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We promote and protect thehealth and safety of Idahoans.
1
Joint Finance-Appropriations Committee
Division of Medicaid
Medicaid Administration
Leslie Clement
Administrator
January 19, 2010
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We promote and protect thehealth and safety of Idahoans.
2
Division as Component of DHWMedicaid
$1,656 Million
79.1%
Family and Community
Services
$99.8 Million
4.8%Behavioral Health
$95.2 Million
4.5%
Public Health
$84 Million
4.0%
Support Services
$34 Million
1.6%
Welfare
$125.4 Million
6.0%
Medically Indigent
$0.1 Million
0.01%
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Coordinated Plan
$479.7 Million
29.0%
Enhanced Plan
$663.5 Million
40.0%
Basic Plan
$449.5 Million
27.2%
Medicaid Administration
$62.8 Million
3.8%
3
Administrative Overhead at 3.8%
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Administrative Cost Components
Personnel
$17.7 Million
28.1%
Operating and Capital
$42.2 Million
67.2%
Trustee and Benefits
$2.9 Million
4.7%
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Funding Sources
$6.6 M
$11.1 M
$9.8 M
$26.3 M
$6.1 M
$1.3 M
$1.1 M
Personnel Operating Trustee and Benefits
Receipts
Dedicated Funds
Federal Funds
General Funds
Total Funds
$17.7 Million
28.1%
Total Funds
$42.2 Million
67.2%
Total Funds
$2.9 Million
4.7%
Federal Funds -
$1.6 Million
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Holdback Impacts
Federal Funds
$712,800
General Funds
$711,800
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Funding Source History
$13.9 M
$25.3 M
$3.4 M
$16.7 M
$38.5 M
$6.0 M
$17.0 M
$45.6 M
$6.0 M
$17.8 M
$38.8 M
$6.0 M
SFY 2008 Expenses SFY 2009 Expenses SFY 2010 Estimated
Expenses
SFY 2011
Recommendation
Receipts
Dedicated Funds
Federal Funds - ARRA
Federal Funds
General Funds
Total Funds$42.8 Million
Total Funds
$61.4 Million
Total Funds
$68.8 MillionTotal Funds
$62.8 Million
Dedicated Funds for all
ears - $0.2 Million
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Focus on cost containment measures.
Medicaid personnel and contractorsrole is to effectively and efficientlymanage benefits while preserving
quality and access.
Legislative Intent Status
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We promote and protect thehealth and safety of Idahoans.
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Chart of InitiativesStrategy 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; reducedcontract
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Reduce waste, fraud, and abuse
DHW Medicaid Program Integrity Unit
AGs Medicaid Fraud Control Unit
Licensing, certification, & complaintfollow-up activities
Quality Assurance reviews
State and federal audits
New MMIS System: Enhanced editing &auditing capabilities
Management Strategies to Control Costs
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We promote and protect thehealth and safety of Idahoans.
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MMIS Operations LBB page 2-56Decision Unit 12.01
Planned implementation of June 2010
Full year of new system operations
Description Total Funds General Funds Federal Funds
ContractedMailingexpenses (50%)
$220,000 $110,000 $110,000
Claims Systemcontracts (75%) $5,428,800 $1,357,200 $4,071,600
Total on-going
Request$5,648,800 $1,467,200 $4,181,600
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We promote and protect thehealth and safety of Idahoans.
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MMIS certification LBB page 2-56Decision Unit 12.02
One-time funding
Contractual payment made to vendors for
successful completion of required certification
Description Total Funds General Funds Federal Funds
MMISCertification $3,847,600 $961,900 $2,885,700
Total One-time Request $3,847,600 $961,900 $2,885,700
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Administration Budget RecommendationMedicaidAdministration
2010Appropriation
2011 GovernorsRecommendation
FTP 283 284
Personnel $18,462,500GF: $6,817,500
$17,666,800GF: $6,648,600
Operating $47,455,100GF: $9,022,900
$42,222,200GF: $9,827,400
Capitol $0 $0
Trustee & Benefits $2,949,600GF: $1,311,000
$2,949,600GF: $1,311,000
Total $68,867,200GF: $17,151,400
$62,838,600GF: $17,787,000
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We promote and protect thehealth and safety of Idahoans.
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Joint Finance-Appropriations CommitteeDivision of Medicaid
Medicaid Trustee & Benefits Payments
Leslie Clement
Administrator
January 19, 2010
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We promote and protect thehealth and safety of Idahoans.
17
Division as Component of DHW Spending
Medicaid
$1,656 Million
79.1%
Family and Community
Services
$99.8 Million
4.8%Behavioral Health
$95.2 Million
4.5%
Public Health
$84 Million
4.0%
Support Services
$34 Million
1.6%
Welfare
$125.4 Million
6.0%
Medically Indigent
$0.1 Million
0.01%
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Provider Payments 96.2 % of Total
Coordinated Plan
$479.7 Million
29.0%
Enhanced Plan
$663.5 Million
40.0%
Basic Plan
$449.5 Million
27.2%
Medicaid Administration
$62.8 Million
3.8%
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Provider Payments by Plan
Basic Plan
Trustee and Benefits
$449.5 Million
28.2%
Enhanced Plan
Trustee and Benefits
$663.5 Million
41.7%
Coordinated Plan
Trustee and Benefits
$479.7 Million
30.1%
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We promote and protect thehealth and safety of Idahoans.
