1 Proprietary and Confidential Arkansas Health Care Reform Task Force TSG Update Report #1 June...

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Proprietary and Confidential

Arkansas Health Care Reform Task Force

TSG Update Report #1June 2015, revised 6/11 12:30PM

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Executive Summary

Today’s Report• Strong cooperation from Agency and Private Option carriers• Address many of the Task Force Questions about Arkansas

Medicaid program and Health Care Independence Program• Offer TSG analysis and preliminary observations • Working on several potentially substantive issues:• Need for improved contract & vendor management from eligibility to program

operation • High Focus on institutional care in both LTC and DD very high cost options are

utilized • Comparison to other state spending shows opportunity to adopt best practice• Multiple Medicaid Waivers already exists; some cross similar populations and

need to consolidate

May 16 Oct 1June 11

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Initial Observations

Finance• Traditional Medicaid had been growing rapidly, has moderated

since 2014 to approximately 2% annually• A significant amount (over $1 billion) of Medicaid is paid

outside the claims process• The Private Option program now accounts for over 20% of

total Medicaid expenditures• Most Long Term Care is provided in Nursing homes at a cost

more than twice that of Assisted Living and even greater than that for home care

• Traditional Medicaid costs are more than Private Option on a PMPM basis, driven by ABD population

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Initial Observations (cont.)

Long Term Services and Supports • Arkansas ranked 40th by AARP for recipient choice• All initial assessments for nursing home placements are

conducted by Nursing Home professionalsDevelopmental Disabilities• 50/50 split between resources expended for institutional care

and home and community based care Pharmacy• Arkansas does not participate in a multi-state rebate pool• Appears that a low percentage of opiate users locked in to a

single dispensing pharmacy

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Procurement• The procurement timeline is VERY lengthy. From the start of

the procurement to the onboarding of a project team is now an 18 month to 2 year process

• Medicaid has experienced a number of challenges related to using staff augmentation (time and materials) contracts affecting several vendors including: EngagePoint, eSystems, Computer Aid Inc (CAI)

• Contracts appear to be missing incentives for the contractors to minimize cost

• Procurement and contracting process has improved significantly over the last 4 years. However, the State has assumed the majority of risk for many projects

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Procurement (cont.)• The State has not invested in many PMO or contract

management experienced personnelSystems Projects• Ongoing information eligibility software systems

implementations are clearly still troubled projects committed to steep development curves and delivery dates

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Eligibility • Redetermination of Private Option eligibility has no current

mechanism to accept real time alerts from the State Wage data base

• The MAGI Eligibility and Enrollment system went live October 1, 2013 and still has unresolved issues

• Cognosante will have 13 people in a PMO role with a focus on avoiding a worst case scenario

• RedMane has been engaged to do the work to support SNAP. This is caught up in confusion between Redmane and IBM

• The new CURAM system was purchased with the expectation that 80% of new applicants could then be handled automatically, or “no touch.” The actual no touch rate is closer to 17%

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Health Independence Account• The FY 2016 management contract is for $8,060,100.00

(Approximately $66.00 per member per month, which does not take into consideration any risk and opportunity cost for vendor to shift a large portion of their business to meet State’s immediate resource need here).

• 42,753 cards issued, of which 10,175 are currently activated. Yet, the amount applied to successful transactions from January to May of 2015 was $170,932.26

• Similar contract with State Employees has over 20,000 users and costs approximately $4 per member per month

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Overall Medicaid Questions

Task Force Queries about costs 2014 Amounts

Prescription drugs 372,716,180Long-term care 970,898,395Nursing home care 696,112,127Assisted living facility care 16,175,328Mental health services 560,230,744Hospital care 1,560,952,845

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Federal and State Share of MedicaidSFY 2014

Federal State Total

Traditional Medicaid 3,354,200,000 1,389,000,000 4,743,200,000

Private Option 371,700,000 2,400,000 374,100,000

Total 3,725,900,000 1,391,400,000 5,117,300,000

Calculation:Includes $24 million of overhead in addition to $5.1 billion in claims70% & 30% of Traditional Medicaid claims 50% & 50% of AdminNote: CHP is actually 80% & 20%, but TSG has not yet identified the full CHP cost. CHP is less than

