Planning for Coverage Expansions: Chronic Conditions Among Low-Income Adults

1. Planning for Coverage Expansions:Chronic Conditions Among Low-Income Adults Rachel L. Garfield Henry J. Kaiser Family Foundation for “Planning for Expansion Populations in 2014” National Governors Association April 19, 2012 Minneapolis, MN

2. Background • Planning for expansion populations requires understanding: • Health needs of newly eligible • How these needs compare to those of currently-enrolled population • Current role of coverage programs for people with significant health needs • Health needs will inform decisions about benefits, delivery systems, provider networks and payment, state take-up of demonstration programs • We uses the Medical Expenditure Panel Survey (MEPS) to: • Compare low-income (<138% FPL) nonelderly adults who were either covered by Medicaid or uninsured, stratified by disease status • Estimate characteristics of likely enrollees in Health Insurance Exchanges (HIEs)

3. Chronic illnesses are less prevalent among uninsured adults <138% FPL than among Medicaid adults *Statistically different from Uninsured(p<0.05). All insurance groups include only those nonelderlywith full-year coverage or a full year without coverage. Cancer excludes skin cancer. Excludes dual eligibles. SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

4. Comorbidities are prevalent among low-income adults with chronic conditions Share with other chronic physical condition Share with chronic mental condition *Statistically different from Uninsured(p<0.05). All insurance groups include only those nonelderlywith full-year coverage or a full year without coverage. Excludes dualeligibles. SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

5. Uninsured adults <138% FPL with chronic illnesses have lower total spending, but higher out-of-pocket spending $13,490* $9,694* $8,099* $5,411 $5,229 $2,211 Diabetes HeartDisease COPD *Statistically different from Uninsured(p<0.05). All insurance groups include only those nonelderly with full-year coverage or a full year without coverage. Excludes dual eligibles. SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

6. Medicaid enrollees with chronic conditions have costly health care needs $13,490* $9,694* $8,099* $5,133 $5,248 $4,456 Diabetes HeartDisease COPD *Statistically different from Uninsured(p<0.05). All insurance groups include only those nonelderly with full-year coverage or a full year without coverage. Excludes dual eligibles. SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

7. Medicaid enrollees with chronic conditions have higher service utilization than those without or the uninsured Medicaid with diabetes Medicaid without diabetes Uninsured with diabetes *Statistically different from Uninsured(p<0.05).†Statistically different from without diabetes (p<0.05). All insurance groups include only those nonelderly with full-year coverage or a full year without coverage.Excludes dual eligibles. SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

8. Uninsured adults <138% FPL with chronic illnesses are less likely than Medicaid adults to have a usual source of care * Statistically different from Uninsured(p<0.05). All insurance groups include only those with full-year coverage or a full year without coverage. Excludes dual eligibles.SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

9. Uninsured adults <138% FPL with chronic illnesses have more difficulty accessing necessary care * Statistically different from Uninsured(p<0.05). All insurance groups include only those with full-year coverage or a full year without coverage. Excludes dual eligibles. SOURCE: Kaiser Family Foundation analysis of 2009 Medical Expenditure Panel Survey data.

10. Health status of likely exchange enrollees versus current coverage groups Includes nonelderly adult population. Source: Kaiser Family Foundation simulation of 2019 Health Insurance Exchange Population, based on 2007 MEPS.

11. Access and utilization among likely exchange enrollees versus current coverage groups Includes nonelderly adult population. Source: Kaiser Family Foundation simulation of 2019 Health Insurance Exchange Population, based on 2007 MEPS.

12. US faces shortfalls in access to care, especially primary care Access has been deteriorating for insured, as well as uninsured National primary care physician shortage Key reform provisions addressing access and payment Increased Medicare and Medicaid payments for primary care Strengthening community health centers Health workforce development Emphasis on primary care through health homes Promoting coordinated primary care for high need Medicare and Medicaid beneficiaries Emphasis on prevention Connecting Coverage to Care

13. Conclusions • There is a high prevalence of chronic conditions among low-income, nonelderly adult Medicaid beneficiaries, and most of these individuals have complex care needs • While prevalence rates among low-income uninsured adults are lower, many newly-eligible beneficiaries will have a need for ongoing services and will present with complex health needs • Reflecting their complex health needs, nonelderly adult Medicaid beneficiaries with chronic conditions have significantly higher spending and utilization than enrollees without these illnesses • Despite their higher use of health services, Medicaid enrollees with chronic conditions report similar access to care as other beneficiaries • Compared to their Medicaid-covered counterparts, uninsured low-income adults with chronic illness have higher out-of-pocket spending, are less likely to use services, and are more likely to report access barriers • Currently uninsured adults with chronic illnesses who will be newly-eligible for Medicaid in 2014 are likely to enter the program with needs that have not been as well met as those of their currently-covered counterparts • Exchange enrollees are also likely to enter coverage with substantial, unmet health needs

14. Faces of Medicaid: The People Behind the Numbers Matthew Bardgett Garden City, KS Michelle Foster Silver Spring, MD Anthony Burke Oklahoma City, OK Kay Dickerson Portland, OR Patricia Clark Scranton, PA Sheila Malone Waterville, ME Brenda Christiansen Murray, UT Heather Holloway St. Joseph, MI For more information, see: http://facesofmedicaid.kff.org/Home/KFF/FacesOfMedicaid.aspx