated during the fiscal year. Vendor payments reported include capitated payments for managed care plans. MSIS payments do not agree with the CMS-64 financial figures because they do not include payments made outside the claims processing system (e.g., payments made to disproportionate share (DSH) hospitals) and differences in accounting time lags. MSIS slightly understates reporting for children under age 1. Many children born in August and September are omitted from MSIS because these newborns may not be added to the State eligibility file until after the end of the fiscal year. State-only SCHIP enrollees are excluded from the tables. There are no Medicaid dollars associated with these individuals while they are in the separate SCHIP program. Hawaii and Utah data is based on FFY2007. Data for these 2 states were unavailable as of publication of this report. Refer to CMS document titled MSIS State Anomalies/Issues: All States (accessible from URL: /02_MSISData.asp ) for details on state specific data anomalies and other data issues. CONTACT INFORMATION Contact Suk-fong Tang, Department of Practice, with comments about the report; contact Dan Walter, Division of State Government Affairs, for Medicaid questions and advocacy advice. FY1994 to FY2005 Medicaid State Reports are also available in Adobe Acrobat PDF format on the AAP Web site, at /medicaid.htm

3 Medicaid State Report FY 2008* (October 1, September 30, 2008) I. MEDICAID ENROLLEES AND EXPENDITURES* AR, LA, OK & TX are included in the West South Central Region A. Federal Medical Assistance Percentage (FMAP)** 60.5%, 72.4% 70.9%, 71.1% (FY08 FMAP, Enhanced) (FY10 FMAP, Enhanced) B. FY 2008 Total Medicaid Enrollment and Expenditures*** 4,278,318 / $16,657M C. Total Medicaid Managed Care^ Enrollment, 06/30/2008 2,116,493 ( % of Total Medicaid Enrollment) (69.6% of 3,041,201^^) D. Percent of Births Paid for by Medicaid, Average^^^ 49.2% E. FY 2008 and FY Averaged DSH## Payment $1,458.8M / $1,475.6M F. Enrollee through Age 20, FY 2007 Enrollees (as Proportion of Population) Through Age 18 2,928,047 2,804,650 ( 38.3% of 7,638,650 ) ( 40.4% of 6,945,781 ) Through Age 5 1,310,964 ( 54.4% of 2,410,471 ) Infants Ages 1 through 5 Ages 6 through ,726 1,047,238 1,493,686 ( 64.0% of 411,961 ) ( 52.4% of 1,998,510 ) ( 32.9% of 4,535,310 ) Ages 6 through 14 1,120,467 ( 35.7% of 3,138,746 ) Ages 15 through ,219 ( 26.7% of 1,396,564 ) Ages 19 and ,397 ( 17.8% of 692,869 ) G. Enrollment, Expenditures*** and Per-enrollee Payment, by Age Group, FY 2007 % Total Enrollees~ % Total Expenditures~ Per Enrollee Payment 68.4% 45.6% $2,593 Through Age % 43.3% $2,571 Through Age % 22.9% $2,915 Infants 6.2% 6.5% $4,136 Ages 1 through % 16.4% $2,607 Ages 6 through % 20.3% $2,269 Ages 6 through % 14.3% $2,126 Ages 15 through % 6.1% $2,701 Ages 19 and % 2.3% $3,080 Age 21 or Older 31.6% 53.8% $6,642 Age 65 or Older 10.2% 19.1% $7,290 H. Non-Blind/Disabled Enrollees: Enrollment and Per-enrollee Payment** FY2007 Number of Enrollees Per Enrollee Payment 2,788,613 $2,084 Through Age 18 2,679,237 $2,090 Notes: * Includes Title XIX Medicaid programs and Title XXI funded Medicaid expansions. Data for HI and UT based on FY2007. ** Regional and US averages of standard and enhanced FMAPs are weighted by total FY2008 Title XIX and Title XXI Medicaid expenditures, respectively. *** Expenditures include Medicaid vendor payments, health plan premiums, capitation and HMO payments reported by the states to CMS. All expenditures include federal and state shares. ^ Includes Primary Care Case Management. ^^ Pointin-time enrollment on 06/30/2008, at 3.0M, was 71.1% of 4.3M total annual enrollment state(s) reported to CMS for FY ^^^ Data for NJ, NM, NV and TX are based on 2002 only. ## Disproportionate Share Hospital Payments. ~Percents may not sum up to 100% due to missing age information for some beneficiaries and unassigned claims.

