State Health Assessment: Findings from the Ohio Medicaid Assessment Survey County Commissioners Association of Ohio October 23, 2013 Presented by The Ohio Colleges of Medicine Government Resource Center
Presentation Outline Background, Methods and Overview Adult and Child Health Status in Ohio Health Insurance and Access to Care Medicaid Population Characteristics 2
Background, Methods and Overview 3
What is the Ohio Medicaid Assessment Survey? The Ohio Medicaid Assessment Survey (OMAS) is a randomdigit-dial telephone survey designed to measure the health system experiences of Ohioans. OMAS provides data supporting policy making and strategy development for the efficient and effective operation of Ohio s Medicaid program. OMAS is the key research dataset for estimates of insurance rates, access to health care, health status, health risks and poverty of children and adults in Ohio. 4
Main OMAS Topics Medicaid status Insurance status Access to health care Health care utilization Unmet health needs Health risk factors Health status Mental health distress Socioeconomic status Health demographics 5
OMAS Interview Summary 2012 OMAS Field Activities Landline Interviews 17,414 Interviews (76% of sample) Cell Phone Interviews 5,198 Interviews (23% of sample) Final Sample Size 22,929 Adult Interviews (19 & older) 5,515 Child Interviews (0 18 years) Child interview is completed by an adult proxy 6
Data & Results Available Online A public version of the 2012 OMAS is available online for download: grc.osu.edu/omas OMAS is a complex designed survey requiring special software to analyze: do NOT analyze the data in Excel Excel spreadsheets with descriptive results are also available online 7
Demographic Overview from 2012 OMAS Ohio Demographics 8
Adult and Child Race/Ethnicity Weighted Distribution, Ohio 90.0% 80.0% 83.4% Adult 74.4% Child 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 11.4% 2.5% 2.4% 0.3% 15.5% 4.9% 4.7% 0.5% 9
Federal Poverty Levels, Adults (19-64 Years) by 100%, 138%, 200% and 400% FPL 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 100% FPL 138% FPL 200% FPL 400% FPL 500,000 0 2004 2008 2010 2012 10
Federal Poverty Levels, Children (0-17 Years) by 100%, 138%, 200% and 400% FPL 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 100% FPL 138% FPL 200% FPL 400% FPL 200,000 0 2004 2008 2010 2012 11
Uninsured Adults (19 64 Years) by Poverty Categories Overall working-aged adult uninsured prevalence is 17.3% (1,214,232) 35.0% 30.0% 31.3% 32.4% 30.3% 26.5% 25.0% 23.1% 20.0% 15.0% 10.0% 5.0% 3.9% 0.0% 90% FPL 138% FPL 200% FPL 300% FPL 400% FPL 401% FPL 12
Uninsured Children (0 18 Years) by Poverty Categories 8.0% Overall children uninsured prevalence is 4.7% (131,257) 7.0% 6.0% 5.6% 6.9% 6.2% 5.7% 5.0% 4.0% 3.0% 2.0% 1.7% 1.0% 0.0% 100% FPL 200% FPL 300% FPL 400% FPL 401% FPL 13
Any Employer Sponsored Insurance (ESI) Adult (19 64 Years) and Children Covered 58.0% 56.9% 56.0% 54.0% 52.0% 50.0% 49.5% 48.0% 46.0% 44.0% Adult ESI Child ESI 14
Ohio Medicaid Enrollment Administrative Data (Source: Ohio Medicaid) 50.0% 45.0% 40.0% 41.3%, (1,195,868) 35.0% 30.0% 25.0% 20.0% 15.0% 12.8% (900,057) 10.0% 5.0% 11.2% (181,668) 0.0% Adults 19-64 Years Adults 65 Years Children 15
Working Adults (19 64 Years) 2004-2012 Working Status, at Least one Week Prior to Interview Total adult (19-64 years) population not working is 34.3% (2,406,205) 16