$100 million so the error is small

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Details of Medicaid in SFY2014

2014 MedicaidTraditional Medicaid

Private Option Total

Case Management 3,739,954 323 3,740,276Clinics 34,412,475 2,328,679 36,741,154DD 517,366,257 33,460 517,399,717Family Planning 12,418,163 413,210 12,831,373Hospital Services 1,527,446,947 33,505,899 1,560,952,845Long Term Care 969,481,900 1,416,495 970,898,395Medicare Related 25,552,148 41,303 25,593,452Mental Health 557,215,870 3,014,874 560,230,744Other Medical 207,176,295 5,696,267 212,872,562Other Practitioners 144,149,229 4,572,814 148,722,043Physician Services 288,569,521 18,171,784 306,741,305Prescription Drug 361,342,169 11,374,010 372,716,180Private Option Premiums 280,360,215 280,360,215Transportation 74,966,307 5,902,497 80,868,804Grand Total 4,723,837,235 366,831,830 5,090,669,065

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Details of Long Term Care, page 1/2

Long Term Care 2014 2015 ytd*Nursing Home

58 - Private SNF 595,637,842 450,426,05863 - Public SNF 38,952,792 29,740,696H2 - Nursing Home Hospice 28,308,947 22,896,34659 - Private SNF Crossover 24,558,516 19,441,567H1 - Hospice 5,717,150 4,458,490ZH - Contracts - Non Claims Based 2,936,880 2,218,395Facility-based 696,112,127 529,181,552

Assisted Living FacilityAL - Assisted Living Facility 16,175,328 14,339,725AP - Assisted Living Pharmacist ConsultantAssisted Living 16,175,328 14,339,725

* SFY 2015 through March

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Details of Long Term Care, page 2/2 Home and Community Based

53 - Personal Care - Regular 95,053,290 74,659,68597 - Elders Choices Waiver 53,580,358 39,348,200L1 - APD Attendant Care 21,475,475 15,101,605L4 - APD Agency Attendant Care, Co Employer 21,380,064 18,046,985I0 - Independent Choices Treatment Elderly 17,961,504 17,354,86524 - Home Health Services 15,887,437 13,012,980SR - AR Seniors 6,977,670 5,839,39073 - Private Duty Nursing EPSDT 6,347,820 4,143,829PP - PACE 5,861,994 4,990,205I1 - Independent Choices Trtmnt Young Disable 5,120,761 704,14574 - Private Duty Nursing Services 3,304,176 2,304,255L6 - APD Counseling Case Management 1,649,267 1,346,170C9 - Personal Care - School Based 1,009,613 693,599I8 - Independent Choices FMS Services 1,003,949 1,347,686L2 - APD-Environmental Adaptations 657,838 518,333I3 - Independent Choices New Trtmnt Yng Dsbl 635,144 84,497I9 - Independent Choices C/FI 338,856 2,796,271I2 - Independent Choices New Trtmnt Elderly 332,071 39,671L5 - APD Traditional Agency Attendant Care 31,291 222,06623 - Home Health Crossover 2,362 29Home & Community-based 258,610,940 202,554,466Grand Total LTC 970,898,395 746,075,743


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Details of Hospital Services, page 1/3

Hospital Services 2014 2015Inpatient31 - Inpatient Acute Care 193,200,621 142,586,63175 - Pediatric Inpatient 150,619,911 125,016,80887 - Inpatient AR Teaching 73,790,282 61,289,35730 - Inpatient Acute Care Crossover 27,990,350 20,740,423A1 - Inpatient Transplant 10,624,015 6,187,60867 - Inpatient Rehab 3,889,939 3,526,24277 - Rural Inpatient 3,500,377 2,364,02703 - Ambulatory Surgical Centers 3,116,066 7,211,637B2 - Emergency Hospital Services 5,098,689 4,331,71188 - Inpatient AR Teaching Crossover 1,625,734 1,047,154D4 - DYS Rehab Services 1,189,270 1,290,00584 - Rural Inpatient Crossover 742,709 561,57776 - Pediatric inpatient Crossover 65,768 48,054

