DHW Medicaid 1-19

8/11/2019 DHW Medicaid 1-19

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We promote and protect thehealth and safety of Idahoans.

1

Joint Finance-Appropriations Committee

Division of Medicaid

Medicaid Administration

Leslie Clement

Administrator

January 19, 2010


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2

Division as Component of DHWMedicaid

$1,656 Million

79.1%

Family and Community

Services

$99.8 Million

4.8%Behavioral Health

$95.2 Million

4.5%

Public Health

$84 Million

4.0%

Support Services

$34 Million

1.6%

Welfare

$125.4 Million

6.0%

Medically Indigent

$0.1 Million

0.01%


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Coordinated Plan

$479.7 Million

29.0%

Enhanced Plan

$663.5 Million

40.0%

Basic Plan

$449.5 Million

27.2%


$62.8 Million

3.8%

3

Administrative Overhead at 3.8%


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4

Administrative Cost Components

Personnel

$17.7 Million

28.1%

Operating and Capital

$42.2 Million

67.2%

Trustee and Benefits

$2.9 Million

4.7%


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5

Funding Sources

$6.6 M

$11.1 M

$9.8 M

$26.3 M

$6.1 M

$1.3 M

$1.1 M

Personnel Operating Trustee and Benefits

Receipts

Dedicated Funds

Federal Funds

General Funds

Total Funds

$17.7 Million

28.1%

Total Funds

$42.2 Million

67.2%

Total Funds

$2.9 Million

4.7%

Federal Funds -

$1.6 Million


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6

Holdback Impacts

Federal Funds

$712,800

General Funds

$711,800


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7

Funding Source History

$13.9 M

$25.3 M

$3.4 M

$16.7 M

$38.5 M

$6.0 M

$17.0 M

$45.6 M

$6.0 M

$17.8 M

$38.8 M

$6.0 M

SFY 2008 Expenses SFY 2009 Expenses SFY 2010 Estimated

Expenses

SFY 2011

Recommendation

Receipts

Dedicated Funds

Federal Funds - ARRA

Federal Funds

General Funds

Total Funds$42.8 Million

Total Funds

$61.4 Million

Total Funds

$68.8 MillionTotal Funds

$62.8 Million

Dedicated Funds for all

ears - $0.2 Million


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8

Focus on cost containment measures.

Medicaid personnel and contractorsrole is to effectively and efficientlymanage benefits while preserving

quality and access.

Legislative Intent Status


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Chart of InitiativesStrategy Status

Cost sharing Pending rules approval

Managed Care contracts New rates; new RFP posted

Transportation Brokerage Reviewing RFP responses

Utilization Management RFP posted

Institutional cost drivers Negotiating pricing changes

Premium Assistance Waiver amendment initiated

National Accreditation Implemented for DDAs

Assessment Provider Streamlined; reducedcontract


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Reduce waste, fraud, and abuse

DHW Medicaid Program Integrity Unit

AGs Medicaid Fraud Control Unit

Licensing, certification, & complaintfollow-up activities

Quality Assurance reviews

State and federal audits

New MMIS System: Enhanced editing &auditing capabilities

Management Strategies to Control Costs


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11

MMIS Operations LBB page 2-56Decision Unit 12.01

Planned implementation of June 2010

Full year of new system operations

Description Total Funds General Funds Federal Funds

ContractedMailingexpenses (50%)

$220,000 $110,000 $110,000

Claims Systemcontracts (75%) $5,428,800 $1,357,200 $4,071,600

Total on-going

Request$5,648,800 $1,467,200 $4,181,600


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12

MMIS certification LBB page 2-56Decision Unit 12.02

One-time funding

Contractual payment made to vendors for

successful completion of required certification

Description Total Funds General Funds Federal Funds

MMISCertification $3,847,600 $961,900 $2,885,700

Total One-time Request $3,847,600 $961,900 $2,885,700


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Administration Budget RecommendationMedicaidAdministration