Working Adults (19 64 Years) by Poverty Status 90.0% 80.0% 76.9% 70.0% 64.4% 60.0% 50.0% 40.0% 35.6% 53.4% 46.6% Working Not Working 30.0% 20.0% 23.1% 10.0% 0.0% 90% FPL 91-138% FPL 139% FPL 17
Full-Time & Part-Time Working Adults (19 64 Years), 2004-2012 90.0% 80.0% 81.1% 78.9% 75.8% 76.1% 70.0% 60.0% 50.0% 40.0% Full-Time Part-Time 30.0% 20.0% 18.4% 20.8% 23.6% 23.6% 10.0% 0.0% 2004 2008 2010 2012 18
Full-Time & Part-Time Working Adults (19-64 Years), by Poverty Status 90.0% 80.0% 81.0% 70.0% 63.8% 60.0% 50.0% 40.0% 52.0% 46.8% 35.6% Full-Time Part-Time 30.0% 20.0% 18.8% 10.0% 0.0% 90% FPL 91-138% FPL 139% FPL 19
Adult and Child Health Status in Ohio 20
Adults Age 19 Years and Older
Percent of Adults with Fair/Poor Health Prevalence of Fair or Poor Self-Rated Health 2004-2012 25 20 15 10 Male Female Overall 5 0 2004 2008 2010 2012 Year 22
Percent of Adults with Fair/Poor Dental or Vision Health Prevalence of Fair or Poor Health of Teeth/Gums and Vision in 2012 30 25 23 25.1 24.1 20 15 15.1 17.6 16.4 10 5 0 Male Female Overall Male Female Overall Teeth/Gums Vision 23
Percent of Adults who are Current Smokers Smoking Prevalence 2004-2012 35 30 25 20 15 10 Male Female Overall 5 0 2004 2008 2010 2012 Year 24
Percent of Adults Binge Drinking 1+ Times in Past Month Binge Drinking Prevalence 2008-2012 30 25 20 15 10 Male Female Overall 5 0 2008 2010 2012 Year 25
Percent of Adults Misusing Pain Medication in Past 12 Months Prevalence of Prescription Pain Medication Misuse in Past 12 Months, 2012 5 4.5 4 4.5 3.9 3.5 3.3 3 2.5 2 1.5 1 0.5 0 Male Female Overall 26
Percent of Adults who are Obese Prevalence of Obesity 2008-2012 40 35 30 25 20 15 10 Male Female Overall 5 0 2008 2010 2012 Year 27
Percent of Adults with 14+ Mentally Distressed Days in Past 30 Days Prevalence of 14+ Mentally Distressed Days 2008-2012 12 10 8 6 4 Male Female Overall 2 0 2008 2010 2012 Year 28
Children Age 18 Years and Younger
Percent of Children with Fair/Poor Health Prevalence of Fair or Poor Health Status Children (0-17 Years), 2004-2012 4 3.5 3 2.5 2 1.5 1 Male Female Overall 0.5 0 2004 2008 2010 2012 Year 30
Percent of Children with Fair/Poor Teeth or Vision Health Prevalence of Fair or Poor Health of Teeth and Vision in 2012 9 8 7 7.9 7 7.5 6 5 4.6 4.6 4.6 Male 4 3 Female Overall 2 1 0 Teeth Vision Children 3-18 Years Children 5-18 Years 31
Percent of Children who are Overweight or Obese Prevalence of Overweight and Obesity Children (11-17 Years), 2008 and 2012 45 40 35 30 25 20 15 Male Female Overall 10 5 0 2008 2012 Year 32
Percent of Children who currently have Asthma Prevalence of Asthma in 2008 and 2012 Children (0-17 Years) 14 12 10 8 6 4 Male Female Overall 2 0 2008 2012 Year 33
Key Findings Among adults: Fair/Poor health status and obesity have increased over time Smoking and binge drinking prevalence has changed little over time Among children: Fair/Poor health status and asthma have increased over time Overweight/obese status has decreased slightly among all children 11-17 years 34
Health System Findings 35
Trends in Insurance Coverage Adults (19 64 Years) 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 63.8% 62.3% 55.3% 54.4% 18.90% 17.00% 17.30% 10.9% 11.2% 13.8% 15.20% 9.2% 2004 2008 2010 2012 0.0% Employer-Sponsored Medicaid Uninsured Results for Other Private, Medicare, and Unknown not displayed above 36
