Ways and means presentation 01262011 final

Indiana Family & SocialServices Administration FY12-13 Biennium Budget

Agency Overview• Overall Budget of $8.6 Billion• Five Divisions: – OMPP – Aging – DMHA – DDRS – DFR• Current Number of Staff 4,478 2

FSSA Headcount FY10 4,789FY11 (01/3/11) 4,478 FY12(est) 4,166 FY13 (est) 4,166 3,800 3,900 4,000 4,100 4,200 4,300 4,400 4,500 4,600 4,700 4,800 4,900 3

Healthy Indiana Plan (HIP) 4

Healthy Indiana Plan (HIP) Update• Enrollment (as of 12/31/2010) – Total enrollment: 42,568 – Childless adults: 15,632 – Parental adults: 26,936• Childless adults wait list continues, but program remains open for parental adults.• Number of individuals on waitlist: 55,032 (as of 12/31/2010) 5

HIP Accomplishments• Member Behavior – 76% of HIP members completed their required annual physical; completion of preventive services makes a member eligible for POWER account rollover in the following year – HIP members required to make POWER account contributions saw a 9% decrease in ER utilization during the first 3 months of enrollment, and 15% after 6 months. HIP members not required to make POWER account contributions only saw an initial 5% decline in ER use after 3 months and no additional decline in subsequent months. – 97% of individuals make their required POWER account contributions• Member Satisfaction -Product Acceptance and Research conducted a survey of HIP members – 94% of members were satisfied with the program – 99% indicated they would reenroll in the program 6

HIP & The Affordable Care Act• May 17, 2010 – Letter from FSSA Secretary Anne Murphy to CMS Director Cindy Mann – CMS questions: • Can HIP be used as the coverage vehicle for the newly eligible population under the Affordable Care Act? • Waiver expires in 2012 and ACA provisions come into effect on January 1, 2014 – What will happen in 2013? • Will State receive an enhanced match for current HIP participants? – This will impact fiscal projections on how much the Affordable Care Act will cost Indiana• August 30, 2010 – Letter regarding Medicaid Disability included follow-up questions regarding HIP. A subsequent call with CMS did not lead to any conclusions.• January 14, 2011 – Governor Daniels sent a letter asking Secretary Sebelius for an answer as to whether or not HIP can continue as the coverage vehicle for the newly eligible adults.• State will be submitting a State Plan Amendment to seek approval for HIP as the coverage vehicle in 2014. 7

HIP – Senate Bill 461• Authored by Senator Pat Miller• Effective 2014 – Use HIP as the Medicaid ACA expansion vehicle instead of the traditional Medicaid program. – Gives Secretary the authority to make benefit modifications to align with ACA requirements. ACA could increase benefit costs 10-15% depending on final CMS rules. – Eligibility alignment to reduce of duplication of federal program.• Effective upon passage – Amend code to require individuals to make a minimum contribution of not less than $60 annually. – State POWER account savings not substantial, but could drive down premium costs. – Allow nonprofit organizations to contribute no more than 50% of the individual’s required payment. – Health plans may contribute if related to health improvement. 8

Enrollment Scenarios December 2013 Projected Enrollment Childless Scenario Parents Adults Total Status Quo 55,000 10,000 65,000 Scenario 1 55,000 17,000 72,000 Scenario 2 55,000 26,000 81,000 Full Enrollment 55,000 36,500 91,500Notes:•Data provided through September 30, 2010.•CY 2008 beginning balance of approximately $73.9M.•Scenarios above assume that HIP would be extended until December 31, 2013. 9

Revenue Projection CY 2013 Projection Scenario Remaining State Tax Tax Revenue Expenditures Revenue Surplus/(Deficit) 12/31/2013 Status Quo $157.3M $127.7M $(29.6M) $206.5M Scenario 1 $177.6M $127.7M $(49.9M) $170.2M Scenario 2 $205.2M $127.7M $(77.5M) $106.9M Full Enrollment $235.0M $127.7M $(107.3M) $23.0MNotes:•Data provided through September 30, 2010.•Scenarios above assume that HIP would be extended until December 31, 2013. 10

Non-Medicaid Base Budget ($’s in millions)$900 $803.7$800 $744.2$700$600 $80.9 M DECREASE$500 General Fund$400 Dedicated Funds$300 $262.7 $240.8$200$100 $0 FY11 Approp FY12-13 Request 13

