Presentation to Legislative Finance Committee Preview of ... · 10/25/2017 · Presentation to...
Transcript of Presentation to Legislative Finance Committee Preview of ... · 10/25/2017 · Presentation to...
New Mexico Human Services Department
Presentation to Legislative Finance CommitteePreview of FY19 Appropriation Request
Brent Earnest, SecretaryOctober 25, 2017
HSD FY19 Appropriation Request Overview Medicaid Budget and Performance◦ Enrollment and Cost trends
Behavioral Health Budget and Performance Child Support Enforcement Income Support Division◦ Temporary Assistance for Needy Families
HHS 2020 and the Medicaid Management Information System (MMIS) replacement project
Centennial Care 2.0 Update
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Today’s Presentation
HSD FY 19 Appropriation Request
FY 19 Budget Request of $7.085 billion 2.34% increase overall $1.116 billion from the
general fund (increase of $83.8 million or 8.12%)
$5.694 billion in federal funds (increase of $82.2 million or 1.46%)
$274.1 million in other state funds and other revenue
Federal Funds80.37%
Other State
Funds and Revenue3.87%
State General Fund
15.76%
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HSD General Fund Budget Change
15.92%
10.22%
18.48%
12.18%
-21.87%
-1.02%
36.45%
4.54%2.90%
-2.37%
0.68% 1.52% 0.152%
8.12%
-30.00%
-20.00%
-10.00%
0.00%
10.00%
20.00%
30.00%
40.00%FY
06 O
P BU
D
FY07
OP
BUD
FY08
OP
BUD
FY09
OP
BUD
FY10
OP
BUD
FY11
OP
BUD
FY12
OP
BUD
FY13
OP
BUD
FY14
OP
BUD
FY15
OP
BUD
FY16
OP
BUD
FY17
OP
BUD
FY18
OP
BUD
FY19
REQ
UEST
Percent Change in HSD General Fund Budget
*GF adjustment due to ARRA
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Enrollment growth trends have slowed◦ By June 2018, enrollment projected to be 917,000,
essentially flat from June 2017.◦ FY19 growth of 0.8% projected, reaching more than
922,000 Cost trends in Centennial Care are significantly
lower than regional and national health care inflation
Uncertainty at the federal level◦ FMAP changes◦ Reauthorization of CHIP program◦ ACA “repeal and replace” legislation◦ Enrollment trends
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FY19 Medicaid Budget Request Highlights
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000Ja
n-13
May
-13
Sep-
13
Jan-
14
May
-14
Sep-
14
Jan-
15
May
-15
Sep-
15
Jan-
16
May
-16
Sep-
16
Jan-
17
May
-17
Sep-
17
Jan-
18
May
-18
Sep-
18
Jan-
19
May
-19
Med
icai
d En
rollm
ent
Expansion/Other Adult Group
Sate Coverage Insurance
Medicaid Adults
Medicaid Children
June 2019Projected Enrollment
OAG: 275,685*
Medicaid Adults:271,512
Medicaid Children:379,107*
*children 19-21 y.o. counted in OAG
Medicaid EnrollmentAugust 2017 911,803
Projected
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January 2014 also launched adult expansion of Medicaid—Alternative Benefit Package Significant enrollment growth in 4 years:
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58%42%
2017
43%57%
2013
Children (<21 Years)
Adults (>=21 Years)
Medicaid Category Enrollment June 2013
EnrollmentAugust 2017
Percentage Increase
Parents/Caretaker Adults (0-47% FPL)
40,776 77,734 91%
Other Adults (48% - 138% FPL)
36,812 (SCI)
268,723(Adult Expansion)
629%
All Medicaid 575,908 911,803 58%
Medicaid Enrollment Transformation
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Enrollment up 5%; Per capita costs down 2%
Centennial Care: Managing Cost Growth
Medicaid: FY 19 Appropriation Request (as of Sept. 1)
Total Medicaid Program spending in FY 19 is projected to be $5.892 billion.
o $997.2 million from the general fund, an $81.5 million increase. Major changes from FY18 include:
FY19 base - additional general fund above FY18 appropriation $15.82Expansion FMAP (drops to 94% in 2018 and 93% in 2019) $14.70Enrollment $11.73Utilization and Price increases (less than 1% change) $11.66Medicare Part B $2.62CHIP FMAP Reduction (100% to 72.13%) $31.23FMAP Change (71.90 to 72.13) ($7.18)County Support Medicaid and Tobacco Settlement Revenue (reduction) $5.34Other Revenue changes ($4.38)Total $81.54
($ in millions)
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The total FY 19 budget request for administration of the Medicaid program is $84.4 milliono $4.864 million increase from FY18o $888.8 thousand increase in general
fund need to support contractual services.