Trends in Insurance Coverage Children (0 17 Years) 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 59.5% 53.3% 46.2% 46.4% 27.4% 40.2% 35.5% 41.2% 2004 2008 2010 2012 20.0% 10.0% 0.0% 4.00% 5.40% 4.60% 4.80% Employer-Sponsored Medicaid Uninsured 37
100.0% 90.0% Insurance Status By Income Adults (19-64 Years) 2011 Annual Family Income By Percent of Federal Poverty Level 80.0% 70.0% 73.3% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2012 OMAS, <90% FPL 42.4% 2012 OMAS, 90-138% FPL 2012 OMAS, 139% FPL 34.5% 31.3% 21.3% 23.4% 10.8% 10.1% 3.6% 5.3% 5.7% 3.4% Medicaid Employer-Sponsored Other Private Insurance Uninsured 38
100.0% 90.0% Insurance Status By Income Children (0-18 Years) 2011 Annual Family Income By Percent of Federal Poverty Level 80.0% 70.0% 70.1% 77.0% 60.0% 50.0% 40.0% 2012 OMAS, 200% FPL 2012 OMAS, 201% FPL 30.0% 20.0% 10.0% 0.0% 16.4% 11.7% 6.9% 4.4% 1.8% 2.7% Medicaid Employer-Sponsored Other Private Insurance Uninsured 39
Usual Source of Care Adults (19 Years & Older) 100.0% 90.0% 80.0% 70.0% 92.7% 91.2% 91.3% 77.7% 82.2% 70.7% 60.0% 50.0% 40.0% 2004 2008 2012 30.0% 20.0% 10.0% 0.0% Usual Source of Care Usual Source of Care and Personal Doctor/Nurse 40
Usual Source of Care Children (0 17 Years) 100.0% 90.0% 80.0% 98.5% 97.9% 92.4% 82.7% 82.7% 80.5% 70.0% 60.0% 50.0% 40.0% 2004 2008 2012 30.0% 20.0% 10.0% 0.0% Usual Source of Care Usual Source of Care and Personal Doctor/Nurse 41
ER Utilization (0,1-2, 3+ visits per year) Adults (19 & Older) Children (0 17 Years) 100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 2004 2008 2010 2012 0% 2004 2008 2010 2012 42
No Routine Medical Visit (past 12 months) 50.0% 45.0% 40.0% Adults (19 & Older) Children (0 17 Years) 35.0% 30.0% 25.0% 20.0% 15.0% 29.2% 25.3% 24.7% 25.9% 24.3% 21.6% 21.8% 19.0% 2004 2008 2010 2012 10.0% 5.0% 0.0% Adults Children 43
Harder to Secure Care 50.0% 45.0% 40.0% 35.0% Adults (19 & Older) Children (3 17 Years) 30.0% 25.0% 20.0% 15.0% 10.0% 22.4% 22.7% 21.1% 22.0% 13.7% 11.4% 2004 2008 2012 5.0% 0.0% Adults Children 44
Key Findings Decline of employer sponsored insurance has slowed with the economic recovery Uninsured are the largest group in the Medicaid expansion population (90%-138%) Little change in ER use over the last decade Most Ohioans report a usual source of care, but fewer will reach a medical home. 45
Ohio Medicaid Profile 46
Ohio Medicaid Enrollment Trend, Administrative Data (Source: Ohio Medicaid) 1,400,000 1,200,000 1,161,067 1,195,868 1,000,000 920,751 1,012,959 900,057 800,000 600,000 556,886 639,721 772,630 Adults, 19-64 Children, 0-19 0-18 Seniors 400,000 200,000 135,232 166,062 173,241 181,668 0 2004 2008 2010 2012 Since 2004, Ohio Medicaid enrollment has experienced a 41.9% growth in adults 19-64 years, and a 23.0% growth in children 0-18 years. 47
Insurance Status & Medicaid, 138% FPL Adults (19-64 Years), 2012 OMAS Including Medicaid Medicaid enrollment is 52% of the total insured adults reporting family income 138% FPL 48
Insurance Status & Medicaid, 138% FPL Adult Parents (19-64 Years), 2012 OMAS 800,000 700,000 671,516 600,000 500,000 446,179 400,000 300,000 257,099 200,000 100,000 0 Uninsured Parents Insured Parents Insured Parents, Medicaid Including Medicaid Medicaid enrollment is 66% of the total insured parents reporting family income of 138% FPL 49
Insurance Status & Medicaid, 138% FPL Non-Parent Adults (19-64 Years), 2012 OMAS Including Medicaid Medicaid enrollment is 41% of the total insured non-parents reporting family income of 138% FPL 50
