A report released by the Nelson A. Rockefeller Institute on Government on October 15 found that state tax collections for the second quarter showed a record drop of 16.6 percent.  The report notes that every state but Vermont saw total tax revenue fall and that 36 states reported revenue declines of 10 percent or more.  The revenue shortages come as many states have already tapped their “rainy day” funds and relied heavily on ARRA funding in their most recent budgets, indicating that states will likely move to cut spending unless revenue increases.

From the report:

Total state tax collections as well as collections from two major sources — sales tax and personal income — all declined for the third consecutive quarter. Overall state tax collections in the April-June quarter of 2009, as reported by the Census Bureau, declined by 16.6 percent from the same quarter of the previous year. We have compiled historical data from the Census Bureau Web site going back to 1962. Both nominal and inflation adjusted figures indicate that the second quarter of 2009 marked the largest decline in state tax collections at least since 1963. The same is true for combined state and local tax collections, which declined by 12.2 percent in nominal terms.

The Nelson A. Rockefeller Institute of Government. (2009). State tax revenues show record drop for second consecutive quarter. Lucy Dadayan and Donald J. Boyd.

Full report: http://www.rockinst.org/pdf/government_finance/state_revenue_report/2009-10-15-SRR_77.pdf

This report released October 6, 2009 by the National Center for Assisted Living (NCAL) found that Medicaid spending on home- and community-based services (HCBS) increased 81.5 percent from FY2001 to FY2007, while nursing home spending grew 9.8 percent over the same period.  The report found that, from 2001 to 2007, Medicaid nursing home spending went from $42.7 billion to $46.9 billion while HCBS spending increased from $9.2 billion to $16.7 billion.  In addition, the number of people receiving Medicaid services in licensed assisted living settings increased 44 percent from 2002 to 2009 and HCBS Medicaid waivers now cover services in residential settings in 37 states while an additional 13 states provide coverage directly though the state Medicaid plan. 

From the report's major findings:

Full Report: http://www.ahcancal.org/ncal/resources/Documents/MedicaidAssistedLivingReport.pdf 

National Center for Assisted Living. (2009). State Medicaid reimbursement policies and practices in assisted living. Robert L. Mollica

This Commonwealth Fund report presents the results of the 2009 State Scorecard on Health System Performance , assessing states’ performance in health care access, quality, cost, and outcomes.  The report found that states’ performance continues to vary widely; however, all states face rising health care costs and poor care coordination.  The report notes that Vermont, Hawaii, Iowa, Minnesota, Maine, New Hampshire, Massachusetts, Connecticut, North Dakota, Wisconsin, Rhode Island, South Dakota, and Nebraska were the overall highest performers; however, the scorecard does not yet reflect the effects of the recession because of a reporting lag. 

From the report:

Focused on identifying opportunities to improve, The Commonwealth Fund’s State Scorecard on Health System Performance assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, costs, and health outcomes. The 2009 State Scorecard paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs. On a positive note, there were gains in children’s coverage as a result of national reforms, and improvement in some measures of hospital and nursing home care following federal efforts to publicly report quality data. The scorecard highlights persistent wide variation in performance across states and continued evidence of poor care coordination. Increasing cost pressures and deterioration in access across the U.S., together with geographic disparities in performance, underscore the urgent need for comprehensive national reforms to ensure access, change the trajectory of costs, and enhance value.

Full report: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2009/Oct/1326_McCarthy_state_scorecard_2009_full_report_FINAL.pdf 

The Commonwealth Fund. (2009). Aiming higher: results from a state scorecard on health System performance, 2009. Douglas McCarthy, Sabrina K. H. How, Cathy Schoen, Joel C. Cantor, and Dina Belloff.

The United Way of Greater Los Angeles commissioned a study conducted by the University of Southern California (USC) that chronicled the consumption of public services by four homeless people over a two-year period. The study reported five principal cost areas: substance abuse, physical health, mental health, criminal justice, and housing.  The study found that permanent housing solutions yield a 43% cost savings.  For two years, the total cost to provide public services without permanent housing was over $80,000 greater than the cost to provide permanent housing in addition to support services.  When permanent housing was provided, mental health services were the only area with increased costs; however, the associated benefits of regularly seeking mental health services had positive impacts on the system.

From the report:

In order to analyze the costs of public services, investigators focused first on the two-year period before the individu­als were placed in permanent supportive housing. During that time period, two of the four had gone through detox six times costing $23,382. Two of the four had been hospitalized (removal of kidney stone and bladder infection) at a cost of $20,250. All four had used the hospital emergency room for health and alcohol issues (19 visits), costing an additional $7,885. All four had been arrested at least once ($2,756) and spent time in jail ($8,545). One of the four had also served 90 days in prison ($12,060).

United Way of Greater Los Angeles. (2009). Homeless cost study.

Full report: http://www.unitedwayla.org/getinformed/news/Documents/HomelessCostStudy_09_r2_v3.pdf

A new fact sheet published by the UCLA Center for Health Policy Research finds that 93 percent of Californians under 65 would have access to health coverage if Congress passes a national health reform bill.  Four million state residents would be eligible for Medi-Cal or would qualify for subsidies to purchase private insurance.

From the document:

If leading proposals in Congress for national health care reform are enacted, most of California’s 6.4 million nonelderly adults and children who were uninsured for all or part of the year in 2007 would directly benefit. The three major proposals in both the House and Senate all would make two key changes: 1) they will expand Medicaid eligibility to include qualified uninsured adults and children with household incomes up to 133% of the Federal Poverty Level (FPL); and 2) they will provide public subsidies to enable qualified uninsured adults and children with household incomes from 134 – 400% FPL to purchase insurance.1 An estimated four million Californians would be newly eligible either for public health insurance (in Medi-Cal, California’s Medicaid program) or for public subsidies to purchase private coverage.

UCLA Center for Health Policy Research. (2009). National Health Care Reform Will Help Four Million Uninsured Adults and Children in California. Lavarreda, Shana & Brown, E. Richard.

Fact sheet: http://www.healthpolicy.ucla.edu/pubs/files/HCR_FS_10-09.pdf

This Families USA report uses 2008 data from the U.S. Census Bureau and the Urban Institute to estimate the 2009 national and state-level uninsurance rates. It estimates that the number of uninsured working Americans has increased by 4 million since 2008, totaling over 50 million uninsured American residents.  The report notes that states with higher unemployment rates have suffered greater percentage losses in health coverage, with the highest percentage losses coming in Oregon, Michigan, South Carolina, Nevada, and North Carolina.  However, the report also notes that insurance rates among children have remained high throughout the recession largely due to the success of Medicaid and the Children’s Health Insurance Program (CHIP).

From the Report:

The current recession has put the job-based coverage of millions at risk. For many, losing a job means losing the coverage that their employer provides. While the safety net of public health insurance programs, including Medicaid and the Children’s Health Insurance Program (CHIP), provides coverage to some who lose their job-based coverage, current eligibility rules limit who qualifies for coverage based on income and family status. In most states, for example, a child is eligible for Medicaid or CHIP if that child’s family income is at or below 200 percent of the federal poverty level ($36,620 for a family of three in 2009). However, the eligibility levels are much lower for parents than they are for children. The median income eligibility level among the 50 states for working parents is 67 percent of the federal poverty level—only $12,268 in annual income for a family of three in 2009. Even worse, in 42 states, Medicaid is simply not available for adults without dependent children unless those adults are permanently disabled.

Families USA. (2009). One-two punch: unemployed and uninsured.

Full report:  http://www.familiesusa.org/assets/pdfs/one-two-punch.pdf