Medical Assistance Division administrative spending is only 1.43% of the total program budget.
Priorities for MAD staff in 2019 include:o Implementation of 1115 Waiver
Renewalo Continued procurement and
implementation of replacement MMIS
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Federal Funds, $66.85 M, 79%
State General Fund, $15.14 M,
18%
Other State
Funds, $2.42 M,
3%
Medicaid: Administration
Medicaid: MCO HEDIS Performance Measures
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64% 66% 68%
0%10%20%30%40%50%60%70%
HEDIS 14 HEDIS 15 HEDIS 16
Annual Dental Visits
47%52%
57%
0%10%20%30%40%50%60%70%
HEDIS 14 HEDIS 15 HEDIS 16
Well Child Visits within 1st 15 mos.
47%52% 54%
0%10%20%30%40%50%60%70%
HEDIS 14 HEDIS 15 HEDIS 16
Asthma Medication Management
48 49 48 45
0102030405060
HEDIS 14 HEDIS 15 HEDIS 16 SFY17Preliminary
ER Visits per 1,000
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73% 71% 77%
0%
20%
40%
60%
80%
HEDIS 14 HEDIS 15 HEDIS 16
Prenatal Care Visits in the 1stTrimester
Medicaid: MCO HEDIS Performance Measures
52%46%
56%
0%10%20%30%40%50%60%
HEDIS 14 HEDIS 15 HEDIS 16
Received greater than 81% of expected prenatal visits
7% 7% 7%6%
0%
2%
4%
6%
8%
CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3
Reduction in hospital readmissions for children within 30 days of discharge
13% 12%10% 10%
0%
5%
10%
15%
CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3
Reduction in hospital readmissions for adults within 30 days of discharge
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Behavioral Health Spending
FY19 request for BHSD is $59.6 million, $37.0 million from the General Fund.◦ Increased federal funding for combating opioid addiction and overdose
crisis
Total HSD Behavioral Health Spending (excl. administration)
FY17 Actuals FY18 Op Bud* FY19 Request
($ in millions) GF FF Total GF FF Total GF FF Total
Medicaid Behavioral Health $107.49 $393.62 $501.11 $115.58 $424.3 $539.87 $107.48 $394.36 $501.83
Behavioral Health Services Division $37.4 $21.05 $58.45 $37.04 $20.6 $57.64 $37.04 $22.57 $59.61
Total $144.89 $414.67 $559.56 $152.62 $444.9 $597.52 $144.52 $416.93 $561.44
Percent change from prior year -1.24% 3.40% 2.15% 5.33% 7.29% 6.78% -5.31% -6.29% -6.04%
Note: *FY18 Operating Budget for MAD BH is overstated. Adjustments to the Medicaid appropriation were not included in the MAD BH program appropriation.
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2,699
3,682
4,890
SFY 15
SFY 16
SFY17
3.5%
5.7%
1.7%
3.8% 3.7%
10.2%
4.4%
5.7%
1.4% 2.2%0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
SFY12 SFY13 SFY14 SFY15 SFY16
5th Grade Reading 8th Grade Math
Number of persons served through Telehealth in rural and frontier counties
Individuals served by BH Collaborative programs
145,534160,843 173,781
0
50,000
100,000
150,000
200,000
CY14 CY15 CY16
Reduction in Proficiency Gaps
Behavioral Health Performance
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29.84%
39.11%
33.28%
42.24%
48.50%
61.92%
52.40%
61.65%
20%
30%
40%
50%
60%
70%
SFY14 SFY15 SFY16 SFY17
Improving Follow-Up Services after Discharge
7 Day 30 Day
87.70% 88.00% 86.40% 86.44%
86.40% 87.10% 83.50% 84.02%
0%
20%
40%
60%
80%
100%
0%20%40%60%80%
100%
2014 2015 2016 2017
Adult Family/Caregiver
Satisfaction with Behavioral Health Services
Behavioral Health Performance
Child Support Enforcement Division
$30.97 million total budgetrequest
o $7.64 million from the general fundo Reduce the vacancy rateo Replace other revenue
o $20.31 million from federal fundingo $3 million from other revenue
69,127 child support cases in FY17
Key priorities◦ Implement Business process model
to ensure more efficient and effective service
◦ Replacement of the old Child Support Enforcement IT system
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$132
.1 M
$137
.1 M $1
40.1
M
$140
.8 M
$139
.6 M
$126. M
$128. M
$130. M
$132. M
$134. M
$136. M
$138. M
$140. M
$142. M
FY13 FY14 FY15 FY16 FY17
Child Support Collections(in millions)
Income Support Division
$965.0 million overall budget Increase of $398.5 thousand in
General Fund needed to maintain Senior SNAP Supplement ($25 per month).