Summary of Base Changes• $9.4M reduction in appropriation request for CHOICE• Implementation of transition from Care Select to Chronic Disease Management that will reduce costs by over $11M.• Reductions of almost $18M in administrative costs due to attrition, efficiencies and contract reductions.• Over $11M in savings from maximizing federal dollars.• Continuation of RCAP moratorium for a savings of $3M.• Reduction of approximately $7M in DD state line funding as a result of transitioning individuals to waiver funded services.• Elimination of DDRS Crisis and Outreach contracts that will save approximately $6M• $15M in annualized savings due to the SOF Transition plan 14

Division of Family Resources(DFR) 15

DFR RegionsHybrid Conversion:Vanderburgh – JanuaryVigo – JuneClark – SeptemberGrant & Allen– Scheduled forFebruary 2011.Indiana has been working closelywith the Federal government. FNSrequires two months of data priorto giving the State approval toexpand to another region. 16

FY11 Timeliness Performance100.0%90.0%80.0%70.0% As-Is Modernized60.0% Hybrid50.0%40.0% July August September October November December 17

Applications Pending Beyond Time Standard as a % Total Pending Applications Statewide 50% 44% 45% 40% 39% 35% 32% 32% 32% 31% 30% 28%Total Pending 25% 23% 24% 25% 23% 20% 16% 15% 10% 5% 0% July 2010 Dec 2010 Jun 2001 Jun 2002 Jun 2003 Jun 2004 Jun 2005 Jun 2006 Jun 2007 Jun 2008 Jun 2009 Jun 2010 Pending Beyond Time Standard as a % Total Pending 18

Regional Application Backlog 12/5/09 – 1/14/11 Applications Pending and Late Excluding HIP Lake St.Joseph Allen Grant Marion Vigo Vanderburgh Clark State Thru Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Total 12/05/09 1,309 830 3,941 3,468 8,653 2,338 2,427 3,053 26,019 01/14/11 273 236 860 1,318 3,547 219 265 563 7,281 Increase/ Decrease -79% -72% -78% -62% -59% -91% -89% -82% -72%Source: Cognos Application Tracking DashboardNote: The change shown is relative to the 12/5/09 backlog 19

Hybrid Performance: Key Metrics State Reported, Cumulative Food Stamp Error Rates*Positive July 2009 8.21%Positive July 2010 2.76%Positive July National Average 2010 3.70%Negative July 2009 15.10%Negative July 2010 2.48%Negative July National Average 2010 7.55% *The most recently available SNAP error rates as reported by FNS are for the month of July 20

Number of Hoosiers Receiving Benefits Increases Since 2002 With the economic downturn, FSSA program enrollment has increased by 42% since 2005. Enrollees by Program (as of June 30 annually) 2002 2003 2004 2005 2006 2007 2008 2009 2010 Current*** Medicaid* 756,904 777,170 822,344 847,625 857,599 877,933 920,332 1,017,571 1,088,637 1,099,103 Food Stamp 428,089 487,197 532,402 557,206 575,602 586,156 639,470 721,155 828,604 872,898 Recipients Food Stamp 180,457 205,208 228,218 241,177 249,914 253,443 273,876 306,562 355,626 378,210 Households TANF 151,269 146,783 148,788 141,055 135,206 117,311 122,743 119,912 104,004 92,439 Number of Hoosiers enrolled in at 776,121 810,694 866,103 899,701 922,434 943,343 1,013,429 1,114,950 1,250,774 1,279,483 least one program*** Medicaid increase in 2008 & 2009 affected by addition of HIP program (18,903 members in 2008 & 50,115 members in 2009). Medicaidnumbers are from ICES and do not include retroactive coverage; numbers are slightly higher in actuality.** Program totals are comprised of only unique cases, and not a sum of individual program data.***Current enrollment through Dec 31, 2010. Source: ICES 21

New Applications for Assistance Groups Received in ICES Statewide 1,400,000 1,195,305 1,200,000 994,471 1,000,000 856,812 788,390 800,000 760,173Applications 695,720 641,687 608,793 600,000 491,076 430,264 400,000 200,000 2001 - Annualized based on 6 months of available data 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 22

Change Package – DFR County Admin $32.6M FY08 FY11 Estimate $71.7M appropriation $56.5M appropriation765,419 applications processed 1,213,382 applications processed 1,632 Contract Staff 2,044 Contract Staff 676 State Employees 767 State Employees 23

Division of Disability andRehabilitative Services (DDRS) 24

Waiver counts: Total participants14,000 12,14412,000 11,383 10,128 10,437 9,59110,000 8,000 6,000 4,000 2,000 0 FY06 FY07 FY08 FY09 FY10 25

