Kentucky Medicaid Overview September 2003

Transcription

1 Kentucky Medicaid Overview September 2003 Kentucky Medicaid provides a broad range of health services to over 660,000 low-income working families, children, and aged, blind, and disabled Kentuckians. During a 12-month period, over 800,000 Kentucky citizens will be the recipients of Medicaid services, representing 20% of the state population. Introduction Enacted in 1965 at the same time as Medicare through Title XIX of the federal Social Security Act, the Medicaid program is the largest of the federal-state partnerships for low-income Americans. Medicaid provides federal matching funds to states for certain health care services for eligible people. Each state administers its own Medicaid program. The federal Centers for Medicare and Medicaid Services (CMS) monitor staterun programs and establish new requirements for service delivery and quality, funding, and eligibility standards. State participation is voluntary and all states have participated since Kentucky Medicaid began in Overview of Kentucky Medicaid The Kentucky Cabinet for Health Services, Department for Medicaid Services, administers Kentucky s Medicaid Program. In each of Kentucky s 120 counties, local Department of Community- Based Services offices also play an important role in Kentucky Medicaid. Medicaid represents a significant portion of Kentucky s overall state budget. Kentucky spends approximately 22% of its annual expenditures on Medicaid, making it the second largest budget item after education and post-secondary education. As a result, an increase in program costs can have a serious impact on the overall fiscal condition of the state. Kentucky Medicaid: covers 1 out of every 3 births covers 1 out of every 4 children covers 1 out of every 7 seniors over age 65 spends a smaller portion on administrative costs than all other state Medicaid programs pays for 70% of all nursing home care in the state covers children in families up to 200% of the Federal Poverty Level (FPL) covers Medicare premiums for eligible seniors and people with disabilities Although the majority of people enrolled in Kentucky Medicaid are families and children, the majority of expenditures pay for services to aged, blind, and disabled Kentuckians. Aged, blind, or disabled enrollees (34%) Federal Share (69.9%) Kentucky Share (30.1%) Contents Eligibility... 2 Key Components... 3 Mandatory Medicaid Services... 4 Delivery Systems... 4 Financing and Expenditures... 7 Controlling Medicaid Expenditures... 9 Why Changing Medicaid Isn t Easy Online Resources Endnotes Family and children enrollees (66%) Aged, blind, or disabled expenditures (70%) Family and children expenditures (30%)

2 KCHIP The Federal Balanced Budget Act (BBA) of 1997 amended the Social Security Act to create Title XXI, the State Children s Health Insurance Program (SCHIP). In each state, SCHIP provides health insurance for children in families with incomes too high to qualify for Medicaid but too low to afford private coverage. The federal government matches the state s SCHIP spending at a higher rate than that for Medicaid. In Kentucky for FY 2003, the federal match for Medicaid is 69.9%, but the federal match for Kentucky s CHIP program (KCHIP) is 78.93%. Kentucky s KCHIP contribution is just 21.07%. As of November 1, 2003, Kentucky families living at % of the Federal Poverty Level (FPL) will be required to pay a $20/month premium to enroll their children in KCHIP. Families living below 150% FPL do not have to pay this premium. Eligibility In general, Medicaid covers low-income children; their parents, guardians, or caretakers; and aged, blind, or disabled people. However, certain income and resource criteria must be met as well. Income criteria are largely based on poverty guidelines established by the federal government. Resource criteria which largely apply only to aged, blind, and disabled people applying for Medicaid are based on savings, home ownership, and other assets. Parents and Children Kentucky Medicaid currently covers over 373,000 low-income children and 63,000 low-income adults in families with children. The majority of eligible adults in families with children are women. Children represent the largest demographic group served by Kentucky Medicaid, with nearly 56% of all eligible Kentuckians being age 18 or younger. Pregnant women who meet certain income criteria are also eligible for coverage during their pregnancy and postpartum. Aged Approximately 40,000 Kentuckians age 65 and over are currently covered by Medicaid. Some are eligible because of income and others because of medical conditions. Some have large medical or long-term care expenses that reduce or spend down their incomes to qualify. Some may also receive K entucky Medicaid/KCHIP Income Eligibility Factors 2003 Federal Poverty Levels (FPL) C overed Populations Income Guidelines* Annual Income Children (up to age 19) <200% Federal Poverty Level (FPL; see right) Family Size 100% FPL 150% FPL 185% FPL 200% FPL Parents < 100% FPL 1 $ 8,980 $ 13,470 $ 16,613 $17,960 Pregnant Women < 185% FPL 2 $ 12,120 $ 18,180 $ 22,422 $24,240 D isabled Individuals ** Receive SSI + or $217/month 3 $ 15,260 $ 22,890 $ 28,231 $30,520 K entuckians age 65 and over ** Receive SSI + or $217/month 4 $ 18,400 $ 27,600 $ 34,040 $36,800 Qualified Medicare Beneficiaries Institutional Level of Care <100% FPL 300% SSI Standard * These apply to the 48 contiguous states and D.C. * Asset tests and other factors affect eligibility, which is determined by the local Department of Community-Based Services. ** Deductions and exceptions apply. People may have medical expenses deducted from income calculations to "spend down" to eligible levels. + SSI = Supplemental Security Income 2 Kentucky Medicaid Overview September 2003

