Medicaid Budget Overview [MS Powerpoint]

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Medicaid Budget Overview [MS Powerpoint]

  1. 1. Joint Finance-Appropriations Committee <ul><li>Division of Medicaid </li></ul><ul><li>Medicaid Administration </li></ul><ul><li>Leslie Clement </li></ul><ul><li>Administrator </li></ul><ul><li>January 19, 2010 </li></ul>
  2. 2. Division as Component of DHW
  3. 3. Administrative Overhead at 3.8%
  4. 4. Administrative Cost Components
  5. 5. Funding Sources
  6. 6. Holdback Impacts
  7. 7. Funding Source History
  8. 8. <ul><li>Focus on cost containment measures. </li></ul><ul><li>Medicaid personnel and contractor’s role is to effectively and efficiently manage benefits while preserving quality and access. </li></ul>Legislative Intent Status
  9. 9. Chart of Initiatives Strategy 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; reduced contract
  10. 10. <ul><li>Reduce waste, fraud, and abuse </li></ul><ul><ul><li>DHW Medicaid Program Integrity Unit </li></ul></ul><ul><ul><li>AG’s Medicaid Fraud Control Unit </li></ul></ul><ul><ul><li>Licensing, certification, & complaint follow-up activities </li></ul></ul><ul><ul><li>Quality Assurance reviews </li></ul></ul><ul><ul><li>State and federal audits </li></ul></ul><ul><ul><li>New MMIS System: Enhanced editing & auditing capabilities </li></ul></ul>Management Strategies to Control Costs
  11. 11. MMIS Operations LBB page 2-56 <ul><li>Decision Unit 12.01 </li></ul><ul><li>Planned implementation of June 2010 </li></ul><ul><li>Full year of new system operations </li></ul>Description Total Funds General Funds Federal Funds Contracted Mailing expenses (50%) $220,000 $110,000 $110,000 Claims System contracts (75%) $5,428,800 $1,357,200 $4,071,600 Total on-going Request $5,648,800 $1,467,200 $4,181,600
  12. 12. MMIS certification LBB page 2-56 <ul><li>Decision Unit 12.02 </li></ul><ul><li>One-time funding </li></ul><ul><li>Contractual payment made to vendors for successful completion of required certification </li></ul>Description Total Funds General Funds Federal Funds MMIS Certification $3,847,600 $961,900 $2,885,700 Total One-time Request $3,847,600 $961,900 $2,885,700
  13. 13. 3 rd Party Recovery Funding LBB page 2-56 <ul><li>Loss of AG position to holdbacks </li></ul><ul><li>Governor restored funding to operating to obtain these legal services in 2011 </li></ul><ul><li>Results in cost avoidance of >$700,000 in trustee & benefits payments. </li></ul>$75,000 $75,000 $150,000 Legal recovery costs Federal Funds General Funds Total Operating
  14. 14. Administration Budget Recommendation Medicaid Administration 2010 Appropriation 2011 Governor’s Recommendation FTP 283 284 Personnel $18,462,500 GF: $6,817,500 $17,666,800 GF: $6,648,600 Operating $47,455,100 GF: $9,022,900 $42,222,200 GF: $9,827,400 Capitol $0 $0 Trustee & Benefits $2,949,600 GF: $1,311,000 $2,949,600 GF: $1,311,000 Total $68,867,200 GF: $17,151,400 $62,838,600 GF: $17,787,000
  15. 15.
  16. 16. Joint Finance-Appropriations Committee <ul><li>Division of Medicaid </li></ul><ul><li>Medicaid Trustee & Benefits Payments </li></ul><ul><li>Leslie Clement </li></ul><ul><li>Administrator </li></ul><ul><li>January 19, 2010 </li></ul>
  17. 17. Division as Component of DHW Spending
  18. 18. Provider Payments 96.2 % of Total
  19. 19. Provider Payments by Plan
  20. 20. 2011 Per Enrollee Per Month 15,000 47,000 $154,000 Total Enrollees $1,500 $1,600 $232 Average $ per Plan 0 22,000 137,000 Number of Children n/a $1,300 $178 Costs of Children 15,000 25,000 17,000 Number of Adults $1,500 $1,900 $680 Cost of Adults Coordinated Enhanced Basic
  21. 21. Current Enrollment by Location 202,153 Total 28,210 7 24,471 6 27,526 5 40,982 4 44,217 3 11,479 2 25,268 1 Enrollment Region
  22. 22. Funding Sources
  23. 23. Holdback Impacts
  24. 24. Permanent Holdback & Adjustments <$38.9> $2.6 <$12.1> <$48.3> Totals <$1.6> < $ .4> <$2.0> Basic Page 2-65 <$31.8> $2.6 <$10.3> <$39.5> Enhanced Page 2-62 <$5.5> <$1.4> <$6.9> Coordinated Page 2-59 Federal Fund Dedicated Fund General Fund Total Funds Plans