475,453,731 376,201,234

SFY2015 amounts are ytd through March

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Hospital Services 2014 2015Outpatient51 - Outpatient Hospital 65,235,915 55,361,04550 - Outpatient Crossover 25,027,896 19,398,991PE - Pediatric Outpatient Hospital 16,682,452 12,068,418CA - Critical Access Hospitals INP MED 12,120,385 8,308,473T8 - Outpatient Teaching Hospital 10,648,668 5,691,219CF - Critical Access Hospitals Out Xover 9,046,704 6,678,158CE - Critical Access Hospitals Out Med 7,194,083 6,470,171CB - Critical Access Hospitals Inp Xover 2,641,051 1,934,098D3 - Developmental Rehab Services 1,697,581 1,269,355RC - RSPD/ Residential Rehab Center 827,486 641,218P1 - Outpatient Rehab 228,828 211,820A3 - Outpatient Transplant Services 53,438 14,018RH - RSPD Extended Rehab Services

151,404,486 118,046,982


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Hospital Services 2014 2015Non-claims basedZC - Cost Settlements - Non Claims Based 565,958,065 398,277,160ZA - Buyin - Non Claims Based 171,256,392 128,629,461ZB - Contracts - Non Claims Based 178,205,287 170,355,509ZD - Miscellaneous - Non Claims Based 18,217,672 15,767,231ZE - HIPP - Non Claims Based 457,212 565,700

934,094,628 713,595,062Grand Total 1,560,952,845 1,207,843,278


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Details of Mental HealthMental Health 2014 2015 ytd*

36 - Community Mental Health (RSPMI) 303,452,811 228,217,24033 - Inpatient Psychiatric u-21 150,996,977 103,243,58571 - EPSDT CHMS 60,129,503 43,609,473E4 - Speech and Language Therapy - CHMS 15,602,735 11,884,771E3 - Occupational Therapy - CHMS 12,582,804 9,873,729E2 - Physical Therapy - CHMS 10,543,674 8,243,946D7 - Rehab Servies School Based CHMS 4,936,651 7,294,812D6 - Rehab Services - School Based RSPMI 229,832 2,136,55432 - Inpatient Psychiatric Crossover u-21 1,471,325 1,081,978SO - Sexual Offender Program 150,225 184,184SA - Substance Abuse Treatment Services 30,240 79,715T6 - School-Based Mental Health Services 45,493 27,710E7 - Speech and Language Therapy - RSPMI 58,475 4,453

560,230,744 415,882,150


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Medicaid Monthly Costs per Beneficiary, 2007-2014

PMPM for Traditional Medicaid* 2007 2008 2009 2010 2011 2012 2013 2014SSI Disabled 763 799 833 865 888 894 890 905Low Income Children & Pregnant Women 231 238 255 267 259 262 269 269Medically Needy Aged 1,015 953 912 948 979 964 914 893Medically Needy Disabled 1,180 1,199 1,172 1,201 1,258 1,247 1,180 1,220ARKids 89 96 96 103 111 116 110 105Medically Needy Families & TANF 224 229 242 267 282 292 291 293Adoption and Foster Care 874 894 887 880 896 862 887 903SSI Aged 345 348 386 441 475 473 475 482Traditional Medicaid 423 444 470 521 536 552 557 565* Calculated by dividing total annual expenditures by enrollment at Mar of each year, by divided by 12 months

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Medicaid Costs per Beneficiary2014-2015

1 2 3 4 1 2 3Costs ($million)Traditional 1,107 1,167 1,212 1,237 1,151 1,214 1,228Private Option 0 0 122 245 293 327 344Total 1,107 1,167 1,334 1,482 1,444 1,541 1,573EnrollmentTraditional 696,584 694,002 669,904 667,729 667,803 667,815 668,770Private Option 73 198,094 202,289 216,232 228,983 243,615Total 696,584 694,075 867,998 870,018 884,035 896,798 912,385Annual per BeneficiaryTraditional 1,589 1,682 1,810 1,853 1,724 1,818 1,837Private Option 94 616 1,210 1,355 1,428 1,414Total 1,589 1,681 1,537 1,704 1,634 1,718 1,724PMPMTraditional 530 561 603 618 575 606 612Private Option 31 205 403 452 476 471Total 530 560 512 568 545 573 575

2014 2015

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Medicaid Program cost? Per state share? Per federal share?