3 Medicaid assistance to help pay their Medicare premiums, copayments, and deductibles. Blind and Disabled An estimated 173,000 Kentuckians covered by Medicaid qualify for services due to a physical or mental impairment that inhibits work and that has lasted or will last at least 12 months or result in death. This excludes disabled people who are first eligible by virtue of age or income. Most people with a major disability are eligible for cash assistance through Supplemental Security Income (SSI) and therefore qualify for Medicaid. Others qualify by spending down their incomes on medical expenses. Some people with a disability also receive Medicaid assistance to help pay their Medicare premiums, copayments, and deductibles. Key Components Kentucky Medicaid benefits include several key components: 1. Hospital Inpatient Services Kentucky Medicaid recipients receive over $509 million annually in hospital inpatient services. Access to hospital care is one of the primary objectives of Kentucky Medicaid. 2. Hospital Outpatient Services Kentucky Medicaid recipients receive over $325 million annually in hospital outpatient services. Access to outpatient facilities, emergency rooms, and ancillary services such as lab and x-ray services is another primary objective of Kentucky Medicaid. 3. Physician Services Kentucky Medicaid recipients receive over $340 million in physician services. These services include office visits and outpatient or inpatient procedures. 4. Nursing Facilities Kentucky Medicaid recipients receive over $595 million annually in care at nursing facilities. 5. Pharmacy Services Kentucky Medicaid recipients receive over $712 million annually in coverage for prescription drugs. 6. Disproportionate Share Hospitals Kentucky hospitals received over $197 million to provide care to indigent people. Pharmacy Services 18.8% Success of KCHIP For three years in a row, the Kentucky Children s Health Insurance Program (KCHIP) successfully used its federal appropriation and was among 14 states eligible for additional federal funding, according to a news release issued by the Cabinet for Health Services on May 12, Kentucky was eligible for up to $72 million of additional funds, but the funds have no effect on the state s Medicaid deficit situation since they can only be spent on services for children enrolled in KCHIP. The money comes from $2.2 billion in funds that other states did not spend in Currently, KCHIP has 50,500 children enrolled and spends about $95 million in state and federal funds annually. Kentucky Medicaid Spending by Key Component Nursing Facilities 15.7% Hospital Inpatient Services 13.4% Physician Services 9.0% Disproportionate Share Hospitals 5.2% Hospital Outpatient Services 8.6% Other 29.3% Kentucky Medicaid Overview September

