Georgia Medicaid Budget and Funding Options

GEORGIA MEDICAID BUDGET AND FUNDING OPTIONS

Presented to:

HomeTown Health

November 12, 2009

By: Josh Belinfante

RobbinsLaw LLC

www.robbinslawllc.com

RobbinsLaw LLCLITIGATION & REGULATORY LAW

Overview

FY 2009 FY 2010 FY 2011

DCH BudgetPolitics of the 2011 SessionProvider FeeCMO Premium Tax


Budgets:Overview Terms Breakdown


Budgets:Overview


Budgets:October 2009


FY 2009

As passed in 2008: Provider rate increases: $70,219,164

Hospitals: $29,419,916 (41% of new funds) Physicians: $17,243,389 Nursing Homes: $17,650,154 Ambulance: $1,986,043 Other Providers (waivers, home health, etc.):

$3,919,662

Executive WithholdRobbinsLaw LLC

LITIGATION & REGULATORY LAW

FY 2009 Amended

Stimulus funds: FMAP: 64.5% match to 73.4% match January 2009 - January 2011

No provider rate increases


FY 2010

Lost Revenue ($208,088,881) 5% Budget Cut ($111,486,829) Federal regulation on CMOs: ($96,602,052)

Required Cuts: ($130,467,938) After all discretionary spending cuts:

($77,620,943)


FY 2010

Revenue:

Governor’s Provider Fee Tobacco Tax

Cuts: 10% Medicaid Expense Cut for Hospitals.

15% rate cut totaling $85,307,375. 6% Expense Cut for Others.

10% rate cut totaling: $93,924,186.


FY 2010

Rates spared.

Fair Rental Value System for SNF’s Funded.

$23M for trauma (super speeder).

High reliance on Stimulus funds.


FY 2010 Amended

Off-Budget by approximately $912M 3% Medicaid Withhold SHBP Redesign 3 Day Furlough 5% Agency Withholds


FY 2010 Amended: DCH Budget

Medicaid Revenue: $114.37M Surplus funds: $52.7M Medicaid enrollment adjustments: $15.8M

PeachCare enrollment adjustments: $21.5M

Miscellaneous: $24.3MRobbinsLaw LLC


FY 2010 Amended: DCH Budget

Medicaid Expenditures: ($ 52.9M) DSH Matching: ($8.6M) 3% Cut: ($44.3M)

Surplus to 2011: $61.4MRobbinsLaw LLC


FY 2011: Overview

Compare: Loss of Stimulus Medicaid Funds:

($347,977,910)

FY 2010: ($208,088,881)


FY 2011: DCH Budget

Medicaid Expenditures ($86.2M) Projected Medicaid growth: $83.2M New ICWP slots: $1.2M ICWP waiting list: $1.8M


FY 2011: DCH Budget

Medicaid Revenue: $92.88M Surplus from FY 2010: $61.4M Lower PeachCare enrollment: $16.7M Nursing home fees: $8.7M Foster care children to CMOs: $2.9 Drug renegotiation: $0.64M Capping CMO rates: $2.54M


FY 2011: DCH Budget

Medicaid Cuts: ($37.1M) Reduce CMO reimbursement rates 1.86%:

$15.7M Reduce FFS reimbursement rates by 1.86%:

$21.4M

Totals: New Revenue: $92.88M Reimbursement Cuts: $37.1M New Expenses: ($86.2M) 3% Reduction: ($44.3M) RobbinsLaw LLC


FY 2011: Problems with DCH Budget Presumes only 3% cut ($44M).

Revenues continue to fall? Competing priorities?

Surplus carryover.


FY 2011: Political Realities

Gubernatorial Race: 1 Senator, 2 Representatives

Congress: 1 Senator, 3 Representatives

Insurance Commissioner: 2 Senators, 1 Representative

Attorney General: 1 Representative

Labor Commissioner: 1 Representative

Court of Appeals: 2 Judgeships RobbinsLaw LLC


FY 2011: Political Realities

Educators Healthcare Corrections Judicial Branch


FY 2011: Provider Fee

New Revenue: $389,576,496 (Net: $372,840,569) CMO and private insurance fee of 1.6%: $90,778,848

CMOs: $49,518,535 (Net: $32,782,608) Commercial: $57,333,746

Hospital fee of 1.6% of gross revenue: $259,724,215 Super Speeder: $23,000,000

Program cuts: none to services.

Additional Expenditures: $171,992,802 Trauma: $60,000,000 Provider Rate Increases: $98,279,417

Hospitals: $52,213,936 (53% of new funds) Physicians: $17,243,389 Nursing Homes: $15,000,000 Other Providers: $5,256,845 (home health, CCSP, MRWP and ICWP) Ambulance: $1,988,999

DSH Funds: $13,713,384 (solves private hospitals).


FY 2011: CMO Tax Exemption Repeal

CMO’s exempt from premium tax (2.25%)

Repeal: $43.2M


Summary & Questions

Josh BelinfanteRobbinsLawLLC

999 Peachtree Street, NESuite 1120

Atlanta, GA 30309404-856-3262

[email protected] LLC


Documents

Georgia Medicaid Budget and Funding Options