Urban Institute Examines Recent Health Policies for Low-Income People in Michigan, New York State

The Urban Institute has released two reports describing the status of health care financing in Michigan and New York state, focusing on the states' Medicaid and CHIP programs. The reports are part of a series produced for the institute's Assessing the New Federalism project (Assessing the New Federalism release, 4/26). The following is a summary of each report's findings:

• Michigan: Seven percent of the state's children and 11% of its adults were uninsured during the late 1990s, compared with national figures of 13% and 16%, respectively. The report attributes the low figures to a high percentage of the state's employers providing health benefits to their workers, as well as to an expansion of public health insurance programs. To control health costs, Michigan shifted during the 1990s from a Medicaid fee-for-service system to one "dominated" by managed care organizations. The same shift occurred for public programs targeted at people with disabilities. The state also expanded its Medicaid and CHIP programs to provide health coverage for children through age 18 in families with incomes up to 200% of the federal poverty level, or $36,200 for a family of four. Michigan in 2001 started the Elder Prescription Insurance Coverage program, which uses state revenue and tobacco settlement funds to provide prescription drug assistance to people age 65 and older with incomes below 200% of poverty. Seniors pay a premium based on income to enroll in the program. State officials are still concerned about increasing prescription drug costs, which currently account for 15% of the Medicaid budget and are rising faster than any other Medicaid service (Tilly et al., "Recent Changes in Health Policy for Low-Income People in Michigan," March 2002). The full report is available online.
• New York: Through the Health Care Reform Act of 2000, New York state, which operates some of the "most comprehensive" Medicaid and CHIP programs in the country, has attempted to reduce its uninsured population by reauthorizing existing programs and establishing new initiatives. The Family Health Plus program is the state's attempt to insure more people through Medicaid, and the Healthy New York program uses state money to provide health care coverage to small-business employees and individual workers. The two programs will cost New York $500 million over a three-and-a-half-year period and will be funded in part by tobacco settlement money and cigarette tax revenues. Other state initiatives include expanding the Elderly Pharmaceutical Insurance Coverage program to enroll an additional 120,000 to 200,000 seniors and implementing the Partnership Plan, which aims to transfer two million Medicaid beneficiaries into managed care organizations. But the report states that "considerable work is needed to translate the many new initiatives into successful programs." The authors add, "If these programs do not meet their enrollment goals, New York and its providers will continue to confront the pressures of a sizeable uninsured population" (Coughlin/Lutzky, "Recent Changes in Health Policy for Low-Income People in New York," March 2002). The full report is available online.