4 Optional Services Covered by Kentucky Medicaid States may opt to cover additional services, which also qualify for federal matching funds. Here are just some of the optional services Kentucky provides: Pharmacy services (prescription medications) Primary care case management (KenPAC) Mental health services Chiropractic services Podiatry School-based health services Support for community living Renal dialysis Adult day care Hospice Preventive services Health Access Nurturing Development Services (HANDS) Home Care Waivers Impact Plus Nurse anesthetist While these services are considered optional, most are central to effective health care (i.e., prescription drugs, dental care, and mental health services). Optional means only that the service is not mandated by federal law. In many cases, eliminating optional services would increase utilization and costs of some mandatory services, particularly emergency room care and hospitalizations. In addition, certain segments of the population, such as families with mentally retarded children, depend heavily upon these optional services, making them difficult to discontinue. Mandatory Medicaid Services Federal guidelines require states to cover a minimum set of services under Medicaid, including: inpatient hospital services; outpatient services, including those delivered in Rural Health Clinics and Federally Qualified Health Centers (FQHCs); physician services; nursing facility services and home health services for people age 21 and older; skilled home health services for adults, including durable medical equipment (optional for others who need durable medical equipment); family planning services and supplies; lab and X-ray services; nurse-midwife, certified family nurse practitioner, and certified pediatric nurse practitioner services; medical and surgical services of a dentist; medical transportation; screening and treatment services to children under age 21 under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program; and vision and hearing services for children. Delivery Systems Kentucky Medicaid s Primary and Acute Health Care package provides physician, hospital, laboratory, pharmacy, preventive, family planning, and other services. People have access to these services through the KenPAC case management program, the Passport managed care system, or a traditional fee-for-service system, depending upon the type of Medicaid for which they are eligible and where they live. All programs cover prescription medications for Kentucky Medicaid consumers. Nursing and other residential facility services are also covered, as are many community-based care options. KenPAC The Kentucky Patient Access and Care (KenPAC) system is a primary care case management program that provides a medical home and primary care provider to people living in most of Kentucky (see the tanshaded counties in the map to the right). 4 Kentucky Medicaid Overview September 2003

5 Medicaid recipients living in these counties are automatically enrolled in KenPAC, with a few exceptions (e.g., long-term care recipients, people enrolled in waiver programs, and people living in institutions). KenPAC emphasizes preventive services and coordinates the use of other health care services, including inpatient hospital and outpatient care, thereby improving the quality of care and health outcomes for people. Approximately 340,000 Kentuckians were enrolled in KenPAC in Passport The Passport Health Plan is a managed care system providing services to Medicaid-eligible recipients in Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble, and Washington Counties (the tan-shaded counties in the map to the right). Medicaid recipients living in these 16 counties are automatically enrolled in Passport, with a few exceptions (e.g., long-term care recipients, people enrolled in waiver programs, and people living in institutions). Like KenPAC, Passport also helps assure access to primary care, emphasizes preventive care, and encourages the appropriate utilization of services in the most cost-effective settings. Approximately 120,000 Kentuckians were enrolled in Passport in Fee-For-Service System Medicaid enrollees who do not qualify for KenPAC or Passport may receive services in a traditional fee-forservice system. These Medicaid beneficiaries present a Medicaid card when they receive health care. The Department for Medicaid Services pays for services based on an established fee schedule, although a few providers are paid on a cost-based schedule. Pharmacy Services (Prescription Medications) Prescriptions are increasingly becoming a core feature of health care for all Americans. Kentucky Medicaid pharmacy expenditures have more than doubled in the past five years. Other states are also seeing similar increases, and, nationally, these recent increases are believed to be due to: price inflation (22%), a shift to higher-priced medications (36%), and an increase in the number of prescriptions filled (42%). 1 Kentucky Access Kentucky Access is a state authorized health plan that offers medical coverage to Kentuckians who find it difficult to obtain health insurance in the private insurance market. It was designed for people who have highcost medical conditions such as AIDS, leukemia, Parkinson s disease, various cardiovascular diseases, various cancers, or psychotic disorders. Kentucky Access is not available for those who qualify for Medicaid; Medicare; group, association, or individual medical coverage; or COBRA or state continuation or conversion coverage. Kentucky Access is not designed to serve indigent citizens or to completely pay for program costs. Kentuckians who have been rejected by a private insurer for individual coverage or who received a higher premium rate than that charged by Kentucky Access for similar coverage may be eligible. People coming off group, church plan, governmental, or COBRA or state continuation coverage and participants in the state s Guaranteed Acceptance Program (GAP) may also be eligible for Kentucky Access. For complete details, contact Kentucky Access Customer Service, toll-free at , or TTY at Kentucky Medicaid Overview September

