The Role of Medicaid in a Restructured Health Care System

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------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

The Role of Medicaid in a Restructured Health Care Syst= em

Cindy Mann

Executive Directo= r

Cente= r for Children and Families

George= town University Health Policy Institute

crm32@georgetown.edu

Novem= ber 4, 2005

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Medicaid’s Current Role in Illinois=

<= ![endif]>

Sourc= es of Coverage

All Children

0-18

Non-Elderly Adults

18-64

Source:= Data based on pooled 2003 and 2004 Current Population Survey (CPS) data.=

Slide 1=

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Medi= caid’s Current Role

•Pays for more than o= ne out of three (37%) births in the state •Provides = a broad set of benefits for elderly and disabled people with significant health care needs •Single largest source of funding for long- term care

Slide 2=

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Elderly and People with Disabilities Account for 70% of
Medicaid Expenditures in Illinois

Total Illinois Medicaid Expenditures in 2002 =3D = $9.2 billion

Slide 3=

Source: Georgetown Center for Children and Families analysis

based on FY 2002 CMS MSIS data.

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4p3d9e+AVwFJUzhivAUi8IEhigxRxEUZCFoQKAEBADs= ------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0020.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

Medi= caid’s Current Role

&#= 8226;Vital support for safety net providers

&#= 8226;Supplements financing for other systems

–Special education and early intervention services for children =

&= #8211;Child welfare system

&#= 8226;Largest source of federal funds to Illinois

• <= /div>

•

Slide 4=

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Tot= al =3D $8 billion

($4.= 53 billion)

Federal Medi= caid Payments as a Share of

Total Federal Funds to Illinois, FY 2003

*”Education” includes elementary, seco= ndary and higher education. <= /span>

*“All Other” varies by state. It includes federal funds for the= State Children’s Health Insurance Program

and may include a range of other federal funds suc= h as economic development, housing, parks and recreation.

Source: Georgetown Center for Children and Families analysis based on National

Association of State Budget Officers (NASBO), 2003= State Expenditure Report,

Fall 2004.

Slide 5=

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7Xrjv9reaLK2TQ/rp1qVPapQKYN3JWqIvIMlF3dfgIGdGYl19BEAHjXnEvJFJY/8QM4vz3xzzTcP ffXUZ4/88tJHf31z308vfvfWax99+eOHf772ZRHukBdf6N77/L1vVMOGEXGFFv38hwjThYYB2UvG 4p3d9e+AVwFJUzhivAUi8IEhigxRxEUZCFoQKAEBADs= ------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0003.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

Under Reform, How Will

•Coverage be financed?<= span style=3D'mso-spacerun:yes'>

•Coverage for people with disabilities and other high medical costs be financed?

•Affordability for low-= and moderate-income people be achieved?

•Costs be contained?

•Quality be assured?= 3;

•Portability, continuit= y of coverage & a more seamless system be achieved?

•<= /span>

Slide 6=

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Broad state discretion to set provider payment rates, establish disease management & incentives to encoura= ge efficient and effective care management

Cost containment

Comprehensive coverage with limited benefi= ciary costs

Coverage for people with limited incomes

Comprehensive benefits - services beyond= those typically available through commercial plans, no lifetime cap, etc.

Coverage for people with disabilities and other high cost cases

Open-e= nded federal financing

Automatically adjusts with costs, caselo= ad

Adequate financing

Medicaid offers

= Key Issues To be Addressed

Slide 7=

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file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0017.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

Coverage not tied to job status; broad control over delivery system, administration, payment rates

- Can merge Medicaid coverage and financing with other systems under a restructured system

- Can design the system to work in tandem with employer-based coverage while also filling in the gaps that will arise in an employ= er-based system

Portability, continuity of coverage, a more seamless system

Broad state discretion/authority to establish, and monitor quality standa= rds

Assure quality

Medicaid offers

= Key Issues To be Addressed

Slide 8=

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charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

Slide 9=

MassHealth = ;

(= One application, o= ne eligibility d= etermination process)<= /span>

= Medicaid financing for some groups of = children and adults

SCHIP financing for a smaller group of children

Premium Assistance component

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Content-Type: image/gif R0lGODlhFABJAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAwAO AEIAgAAAAAAAAAJohB0Zx6fb2ItSUWcvmJpfT4GR2JBVom3Zt4bt+JbxCbFoN2O3Xbu734P9hEHZ 0FikpUy6ZHOZQ0RVRyWu+rw6pVjulvpleqFdMDk8FZu15zbtAV/E4955zf7DB+1EEx3YpaamkiIV UQAAOw== ------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0028.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