2011 Per Enrollee Per MonthBasic Enhanced Coordinated
Cost of Adults $680 $1,900 $1,500
Number ofAdults
17,000 25,000 15,000
Costs ofChildren
$178 $1,300 n/a
Number of
Children
137,000 22,000 0
Average $per Plan
$232 $1,600 $1,500
TotalEnrollees
$154,000 47,000 15,000
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Current Enrollment by LocationRegion Enrollment
1 25,268
2 11,4793 44,217
4 40,982
5 27,526
6 24,471
7 28,210
Total 202,153
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Funding Sources
$319.0 M
$1,107.7 M
$86.0 M
$80.0 M
Trustee and Benefits
Receipts
Dedicated Funds
Federal Funds
General Funds
Total Funds
$1,592.7 Million
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Federal Funds
$62.3 Million
General Funds
$35.2 Million
Holdback Impacts
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Permanent Holdback & Adjustments
PlansTotalFunds
GeneralFund
DedicatedFund
FederalFund
Coordinated
Page 2-59
Enhanced
Page 2-62
$2.6
BasicPage 2-65
< $ .4>
Totals $2.6
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Impact of Holdbacks on Providers
Provider Type Holdback % of total
Hospitals $16.2 29%
Long-term Care $ 8.4 15%
Pharmacy $ 2.2 4%
Mental Health $ 7.0 12.5%
Medical/Dental $ 7.0 13%
Developmental DisabilityServices
$ 7.0 12.5%
Other $ 7.0 12.5%All Providers $54.8 M Total $11.4 General Funds
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History of Funding
$354.4 M
$822.2 M
$79.1 M
$310.8 M
$891.8 M
$82.4 M
$84.4 M
$293.2 M
$958.8 M
$117.6 M
$76.4 M
$319.0 M
$1,036.4 M
$71.3 M
$86.0 M
$80.0 M
SFY 2008 Expenses SFY 2009 Expenses SFY 2010 Estimated
Expenses
SFY 2011
Recommendation
Receipts
Dedicated Funds
Federal Funds - ARRA
Federal Funds
General Funds
Total Funds
$1,258.6 Million
Total Funds
$1,375.6 Million
Total Funds
$1,461.1 Million
Total Funds
$1,592.7 Million
Dedicated Funds
2008 - $2.9 Million
2009 - $6.2 Million
2010 - $15.1 Million
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Focus on cost containment measures.
Medicaid personnel and contractorsrole is to effectively and efficientlymanage benefits while preserving
quality and access.
Legislative Intent Status
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We promote and protect thehealth and safety of Idahoans.
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Chart of InitiativesStrategy 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; reducedcontract
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We promote and protect thehealth and safety of Idahoans.
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Four primary avenues to control costs:
1. Reduce Prices
2. Limit/Eliminate Benefits3. Limit/Eliminate Eligibility categories
4. Management
Cost Containment Strategies
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We promote and protect thehealth and safety of Idahoans.
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PricingFederal law:
Imposes significant requirements
Sets certain provider rates Requires that payment is consistent with
efficiency, economy, and quality of care.
Requires that payment must attract enough
providers so that Medicaid services are availableto the same extent as non-Medicaid services
Stateshave some flexibility subject to approval
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Benefits
Federal law:
Requires certain benefits
Requires states cover EPSDT Requires certain standards
States have some flexibility:
Define scope, amount and duration
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Eligibility- MOENo changes permissible at this time
States cannot reduce eligibility andreceive the increased FMAP
Proposed health legislation States cannot reduce eligibility for adults
until 12/2013; certain exceptions areallowed for non-pregnant, non-disabledadults
States cannot reduce eligibility for childrenuntil 09/2019
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We promote and protect thehealth and safety of Idahoans.
2010 Forecasted Expenditures: Shortfall
Supplemental 4.31 LBB page 2-53
PlanTotalFund
GeneralFund
Dedicated/Other Fund
FederalFund
Basic
Page 2-65
$15.0 $2.8 $13.3
Enhanced
Page 2-62
$36.5 $7.6 $29.5
CoordinatedPage 2 -59
$13.1 $3.5 $ 10.0
Total $64.6 $13.9 $52.8
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Nursing Facility Provider Assessment
Supplemental 4.36 LBB page 2-59
PlanTotalFund
DedicatedFund
FederalFund
Coordinated $11.5 $2.4 $9.1
Total $11.5 $2.4 $9.1
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Benefit Plan Maintenance LBB page 2-52
PlansTotalFunds
GeneralFunds
DedicatedFunds
FederalFunds
Basic $32.4 $20.3 $.7 $11.4
Enhanced $72.4 $52.4 $1.9 $18.1
Coordinated $21.8 $21.9 $ $.07
Total $126.9 $94.6 $2.4 $29.5
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We promote and protect thehealth and safety of Idahoans.
Mid-Year FMAP Change LBB page 2-52
PlanOther State
FundsFederal Fund
Basic $13.8
Enhanced $39.8
Coordinated $17.6
Total $71.2
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..
Basic Plan Recommendation
Basic Plan2010
Appropriation2011
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
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Enhanced Plan Recommendation
Enhanced Plan2010
Appropriation2011
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
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We promote and protect thehealth and safety of Idahoans.
Coordinated Plan Recommendation
CoordinatedPlan
2010Appropriation
2011Recommendation
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
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We promote and protect thehealth and safety of Idahoans.
Questions?
Leslie Clement
208-364-1804
mailto:[email protected]:[email protected]