Medicaid State Report

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Medicaid State Report NEW JERSEY, FY 1996 (October 1, 1995 - September 30, 1996) Produced by the Department of Research Division of Health Policy Research I.

1 Medicaid State Report NEW JERSEY, FY 1996 (October 1, September 30, 1996) Produced by the Department of Research Division of Health Policy Research I. POPULATION AND CHILD HEALTH DATA Total Population, 1996 % Under Age 21 % Under Age 6 % Infants % Age 1 Through 5 % Age 21 and Older Infant Mortality, Low Birth Weight and Prenatal Care, 1995 Infant Mortality per 1,000 Live Births Neonatal Mortality Postneonatal Mortality % Low Birth Weight Infants Under 2500 Grams Under 1500 Grams % Not Receiving Prenatal Care In First Trimester Until Third Trimester or Not At All Total White Other Total White Other Total White Other % 17.2% NEW JERSEY MID ATLANTIC REGION* UNITED STATES 7,997, % 7.2% % 13.6% % 29.0% % 19.4% 38,243, % 8.5% 7.1% % 15.9% 3.4% % % 18.7% 265,253, % % % 7.0% II. MEDICAID ENROLLEES, RECIPIENTS, AND EXPENDITURES, FY 1996 A. Federal Medical Assistance Percentage (FMAP) and AFDC Income Thresholds FY96, FY98 and Enhanced FMAP~ % AFDC Income Threshold (%Poverty) For a Family of 3, 1996 $5,322 ( 41.0% of $12,980 ) % $6,101 ( 47.0% of $12,980 ) 56.7% 6 7 $5,311 ( 4 of $13,082 ) #B. Enrollees, Recipients, and Expenditures** Total, FY1996^ % Under Age 21 % Under Age 6 % Infants % Age 1 Through 5 % Age 21 and Older Enrollees Recipients Expenditures 876, ,180 $3,726 M 5,968,983 5,163,218 $30,737 M 40,996,808 35,027,510 $121,419 M 53.1% % 48.2% % 51.8% Total Medicaid Managed Care Enrollment, ,644 1,915,734 15,345,502 Percent of Births Paid for by Medicaid, 1995^^ 29.0% 38.1% % 0.8% 9.8% 84.8% Enrollees Recipients % 17.5% % 49.6% 2 4.3% 16.9% 5 Expenditures 19.5% 7.6% 2.9% 12.0% 8 Enrollees Recipients Expenditures Note: 'na' Data unavailable. * Includes NJ, NY & PA. ~ Region and US estimates of FY96 FMAPs are weighted by FY96 expenditures. FY98 and Enhanced FMAPS are unweighted averages. # Enrollee data are not available for NE. Recipient and Expenditures by Age data for AZ are from FY95 and not included in regional and US estimates. ^ Does not include HI children enrolled in managed care. ** Does not include Disproportionate Share Hospital (DSH) payments. FY96 DSH payments to New Jersey were $665,819,124. ^^ CT, MD, OH and SC data are from state fiscal year IL and OK data are estimates. HI, KS, KY, NJ, PA and VA data are from DC and ME data are unavailable. Regional and US estimates do not include the last 8 states. 56.6% 24.7% 5.2% 19.5% % 24.0% % % 3.7% 5.8% 13.0% 77.5%