6 What s a Waiver? Federal law requires that Medicaid consumers have freedom of choice of providers, that the program is available statewide, and that services are comparable in amount, duration, and scope. States can also choose to cover optional services and eligible groups. Some options are specifically described in the Social Security Act, while other options are available through waivers. The term waiver is used whenever an exception to federal law has been granted to the state by the Centers for Medicare and Medicaid Services (CMS). For example, Home- and Community- Based Care waivers, provided under Section 1915(c), allow people to receive Medicaid-covered care in the community or at home rather than in a nursing facility. A few of the waivers Kentucky has implemented include: a 1115 waiver, implemented in 1997 to enroll recipients in a managed care organization; the Passport program serving 16 counties is an example; a 1915(b) waiver, implemented in 1998 so the state could establish a non-emergency transportation brokerage system; and numerous 1915(c) waivers that allow people to receive care in their own homes or community. A recent study shows that, when compared to Kentucky: 23 states had a higher total net expenditure per eligible person in 2000, 40 states had higher average costs per prescription (Kentucky s average cost per prescription was $43.16), 15 states paid higher dispensing fees, and 13 states had higher percentage drug expenditures than Kentucky. 2 Nursing and Other Residential Facility Services Medicaid covers nursing facility care to eligible residents of licensed, Medicaid-certified nursing facilities. These people are most often people who have chronic or disabling conditions and meet certain level of care criteria. Because nursing facility services are rarely covered by private insurance or Medicare, Medicaid is the primary source of coverage for many who need these services. Kentucky Medicaid is the leading payer of nursing facility services in the state and it covers 70% of all days of care for nursing facility residents. Medicaid also covers care in residential facilities for eligible people with developmental disabilities, including mental retardation. To qualify, people must need a planned program of active treatment, live in the facilities, and meet certain other criteria. Over 95% of all Kentuckians living in intermediate care residential facilities for the mentally retarded are Medicaid consumers. Payments to Disproportionate Share Hospitals Acute Care and Psychiatric Hospitals qualifying as Disproportionate Share Hospitals under federal and state statutes are eligible for funding from Medicaid for uncompensated care provided to indigent people. Hospitals are required to determine eligibility and submit required forms to the Department of Medicaid Services. Community-Based Care Options Kentucky Medicaid supports a number of waivers that allow people to receive care in their homes or the community rather than in a nursing facility or other institution. These waivers include: Home- and Community-Based Waivers provide coverage to people who are aged or disabled and who would, without these services, require at least nursing facility care. For any given individual, home care is less expensive than institutional care. Evidence suggests that those who enter institutional care settings generally do not return 6 Kentucky Medicaid Overview September 2003