Federal State Total PercentTraditional Medicaid 3,354,200,000 1,389,000,000 4,743,200,000 92.7%Private Option 369,300,000 2,400,000 371,700,000 7.3%Total 3,723,500,000 1,391,400,000 5,114,900,000 100.0%Percent 73% 27% 100%

Federal State Total PercentTraditional Medicaid 3,593,600,000 964,400,000 4,558,000,000 82.5%Private Option 966,200,000 2,419,000 968,619,000 17.5%Total 4,559,800,000 966,819,000 5,526,619,000 100.0%Percent 89% 19% 108%

SFY 2014

SFY 2015ytd

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Medicaid Trends

2015 amount is through March 31

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Top Growth Areas in Traditional Medicaid: by Cost Category

CAGRNon-Private Option 2014 Amount 2007-2014 2010-2014 2013-2014

Hospital Services 1,527,446,947 8.0% 4.9% 3.7%Long Term Care 969,481,900 4.3% 3.0% 1.4%Mental Health 557,215,870 4.5% 4.1% 1.6%DD 517,366,257 5.5% 4.7% 4.2%Prescription Drug 361,342,169 1.1% 1.5% 2.8%Physician Services 288,569,521 0.8% -0.7% -2.2%Other Medical 207,176,295 6.8% 4.7% -0.4%Other Practitioners 144,149,229 9.0% 3.2% -0.1%Other 151,089,048 4.3% 0.7% -5.5%Total Traditional Medicaid 4,723,837,235 5.2% 3.5% 2.0%

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Top Growth Areas in Traditional Medicaid: by Beneficiary Aid Category

CAGRNon-Private Option 2014 Amount 2007-2014 2010-2014 2013-2014

SSI Disabled 1,268,479,435 5.1% 3.3% 2.5%Low Income Children & Pregnant Women 996,925,440 4.3% 2.3% 1.7%Non Claims Based Payments 983,120,246 11.4% 8.2% 5.7%Medically Needy Aged 675,094,363 3.6% 2.8% 0.7%Medically Needy Disabled 430,435,526 5.7% 4.7% 5.4%ARKids 95,842,949 2.1% 0.5% -6.5%Medically Needy Families & TANF 93,802,812 -4.2% -2.7% -5.0%Adoption and Foster Care 77,948,703 4.5% 4.7% 5.5%SSI Aged 36,675,944 -2.1% -3.8% -3.8%Spenddown Disabled 34,119,900 -2.7% -9.2% -25.3%Other 31,391,917Total 4,723,837,235 5.2% 3.5% 2.0%

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Projection of State Share

State Share - High Scenario 2014 2015 2016 2017 2018 2019 2020Traditional 1,417 1,467 1,572 1,745 2,004 2,383 2,934Private Option 0 0 0 67 94 132 237Total Claims 1,417 1,467 1,572 1,812 2,098 2,515 3,171Admin 12 12 13 14 15 16 18Total 1,429 1,479 1,585 1,893 2,207 2,664 3,427

State Share -- Low Scenario 2014 2015 2016 2017 2018 2019 2020Traditional 1,417 1,441 1,490 1,567 1,676 1,822 2,014Private Option 0 0 0 62 81 104 169Total Claims 1,417 1,441 1,490 1,629 1,756 1,926 2,183Admin 12 12 13 14 15 16 18Total 1,429 1,454 1,503 1,705 1,852 2,047 2,371

Match Rates are Calendar Year Per ACA - Calculations are Based on Blended Rate for Each State Fiscal Year2,014 2,015 2,016 2017 2018 2019 2020 2021

