Presentation to the
House Appropriations
Subcommittee on Health & Human Services
Medicaid and CHIP Caseloads
April 17, 2006
Medicaid and CHIP
Caseloads
• Medicaid Caseload
 Historical caseload from September 1977 to
present
 Caseload history by risk group and fiscal year
 Recent caseload by risk group
• Children’s Health Insurance Program
Caseload
 Historical caseload from September 2003
Page 2
Medicaid Acute Care Historical Caseload:
September 1977 – March 2006
CHIP Phase I
3,000,000
2,500,000
1,500,000
Pregnant Women
TANF Adults
TANF Children
Disabled & Blind
Aged & Medicare
1,000,000
500,000
0
Se
p7
Se 7
p7
Se 8
p7
Se 9
p8
Se 0
p8
Se 1
p8
Se 2
p8
Se 3
p8
Se 4
p8
Se 5
p8
Se 6
p8
Se 7
p8
Se 8
p8
Se 9
p9
Se 0
p9
Se 1
p9
Se 2
p9
Se 3
p9
Se 4
p9
Se 5
p9
Se 6
p9
Se 7
p9
Se 8
p9
Se 9
p0
Se 0
p0
Se 1
p0
Se 2
p0
Se 3
p0
Se 4
p05
Recipient Months
2,000,000
Federal Mandate Children
Medically Needy
Expansion Children
Newborns
Page 3
Medicaid Historical Caseload
• Medicaid caseloads have grown historically as a
result of the expansion of eligibility groups, most
notably Children’s groups
• Historical declines were seen in the Medicaid
caseload overall after sustained growth from 1977
forward, beginning fiscal year 1997, following federal
welfare reform
 By the end of fiscal year 2000, caseloads had stabilized and
were beginning to increase
 Currently, caseloads have declined since November 2005,
however not all risk groups are declining
Page 4
Medicaid Historical Caseload
ADULT, AGED, AND DISABILITY-RELATED
Aged &
Medicare
Related
Disabled &
Blind
WITHOUT
StarPlus
TANF Adults
Pregnant
Women
CHILDREN's RISK GROUPS
Medically
Needy
(including
TANF
Delinked)
TANF
Children
Newborns
Ages 1-5
Expansion
Children
CHIP
Ages 6-18
Federal
Mandate
(includes
CHIP I)
TOTAL
Medicaid
FY95
290,140
181,754
229,642
84,407
19,346
643,059
100,686
345,034
175,059
2,069,129
FY96
299,607
190,783
207,646
84,826
18,295
597,009
103,669
345,185
215,782
2,062,802
FY97
304,386
193,305
189,336
84,223
17,887
530,734
104,612
323,424
239,639
FY98
304,555
197,721
154,916
82,613
18,067
443,627
105,077
298,048
FY99
308,351
202,093
119,016
81,666
17,974
363,128
106,511
FY00
307,825
181,812
106,724
84,393
21,152
341,031
FY01
309,596
185,615
106,227
89,489
25,740
FY02
312,066
194,641
113,448
96,132
FY03
316,143
208,957
116,710
FY04
320,548
223,123
FY05
323,374
% Change
(Trend)
Medicaid
Children's
Risk Groups
CHIP
Enrollment
COMBINED
Total CHILDREN
(CHIP &
Medicaid)
Adults and
Children,
Medicaid and
CHIP TOTAL
1,263,839
1,263,839
2,069,129
-0.3%
1,261,645
1,261,645
2,062,802
1,987,547
-3.6%
1,198,409
1,198,409
1,987,547
258,481
1,863,106
-6.3%
1,105,233
1,105,233
1,863,106
286,946
326,710
1,812,393
-2.7%
1,083,295
1,083,295
1,812,393
109,025
293,417
340,315
1,785,693
-1.5%
1,083,788
28,300
1,112,088
1,813,993
343,772
115,073
316,490
357,572
1,849,573
3.6%
1,132,907
251,575
1,384,482
2,101,148
33,364
361,834
119,030
408,808
443,373
2,082,697
12.6%
1,333,045
497,705
1,830,750
2,580,402
102,736
45,657
374,821
125,624
565,532
609,938