Waiver counts: New consumers1,400 1,1891,200 1,108 1,0601,000 858 800 631 600 400 200 0 FY06 FY07 FY08 FY09 FY10 26

BCDS – First Steps – Children served26,000 25,19825,000 24,133 24,25824,000 22,87223,000 22,56722,00021,000 SFY06 SFY07 SFY08 SFY09 SFY10 27

Division of Aging (DA) 28

Average Nursing Facility Report Card Score200195 194 188190185180175 171 Phase 2 01/01/10170165 December 2007 December 2009 December 2010160 29

DA – Medicaid Waiver Clients10,000 9,361 8,000 6,000 4,000 3,180 2,000 - January 2005 November 2010 30

Nursing Facility Clients vs. Medicaid Waivers Clients30,000 28,333 28,63625,00020,00015,000 Medicaid Waivers Nursing Facilities10,000 9,361 5,000 3,180 - January 2005 November 2010 Waiver % Increase 295% NF % Increase 1% 31

Fy10 Average state cost per client$8,000 $7,102$7,000$6,000$5,000$4,000 $3,359$3,000$2,000$1,000 $- A&D Waiver CHOICE 32

Choice and A&D Waiver Comparison A&D Waiver CHOICEAnnual State $30.9M $29.4MExpendituresAvg. Clients 9,167 4,399Served PerMonthAvg. Cost Per $3,359 $7,102ClientEligibility •3+ ADLs and/or • 2+ ADLs 1 Skilled Nursing Need • 150% of Poverty Level • 300% of Poverty Level • Assets cannot exceed $500,000 • Meets NF LOC • Does not have to meet NF LOC • Medicaid Eligible • Does not have to be Medicaid EligibleWaitlist as of 4,957 5,49011/ 2010 33

Division of Mental Health andAddictions (DMHA) 34

Proposal Details Richmond: • Close substance Logansport: abuse unit (101 • Close civil beds (222 beds) beds) •Close youth services unit (20 beds) • Close MRDD Larue Carter: unit (30 beds) Youth services from •Use 50 beds for Richmond moved to LC SMI patients (utilization of 20 Existing Beds) Evansville: Madison:• Close 30 bed MRDD unit • Close two& transition to community MRDD units (30•Utilize 30 bed unit for beds)SMI patients •Utilize 30 beds for SMI patients 35

SOF Transition Plan Status– SOF Transition as of 1/11/11 • Appropriate patients with intellectual disabilities have been identified for discharge to community placements by April 2011. • Overall Discharges to Occur: – 110 patients to other State Hospitals – 116 MR/DD patients to Community • 38 patients with mental illness have been transferred from Logansport to other State hospitals. • 22 patients with MR/DD have been transferred to the community. 36

SOF Transition Plan Status (Cont’d)• Logansport has closed 4 patient units (98 beds)• No staff layoffs have occurred. Staffing reduction at Logansport (112) and Richmond (36) has been due to attrition.• LSH – currently 682 employees; target is 492 – Currently 246 patients; target is 166• RSH – Currently 509 employees; target is 498 – Currently 234 patients; target is 211 37

Logansport Transition Plan Change• Capacity increased from 134 patients to166 patients• Change made based on clinical review of patients and determination that certain patients still needed the structure and security provided by the hospital• Revised plan announced to staff 1/6/11• Staffing increased to 492 (up from 482)• Focus on forensic, sexual responsibility unit, IRTC step down, women, MR/DD 38

Fy10 SOF Occupancy Rates100.00% 95.85% 91.77% 87.04% 88.67% 82.85%80.00%60.00% 42.04%40.00%20.00% EPCC Evansville Madison Logansport Richmond Larue Carter 39

FY10 SOF Operating Cost - PPDLarue Carter $557.63 Richmond $407.40 Logansport $457.13 Madison $606.27 Evansville $486.58 EPCC $917.54 $- $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 40

MRO Update• Changes to MRO program became effective 7/1/10• Impetus for the change was to bring the program into compliance with federal guidelines. Audit findings resulted in payback to the federal government.• System changes created mutually with impacted providers.• Service packages and allotted service units defined to support recovery and community living. 41

MRO Update (Cont’d)• Significant start up efforts lead to successful kick off.• Providers are adjusting service arrays to meet consumer needs and program guidelines.• Consumers are receiving the amount and intensity of services identified through a standardized assessment. 42