0 0 0 5% 6% 7% 10% 10%

Projected in Millions of Dollars

Revised 6-11 12:30PM

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Enrollment History

Enrollees as of March each year* 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Low Income Children & Pregnant Women 267,258 276,605 278,261 283,867 301,923 303,656 303,402 308,984 339,666 352,690SSI Disabled 97,592 100,425 103,863 107,390 111,325 114,384 115,846 116,827 114,596 107,963ARKids 77,504 81,038 81,520 76,016 74,757 76,961 77,709 75,978 69,776 59,322Medically Needy Aged 43,209 47,525 51,838 53,116 55,095 58,477 61,116 62,984 64,375 64,111Medically Needy Families & TANF 47,002 41,950 36,263 32,661 30,220 28,982 28,328 26,690 35,467 39,210Medically Needy Disabled 20,585 21,944 23,894 24,900 25,289 27,091 28,838 29,398 30,860 30,642Adoption and Foster Care 5,466 5,779 5,908 6,151 6,556 7,007 6,944 7,191 7,776 8,258SSI Aged 10,303 9,567 8,849 8,092 7,594 7,223 6,691 6,344 6,042 5,726Other 80,068 76,579 66,478 62,542 64,252 63,337 61,730 60,717 794 738Spenddown Disabled 1,897 1,765 1,749 1,722 1,804 1,777 1,803 1,325 530 106Spenddown Families & TANF 957 912 863 807 813 609 625 455 22 4Non Private Option 651,841 664,089 659,486 657,264 679,628 689,504 693,032 696,893 669,904 668,770Private Option (Medically Fragile and PMPM) 198,094 243,615All Medicaid and Private Option 651,841 664,089 659,486 657,264 679,628 689,504 693,032 696,893 867,998 912,385* March is the most recent month for which we have 2015 data

Enrollment in Traditional Medicaid grew at 1.0% per year 2006-2013Then, 30,000 people moved from Medicaid to Private Option

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Enrollment Projection

• State population has been growing at 0.4% per year• Medicaid enrollment has increased 0.4-0.5% for most of the

past decade, except 2010 which seems to be an outlier• While baby boomers will develop into the Aged, the best

predictions (US Admin on Aging) is that the Aged population will shift from 22% to 26% of total by 2020, that is 0.35% change per year

• Thus, it is likely that traditional Medicaid enrollment will continue to increase at about the rate of the state population

• While Private Option continues to grow in 3Q2015, it is likely to plateau in 2015

• Thus at this point, it seems prudent to project all categories of beneficiaries at 0.5%

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Preliminary Enrollment Estimate

TraditionalPrivate Option* Total

2006 651,841 651,8412007 664,089 664,0892008 659,486 659,4862009 657,264 657,2642010 679,628 679,6282011 689,504 689,5042012 693,032 693,0322013 696,893 696,8932014 669,904 198,094 867,9982015 668,770 243,615 912,3852016 672,000 245,000 917,0002017 679,000 247,000 926,0002018 689,000 251,000 940,0002019 703,000 256,000 959,0002020 721,000 262,000 983,0002030 777,000 282,000 1,059,000

* Medically Fragile and Capitated Beneficiaries

Actu

alPr

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Expenditure Forecast Detail:High Growth Scenario

