Faces of the Pennsylvania Medicaid Program (Summer 2007 Trust Magazine briefing)

Aug 20, 2007

Even though Medicaid is more than 40 years old—it was created by Congress in 1965—and is extensive, covering about 14 percent of the U.S. population, there is little understanding of its structure and reach. This might not be surprising, since the program has evolved significantly, and, as it has grown, fewer people have been able to keep up with the scope of its activities.

This is the rationale for Faces of the Pennsylvania Medicaid Program, a recent report from the Pew-supported Pennsylvania Medicaid Policy Center at the University of Pittsburgh and directed primarily to policy makers and other key stakeholders in health care. The report’s authors are Monica R. Costlow, policy analyst at the center, and Judith R. Lave, Ph.D., the center’s director. They state: “The complexity of Medical Assistance (as it is known in the Commonwealth), its eligibility criteria, the type of services covered, governance and funding makes it impenetrable to many and hampers the debate about future reform.”

Originally, Medicaid was designed to provide health care services to individuals receiving cash welfare assistance. “It could now be more accurately described as an insurance program that fills in key gaps in the health care financing system and pays for medical and long-term care for eligible low-income citizens, such as children, pregnant women, individuals with disabilities and seniors,” say Costlow and Lave.

Some salient conclusions of the Faces study:

  • The Pennsylvania program covered more than 1.8 million people in an average month in 2006, representing close to 15 percent of the state’s population.
  • More than one-third of the Commonwealth’s children relied on Medical Assistance for their health care coverage in 2005, ranging from 12.4 percent in Chester County to 63.4 percent in Philadelphia County.
  • Although children and families constituted the largest proportion of Medicaid recipients in 2005 (61 percent), they accounted for only 24 percent of expenditures.
  • Disabled individuals—the second largest enrollment group at 20 percent—accounted for 33 percent of program expenditures.
  • The elderly represented 13 percent of Medicaid recipients and accounted for 35 percent of expenditures.

These figures show that the program “plays an important role in reducing the number of individuals who might otherwise be uninsured,” the authors note. As for caregivers, nearly 68,000 hospitals, long-term care facilities, dentists and physicians participate in Medical Assistance, “making it an important funding stream for health care institutions that serve a disproportionately large number of poor patients,” the authors say.

“As the cost of health care rises and thus the impact of Medical Assistance on the state’s budget becomes greater, attention has focused in Pennsylvania on how the program can most effectively meet its mission of providing health care coverage to some of the Commonwealth’s most vulnerable citizens,” they conclude. “This report and future analyses provided by the [center] are intended to provide a nonpartisan, independent and factbased context for these deliberations.”

More information is available at www.pamedicaid.pitt.edu.

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