7 home. Therefore prevention or delay of institutional care is important both for quality of life and for cost containment. Model Waiver II provides services to people who are dependent on a ventilator and would require nursing facility care if these services were not provided at home. Impact Plus provides services to children under age 21 who have complex mental health care needs and are at risk of institutionalization. Medicare Premium Assistance Kentucky Medicaid helps some elderly Kentuckians who are eligible for both Medicaid and Medicare pay their Medicare premiums. These dually eligible seniors are qualified to receive some assistance with Medicare premiums. Financing and Expenditures Between 1987 and 2000, federal Medicaid matching funds to states increased from 26% of the federal budget ($108 billion) to 43% ($246 billion). 3 Much of the complexity in the Kentucky Medicaid budget is the result of trying to maximize federal matching dollars. Medicaid Financing Kentucky Medicaid is funded through General Revenue Funds (GRF), Agency Funds (AF), and federal matching funds based on the Federal Medical Assistance Percentage (FMAP). Kentucky s FMAP match for FY 2003 is: 50% for Medicaid administrative activities, 69.9% for Medicaid medical assistance services, and 78.93% for KCHIP. Federal Fiscal Relief added 2.95% to the match rate for medical assistance services for the five (5) quarters starting April The enacted Kentucky Medicaid Budget for State Fiscal Year (SFY) 2004 is $3.2 billion. Actual expenditures are projected to be $600 million greater than the budgeted amount. Medicaid Expenditures In SFY 2002, Kentucky Medicaid spent nearly $2.2 billion or almost 56% of its budget on: pharmacy services ($712 million), nursing facilities ($595 million), inpatient hospital services ($509 million), and outpatient hospital services ($325 million). Federal Fiscal Relief for Medicaid, 2003 The Jobs and Growth Tax Relief Reconciliation Act of 2003 allocated $10 billion to provide fiscal relief to state Medicaid budgets. Kentucky s share of these increased Medicaid federal funds totaled $138.9 million. In a press release issued May 23, 2003, Governor Patton said that these flexible grant funds [would] help Kentucky weather the continued economic downturn and offset predicted revenue shortfall in the current biennium. The Governor commented that this one-time federal allocation [would] provide the Commonwealth the opportunity to further assess the structure and fiscal outlook for the Medicaid Program. The federal Tax Relief Reconciliation Act funds are a onetime allocation and while they helped balance Kentucky s Medicaid budget at the end of SFY 2003, the state s Medicaid budget woes are expected to worsen in SFY 2004 and Acting State Budget Director Mary Lassiter told a legislative subcommittee on May 29, 2003, that the current increase in federal funds would be a shot in the arm [to Medicaid] though not enough to cover Medicaid s projected shortfall for SFY 2004, which is estimated to be $169 million. A survey by the National Governors Association and the National Association of State Budget Officers indicates that 37 states have cut $14.5 billion from their current year s budgets in order to contain costs. 4 Kentucky Medicaid Overview September

8 Medicaid is an open-ended entitlement program, which means the services must be provided to those who meet eligibility guidelines. Families and children constitute the largest segment of the Kentucky Medicaid population (66% of covered Kentuckians) but account for only 30% of all Kentucky Medicaid costs. Medicaid budgeting is far more difficult than budgeting for other state programs because Medicaid expenditures are heavily influenced by economic conditions and other factors beyond the control of administrators and legislators. For example, as incomes decrease, more people are eligible for Medicaid. At the same time, state tax revenues are also decreasing. The result is that Medicaid costs increase while states are experiencing their greatest economic challenges. 700, , , , , , ,000 Growth in Kentucky Medicaid Enrollment, SFY SFY 00 SFY 01 SFY 02 Identifying Causes of Spending Increases In general, the chief causes of Medicaid s spending growth are SFY 03 the same factors increasing private health insurance costs. A recent survey of Medicaid officials in all 50 states and the District of Columbia identified the leading reasons for Medicaid expenditure growth as: prescription medications, enrollment growth, medical inflation and utilization, and long-term care costs. 5 The projected average annual growth rate for Medicaid costs through 2005 is higher than the rate projected for Medicare but lower than the rate projected for private insurance. 6 Medicaid spending is a function of changes in the number and types of consumers enrolled. A recent 3-year increase in enrollment is likely the result of: expanded eligibility criteria, a growing aging population, simplification of the application process, increased outreach activities, a weakened economy, and a natural correction after decreases in enrollment when Medicaid was delinked from welfare in Of federal Medicaid spending growth between 2001 and 2002, 57% was due to people in the aged, blind, and disabled program; 28% was due to children and families; and 15% was due to factors not related to a specific population. 7 The Kentucky Department for Medicaid Services estimates that 74% of present spending increases are due to higher costs 8 Kentucky Medicaid Overview September 2003