Forecast-High

Non-Private Option Growth Rate 2,014 2,015 2016 2017 2018 2019 2019Hospital Services 4.9% 1,527,446,947 1,602,000,000 $1,762,200,000 $2,033,100,000 $2,460,100,000 $3,122,100,000 $4,155,700,000Long Term Care 3.0% 969,481,900 998,500,000 $1,059,200,000 $1,157,300,000 $1,302,400,000 $1,509,600,000 $1,802,200,000Mental Health 4.1% 557,215,870 580,200,000 $629,100,000 $710,300,000 $835,100,000 $1,022,300,000 $1,303,200,000DD 4.7% 517,366,257 541,900,000 $594,400,000 $682,800,000 $821,500,000 $1,035,200,000 $1,366,200,000Prescription Drug 1.5% 361,342,169 366,600,000 $377,300,000 $394,000,000 $417,400,000 $448,600,000 $489,200,000Physician Services -0.7% 288,569,521 286,500,000 $282,400,000 $276,400,000 $268,600,000 $259,200,000 $248,300,000Other Medical 4.7% 207,176,295 216,900,000 $237,600,000 $272,500,000 $327,100,000 $411,000,000 $540,500,000Other Practitioners 3.2% 144,149,229 148,800,000 $158,600,000 $174,500,000 $198,100,000 $232,200,000 $281,000,000Transportation 2.2% 74,966,307 76,600,000 $80,100,000 $85,600,000 $93,500,000 $104,500,000 $119,400,000Clinics 3.9% 34,412,475 35,800,000 $38,700,000 $43,400,000 $50,600,000 $61,300,000 $77,200,000Medicare Related 0.9% 25,552,148 25,800,000 $26,300,000 $27,000,000 $28,000,000 $29,300,000 $31,000,000Family Planning -12.6% 12,418,163 10,800,000 $8,200,000 $5,500,000 $3,200,000 $1,600,000 $700,000Case Management 5.4% 3,739,954 3,900,000 $4,300,000 $5,000,000 $6,200,000 $8,100,000 $11,100,000Medicaid-Non PO 3.5% 4,723,837,235 4,890,400,000 $5,241,400,000 $5,815,600,000 $6,680,300,000 $7,944,100,000 $9,780,100,000Private OptionMedically Fragile FFS 0.5% 86,471,615 86,900,000 $87,800,000 $89,100,000 $90,900,000 $93,200,000 $96,000,000Private Option Premiums 4.0% 280,360,215 1,033,000,000 $1,117,900,000 $1,258,400,000 $1,473,600,000 $1,795,100,000 $2,274,800,000Total Private Option 366,831,830 1,119,900,000 1,205,700,000 1,347,500,000 1,564,500,000 1,888,300,000 2,370,800,000Admin 2.0% 24,185,460 24,700,000 $25,700,000 $27,300,000 $29,600,000 $32,700,000 $36,800,000Total 5,114,854,525 6,035,000,000 6,472,800,000 7,190,400,000 8,274,400,000 9,865,100,000 12,187,700,000


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Expenditure Forecast Detail:Low Growth Scenario


Forecast-Low

Non-Private Option Growth Rate 2014 2015 2016 2017 2018 2019 2020Hospital Services 3.7% 1,527,446,947 1,584,700,000 $1,705,700,000 $1,904,800,000 $2,206,900,000 $2,652,700,000 $3,308,100,000Long Term Care 0.3% 969,481,900 972,800,000 $979,500,000 $989,700,000 $1,003,400,000 $1,020,800,000 $1,042,100,000Mental Health 1.4% 557,215,870 565,200,000 $581,500,000 $606,800,000 $642,300,000 $689,600,000 $751,000,000DD 2.4% 517,366,257 529,700,000 $555,200,000 $595,700,000 $654,400,000 $736,000,000 $847,400,000Prescription Drug 0.9% 361,342,169 364,500,000 $371,000,000 $380,900,000 $394,500,000 $412,200,000 $434,500,000Physician Services -1.0% 288,569,521 285,800,000 $280,300,000 $272,200,000 $261,700,000 $249,200,000 $235,000,000Other Medical 2.4% 207,176,295 212,200,000 $222,700,000 $239,400,000 $263,600,000 $297,400,000 $343,700,000Other Practitioners -1.3% 144,149,229 142,200,000 $138,400,000 $132,900,000 $125,900,000 $117,700,000 $108,500,000Transportation 2.3% 74,966,307 76,700,000 $80,200,000 $85,700,000 $93,700,000 $104,700,000 $119,700,000Clinics 2.3% 34,412,475 35,200,000 $36,800,000 $39,400,000 $43,100,000 $48,300,000 $55,300,000Medicare Related -1.0% 25,552,148 25,300,000 $24,800,000 $24,100,000 $23,100,000 $22,000,000 $20,700,000Family Planning 0.0% 12,418,163 12,400,000 $12,400,000 $12,400,000 $12,400,000 $12,400,000 $12,400,000Case Management 14.0% 3,739,954 4,300,000 $5,600,000 $8,300,000 $14,000,000 $26,900,000 $58,900,000Medicaid-Non PO 1.7% 4,723,837,235 4,803,600,000 $4,967,200,000 $5,223,100,000 $5,585,000,000 $6,072,800,000 $6,714,700,000Private OptionMedically Fragile FFS 0.5% 86,471,615 86,900,000 $87,800,000 $89,100,000 $90,900,000 $93,200,000 $96,000,000Private Option Premiums 2.2% 280,360,215 1,033,000,000 $1,078,700,000 $1,151,100,000 $1,255,200,000 $1,398,700,000 $1,592,700,000Total Private Option 366,831,830 1,119,900,000 1,166,500,000 1,240,200,000 1,346,100,000 1,491,900,000 1,688,700,000Admin 2.0% 24,185,460 24,700,000 $25,700,000 $27,300,000 $29,600,000 $32,700,000 $36,800,000Total Medicaid 5,114,854,525 5,948,200,000 6,159,400,000 6,490,600,000 6,960,700,000 7,597,400,000 8,440,200,000