The increase in Federal funds is primarily due to an increase in SNAP caseload and higher projected spending in the LIHEAP Program- 100% Federal funding.
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Federal Funds95.38%
State General Fund4.55%Other State
Funds0.07%
SNAP Participation
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130,000
150,000
170,000
190,000
210,000
230,000
250,000
17,000,000
18,000,000
19,000,000
20,000,000
21,000,000
22,000,000
23,000,000
24,000,000
Oct 2009
Dec 2009
Feb 2010
Apr 2
010
Jun 2010
Aug 2010
Oct 2010
Dec 2010
Feb 2011
Apr 2
011
Jun 2011
Aug 2011
Oct 2011
Dec 2011
Feb 2012
Apr 2
012
Jun 2012
Aug 2012
Oct 2012
Dec 2012
Feb 2013
Apr 2
013
Jun 2013
Aug 2013
Oct 2013
Dec 2013
Feb 2014
Apr 2
014
Jun 2014
Aug 2014
Oct 2014
Dec 2014
Feb 2015
Apr 2
015
Jun 2015
Aug 2015
Oct 2015
Dec 2015
Feb 2016
Apr 2
016
Jun 2016
Aug 2016
Oct 2016
Dec 2016
Feb 2017
Apr 2
017
Jun 2017
Total SNAP
Hou
seho
lds in New
Mexico
Total SNAP
Hou
seho
lds in th
e US
SNAP: Monthly Number of Households
National Households New Mexico Households
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Supplemental Nutrition Assistance Program
87.1
%
93.3
%
95.6
%
92.5
%
96.9
%
82.5
%
90.0
%
97.4
%
92.4
%
97.1
%
0%
20%
40%
60%
80%
100%
0%
20%
40%
60%
80%
100%
2014 2015 2016 2017 2018(1st Qtr.)
Regular - 30 Day Expedited - 7 Day
82.1%
88.8%92.4% 92.2%
80.0%
85.0%
90.0%
95.0%
100.0%
Timeliness of application processing
Percent of eligible children participating in SNAP
TANF Participation
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5,000
7,000
9,000
11,000
13,000
15,000
17,000
19,000
21,000
23,000
950,000
1,050,000
1,150,000
1,250,000
1,350,000
1,450,000
1,550,000
1,650,000
1,750,000
1,850,000
1,950,000
Oct‐05
Feb‐06
Jun‐06
Oct‐06
Feb‐07
Jun‐07
Oct‐07
Feb‐08
Jun‐08
Oct‐08
Feb‐09
Jun‐09
Oct‐09
Feb‐10
Jun‐10
Oct‐10
Feb‐11
Jun‐11
Oct‐11
Feb‐12
Jun‐12
Oct‐12
Feb‐13
Jun‐13
Oct‐13
Feb‐14
Jun‐14
Oct‐14
Feb‐15
Jun‐15
Oct‐15
Feb‐16
Jun‐16
Oct‐16
Feb‐17
Total TAN
F Ca
ses in New
Mexico
Total TAN
F Ca
ses in th
e US
TANF: Monthly Number of Families
US: Number of TANF Families New Mexico: Number of TANF Families
Temporary Assistance for Needy Families – (TANF)
FY19 TANF appropriation request of $136.3 million:◦ TANF block grant of $109.9
million and $25.5 million of current carry over balances.
◦ Cash assistance, flat with FY18 OpBud. Includes restoring (increasing)
monthly cash assistance grant by 7.5%
◦ Maintains support of programs at other agencies
◦ Continues support services programs, such as attaining high school equivalency and employment programs.
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Cash Assistance, $51.1 M, 38%
Administration, $11.5 M, 8%Support Services,
$19.7 M, 14%
Other Agencies, $54. M, 40%
TANF Work Participation Rate Caseload has decreased
o In 2012, HSD had an average caseload of 18,201
o In 2017, the average was 11,055
Increase of child only caseso In 2012, the average child only cases
was 37.1% of the caseload.o In 2017, the average child only cases
was 45.3% of the caseload.
1 parent household has decreasedo In 2012, the average number of one
parent households was 56.2% of the caseload.
o In 2017, the average number of one parent households had dropped to 47.2% of the caseload.