2 MEDICAID STATE REPORT FOR NEW JERSEY, FY96 Page 2 II. CONTINUED # C. Expenditures by Age, FY 1996 Per Enrollee Per Recipient All Ages Children Under Age 21 Under Age 6 Infants Age 1 Through 5 Age 6 Through 20 Adults $4,251 $1,215 $1,013 $978 $1,020 $7,679 NEW JERSEY $1,364 $5,217 $1,653 $8,597 $1,338 $1,564 $1,305 $1,897 MID ATLANTIC REGION Per Enrollee Per Recipient Per Enrollee Per Recipient $5,149 $1,900 $1,756 $3,128 $1,375 $9,016 $2,005 $5,953 $2,347 $9,514 $2,123 $4,051 $1,633 $2,515 UNITED STATES $2,945 $1,167 $1,130 $2,085 $878 $5,229 $1,191 $3,466 $1,486 $1,407 $2,656 $1,085 $5,905 $1,549 # D. Percent Enrollees, Recipients, and Expenditures($) by Eligibility Category, FY 1996 Children Under Age 21 Categorically Needy - Cash Categorically Needy - Noncash Medically Needy Expansions* Adults Categorically Needy - Cash Categorically Needy - Noncash Medically Needy Expansions* Blind and Disabled Aged Other Title XIX (mostly children) # E. Enrollees, Recipients, and Expenditures ($Million) by Race and Age, FY 1996 Total Under Age 21 % Non-hispanic White % Non-hispanic Black % Hispanic % Other 49.8% 28.2% 19.9% 12.2% 6.1% 17.9% 1 465, % 57.6% 23.1% 44.0% 56.0% 43.2% % 54.4% 43.9% 56.1% Note: * Includes recipients made eligible through Medicaid expansions. "na" Data unavailable. Enrollees Recipients Expenditures Enrollees Recipients Expenditures Enrollees Recipients Expenditures 23.9% % 20.8% 13.2% 342, % 56.3% 25.1% 55.2% % % 53.1% 6.0% % 5.6% 8.9% 5.1% 3.2% 48.2% 3 $566 M 3,155,132 2,554,631 $5,996 M 23,142,242 18,257,442 $27,122 M % % 34.1% 65.9% 17.6% 44.3% 55.7% 14.5% % 45.7% 2 7.9% 1 3.9% % % % 18.2% 44.5% 55.5% 21.8% 42.6% % 27.1% 7.2% 11.8% 3.9% 19.6% % 32.4% % 23.9% % 19.2% 45.2% 54.8% 24.5% 43.2% 56.8% 12.1% 7.9% 7.7% 4.8% % 38.7% % 32.9% 67.1% 19.2% % 13.4% 46.8% 53.2% 43.7% 38.1% % 26.8% 14.1% % 2.9% 2.2% % % % 20.8% 48.1% % 49.4% 2 6.9% % 3.0% 18.1% 12.1% 2.0% 55.2% % 42.9% 57.1% 19.8% % 15.3% 4.1% 5.1% Enrollees Recipients Expenditures Enrollees Recipients Expenditures Enrollees Recipients Expenditures 30.8% 42.2% 57.8% % % 44.1% 55.9% % 47.0% % # Enrollee data are not available for NE. Recipient and expenditures by age data for AZ are from FY95 and not included in regional and US estimates. Enrollees and recipients with missing age data are not included in the percents. Managed care enrollees, service recipients and expenditure data are not included for HI since the state does not report managed care data on the HCFA2082.

