California Partnership of Healthcare Advocates
Conference 2010
Medi-Cal Update
Rene Mollow, MSN, RN, Chief
Medi-Cal Eligib...
2
“Preserve and Improve the Health
Status of all Californians”
Medi-Cal Year In Review
• Child Health Insurance Program
Re...
3
“Preserve and Improve the Health
Status of all Californians”
CHIPRA Medicaid Provisions
• Ability to waive the five year...
4
“Preserve and Improve the Health
Status of all Californians”
• Temporary Federal Medical Assistance Percentage (FMAP)
In...
5
“Preserve and Improve the Health
Status of all Californians”
Federal Health Care Reform
• House Bill?
• Senate Bill?
• M...
6
“Preserve and Improve the Health
Status of all Californians”
State Budget Deficit and
Medi-Cal Impacts
• Originally esti...
7
“Preserve and Improve the Health
Status of all Californians”
State Budget Deficit and
Medi-Cal Impacts (cont.)
• May Rev...
8
“Preserve and Improve the Health
Status of all Californians”
Medi-Cal Optional Benefit
Elimination
• Effective July 1, 2...
9
“Preserve and Improve the Health
Status of all Californians”
Medi-Cal Year in Progress
• Ongoing State Budget Deficit
• ...
10
“Preserve and Improve the Health
Status of all Californians”
DHCS 2010-2011
Proposed Budget
• General Fund: $9.15 billi...
11
“Preserve and Improve the Health
Status of all Californians”
State Budget Deficit and
Medi-Cal Impacts
• Statewide defi...
12
“Preserve and Improve the Health
Status of all Californians”
ARRA Federal Funding
Extension
• Length of time
• Impacts ...
13
“Preserve and Improve the Health
Status of all Californians”
Federal Section 1115 Goals
• Strengthen California’s healt...
14
“Preserve and Improve the Health
Status of all Californians”
Federal Section 1115
Initiatives
• Promote organized deliv...
15
“Preserve and Improve the Health
Status of all Californians”
Waiver Stakeholder Efforts
• Waiver stakeholder committee
...
16
“Preserve and Improve the Health
Status of all Californians”
So what does all of this
mean for you?
• Need to maintain ...
17
“Preserve and Improve the Health
Status of all Californians”
Questions and Answers
Upcoming SlideShare
Loading in …5
×

Medi-Cal Update

390 views
323 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
390
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • <number>
    Public Law 111-03 Signed into law by President Obama on February 4, 2009.
    Reauthorized federal funding for another 5 years for state health insurance programs for low income children not eligible for Medicaid and certain pregnant women
    Healthy Families is California’s version of CHIP
    ARRA (Public Law 111-05) was signed into law by President Obama on February 17, 2009.
    $781 billion in federal funding available nationally.
    $87 billion in additional federal funding available for Medicaid programs.
    $45 billion of federal funding will be available for health information technology.
    Approximately $80 billion in ARRA funding is expected to come to California.
  • California adding coverage of pregnant women and children under the 5 year bar
    Using SSN to verify citizenship – current match percentage is approximately 94 percent
    No enrollment bonus for CA
    No outreach monies sought by the state given the current economic conditions
  • Estimated FMAP for CA over the 27 month period is approx $10 billion – FMAP at 61.59 percent during this time period; will revert back to the 50 percent FMAP beginning January 1, 2011 unless extended; have drawn down approximately $5.7 billion in increased FFP – must meet MOE requirements for eligibility and prompt payment for hospitals and nursing homes
    DSH Allotment increase for FFY 2009 and FFY 2010 is 2.5 percent increase over current allotment – CA estimates are an additional $27 million for each of these years for eligible DSH hospitals.
    Regulations – rescinded school-based administration and transportation and outpatient hospital; partial rescission with TCM regs; delayed implementation of provider taxes/GME
    TMA – extended from 6 mo to 12 mo; could eliminate the 3 month of the last 6 month enrollment in Medicaid for program eligibility; program approved until 12/2010
    Extended the QI program until 12/2010
    HIT Incentive Payments – program begins 2011 – 2016; eligible providers include physicians, hospitals, clinics who can demonstrate meaningful use:
    Medicare: $23 billion in federal funding for Medicare Incentive Program, up to $44,000 per physician – CA estimated share is approx $2.3 billion;
    Medicaid: $22 billion in federal funding for Medicaid Incentive Program, up to $64,000 per physician – CA estimated share is approx. $2.2. billion.
  • <number>
  • For State Fiscal Year (SFY) 2009-10, a $42 billion budget deficit was projected.
    The 2009-10 Budget Act (AB 5 [Evans]) signed into law in early March 2009, provided $36 billion in solutions for the deficit and included a “federal funds trigger” if federal stimulus funding was not realized at a certain level.