FSSA Capital Request• Capital request for State Hospitals include both Preventive Maintenance and Capital projects needed to maintain the current facilities.• Capital project request for the State hospitals is being maintained at the same level as the last biennium budget. – Preventive Maintenance - $5,553,395 – Capital Projects - $8,479,768• Request have been limited to those projects that are needed to maintain the infrastructure of the facilities and life safety issues. 43

FSSA Capital Request• Capital projects have been prioritized over the SOF system as a whole and not by each individual hospital.• Major capital projects: – Replacement of current SOF Pharmacy System-current system is no longer going to be supported by the current vendor during the next biennium therefore this system will need to be replaced (Project request $1.8 million). – Remainder of projects are various projects among the hospitals for infrastructure and life safety (Project request $6.9 million). 44

Office of Medicaid Policy andPlanning (OMPP) 45

Medicaid General Fund Appropriations$2,500,000,000 $269M$2,000,000,000 $111M $303M $303M$1,500,000,000 GROWTH SHORTFALL$1,000,000,000 ARRA GF APPROP $500,000,000 $0 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 (est) (est) (est) 46

Projected Medicaid Assistance Need and Increase Requested Relative to SFY 2011 Appropriation (in $millions) SFY12 SFY13December 2010 Projection $1,843 $2,001 – Administrative Savings Target (100) (112) – Legislative Initiatives in Budget Bill (20) (22)December 2010 Adjusted Projection $1,723 $1,867SFY 2011 Appropriation $1,429 $1,429 – SFY 2011 ARRA adj 303 303Total SFY 2011 with ARRA $1,732 $1,732 – Growth Compared to SFY 2011 (9) 135Total Increase From SFY 2011 Appropriation $294 $438 47

December 2010 Medicaid Assistance Adjusted ProjectionEXPENDITURES FY 2010 Growth FY 2011 Growth FY 2012 Growth FY 2013 Fee for Service $1,811.7 15.8% $2,097.5 6.3% $2,229.2 10.7% $2,467.1 Capitation Payments and PCCM Fees 1,194.2 (10.6%) 1,067.3 9.5% 1,168.3 8.6% 1,268.8 Healthy Indiana Plan 243.1 (4.0%) 233.4 12.2% 261.9 15.9% 303.4 Long Term Care Institutional Care 1,482.1 2.7% 1,521.4 (0.8%) 1,509.7 3.5% 1,562.6 Long Term Care Community Care 646.3 3.1% 666.5 10.4% 736.1 5.4% 775.7 Medicare Buy-In, Clawback 258.2 2.3% 264.1 20.6% 318.5 8.2% 344.7 Medicaid Rehabilitation Option 256.9 (29.0%) 182.4 10.0% 200.8 8.2% 217.3 Rebates and Collections (174.9) 52.5% (266.8) 15.3% (307.7) 9.2% (336.1) Remove CHIP Program, Provider Tax Receipts (247.7) 5.4% (261.0) 7.6% (280.8) 4.4% (293.1) Other Expenditures (DSH, UPL, etc.) 674.2 58.0% 1,065.4 (8.2%) 977.7 (1.1%) 967.3Medicaid Expenditures (State and Federal) $6,144.1 6.9% $6,570.3 3.7% $6,813.6 6.8% $7,277.7FUNDING Federal Funds 4,012.8 7.0% 4,293.5 3.8% 4,456.8 6.7% 4,757.0 DSH 30.0 61.7% 48.4 (19.3%) 39.1 (0.3%) 39.0 Non-State IGTs 25.3 827.2% 234.4 33.4% 312.7 1.8% 318.2 Cigarette Tax Revenues 71.6 18.1% 84.6 30.7% 110.6 10.5% 122.2 QAF Transfer to SBA (33.3) 19.1% (39.6) (49.7%) (19.9) 0.5% (20.0) GF Directed IGTs 288.3 (91.9%) 23.5 714.7% 191.4 1.3% 193.9Non-Medicaid Assistance Funds $4,394.7 5.7% $4,644.8 9.6% $5,090.7 6.3% $5,410.3Forecasted Medicaid GF Assistance Need $1,749.5 10.1% $1,925.5 (10.5%) $1,723.0 8.4% $1,867.4Less ARRA FMAP Stimulus Funding $573.4 (18.8%) $465.3Required Medicaid General Fund Assistance $1,176.1 24.2% $1,460.2 18.0% $1,723.0 8.4% $1,867.4General Fund Medicaid Assistance Appropriation $1,116.0 28.0% $1,428.8 Contingency Fund Contribution $57.6Sub-total (Shortfall)/Surplus ($2.5) ($31.4) 48