2010Appropriation

2011 GovernorsRecommendation

FTP 283 284

Personnel $18,462,500GF: $6,817,500

$17,666,800GF: $6,648,600

Operating $47,455,100GF: $9,022,900

$42,222,200GF: $9,827,400

Capitol $0 $0

Trustee & Benefits $2,949,600GF: $1,311,000

$2,949,600GF: $1,311,000

Total $68,867,200GF: $17,151,400

$62,838,600GF: $17,787,000


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Joint Finance-Appropriations CommitteeDivision of Medicaid

Medicaid Trustee & Benefits Payments

Leslie Clement

Administrator

January 19, 2010


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Division as Component of DHW Spending

Medicaid

$1,656 Million

79.1%

Family and Community

Services

$99.8 Million

4.8%Behavioral Health

$95.2 Million

4.5%

Public Health

$84 Million

4.0%

Support Services

$34 Million

1.6%

Welfare

$125.4 Million

6.0%

Medically Indigent

$0.1 Million

0.01%


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Provider Payments 96.2 % of Total

Coordinated Plan

$479.7 Million

29.0%

Enhanced Plan

$663.5 Million

40.0%

Basic Plan

$449.5 Million

27.2%


$62.8 Million

3.8%


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19

Provider Payments by Plan

Basic Plan


$449.5 Million

28.2%

Enhanced Plan


$663.5 Million

41.7%

Coordinated Plan


$479.7 Million

30.1%


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2011 Per Enrollee Per MonthBasic Enhanced Coordinated

Cost of Adults $680 $1,900 $1,500

Number ofAdults

17,000 25,000 15,000

Costs ofChildren

$178 $1,300 n/a

Number of

Children

137,000 22,000 0

Average $per Plan

$232 $1,600 $1,500

TotalEnrollees

$154,000 47,000 15,000


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Current Enrollment by LocationRegion Enrollment

1 25,268

2 11,4793 44,217

4 40,982

5 27,526

6 24,471

7 28,210

Total 202,153


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Funding Sources

$319.0 M

$1,107.7 M

$86.0 M

$80.0 M


Receipts

Dedicated Funds

Federal Funds

General Funds

Total Funds

$1,592.7 Million


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Federal Funds

$62.3 Million

General Funds

$35.2 Million

Holdback Impacts


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Permanent Holdback & Adjustments

PlansTotalFunds

GeneralFund

DedicatedFund

FederalFund

Coordinated

Page 2-59

Enhanced

Page 2-62

$2.6

BasicPage 2-65

< $ .4>

Totals $2.6


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Impact of Holdbacks on Providers

Provider Type Holdback % of total

Hospitals $16.2 29%

Long-term Care $ 8.4 15%

Pharmacy $ 2.2 4%

Mental Health $ 7.0 12.5%

Medical/Dental $ 7.0 13%

Developmental DisabilityServices

$ 7.0 12.5%

Other $ 7.0 12.5%All Providers $54.8 M Total $11.4 General Funds


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History of Funding

$354.4 M

$822.2 M

$79.1 M

$310.8 M

$891.8 M

$82.4 M

$84.4 M

$293.2 M

$958.8 M

$117.6 M

$76.4 M

$319.0 M

$1,036.4 M

$71.3 M

$86.0 M

$80.0 M

SFY 2008 Expenses SFY 2009 Expenses SFY 2010 Estimated

Expenses

SFY 2011

Recommendation

Receipts

Dedicated Funds

Federal Funds - ARRA

Federal Funds

General Funds

Total Funds

$1,258.6 Million

Total Funds

$1,375.6 Million

Total Funds

$1,461.1 Million

Total Funds

$1,592.7 Million

Dedicated Funds

2008 - $2.9 Million

2009 - $6.2 Million

2010 - $15.1 Million


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27

Focus on cost containment measures.