2,466,119
18.4%
1,675,915
506,968
2,182,883
2,973,087
90,000
112,256
43,763
341,624
136,024
664,828
727,727
2,659,892
7.9%
1,870,203
409,865
2,280,068
3,069,757
241,904
70,061
118,353
49,883
294,024
145,160
717,656
794,648
2,755,063
3.6%
1,951,488
333,707
2,285,195
3,088,770
327,474
259,462
58,476
120,746
46,630
264,022
154,087
722,721
802,274 2,755,892
0.0%
1,943,104
317,824
2,260,808
3,073,716
FY06
330,045
258,933
84,208
121,742
68,193
328,207
157,648
763,819
873,866
2,986,661
5.5%
2,123,540
362,175
2,485,715
3,348,836
FY07
346,384
276,522
84,966
122,959
68,993
333,129
166,854
781,099
933,312
3,114,218
4.3%
2,214,394
398,630
2,613,024
3,512,848
FY06 YTD
S.B. 1
* SB 1 includes adjustments for new programs and policies, including Medicaid Buy-In (+2,273 each year D&B); New Acute Care clients from Waiting List (+1,078 in 2006, 469 in Aged, 609 in D&B; +3,196 in 2007, 1401 in Aged, 1,795
in D&B; Fewer Expansion Children due to CHIP Perinatal Program (-14,386 in 2006; -39,214 in 2007); and additional Medically Needy (+10,118 in 2006; +10,918 in 2007). CHIP includes the addition of 20,000 clients each year, as
adjusted in Conference Committee, and 17,425 and 47,498 additions in 2006 and 2007 due to the Perinatal Program.
Page 5
Medicaid Historical Caseload
• Total Medicaid caseload grew 54 percent from
fiscal year 2000 to 2005, by close to 1 million clients
• In that same time, the non-disabled Children served
by Medicaid grew by 80 percent, from slightly over 1
million Children to slightly less than 2 million.
 Non-disabled Children currently comprise 70 percent of the
Medicaid caseload
 Adding CHIP Children to that picture brings the growth since
fiscal year 2000 to 105 percent, with over 1.1 additional
Children served by Medicaid or CHIP from 2000 to 2005.
Page 6
Medicaid Historical Caseload
ADULT, AGED, AND DISABILITY-RELATED
Aged &
Medicare
Related
First Quarter FY 2005
September
322,655
October
322,583
November
322,689
Second Quarter FY 2005
December
319,181
January
323,809
February
323,525
Third Quarter FY 2005
March
323,689
April
323,828
May
323,710
Fourth Quarter FY 2005
June
324,547
July
324,926
August
325,340
First Quarter FY 2006
September
326,032
October
327,754
November
328,013
Second Quarter FY 2006
December
326,885
January
327,941
February
327,508
Third Quarter FY 2006
March
328,183
Disabled &
Blind
WITHOUT
StarPlus
TANF Adults
Pregnant
Women
Medically
Needy
(including
TANF
Delinked)
CHILDREN's RISK GROUPS
TANF
Children
Newborns
Ages 1-5
Expansion
Children
CHIP
Ages 6-18
Federal
Mandate
(includes
CHIP I)
Medicaid
Children's Risk
Groups
TOTAL
Medicaid
CHIP
Enrollment
COMBINED
Total CHILDREN
Adults and
(CHIP &
Children, Medicaid
Medicaid)
and CHIP TOTAL
% Change
232,865
79,453
118,499
49,150
315,970
141,839
701,711
777,185
2,739,327
5.5%
1,936,705
355,528
2,292,233
3,094,855
234,952
78,127
117,654
50,449
313,564
143,382
705,406
782,861
2,748,978
4.5%
1,945,213
348,145
2,293,358
3,097,123
237,513
76,804
115,933
50,436
311,729
143,848
708,897
787,736
2,755,585
4.7%
1,952,210