    Medi-Cal solutions amounted to $693 million and included:
    $24.7 million reduction in statutory cost of living increases for county administration
    $50.8 million reduction in 2008-09 and $668.7 million in 2009-10 for various eligibility and benefit changes
    $85.5 million shift from 2008-09 to 2009-10 to reflect a one-month checkwrite delay for fee-for-service providers
  • May Revise - Medi-Cal program reductions amounted to an additional $1.4 billion including the following:
    Obtaining federal flexibilities and stabilization - $1 billion attributable to prior expenditures eligible for federal funding
    Reductions in nursing home rates - $96.4 million attributable to increased revenue from AB 1629 fees and suspension of a 5 percent statutory rate adjustment
    Reforms with pharmacy pricing - $66 million in savings due to new drug pricing policies
    Reforms with the Adult Day Health Care program - $28.1 million in savings including freezing rates and limiting services to three days per week
    Enacted reforms, budget solutions and the federal stimulus funding will help to control the unsustainable growth of the Medi-Cal program in the out-years
  • General exemptions
    Pregnant women, if the excluded optional benefit is part of their pregnancy-related services or for services to treat a condition that might complicate the pregnancy.
    Eligible beneficiaries under the Early and Periodic Screening Diagnosis and Treatment (EPSDT) program i.e. are under the age of 21 and have full-scope Medi-Cal eligibility.
    Individuals receiving long-term care in a licensed skilled or intermediate care facility (NF-A and NF-B) or who are enrolled in a Program for the All-inclusive Care for the Elderly (PACE).
    Individuals receiving continuing care services.
  • <number>
    The majority of Medi-Cal fee-for-service spending is for beneficiaries who have multiple chronic medical conditions.
    For many, Medi-Cal does not provide care coordination to help assist in securing needed health care services.
  • Major source of health care financing in California and supports the health care safety net infrastructure for all Californians.
    Provides the majority of covered benefits for individuals living with HIV/AIDS
    Is a payer for 46 percent of all births and two-thirds of all nursing home residents
    Provides almost two-thirds of all net patient revenue in California’s public hospitals - 22 public hospitals – 17 county, 5 UC and Medi-Cal is a significant funding of services provided.
    Is the largest Medicaid program in terms of covered individuals; second largest in terms of dollars expended (NY largest)
    Covers: one in three children; more than one in ten adults under 65 years of age; the majority of individuals living with AIDS; over one million individuals dually eligible for Medicare and Medi-Cal; Medicaid is a major funder of mental health services nationally.
    Is a major source of health care financing in California and supports the health care safety net infrastructure for all Californians; 1 in 6 Californians covered:
    Pays for 46 percent of all births in the state
    Pays for 2/3 of all nursing home residents
  • <number>
  • <number>
  • <number>
    Waiver stakeholder committee will include the following representatives:
    Seniors
    Persons with disabilities
    Legal services representatives of the affected populations
    Health plans
    Specialty care providers
    Physicians
    Hospitals
    County government
    Labor
    Others
    Stakeholder committee has meet twice now – Jan, March 10th; all technical groups have met at least once – all meetings in Sacto and open to the public
    Working to prepare additional detail to CMS and the stakeholder workgroup will help assist in developing the detail for the proposal
    Supported by the following foundations – CHCF, TCE, Blue Shield, Lucille Packard; SCAN is funding CHCS on our behalf to develop and conceptualize how DHCS can move duals into organized systems of care.
  • Medi-Cal Update

    1. 1. California Partnership of Healthcare Advocates Conference 2010 Medi-Cal Update Rene Mollow, MSN, RN, Chief Medi-Cal Eligibility Division
    2. 2. 2 “Preserve and Improve the Health Status of all Californians” Medi-Cal Year In Review • Child Health Insurance Program Reauthorization Act (CHIPRA) of 2009 • American Recovery and Reinvestment Act (ARRA) of 2009 • Federal Health Care Reform • State Budget – Elimination of optional benefits
    3. 3. 3 “Preserve and Improve the Health Status of all Californians” CHIPRA Medicaid Provisions • Ability to waive the five year bar on covering immigrant children and pregnant women residing lawfully in the US. • Provides alternative means for verifying citizenship status. • Provides bonus payments for increased enrollments into Medicaid and CHIP programs when certain conditions are met. • Provides funding for outreach and enrollment strategies to increase enrollments in Medicaid and CHIP programs.