Medicaid personnel and contractorsrole is to effectively and efficientlymanage benefits while preserving

quality and access.

Legislative Intent Status


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Chart of InitiativesStrategy Status

Cost sharing Pending rules approval

Managed Care contracts New rates; new RFP posted

Transportation Brokerage Reviewing RFP responses

Utilization Management RFP posted

Institutional cost drivers Negotiating pricing changes

Premium Assistance Waiver amendment initiated

National Accreditation Implemented for DDAs

Assessment Provider Streamlined; reducedcontract


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Four primary avenues to control costs:

1. Reduce Prices

2. Limit/Eliminate Benefits3. Limit/Eliminate Eligibility categories

4. Management

Cost Containment Strategies


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PricingFederal law:

Imposes significant requirements

Sets certain provider rates Requires that payment is consistent with

efficiency, economy, and quality of care.

Requires that payment must attract enough

providers so that Medicaid services are availableto the same extent as non-Medicaid services

Stateshave some flexibility subject to approval


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Benefits

Federal law:

Requires certain benefits

Requires states cover EPSDT Requires certain standards

States have some flexibility:

Define scope, amount and duration


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Eligibility- MOENo changes permissible at this time

States cannot reduce eligibility andreceive the increased FMAP

Proposed health legislation States cannot reduce eligibility for adults

until 12/2013; certain exceptions areallowed for non-pregnant, non-disabledadults

States cannot reduce eligibility for childrenuntil 09/2019


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2010 Forecasted Expenditures: Shortfall

Supplemental 4.31 LBB page 2-53

PlanTotalFund

GeneralFund

Dedicated/Other Fund

FederalFund

Basic

Page 2-65

$15.0 $2.8 $13.3

Enhanced

Page 2-62

$36.5 $7.6 $29.5

CoordinatedPage 2 -59

$13.1 $3.5 $ 10.0

Total $64.6 $13.9 $52.8


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Nursing Facility Provider Assessment

Supplemental 4.36 LBB page 2-59

PlanTotalFund

DedicatedFund

FederalFund

Coordinated $11.5 $2.4 $9.1

Total $11.5 $2.4 $9.1


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Benefit Plan Maintenance LBB page 2-52

PlansTotalFunds

GeneralFunds

DedicatedFunds

FederalFunds

Basic $32.4 $20.3 $.7 $11.4

Enhanced $72.4 $52.4 $1.9 $18.1

Coordinated $21.8 $21.9 $ $.07

Total $126.9 $94.6 $2.4 $29.5


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Mid-Year FMAP Change LBB page 2-52

PlanOther State

FundsFederal Fund

Basic $13.8

Enhanced $39.8

Coordinated $17.6

Total $71.2


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..

Basic Plan Recommendation

Basic Plan2010

Appropriation2011

Recommendation

Enrollment 148,000 154,000

General Fund $63,375,900 $ 72,192,500

Dedicated Fund

Other Funds$41,110,000

$ 23,789,700

$ 30,786,000

Federal Fund $299,607,300 $322,729,400

Total $404,093,200 $449,497,600


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Enhanced Plan Recommendation

Enhanced Plan2010

Appropriation2011

Recommendation

Enrollment 45,400 47,400

General Fund $133,430,200 $145,184,000

Dedicated Fund

Other$39,137,000

$ 42,080,900

$ 38,975,100

Federal Fund $421,460,900 $437,253,600

Total $594,028,100 $663,493,600


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Coordinated Plan Recommendation

CoordinatedPlan

2010Appropriation

2011Recommendation

Enrollment 15,065 15,575

General Fund $95,220,770 $101,641,600

Dedicated Fund

Other$10,922,500

$ 20,157,800

$ 10,226,700

Federal Fund $334,097,600 $347,667,700

Total Funds $440,240,800 $479,693,800


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Questions?

Leslie Clement

[email protected]

208-364-1804
mailto:[email protected]:[email protected]

DHW Medicaid 1-19

Documents

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