340,101
2,292,311
3,095,686
237,572
74,967
114,532
49,916
308,971
145,061
709,943
787,947
2,748,090
3.8%
1,951,922
335,751
2,287,673
3,083,841
240,639
73,508
116,423
50,905
305,858
145,435
714,537
792,546
2,763,660
3.9%
1,958,376
332,055
2,290,431
3,095,715
241,749
69,842
115,898
50,095
299,002
143,966
712,778
789,542
2,746,397
3.8%
1,945,288
330,393
2,275,681
3,076,790
242,801
67,846
117,252
50,602
292,081
144,809
717,297
792,772
2,749,149
3.4%
1,946,959
328,350
2,275,309
3,077,499
243,978
65,584
118,183
50,202
283,927
144,553
722,293
798,034
2,750,582
3.9%
1,948,807
326,836
2,275,643
3,077,418
245,513
64,328
119,820
49,149
278,321
145,028
725,867
800,188
2,751,924
3.2%
1,949,404
326,809
2,276,213
3,078,733
246,656
63,755
120,987
49,366
274,025
146,490
728,238
804,480
2,758,544
1.9%
1,953,233
326,473
2,279,706
3,085,017
248,286
63,310
121,617
49,151
272,370
147,881
728,585
805,105
2,761,231
2.4%
1,953,941
327,267
2,281,208
3,088,498
250,320
63,211
123,436
49,177
272,472
149,632
736,322
817,384
2,787,294
2.2%
1,975,810
326,770
2,302,580
3,114,064
252,667
63,488
122,388
48,812
273,436
150,662
735,767
820,524
2,793,776
2.0%
1,980,389
326,557
2,306,946
3,120,333
257,796
62,134
122,003
48,860
271,039
151,847
737,263
821,181
2,799,877
1.9%
1,981,330
323,343
2,304,673
3,123,220
259,496
60,578
120,265
47,444
269,284
152,416
735,169
817,764
2,790,429
1.3%
1,974,633
321,562
2,296,195
3,111,991
258,967
59,036
118,436
46,090
266,128
154,176
727,928
806,545
2,764,193
0.6%
1,954,777
322,898
2,277,675
3,087,091
261,246
57,318
120,993
46,082
262,148
155,251
720,932
799,145
2,751,057
-0.4%
1,937,476
317,408
2,254,155
3,067,736
262,522
54,283
120,817
44,666
255,890
155,740
703,999
779,243
2,704,667
-1.4%
1,894,872
310,981
2,205,853
3,015,648
263,542
52,498
120,319
44,458
250,231
158,519
771,515 2,687,251 -1.4%
1,878,251
302,020
2,180,162
2,989,162
1,803,617
66.5%
Medicaid Managed Care Percentage for March 2006
697,986
March Total w/STAR+Plus2,713,820
Page 7
Medicaid Acute Care
Caseload
• Medicaid caseload trends, which averaged approximately 8
percent in fiscal year 2004 after double-digit growth in both fiscal
years 2002 and 2003, began to stabilize at approximately 4
percent overall beginning December 2004.
 At that time, trends for the two largest Children’s Medicaid groups
(non-TANF, non-disabled ages 1 to 18) dropped below 10 percent
for the first time in many years.
 From March 2005 through October 2005, the growth trend for this
group of Children stabilized at 6 percent.
 For comparison, from March 2004 through October 2004, the
growth trend for this group of Children averaged 15 percent.
• The slowed growth beginning December 2004 may be a result
of changes in the economy and outside forces impacting client
behavior. However, the more recent declines may be driven by
a number of interacting factors in the short-term.
Page 8
Medicaid Acute Care
Caseload
• Medicaid caseload (overall) continued to increase
until November 2005, at which point began the first
sustained caseload decline since FY1999.