  25. 25. <ul><li>Impact of Holdbacks on Providers </li></ul>12.5% $ 7.0 Other 12.5% $ 7.0 Developmental Disability Services 13% $ 7.0 Medical/Dental 12.5% $ 7.0 Mental Health 4% $ 2.2 Pharmacy 15% $ 8.4 Long-term Care 29% $16.2 Hospitals % of total Holdback Provider Type $11.4 General Funds $54.8 M Total All Providers
  26. 26. History of Funding
  27. 27. <ul><li>Focus on cost containment measures. </li></ul><ul><li>Medicaid personnel and contractor’s role is to effectively and efficiently manage benefits while preserving quality and access. </li></ul>Legislative Intent Status
  28. 28. Chart of Initiatives Strategy 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; reduced contract
  29. 29. <ul><li>Four primary avenues to control costs: </li></ul><ul><li>Reduce Prices </li></ul><ul><li>Limit/Eliminate Benefits </li></ul><ul><li>Limit/Eliminate Eligibility categories </li></ul><ul><li>Management </li></ul>Cost Containment Strategies
  30. 30. Pricing <ul><li>Federal law: </li></ul><ul><li>Imposes significant requirements </li></ul><ul><li>Sets certain provider rates </li></ul><ul><li>Requires that payment is consistent with efficiency, economy, and quality of care. </li></ul><ul><li>Requires that payment must attract enough providers so that Medicaid services are available to the same extent as non-Medicaid services </li></ul><ul><li>States have some flexibility subject to approval </li></ul>
  31. 31. Benefits <ul><li>Federal law: </li></ul><ul><li>Requires certain benefits </li></ul><ul><li>Requires states cover EPSDT </li></ul><ul><li>Requires certain standards </li></ul><ul><li>States have some flexibility: </li></ul><ul><li>Define scope, amount and duration </li></ul>
  32. 32. Eligibility- MOE <ul><li>No changes permissible at this time </li></ul><ul><li>States cannot reduce eligibility and receive the increased FMAP </li></ul><ul><li>Proposed health legislation </li></ul><ul><li>States cannot reduce eligibility for adults until 12/2013; certain exceptions are allowed for non-pregnant, non-disabled adults </li></ul><ul><li>States cannot reduce eligibility for children until 09/2019 </li></ul>
  33. 33. Management Strategies <ul><li>Improve: </li></ul><ul><ul><li>Technology tools: front-end edits </li></ul></ul><ul><ul><li>Payment methodology </li></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><li>Benefit Design </li></ul></ul><ul><ul><li>Utilization & case management </li></ul></ul><ul><ul><li>Communications </li></ul></ul><ul><ul><li>Sharing costs </li></ul></ul>
  34. 34. <ul><li>2010 Forecasted Expenditures: Shortfall </li></ul>Supplemental 4.31 LBB page 2-53 $52.8 $ 10.0 $29.5 $13.3 Federal Fund <$2.1> <$.3> <$ .7> <$1.1> Dedicated/Other Fund Plan Total Fund General Fund Basic Page 2-65 $15.0 $2.8 Enhanced Page 2-62 $36.5 $7.6 Coordinated Page 2 -59 $13.1 $3.5 Total $64.6 $13.9
  35. 35. <ul><li>Nursing Facility Provider Assessment </li></ul>Supplemental 4.36 LBB page 2-59 Plan Total Fund Dedicated Fund Federal Fund Coordinated $11.5 $2.4 $9.1 Total $11.5 $2.4 $9.1
  36. 36. Benefit Plan Maintenance LBB page 2-52 Plans Total Funds General Funds Dedicated Funds Federal Funds Basic $32.4 $20.3 $.7 $11.4 Enhanced $72.4 $52.4 $1.9 $18.1 Coordinated $21.8 $21.9 $<.2> $.07 Total $126.9 $94.6 $2.4 $29.5
  37. 37. Mid-Year FMAP Change LBB page 2-52 Plan Other State Funds Federal Fund Basic $13.8 <$13.8> Enhanced $39.8 <$39.8> Coordinated $17.6 <$17.6> Total $71.2 <$71.2>
  38. 38. <ul><li>…… .. </li></ul>Basic Plan Recommendation Basic Plan 2010 Appropriation 2011 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
  39. 39. Enhanced Plan Recommendation Enhanced Plan 2010 Appropriation 2011 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
  40. 40. Coordinated Plan Recommendation Coordinated Plan 2010 Appropriation 2011 Recommendation 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
  41. 41. Questions? Leslie Clement [email_address] 208-364-1804

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