3 MEDICAID STATE REPORT FOR NEW JERSEY, FY96 Page 3 II. CONTINUED NEW JERSEY MID ATLANTIC REGION UNITED STATES #F. Expenditures by Age and Type of Service^ Physician Services Dental Services Other Practitioners EPSDT* Family Planning Services Rural Health Clinics Other Clinics Outpatient Hospital Inpatient Hospital Nursing Home/Intermediate Care Mental/Psychiatric Hospital Care Home Health Care Lab and X-Ray Drug Other Services CHILDREN Under % 2.6% 17.0% na 3.2% % 6.5% 8.3% ADULTS na 7.3% 15.3% 44.4% 0.8% 12.0% 1 CHILDREN Under 21 ADULTS CHILDREN Under 21 ADULTS 1 6.6% Total % 1.0% 13.6% 24.0% 97.3% % 13.0% 8.3% 2.1% % % 28.1% 1 2.4% 2.0% 5.2% 4.7% 7.8% 3 3.3% 4.4% 6.6% 6.1% 4.3% 3.0% 16.5% 43.3% 9.5% 9.2% #G. Cost per User of Service and Percent of Recipients Using Each Service Physician Services Dental Services Other Practitioners EPSDT* Family Planning Services Rural Health Clinics Other Clinics Outpatient Hospital Inpatient Hospital Nursing Home/Intermediate Care Mental/Psychiatric Hospital Care Home Health Care Lab and X-Ray Drug Other Services CHILDREN Under 21 ADULTS $ % $ % $ % $ % $421 1 $ % $ % $50 $ % $ % na na na na $411 1 $990 2 $ % $1,177 5 $7, % $6,141 2 $81,197 $27, % $41,512 $40,829 $4,306 $10,152 1 $ % $228 5 $195 7 $1, % $1,312 1 $ % CHILDREN Under 21 ADULTS CHILDREN Under 21 ADULTS $147 $163 $486 $374 $185 $258 $765 $430 $7,067 $89,967 $21,711 $4,227 $42 $161 $ % 28.7% 8.7% 33.2% 1.8% 12.9% % 25.2% 58.6% 33.7% $283 $193 $189 $203 $279 $285 $2,067 $844 $9,393 $50,458 $61,608 $14,970 $96 $975 $1, % 23.7% 21.8% % % 3 $238 6 $ % $287 1 $ % $136 $206 $ % $ % $4,880 $54,064 $19,300 $3,500 $ % $ % $ % $394 6 $186 1 $162 2 $ % $226 1 $ % $1, % $ % $5, % $24,889 1 $27,205 $7, % $129 4 $ % $ % Note: 'na' Data unavailable. 'NA' Not applicable. # Recipient and expenditures by type of service data for AZ and GA are from FY95 and not included in regional and US estimates. Managed care service utilization and expenditure data are not included for HI since the state does not report managed care data on the HCFA2082. * EPSDT services are known to be under-reported in many states due to complexities in the reporting process. ^ When less than 0.05% of expenditures is accounted for by a type of service, it is rounded to. + Percents do not sum to 100 because recipients use many services; when less than 0.05% use a service, it is rounded to.

4 MEDICAID STATE REPORT FOR NEW JERSEY, FY96 Page 4 III. TITLE XIX AND TITLE XXI PROGRAM ELIGIBILITY BASED ON FAMILY INCOME AS A PECENTAGE OF THE FEDERAL POVERTY LEVEL (FPL), JUNE 1998 [Total Number of States with Expansions or Medically Needy Program in Brackets] 300% 200% 100% 235% 185% 133% ELIGIBILITY Potential Federally Legislated Title XXI NJ KidCare Part B and C Medicaid/ NJ KidCare Part A Federal Mandate A. Title XIX Medicaid Eligibility and Expansions [44] By federal mandate, all states must cover pregnant women and children to age 6 to 133% of the Federal Poverty Level (FPL) and children through age 14 up to 100% FPL, as of October 1, In addition, 1996 federal welfare legislation requires states to use the AFDC income eligibility levels in effect as of July 16, 1996 to determine Medicaid eligibility. This establishes a state specific minimum eligibility level for poor children ages 15 through Age New Jersey expanded its Title XIX Medicaid program to 185% FPL for pregnant women and infants. The Medically Needy [34] were covered to 52% FPL in As of June 10, 1998, New Jersey implemented a proposal for a Section 1115 Waiver. IV. TITLE XIX (MEDICAID) AND FEDERALLY LEGISLATED TITLE XXI MEDICAID / SCHIP ELIGIBILITY FOR UNINSURED CHILDREN UNDER AGE 19, 1998 ESTIMATES Analysis of the March Current Population Surveys and 1998 Census Bureau projections of child population revealed an estimated 383K uninsured children under age 19, of whom 131.2K are unenrolled Medicaid eligibles, 115.5K are federally legislated Title XXI/SCHIP eligibles~. Full implementation of and maximum enrollment into both Title XIX and Title XXI programs would reduce New Jersey's uninsured child population to 136.0K, or 6.5% of the state's 2,092K children under age 19. Title XIX/Title XXI Ineligible 136.0K (35.5%) Federally Legislated Title XXI Eligible 115.5K~ (3) Title XIX Eligible 131.2K (34.3%) B. Title XXI SCHIP/Medicaid Program Eligibility: Part A of NJ KidCare, New Jersey's Title XXI program, covers children ages 6 through 18 to 133% FPL. New Jersey Kid Care Parts B&C covers remaining children to 200% FPL. Federally legislated maximum Title XXI SCHIP/Medicaid program eligibility for infants in New Jersey is 235% FPL. For children age 1 through 18, New Jersey expanded its Title XXI SCHIP program eligibility to the maximum federally legislated limit. As of June 26, 1998, 42 states and the District of Columbia submitted their Title XXI/SCHIP plans and HCFA approved 22 of the submitted plans. ~ This estimate represents federally legislated eligibility (at or below 200% FPL or 50 percentage points above the state's Medicaid income limit as of March 31, 1997). Coverage could be provided through Medicaid or a separate state program.