    4. 4. 4 “Preserve and Improve the Health Status of all Californians” • Temporary Federal Medical Assistance Percentage (FMAP) Increase • Temporary Increase In Disproportionate Share Hospital (DSH) Allotment • Extension of Moratoria on Certain Medicaid Regulations • Extension of Transitional Medical Assistance (TMA) Program • Extension of the Qualifying Individual (QI) Program • Protections for Indians under Medicaid and CHIP • Health Information Technology Incentives for Medicaid Providers • Income Disregards for Select Populations ARRA Medicaid Provisions
    5. 5. 5 “Preserve and Improve the Health Status of all Californians” Federal Health Care Reform • House Bill? • Senate Bill? • Medicaid Impacts
    6. 6. 6 “Preserve and Improve the Health Status of all Californians” State Budget Deficit and Medi-Cal Impacts • Originally estimated $42 billion deficit; by May Revise, total deficit for SFY 2009-10 to $60 billion. • The $60 billion gap was closed by the following actions: Dollars in chart are in millions Budget Act 2009 Enacted in February Budget Act 2009 Amendments Enacted in July Total Solutions Cuts $14,893 $16,125 $31,018 Taxes $12,513 - $12,513 Federal Stimulus $8,016 - $8,016 Other $402 $8,034 $8,436 Total $35,824 $24,159 $59,983
    7. 7. 7 “Preserve and Improve the Health Status of all Californians” State Budget Deficit and Medi-Cal Impacts (cont.) • May Revise - Medi-Cal program reductions amounted to an additional $1.4 billion including the following:  Reductions in payments to private hospitals – $47.9 million which is commensurate with the 10 percent reduction public hospitals received  Expansion of anti-fraud efforts - $46.4 million in savings to combat fraud waste and abuse in the Medi-Cal program  Improvements in health care coordination and controlling long-term Medi-Cal costs - $400 million in savings estimated to be achieved by 2012-13 in program reforms under a demonstration project or waiver, to utilize managed care and other specialized delivery systems of care for vulnerable populations including seniors, persons with disabilities, children with significant health care needs and individuals with behavioral health problems.
    8. 8. 8 “Preserve and Improve the Health Status of all Californians” Medi-Cal Optional Benefit Elimination • Effective July 1, 2009, the following optional benefits were excluded from coverage under the Medi-Cal program (both fee-for-service and managed care): ‒ Adult dental services (with exceptions) ‒ Acupuncture services ‒ Audiology and Speech Therapy services ‒ Chiropractic services ‒ Optometric and optician services, including services provided by a fabricating optical laboratory ‒ Podiatric services ‒ Psychology services ‒ Incontinence creams and washes
    9. 9. 9 “Preserve and Improve the Health Status of all Californians” Medi-Cal Year in Progress • Ongoing State Budget Deficit • ARRA Extension? • Federal Section 1115 Demonstration – The hospital financing waiver expires August 31, 2010 – The program growth curve of Medi-Cal needs to be slowed to ensure long term sustainability – Medi-Cal needs to be ready for national health reform
    10. 10. 10 “Preserve and Improve the Health Status of all Californians” DHCS 2010-2011 Proposed Budget • General Fund: $9.15 billion • Federal Funds: $27 billion • Special Funds and Reimbursements: $3.5 billion • Total Funds: $40.55 billion ‒ State operations: $438.9 million; balance is Local Assistance • Serves approximately 7.5 million beneficiaries. – 3.4 million are children/youth age 19 or younger – 1.4 million are eligible for Medicare and Medi-Cal
    11. 11. 11 “Preserve and Improve the Health Status of all Californians” State Budget Deficit and Medi-Cal Impacts • Statewide deficit estimated at $20 billion • Medi-Cal solutions include: – Cost containment strategies for a savings of $750 million – Elimination of full scope Medi-Cal for certain immigrants – Eliminate Optional Adult Day Health Care Benefits • Federal Funding • Triggers
    12. 12. 12 “Preserve and Improve the Health Status of all Californians” ARRA Federal Funding Extension • Length of time • Impacts for California – Maintenance of eligibility effort
    13. 13. 13 “Preserve and Improve the Health Status of all Californians” Federal Section 1115 Goals • Strengthen California’s health care safety net. • Maximize opportunities to reduce the number of uninsured individuals. • Optimize opportunities to increase federal financial participation and maximize financial resources to address uncompensated care. • Promote long-term, efficient, and effective use of state and local funds. • Improve health care quality and outcomes. • Promote home-and community-based care.
    14. 14. 14 “Preserve and Improve the Health Status of all Californians” Federal Section 1115 Initiatives • Promote organized delivery systems • Strengthen and expand the health care safety net • Implement value-based purchasing strategies • Enhance the delivery system for the uninsured to prepare for national reform
    15. 15. 15 “Preserve and Improve the Health Status of all Californians” Waiver Stakeholder Efforts • Waiver stakeholder committee – Will advise on the preparation of the waiver implementation plan and for ongoing advice during term of waiver • Four technical workgroups – Behavioral Health – Seniors and Persons with Disabilities – California Children Services – Health Care Coverage Initiative http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx
    16. 16. 16 “Preserve and Improve the Health Status of all Californians” So what does all of this mean for you? • Need to maintain presence in communities of need • Important to be aware of public program changes and impacts to those you assist on a daily basis • Essential to maintain current efforts to help individuals navigate a dwindling health care safety net delivery system • Serve as a critical link to helping people access services
    17. 17. 17 “Preserve and Improve the Health Status of all Californians” Questions and Answers

    ×