Slide 1= 0

<= b>Dirigo applications sent to Dirigo = by employer

Dirigo Agency

determines = employee discount

Contracts with private insurer to <= span style=3D'position:absolute;top:43.0%;left:55.24%;width:16.47%;height:4.0%'= >provide coverage to all Dirig= o participants

All participants receive the = same card and see the same providers*=

Medicaid Can = Be Integrated

into Broader Reform: Dirigo

100% discount for Medicaid eligible employees and families

Sliding income discount for employees/families between Medicaid

and 300% FPL

*Note: Medicaid-eligible Dirigo enrollees eligible= for some additional

“wrap-around” services= .

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M= edicaid Coverage/Financing Limitation

= 226;No financial participation for childless adults

–Eleven states and the District of Columbia have waivers allowing some Medicaid financing for this group

&= #8211;Budget neutrality constraints

Slide11=

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Oth= er Medicaid Considerations

•Limits on premiums a= nd cost sharing that can be charged •Provider payment rat= es often lower than commercial insurance

<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Relativel= y low administrative costs

Slide 1= 2

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Medicaid vs. Private Insurance Costs,
Per Capita=

Source: Hadley and Holohan, Inquiry, 2004

Slide 1= 3

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------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0024.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

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tcbsh6y3jptYhYHxnEBleCYcQrcLBAEEurMHge8D7a578Lwz2PvxwhWPe+7MC9+879Aj/7v0wEsf fPTNXz889dzD5WGGX6ju+vjkazbU9zANJX757LeuG4b1DZSZbtbtsHr7+L/VUQ32DxXVUKnJnwBZ Rx+ujOQlA0zgTwICADs= ------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/slide0021.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Role of Medicaid in a Restructured Health Care System

Medicaid Federal Reforms that Could Help States Meet Their Coverage Goals

&#= 8226;Automatic “FMAP” adjuster

= 211;To require federal share of costs to rise during economic downturns

= 226;Coverage permitted without regard to “categories” =

&= #8211;Option to cover childless adults

= 226;Reduce cost shift of Medicare costs to state Medicaid programs

Slide 1= 5

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Dual Eligibles Account for More than One-Fourth of Total Medicaid Expen= ditures in Illino= is

Dual Eligibles

28%<= /div>

Source: Urban Institute estimates based on data fr= om the Medicaid Statistical

Information System (MSIS) and Medicaid Financial Management Reports prepared

for the Kaiser Commission on Medicaid and the Unin= sured, 2003.

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FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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charset="us-ascii" The Role of Medicaid in a Restructured Health Care System ------=_NextPart_01C5E540.8EE11330 Content-Location: file:///C:/A359C635/TheRoleOfMedicaid_CindyMann_11042005_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

1	The Role of Medi= caid in a Restructured Health Care System Cindy Mann Executive Director Center for Children and Families Georgetown University Health Policy Institute crm32@georgetown.edu November 4, 2005
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3	Medicaid’s= Current Role Pays for more than one out of three (37%) births in the state Provides a broad set of benefits for elderly and disabled people with significant health care needs Single largest source of funding for long- term care
4	Elderly and Peop= le with Disabilities Account for 70% of Medicaid Expenditures in Illinois
5	Medicaid’s= Current Role Vital support for safety net providers Supplements financing for other systems Special education and early intervention services for children Child welfare system Largest source of federal funds to Illinois
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7	Under Reform, Ho= w Will Coverage be financed? Coverage for people with disabilities and other high medical costs be financed? Affordability for low- and moderate-income people be achieved? Costs be contained? Quality be assured? Portability, continuity of coverage & a more seamless system be achieved?
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12	Medicaid Coverage/Financing Limitation No financial participation for childless adults Eleven states and the District of Columbia have waivers allowing so= me Medicaid financing for this group Budget neutrality constraints
13	Other Medicaid Considerations Limits on premiums and cost sharing that can be charged Provider payment rates often lower than commercial insurance Relatively low administrative costs
14	Medicaid vs. Pr= ivate Insurance Costs, Per Capita
15	Slide 14
16	Medicaid Federal Reforms that Could Help States Meet Their Coverage Goals Automatic “FMAP” adjuster To require federal share of costs to rise during economic downturns= Coverage permitted without regard to “categories” Option to cover childless adults Reduce cost shift of Medicare costs to state Medicaid programs
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