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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
RobbinsLaw LLCLITIGATION & REGULATORY LAW
Budgets:Overview Terms Breakdown
RobbinsLaw LLCLITIGATION & REGULATORY LAW
Budgets:Overview
RobbinsLaw LLCLITIGATION & REGULATORY LAW
Budgets:October 2009
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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)
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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.
RobbinsLaw LLCLITIGATION & REGULATORY LAW
FY 2010
Rates spared.
Fair Rental Value System for SNF’s Funded.
$23M for trauma (super speeder).
High reliance on Stimulus funds.
RobbinsLaw LLCLITIGATION & REGULATORY LAW
FY 2010 Amended
Off-Budget by approximately $912M 3% Medicaid Withhold SHBP Redesign 3 Day Furlough 5% Agency Withholds
RobbinsLaw LLCLITIGATION & REGULATORY LAW
FY 2010 Amended: DCH Budget
Medicaid Revenue: $114.37M Surplus funds: $52.7M Medicaid enrollment adjustments: $15.8M
PeachCare enrollment adjustments: $21.5M
Miscellaneous: $24.3MRobbinsLaw LLC
LITIGATION & REGULATORY LAW
FY 2010 Amended: DCH Budget
Medicaid Expenditures: ($ 52.9M) DSH Matching: ($8.6M) 3% Cut: ($44.3M)
Surplus to 2011: $61.4MRobbinsLaw LLC
LITIGATION & REGULATORY LAW
FY 2011: Overview
Compare: Loss of Stimulus Medicaid Funds:
($347,977,910)
FY 2010: ($208,088,881)
RobbinsLaw LLCLITIGATION & REGULATORY LAW
FY 2011: DCH Budget
Medicaid Expenditures ($86.2M) Projected Medicaid growth: $83.2M New ICWP slots: $1.2M ICWP waiting list: $1.8M
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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
LITIGATION & REGULATORY LAW
FY 2011: Problems with DCH Budget Presumes only 3% cut ($44M).
Revenues continue to fall? Competing priorities?
Surplus carryover.
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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
LITIGATION & REGULATORY LAW
FY 2011: Political Realities
Educators Healthcare Corrections Judicial Branch
RobbinsLaw LLCLITIGATION & REGULATORY LAW
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).
RobbinsLaw LLCLITIGATION & REGULATORY LAW
FY 2011: CMO Tax Exemption Repeal
CMO’s exempt from premium tax (2.25%)
Repeal: $43.2M
RobbinsLaw LLCLITIGATION & REGULATORY LAW
Summary & Questions
Josh BelinfanteRobbinsLawLLC
999 Peachtree Street, NESuite 1120
Atlanta, GA 30309404-856-3262
LITIGATION & REGULATORY LAW