4 MEDICAID STATE REPORT FOR, FY2008* Page 2 II. MEDICAID* SERVICE UTILIZATION A. Payments by Age and Type of Service** Physician Services Dental Services Clinic Services Other Practitioner Services Outpatient Hospital Inpatient Hospital Intermediate Care Facilities (ICF-MRs)^ Nursing Home Mental Health Facility Services Personal Care Services Home Health Services Lab and X-Ray Prescribed Drugs Capitated Payment Primary Care Case Management Services Sterilization Services Other Care Services~ Total~~ B. Average Payments per User of Service and Percent of Enrollees Using Each Service** CHILDREN Under 21 ADULTS 2.8% 4.6% 0.1% 0.4% 0.2% 0.4% 0.2% 0.9% 0.7% 6.8% 5.5% 0.3% 5.4% 11.6% 0.3% 2.5% 2.3% 0.9% 1.3% 6.7% 5.3% 14.0% 7.2% 0.1% 1.7% 11.6% 45.6% 53.8% CHILDREN Under 21 ADULTS Per-user %Use+ Per-user %Use+ Physician Services $ % $ % Dental Services $ % $ % Clinic Services $ % $ % Other Practitioner Services $ % $ % Outpatient Hospital $ % $ % Inpatient Hospital $5, % $4, % Intermediate Care Facilities (ICF-MRs)^ $68,827 $78, % Nursing Home $21,769 $21, % Mental Health Facility Services $9, % $21,835 Personal Care Services $1, % $2, % Home Health Services $4, % $1, % Lab and X-Ray $ % $ % Prescribed Drugs $ % $1, % Capitated Payment $1, % $3, % Primary Care Case Management Services $8 29.8% $8 10.5% Sterilization Services $1,733 $1, % Other Care Services~ $ % $5, % Total $2, % $8, % * Includes Title XIX Medicaid programs and Title XXI funded Medicaid expansions. Data for HI and UT are based on FFY2007. ** Services included in each service category are defined in the CMS document: MSIS Tape Specifications and Data Dictionary, p156 (URL: ~ May include, but are not limited to, Home and Community Waiver, prosthetic devices and eyeglasses. ~~ Expenditures do not sum to 100% due to unassigned claims and missing service recipient data. + Sum of percents may exceed 100% since enrollees may use multiple services. ^ for the mentally-retarded. 'na' Data unavailable. 'NA' Not applicable.

5 SOURCES: IA. IB. IC. ID. IE. IF-H. IIA,B. Federal medical assistance percentages and enhanced Federal medical assistance percentages, effective October 1, 2007-September 30, 2008 (Fiscal year 2008) Federal Register: November 30, 2006 (Volume 71, Number 230) Page Available at URL: [Accessed 7/20/2010]. Federal medical assistance percentages and enhanced Federal medical assistance percentages, effective October 1, 2009-September 30, 2010 (Fiscal year 2010) Federal Register: November 26, 2008 (Volume 73, Number 229) Page Available at URL: [Accessed 7/20/2010]. [Accessed 07/18/2010] Center for Medicare and Medicaid Services. Medicaid Managed Care Enrollment as of June 30, Available at URL: [Accessed 07/01/2009] Maternal and Child Health Update: States Increase Eligibility for Children's Health in 2007, National Governors Association, Appendix A. Available at [Accessed 05/11/2009] Medicaid Financial Management Report, FFY Center for Medicare and Medicaid Services. Available at URL: ExpendSystem/02_CMS64.asp#TopOfPage [Accessed 10/01/2009] Medicaid Financial Management Report, FFY 2007 (Preliminary). Center for Medicare and Medicaid Services. Special data request, October Disproportionate Share Hospital Payment, in Distribution of Medicaid Spending by Service, FY2008. Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on data from Centers for Medicare and Medicaid Services-64 reports, Available at URL: comparetable.jsp?typ=4&ind=178&cat=4&sub=47 [Accessed 7/20/2010]. [Accessed 7/8/2010] Interim State Projections of Population by Single Year of Age: July 1, 2004 to Population Division, US Census Bureau. Available at URL: /projections/downldfile3.xls [Accessed 07/01/2010] [Accessed 07/08/2010]