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34.4% 33.5%36.6%
48.4%
51.9%
46.0%
51.7%
39.3%36.1%
54.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2012 2013 2014 2015 2016
FFY Work Participation Rates
US Average New Mexico
Job Readiness Activities ISD remains focused on helping TANF
recipients prepare for and find employmento CareerLinkso Wage Subsidyo High School Equivalency Credential Programo Vocational Training Program
Partnership with the Department of Workforce Solutions
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Temporary Assistance for Needy Families – (TANF)
Temporary Assistance for Needy Families – (TANF)
Admin Includes: Income Support Administration and Program Support Administration Cash Assistance Includes: Cash Assistance, Clothing Allowance, Diversion Payments, Wage
Subsidy and State Funded Legal Aliens Support Services Include: NM Works Program, Transportation, Career Links, High School
Equivalency program, Vocational Training Program and Employment Related Costs Other Agencies Include: CYFD Pre K, CYFD Child Care, CYFD Home Visiting, CYFD
Supportive Housing and PED Pre K
PROGRAM($ in millions) GF FF TOTAL GF FF TOTAL
General Funds in HSD for TANF 0.09 - 0.09 0.09 - 0.09Unspent balances from prior periods - 69.7 69.7 - 48.3 48.3TANF Block Grant - 109.9 109.9 - 109.9 109.9TANF Contingency - - - - - - TOTAL REVENUE 0.09 179.6 179.7 0.09 158.2 158.3ADMIN TOTAL - 11.5 11.5 - 11.5 11.5Cash Assistance 0.09 51.2 51.3 0.09 51.0 51.1Support Services - 20.7 20.7 - 19.7 19.7Other Agencies - 54.0 54.0 - 54.0 54.0TOTAL 0.09 137.4 137.5 0.09 136.2 136.3Calculated Carryover Balance 42.3 21.9
FY18 OP BUD FY19 REQUEST
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Program Support provides administrative support to the program divisions of HSD
The FY19 budget request for Program Support is $53.3 million, with $15.8 million requested from the General Fund
Key projects and results◦ ASD: Unqualified opinion from independent auditors
(FY16); FY17 in progress and on track◦ ITD: Maintain and support critical and large-scale,
statewide IT systems◦ ITD: MMIS and CSES replacement projects in progress
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Program Support and Information Technology
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System processes 10 million transactions, totaling $6 billion in medical care for 900,000 New Mexicans through 27,675 providers and 4 MCOs.
Aligns with federal requirements◦ Risk of reduced federal funding for non‐compliant system
90% Federal ‐ 10% State funding Creates a client‐centric business solution and is the foundation for additional development within New Mexico’s Health & Human Services (HHS) enterprise.◦ Connecting existing services in HSD with DOH, CYFD, and ALTSD to deliver a customer‐centric focus through shared technology Unified Portal and Consolidated Customer Service Center and Data Services
Medicaid Management Information System Replacement (MMISR)
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Undertaking five procurements to implement MMISRo System Integrator (SI) -- in contract negotiationo Data Services (DS) -- finalizing vendor selectiono Quality Assurance (QA) -- release RFP in November 2017o Benefit Management Services (BMS) -- release RFP in February 2018o Financial Services (FS) -- release RFP in May 2018
HSD requests $6.8 million in State General Fund to support the continuation of the $175.6 million MMISR project.o The legislature has appropriated $87.09 million (Federal and State
share) in project funds to date.o The project received approval of an Advanced Planning Document
Update Budget from CMS in June 2017.
Category or Account Description
FY17 & Prev
ActualFY18
BudgetedFY19
Request FY20 EstimateFY21
Estimate TotalGeneral Fund $1,699.0 $7,010.0 $6,801.9 $2,033.4 $3.6 $17,845.9
Federal Funds $15,636.2 $62,744.7 $64,445.3 $14,838.3 $33.1 $157,758.3
Total $17,335.2 $69,754.7 $71,605.9 $16,871.7 $36.7 $175,604.2
MMISR Costs and Budget
Next Public Meeting: Albuquerque – Monday, October 30, 2017, 5:30 to 7:30 pm◦ National Hispanic Cultural Center◦ By phone: 1-888-757-2790, participant code 991379#
Additional info: ◦ http://www.hsd.state.nm.us/centennial-care-2-0.aspx
To submit comments:◦ Email to [email protected]◦ Mail to Human Services Department, ATTN: HSD Public
Comments, PO Box 2348, Santa Fe, NM 87504-2348
Comments will be accepted until 5:00pm MST on Monday, November 6, 2017
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Centennial Care 2.0 Information
Questions?
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