• Mission & Governance
• Services Overview
• How to Get Involved
• Standing Committees
• NCSL Foundation

• Issue Areas: A-Z
• State-Federal Relations
• NCSL Standing Committees
• News from D.C. and the States

• About State Legislatures
• Elections, Campaigns & Redistricting
• NCSL's StateConnect Directory
• Web Sites

• Online Guide to NCSL Services
• Staff Sections and Networks
• Meetings & Professional Development
• Staff Directories

• Meetings Calendar
• Online Registration
• Meetings Home Page
• Legislative Summit

• Bookstore
• State Legislatures Magazine
• NCSL's StateConnect Directory

 

HIGHLIGHTS FY 2009 ADMINISTRATION BUDGET REQUEST
SELECTED HEALTH PROGRAMS- IN BRIEF  Download PDF Version
Prepared by: Joy Johnson Wilson, Health Policy Director
Updated February 5, 2008

FY 2009 ENTITLEMENT FUNDING
Medicaid - The Administration proposes Medicaid savings of $1.7 billion in FY 2009 and $17.4 billion in FY 2009 -2013. These savings would be achieved largely through familiar legislative proposals. The largest saving would be achieved by: (1) eliminating enhanced administrative matching; (2) redefining targeted case management as an administrative activity, as opposed to a Medicaid service; and (3) imposing cost allocation. The sole regulatory proposal, which has been proposed in previous budgets, would codify current practice regarding "free care." Finally, the budget proposes a modest increase in funding for Medicaid survey and certification. States will be expected to inspect substantially more facilities than were inspected in FY 2008.

State Children's Health Insurance Program (SCHIP) - The Administration proposes to dramatically increase funding for SCHIP. Last year, the Administration proposed to increase SCHIP funding over a five-year reauthorization period by $5.9 billion over the $25 billion budget baseline. The FY 2009 budget proposal would provide $19.7 billion over the five year reauthorization period. The Administration proposes to reauthorize the program this year. The proposal includes: (1) $450 million for outreach over the five year period; (2) continues emphasis on preventing "crowd out" presumably by restricting eligibility to children in households with incomes at or below 250 percent of the federal poverty level (FPL); (3) eliminating or restricting the use of "income disregards" in establishing eligibility; and (4) moving adults, except pregnant women, off of SCHIP and onto Medicaid.

Medicare - The Administration proposes Medicare savings of $12.8 billion in FY 2009 and $182.7 billion in FY 2009 FY 2013. These savings would be achieved in large part by restricting Medicare reimbursement increases for Medicare providers. Hospitals are particularly hard hit. The budget also does not provide funding to address the pending drop in reimbursement for Medicare physicians that Congress temporarily halted late last year. The temporary fix expires June 30, 2008. Finally, the Medicare Modernization Act included a provision that requires the Administration to submit a plan to Congress to address Medicare expenditures when the expenditures exceed 45 percent of the general fund. The law requires the Administration to submit a plan to Congress within 15 days of submitting the federal budget request. These changes would be in addition to those proposed in the FY 2009 budget submission. Also of note is the new Medicare initiative that would prohibit Medicare reimbursement for preventable adverse events. State Medicaid programs will have to be vigilant to prevent Medicare providers from seeking Medicaid reimbursement when Medicare refuses to pay, as there is no parallel Medicaid initiative.

Emergency Health Services for Undocumented Immigrants -Due to expire September 30, 2008, this program, authorized in the Medicare Modernization Act (MMA) provides $250 million annually in FY 2003 - FY 2008 for payments to eligible providers to cover emergency health care services provided to undocumented immigrants and certain other non-citizens who are not eligible for Medicaid. The funds are distributed to the states with the highest numbers of undocumented immigrants.

FY 2009 DISCRETIONARY HEALTH PROGRAMS

The FY 2009 proposals for discretionary health programs is almost a mirror image of proposals from years past. Noteworthy proposed program eliminations include: (1) Social Services Block Grant; (2) Children's Graduate Medical Education; and (3) the Preventive Health Block Grant. Modest increases were proposed for the following programs: (1) AIDS Drug Assistance Program; (2) Children's Mental Health Services Program; (3) Community Health Centers; (4) Grants to States to Prevent Homelessness; and (5) Vaccines for Children.

For additional analysis and charts, click here. Download PDF Version