Insurance Status & Medicaid, 200% FPL Children (0-18 Years), 2012 OMAS Including Medicaid Medicaid enrollment is 75% of the total insured children with family income of 200% FPL 51
Summary of Population Universe for Medicaid Expansion, 2012 OMAS Population Group Uninsured With Other Insurance (not Medicaid or Medicare) Newly Eligible Adults (19-64 years) 138% FPL 737,071 604,094 Non Parents 138% FPL 479,972 405,094 Parents 90-138% FPL 108,745 109,312 Potential Woodwork Effect Children 200% FPL 101,916 326,800 Parents 90% FPL 148,352 89,687 There is a potential woodwork effect for seniors and Medicare not included in this chart. 52
Medicaid Enrollee Health Risk Behaviors Adults (19-64 Years), 138% FPL, 2012 OMAS Medicaid Parent Medicaid Not a Parent Not Medicaid 53
Medicaid Enrollee Health Status Adults (19-64 Years), 138% FPL, 2012 OMAS Medicaid Parent Medicaid Not a Parent Not Medicaid 54
Medicaid Enrollee Usual Source & Types of Care Adults (19-64 Years), 138% FPL, 2012 OMAS 100.0% 90.0% 80.0% 70.0% 60.0% Medicaid Parent Medicaid Not a Parent Not Medicaid 91.6% 93.1% 91.7% 89.7% 81.6% 74.7% 57.8% 50.0% 40.0% 30.0% 43.8% 30.4% 46.1% 31.2% 41.2% 20.0% 10.0% 0.0% * * * * Usual source of care includes the report of an emergency department as the usual source of care. 55
Medicaid Enrollee Chronic Disease* Adults (19-64 Years), 138% FPL, 2012 OMAS *Aggregate chronic disease variable consists of ever having a diagnosis for hypertension, heart attack (due to conditions that usually lead to a heart attack), coronary heart disease, congestive heart failure, diabetes (non-pregnancy associated, and cancer. 56
Summary: Current Medicaid Enrollment Medicaid enrollment of 19-64 year old adults has increased significantly since 2010. The impact of the woodwork effect on the cost of expansion is lower than when it was last estimated from the 2010 OFHS. Reduction in ESI was less than expected from 2008 to 2010 projections. Medical inflation has been less than expected in Ohio. 52% of all insured adults 138% FPL, and 66% of all insured Parents 138% FPL are already covered by Medicaid. 57
Summary: Newly Medicaid Eligible The new adult populations eligible for Medicaid as a result of the ACA look similar to the Parents on Medicaid. Have higher risk behaviors for alcohol use and slightly higher prescription pain reliever misuse and lower risk behaviors for tobacco use then Parents on Medicaid. Health status measures look more like the Parents on Medicaid then other adults on Medicaid (Disabled community). They have higher needs for dental and vision care then Parents on Medicaid. Lower use of medical care then Parents on Medicaid, except for use of specialty care. Higher Prevalence of chronic disease then Parents on Medicaid 58
Online Access to Data and Results
Data and Results are Available Online Numerous resources are available on the OMAS website (grc.osu.edu/omas). These materials can be downloaded and include: A public version of the 2012 OMAS dataset; Total documentation of the dataset; Excel spreadsheets of basic statistical runs (cheat-sheets); Special topic reports and briefs; Sample analysis code for SAS and Stata; and Materials related to the 1998, 2004, 2008, and 2010 Ohio Family Health Survey (OFHS). 60
Further Questions Please Contact Timothy R. Sahr The Ohio Colleges of Medicine Government Resource Center 150 Pressey Hall 1070 Carmack Road Columbus, OH 43210 Phone: 614.366.0328 Timothy.Sahr@osumc.edu 61