9 and use of services, while 26% are due to the increased number of eligible people. In general, elderly and disabled people use medical care and medications more often than the general population. Therefore, cost increases for these services have an even greater impact on the Medicaid budget. Controlling Medicaid Expenditures In FY 2002, 45 states implemented cost containment measures aimed at controlling spending growth. Most states expect FY 2004 to be an even more difficult budget year. Strategies states are using to reduce expenditures are outlined below. 8 Kentucky Medicaid s Administrative Costs Kentucky spends less than all other states in administering its Medicaid benefits, spending approximately 2.6% of the entire Medicaid budget on administration. Unisys Corporation serves as the fiscal agent on a contractual basis and eligibility services are provided by the Kentucky Cabinet for Families and Children. Provider Rate Cuts or Freezes A large number of states plan to cut or freeze provider payments, especially automatic cost increases tied to an economic price index for hospitals or nursing homes. Long-Term Care Several states proposed long-term care cuts, including instituting new payment procedures, closing nursing homes, and requiring that long-term care facilities have both Medicare and Medicaid certification. Pharmacy-Related Cost Containment The most common pharmacy-related cost-containment actions were requiring prior authorization of selected brand name products and reducing costs of drug products by increasing discounts or creating a Maximum Allowable Cost (MAC) list for generic medications. In Kentucky, there is now a preferred drug list, which limits what medications Kentucky Medicaid will cover. Also, some Kentucky Medicaid recipients are now required to pay copayments for some medications. Benefit Reductions Several states reduced benefits, including dental, home health, podiatry, chiropractic, vision, psychological counseling, and medical translator services. Copayments for Non-Pharmacy Services Copayments are now required in some states for services such as transportation, doctor visits, non-emergency room visits, waiver services, and certain fee-for-service ambulatory Kentucky Medicaid Overview September

10 services. Some Medicaid recipients in Kentucky are now required to pay copayments for some optional services. Managed Care Expansions Some states proposed managed care expansions such as moving people from fee-for-service programs into managed care, expanding primary care case management (PCCM) statewide, requiring mandatory enrollment into PCCM, and expanding risk-based managed care. Disease Management Programs Increasingly, states are using a disease management approach to lower costs and provide timelier, more appropriate, and higher quality care. Specific disease management programs target chronic conditions like asthma, diabetes, congestive heart failure, hypertension, and chronic obstructive pulmonary disease. Eligibility Cuts In FY 2003, 18 states planned eligibility cuts or restrictions compared to 8 states in FY Of the 18 states, 3 enacted cuts that will eliminate coverage for a large number of people on Medicaid. Cost-containment strategies like these can be very complex. Often, a policy change that appears reasonable can produce an unintended consequence that undermines the intent of the Medicaid program or that causes increased spending on other Medicaid services. For example, reducing or freezing provider payments can reduce the number of providers willing to accept Medicaid patients. This in turn increases the use of hospital emergency rooms for routine treatment, which is more expensive. Why Changing Medicaid Isn t Easy Kentucky Medicaid is not a single program but rather a collection of programs, services, and funding mechanisms that is part of the health and human services system. In many cases, an adjustment to one element of this system will have unintended effects or consequences on other elements. Therefore, policymakers, state administrators, and others use a systems approach when considering changes to Medicaid. Medicaid has a significant economic impact on the state 10 Kentucky Medicaid Overview September 2003