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Comparing Nursing Homes to Assisted Living

Based on Data from September 2014

58 - Private SNF

59 - Private SNF

Crossover

63 - Public SNF

Assisted Living

FacilityTotal September Amount

$48,296,194 $1,674,318 $2,908,318 $1,421,416

# Recipients 11,534 1,512 229 749

Ave/person/month $4,187 $1,107 $12,700 $1,898

Per Day* 140 37 423 63

* To calculate, TSG divided the total September 2014 expense by the number of beneficiaries that were in a facility at any time during the month. Also, TSG divided the monthly amount by 30 days. Both of these approaches will somewhat understate the average cost.

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Comparing Arkansas Medicaid Spending to Other States

* To calculate, TSG divided the total September 2014 expense by the number of beneficiaries that were in a facility at any time during the month. Also, TSG divided the monthly amount by 30 days. Both of these approaches will somewhat understate the average cost.

(Source: CMS/Truven Health Analytics: 4/28/14)Expenditures Per Resident: Total LTSS Costs: FY 2012Note: As part of this project, TSG will be reaching out independently to states and may obtain more updated data, including financial data within the State of Arkansas Medicaid so the use of Truven’s data analysis is only to provide the Task Force with some snapshot of comparison without knowing exactly the data sets that Truven used for their report.

State Expenses Per Resident

State Rank

Arkansas $606.64 11

Mississippi 505.92 18

Louisiana 488.72 19

Missouri 454.56 23

Kansas 415.29 27

Tennessee 360.82 32

Oklahoma 322.92 37

Texas 291.09 42

US $445.92 NA

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Comparing Arkansas Medicaid Spending to Other States (cont.)

State Acute Care Long Term Care DSH Payments

Total

US 68.2% 28.4% 3.7% 100%

Arkansas 64.2% 34.3% 1.5% 100%

Kansas 72.2% 24.8% 3.7% 100%

Louisiana 58.7% 30.5% 10.7% 100%

Mississippi 65.4% 30% 4.6% 100%

Missouri 66.6% 25.5% 7.9% 100%

Oklahoma 72.9% 26.2% .9% 100%

Tennessee 87.8% 11.3% .8% 100%

Texas 79.5% 19.7% .8% 100%

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State Medicaid Waivers

• Arkansas Health Care Independence Program: 1115• Arkansas Elder Choices: 1915 (c)• Arkansas Tax Equity & Fiscal Responsibility: 1115• Alternative Community Services: 1915 (c)• Alternatives for People with Physical Disabilities: 1915 (c)• Non-Emergency Transportation: 1915 (b4)• AR Autism: 1915 (c)• ARKidsB: 1115• AR Living Choices Assisted Living: 1915 (c)

Note: Does not include State Plan Amendments

1 Proprietary and Confidential Arkansas Health Care Reform Task Force TSG Update Report #1 June...

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