• Caseload growth or decline differs by risk group
 Newborns and Disabled and Blind are increasing
steadily
 Aged and Medicare related are increasing at a
rate of 1.5% (slightly lower than population)
 Pregnant Women remain mostly stable, with some
very recent growth
 All other groups are declining
Page 9
Medicaid Caseload: October
2005 & March 2006
Other Adult
Aged & Disability-Related
Children
3,000,000
2,799,877
2,687,251
232,997
217,275
2,500,000
585,550
591,725
2,000,000
1,500,000
1,000,000
1,981,330
1,878,251
October 2005
March 2006
500,000
0
Page 10
CHIP Caseload
Month
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
Mar-04
Apr-04
May-04
Jun-04
Jul-04
Aug-04
Sep-04
Oct-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
Apr-05
May-05
Jun-05
Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
Total
Enrollment
507,259
488,690
458,166
438,164
416,302
399,306
388,281
377,051
365,731
358,230
361,464
359,734
355,528
348,145
340,101
335,751
332,055
330,393
328,350
326,836
326,809
326,473
327,267
326,770
326,557
323,343
321,562
322,898
317,408
310,981
302,020
294,189
New
Enrollment
Renewals
Completed
Renewal Deemed
Ineligible
Total
Disenrollment
NonRenewals
Actual
Renewal
Rate
Attempted
Renewal
Rate
Total
Disenrollment
Rate
18,606
14,782
13,723
9,843
14,843
20,730
22,428
23,798
23,651
23,284
23,323
19,678
18,252
17,983
18,926
21,538
20,385
20,876
19,163
20,379
21,278
19,623
20,404
18,998
18,624
17,176
19,129
20,385
11,591
23,937
23,728
20,632
22,509
29,357
24,545
45,367
38,442
37,386
44,822
46,383
41,005
37,349
37,573
36,754
41,921
41,722
36,919
35,108
33,994
33,223
37,171
39,088
37,899
35,735
35,195
34,128
37,059
39,485
37,964
18,460
25,285
19,482
3,690
4,297
4,477
4,452
7,542
7,441
6,855
6,831
8,448
6,522
3,464
3,076
3,065
4,943
6,195
7,726
7,547
6,664
6,982
8,031
7,248
6,156
6,625
6,029
5,693
7,070
6,527
6,297
1,227
4,387
10,370
17,374
33,269
47,560
29,724
36,539
34,401
33,339
34,947
34,864
30,677
21,721
21,349
22,372
25,257
26,969
25,887
24,078
22,536
21,206
21,875
21,288
19,955
19,609
19,493
18,832
20,360
20,902
19,048
20,303
26,553
31,220
1,893
16,231
12,983
11,183
17,323
16,806
15,401
17,093
16,947
13,574
7,800
8,545
9,713
10,974
11,782
10,398
9,986
9,107
8,230
8,398
8,087
8,062
7,517
7,142
6,892
7,914
8,024
7,428
17,290
20,097
19,298
91.6%
58.1%
69.3%
68.7%
72.4%
69.6%
70.8%
72.4%
73.2%
75.1%
82.7%
81.5%
79.1%
79.3%
78.0%
78.0%
77.9%
78.9%
80.1%
81.6%
82.9%
82.5%
82.6%
83.1%
83.2%
82.4%
83.1%
83.6%
51.6%
55.7%
50.2%
92.8%
62.3%
72.3%
72.2%
75.3%
73.2%
74.2%
75.1%
76.4%
77.8%
84.0%
82.6%
80.4%
81.0%
80.3%
81.1%
81.0%
81.7%
83.0%
84.3%
85.1%
84.5%
84.9%
85.2%
85.2%
84.8%
85.2%
85.6%
53.2%
59.6%
60.7%
3.4%
6.8%
10.4%
6.8%
8.8%
8.6%
8.6%
9.3%
9.5%
8.6%
6.0%
5.9%
6.3%
7.3%
7.9%
7.7%
7.3%
6.8%
6.5%
6.7%
6.5%
6.1%
6.0%
6.0%
5.8%
6.3%
6.5%
5.9%
6.4%
8.5%
10.3%
29,479
19,081
10,065
37,167
19,740
49.2%
59.6%
12.7%
Page 11
CHIP Caseload
• Total CHIP caseload began declining in October 2003 as a
result of policy changes, after having stabilized for most of fiscal
year 2003 at approximately 507,000.
• CHIP caseload stabilized to approximately 326,500 from April –
September 2005 (within 500 of the average each month), with a
decline of 3,000 holding steady through December 2005
 Beginning January 2006, CHIP caseload declined by almost
6,000 to 317,408, with similar declines in the following
months.
 Currently, CHIP caseload is 294,189 for April 2006.
Page 12
CHIP Caseload
• Beginning November 28, 2005, the eligibility for the CHIP
program changed from Affiliated Computer Services (ACS) to
Texas Access Alliance (TAA). The first clients processed by TAA
were seen in the January 2006 caseload.
 March 2006 is the first month that new enrollment fees were
to be paid by clients.
 In addition to changing vendors, new business rules were
implemented, including requiring verification of income
status upon renewal for CHIP, rather than only a statement
that income had not changed.
• The decline in the CHIP caseload, like the decline in
the Medicaid caseload, may be driven by a number of
factors.
Page 13