11 economy, as Medicaid brings new funding to the state through federal matches that fluctuate relative to state spending. Kentucky Medicaid has an obvious impact on the lives of the low-income individuals, children, and families it serves. Connections between Kentucky Medicaid and other important issues, however, are not always as clear. For example, Kentucky Medicaid: helps maintain a healthy work force; helps reduce personal bankruptcies, the number one reason for which is unpaid medical debt; helps kids stay healthy and succeed in school; supports welfare-to-work efforts; and supports nearly all state-funded health and human service-related agencies including university medical schools, services for the aging, mental health agencies, and health departments. Medicaid also supports the state s entire health care infrastructure by helping to: reduce uncompensated care, promote earlier treatment in appropriate settings and reduce preventable hospitalizations, decrease unnecessary emergency room use, and support education and training in academic medical centers. Without the Medicaid program, these infrastructure costs would be passed on to employers and their employees through higher insurance premiums. In addition, individuals, families, and society as a whole would bear the human costs of untreated illnesses. Kentucky Medicaid is an important and complex system that touches the lives of individuals and families across the state. Understanding the basics of this system is an important step toward improving the health of millions of Kentuckians. Medicaid s Role in the Economy Representing 12% of the U.S. gross domestic product, health care is a large and growing part of state and local economies. Medicaid makes up a significant portion of the total national spending on major health concerns. 9 Total personal health care Total national spending in 2000 (billions) Portion paid by Medicaid $ 1, % Professional services $ % Hospital care $ % Prescription drugs $ % Nursing home care $ % For More Information about Medicaid Kentucky Medicaid Overview provides a brief outline of the Kentucky Medicaid program. For more information about the federal Medicaid program, including federal eligibility requirements, benefits, financing, and administration, please refer to The Medicaid Resource Book, a publication of The Kaiser Commission on Medicaid and the Uninsured, published by The Henry J. Kaiser Family Foundation. The Medicaid Resource Book is available at or by calling For more information about Kentucky Medicaid, please visit the Kentucky Cabinet for Health Services, Department of Medicaid Services web site at Kentucky Medicaid Overview September

12 Online Resources Agency for Healthcare Research and Quality Center for Health Care Strategies Center on Budget and Policy Priorities Centers for Medicare and Medicaid Services (CMS) Families USA Health Affairs Heritage Foundation The Kaiser Commission on Medicaid and the Uninsured Kentucky Cabinet for Health Services Kentucky Youth Advocates National Association of State Medicaid Directors National Center for Health Statistics The Urban Institute Endnotes 1 Kaiser Commission on Medicaid and the Uninsured (2002). Medicaid Spending Growth: Results from a 2002 Survey. Menlo Park, CA: The Henry J. Kaiser Family Foundation. 2 National Pharmaceutical Council (2001). Pharmaceutical Benefits under State Medical Assistance Programs. Washington, DC: Author. 3 National Association of State Budget Officers (2001) State Expenditure Report. Washington, DC: Author. 4 National Governors Association and the National Association of State Budget Officers (2003). The Fiscal Survey of States. Washington DC: Author. 5 Kaiser Commission on Medicaid and the Uninsured (2002). Medicaid Spending Growth: Results from a 2002 Survey. Menlo Park, CA: The Henry J. Kaiser Family Foundation. 6 Health Care Financing Administration (2001). National Health Expenditure Projections. Washington, DC: Author. 7 Kaiser Commission on Medicaid and the Uninsured (2002). Analysis of CBO Medicaid Baseline. Menlo Park, CA: The Henry J. Kaiser Family Foundation. 8 Kaiser Commission on Medicaid and the Uninsured (2002). Medicaid Spending Growth: Results from a 2002 Survey. Menlo Park, CA: The Henry J. Kaiser Family Foundation. 9 National Governors Association and the National Association of State Budget Officers (2003). The Fiscal Survey of States. Washington DC: Author. Kentucky Medicaid Overview is a project of the Foundation for a Healthy Kentucky and The Health Foundation of Greater Cincinnati. Statistics were provided by the Kentucky Department for Medicaid Services unless otherwise indicated. All dollar figures are for Fiscal Year 2002 and include the Passport Health Plan unless otherwise noted. Additional copies of Kentucky Medicaid Overview are available by calling the Foundation for a Healthy Kentucky toll-free at or by visiting or by calling The Health Foundation of Greater Cincinnati toll-free at , ext. 6658, or by visiting 12 Kentucky Medicaid Overview September 2003