5 REFERENCES I. "State Population Projections: 1995 to Detailed State Projections Data files (PE-45). US Department of Commerce. Bureau of the Census. Available at : A April 7, National Center for Health Statistics. Division of Vital Statistics. Number of infant and neonatal deaths and mortality rates, by race for the United States, each division, each State, Puerto Rico, Virgin Islands and Guam, and by sex for the United States, Low birth weight by state and race of mother, Percent of mothers beginning prenatal care in the first trimester and percent of mothers with late or no prenatal care by race of mother: United States and each State, Puerto Rico, Virgin Islands, and Guam, II. Medicaid Services State by State, October 1996." Health Care Financing Administration. Intergovernmental Affairs Office. State Children s Health Insurance Program; Reserved Allotments to States for Fiscal Year 1998; Enhanced Federal Medical Assistance Percentages. Federal Register, September 12, Published by the Department of Health and Human Services as Notice MB-115- N. Annual Update of the HHS Poverty Guidelines. Federal Register: February 24, 1998 (Volume 63, Number 36, pages ). "Medicaid Statistical File, FY 1996." Based on data from the HCFA Health Care Financing Administration. Bureau of Data Management and Strategy. Medicaid Hospital Expenditures by Type of Service and by Region, Total Computable, Fiscal Year From the Medicaid Statistics System (MSS). Medicaid Managed Care State Enrollment, June 30, Health Care Financing Administration. Available at : A April 7, "MCH Update: State Medicaid Coverage of Pregnant Women and Children, September 1997." National Governors' Association. III. Title XIX and Title XXI Program Eligibility as a Percentage of the Federal Poverty Level. American Academy of Pediatrics Division of State Government and Chapter Affairs, July The Kaiser Commission on Medicaid and the Uninsured, February Comprehensive State Health Reform Demonstrations Health Care Financing Administration. Available at : ord-1115.htm. A July 20, State Approaches to Title XXI. American Academy of Pediatrics Division of State Government and Chapter Affairs, June State Facts: Health Needs and Medicaid Financing. American Academy of Pediatrics Division of State Government and Chapter Affairs, June IV. American Academy of Pediatrics Division of Health Policy Research analysis of 1994 to 1997 March Demographic Files, Current Population Surveys, conducted by the Bureau of the Census for the Bureau of Labor Statistics. ORDERING INFORMATION Complete sets of the state reports can be purchased by contacting the American Academy of Pediatrics, Department of Research, 141 Northwest Point Blvd., PO. Box 927, Elk Grove Village, Illinois, 60007; (800) , extension 7627 or (847) Contact Beth Yudkowsky, Division of Health Policy Research, with comments about the report; contact Jean Cilik, Division of State Government and Chapters Affairs, for Medicaid questions and advocacy advice. The Medicaid State Reports, FY 1996 will also be made available on the Research page of the AAP Web site at

Medicaid. (Title XIX and Title XXI) STATE REPORTS FY Division of Health Services Research MICHIGAN. SUK-FONG S TANG, PhD.

Medicaid. (Title XIX and Title XXI) STATE REPORTS FY Division of Health Services Research MICHIGAN. SUK-FONG S TANG, PhD. Medicaid STATE REPORTS FY 2001 (Title XIX and Title XXI) Text7: Division of Health Services Research SUK-FONG S TANG, PhD General Information about CMS/MSIS2082, data source of this report: (Based on CMS