Verify: Who uses Medicaid in Colorado

What has the Medicaid expansion been doing for Coloradoans?

VERIFY – YOU’VE GOT QUESTIONS, WE’LL FIND ANSWERS

A 9NEWS project to make sure what you’ve heard is true, accurate, verified. Want us to verify something for you? Email verify@9news.com

THE QUESTION

One of the most controversial changes proposed by the Republican healthcare plans is the rollback of federal dollars for Medicaid.

The Affordable Care Act raised the income limits to qualify for Medicaid, adding millions of people to the program.

The House plan, for example, proposed cutting $772 billion in Medicaid payments between now and 2026, according to a report by the Congressional Budget Office

We’ve received a series of viewer questions at 9NEWS about who uses Medicare and whether they work or are in the country legally.

WHAT WE FOUND

We used data from Health First Colorado, the name for Medicaid in Colorado, for fiscal year 2015-2016. And we talked with Marc Williams from the Colorado Department of Health Care, Policy and Financing about what some of those numbers mean.

Overview:

  • About one in five people living in the Centennial State used Medicaid during that period.
  • Thirty-four percent identified a Caucasian, but 29 percent chose not to identify their race.
  • Three out of four recipients were employed.
  • The Medicaid expansion in Obamacare provided coverage to 407,338 Coloradans.
  • Alamosa County had the largest percentage of its population using Medicaid (44 percent)
  • Denver County had nearly 200,000 people or 30 percent of its population in the program.
  • Douglas County had the smallest percentage of Medicaid enrollees at 8 percent.

Children and Adolescents (People 20 and younger):

Forty-two percent (of all colorado kids or just in a certain area?) fall into this category, making it the second largest group of people who use Medicaid in Colorado.

That’s partially because the income requirements for the Children’s Health Insurance Program are higher than the adult income requirements for Medicaid, Williams said.

Nearly one in two babies born in Colorado used the program, which is slightly above the national average of 40 percent. This includes prenatal care, labor, delivery and postpartum care.

Children and adolescents are the cheapest group of Medicaid recipients in Colorado. They use 18 percent of the funds despite being almost half of the people enrolled.

People 65 or older:

In contrast, this is the most expensive group covered by Medicaid.

They are 3 percent of the people using the program in Colorado, but they account for 15 percent of the spending.

We asked why people in this group need Medicaid when they are eligible for Medicare.

Most times Medicaid doesn’t cover living at a nursing home, assisted living or long-term care facility, Williams said.

That’s where Medicare comes in for people who qualify.

‘It’s a measure of last resort,” Williams said.

People using Medicaid to cover living at these places must exhaust most of their personal finances first. The program can also take a chunk of a person’s life insurance after death as a partial payment.

Nationally, long-term care services like nursing homes make up 42 percent of all Medicaid spending even though only 6 percent of enrollees use them, according to the Congressional Budget Office.

People with disabilities:

About 7 percent of Coloradans on Medicaid fell into this category for fiscal year 2015 – 2016.

“These are people who have long-term physical and mental disabilities; often times it’s both,” Williams said.

Overall, about 27 percent of the Medicaid money spent in Colorado goes to services for this group of people.

Adults covered by the Affordable Care Act:

The number of people using the program in the state increased by about 76 percent since the Medicaid expansion took effect in 2013.

That translates into 31 percent of adult enrollees in Colorado.

This group used 27 percent of the money allocated by Colorado and the federal government, which is on par with their counterparts who qualified before the expansion.

People in the country illegally:

Federal law prohibits people who aren’t U.S. citizens from using federal healthcare programs like Medicaid and Medicare. Legal immigrants who have lived in the U.S. for less than five years don’t qualify either.

However, there is one exception: Emergency Medicaid.

This part of the program started in 1986 when Congress passed a law saying hospitals that accept Medicaid had to see people with emergency medical conditions regardless of citizenship or ability to pay.

The law defined an emergency condition as “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs."

Basically, the program doesn’t cover things like the flu, a twisted ankle or sore throat.

Nationally, Emergency Medicaid is about one percent of the total Medicaid budget.

Colorado spent about $39 million on non-citizen emergency services in fiscal year 2015 - 2016, Williams said. The overall budget for that year was about $8 billion. 

 

© 2017 KUSA-TV


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