Medicaid is the second largest program in the state budget, only trailing K-12 education. Each year, the Legislature wrestles with how to fund Medicaid to ensure access to health care coverage for those enrolled. This will continue to be a challenge in the FY 2013 program.
The latest Medicaid Forecasting Group report highlights the significance of the problem to the state. Last month 393,867 Iowans were enrolled in the program. That equates to one out of every seven Iowans participating in the some part of the program. The program has added 7531 Iowans during FY 2012.
The largest group was children, with 225,375 kids on Medicaid. 75,305 disabled Iowans are also enrolled. The non-senior adult enrollment (mostly parents of eligible children) is 63,073, with the senior enrollment level at 30,114. Data on expenditures tell a much different story. Nearly 25 percent of the caseload is either disabled or senior Iowans. These two groups account for around 70 percent of spending.
Even with the growth in caseload, current data on the Medicaid budget shows a projected surplus of $6 million at the end of FY 2012. The surplus amount could grow, as the flu season has been relatively mild to this point. For FY 2013, the range on Medicaid spending is projected to be an increase between $77 million and $117 million. The Governor’s budget proposes spending growth of $80 million, with a number of cost containment and funding adjustments to bring the net increase to $43.6 million.
One bright point in Medicaid is the action taken by the Legislature last year is the reductions in the waiting lists for people to get on the Home and Community Based waiver services. These services allow Iowans to remain in their homes and communities, instead of being in a institutional-based care. During the 2011 session, the Legislature dedicated $5 million in FY 2012 and FY 2013 to reduce the waiting lists.
The funding for FY 12 was dedicated to addressing the waiting lists for the Intellectual Disabilities, Children’s Mental Health, and Brain Injury waivers. The ID waiver waiting list was eliminated in the fall and the amount of time Iowans have to spend on the CMH and BI waivers have been significantly reduced. In FY 13, the Legislature has already committed another $5 million to address the remaining waiting lists, with major emphasis being placed on reducing the waiting list for the Ill & Handicapped and Physical Disability waiting lists.