State of Indiana, Family and Social Services Administration Average Monthly Enrollment Forecast: SFY 2010 - SFY 2013 Using Data through October 31, 2010 Total MedicaidAverage Monthly Enrollment FY 2010 Growth FY 2011 Growth FY 2012 Growth FY 2013ADULTS AND CHILDREN Adults 112,210 6.2% 119,133 7.5% 128,045 4.4% 133,632 Children 539,095 5.5% 568,727 6.8% 607,213 5.0% 637,735 Mothers 30,383 1.8% 30,931 2.4% 31,661 2.2% 32,366 CHIP 79,687 8.1% 86,122 9.0% 93,845 5.9% 99,420 Healthy Indiana Plan 46,082 (0.3%) 45,949 13.8% 52,289 13.7% 59,463Total Adults and Children 807,458 5.4% 850,863 7.3% 913,052 5.4% 962,617AGED, BLIND AND DISABLED Institutionalized 34,375 1.2% 34,787 1.0% 35,128 1.4% 35,617 Waiver 21,033 3.9% 21,859 5.1% 22,964 1.9% 23,408 No Level of Care Dual 76,214 11.2% 84,785 6.5% 90,268 3.6% 93,554 Non-Dual 78,815 12.2% 88,461 7.3% 94,881 3.9% 98,568 Partial 28,767 6.9% 30,756 4.7% 32,192 3.5% 33,304Total Aged, Blind, and Disabled 239,205 9.0% 260,648 5.7% 275,433 3.3% 284,451OVERALL TOTAL 1,046,663 6.2% 1,111,510 6.9% 1,188,485 4.9% 1,247,068 49

Medicaid General Fund Appropriations$2,000,000,000 $135M$1,800,000,000$1,600,000,000 $303M $303M$1,400,000,000$1,200,000,000$1,000,000,000 GROWTH SHORTFALL $800,000,000 ARRA $600,000,000 GF APPROP $400,000,000 $200,000,000 $0 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 (est) (est) (est) 50

Medicaid Cost Components• Eligibility – No Reductions Allowed Due to ARRA through June 30, 2011 – No Reductions Allowed Due to ACA through December 31, 2013• Benefits – Mandatory Benefits must be provided to receive Federal matching funds – Changes to any current Optional Benefits not required under ACA will require Legislative Action• Provider Reimbursement 51

Medicaid Optional Services State & # of Potential Federal State Only Recipients SavingsServices Indiana Code or Indiana Adminstrative Code Citation SFY2010 SFY2010 SFY2010 SFY2012Targeted Case Management IAC/Federal waivers $1.0 $0.2 4,000 $0.3Prosthetic/Orthotic Services 405 IAC 5-19-3(5), 5-19-11, 5-26-6 $0.2 $0.05 2,500 $0.1 IC 12-15-2-8 (ICF/MRs); 12-15-5-1(19); IC 12-15-32ICF/MR (CRFs/DD); 12-15-5-1(20) $311.4 $76.9 4,200 $0.0 IC 12-15-5-1(4) gives authority for outpatient and clinicClinics (NP, Title V or Therapy) services, however these include many services beyond these particular clinic services $0.1 $0.02 600 $0.03Hospice Services Dual Eligible IC 12-15-5-1(15) and 12-15-40 $50.8 $12.5 5,500 $0.0Hospice Services Non-Dual Eligible IC 12-15-5-1(15) and 12-15-40 $7.8 $1.9 600 $2.6Ambulatory Surgical See note for clinics $5.1 $1.3 14,100 $1.7Rehabilitation Facility Care IAC $11.1 $2.7 1,000 $3.7MRO IAC $160.1 $39.5 35,800 $0.0Dental IC 12-15-5-1(8) $58.5 $14.4 116,500 $11.6Chiropractic Services IC 12-15-5-1(3) $3.0 $0.7 1,000 $0.8Podiatrist Services IC 12-15-5-1(14) $2.1 $0.5 28,700 $0.5Eye Care & Eyewear IC 12-15-5-1(12) & IC 12-15-5-1(11) $11.9 $2.9 148,300 $3.9Waiver $645.8 $159.4 26,250 $0.0Total $1,268.9 $313.2 $25.2 52

FY12-13 Budget Challenges• Health care reform –No funding included in budget request• Legislative opportunities: – State Operated Facilities – Medicaid Optional Services – First Steps capitation requirement – TANF – QAF Maximization 53

QUESTIONS? 54 54

Ways and means presentation 01262011 final

by Jennifer Hurtubise on Feb 07, 2011

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Ways and means presentation 01262011 final — Presentation Transcript