Larry E. TisdaleVice-President of Finance
Medicaid RedesignBetter for Idaho’s taxpayers, businesses, and patients
\=
Required
Optional – at
State’s Discreti
on
Medicaid
Expansion in
PPACA
Where we stand
Health care
options for Idaho’s
low income workers
MedicaidCounty Indigent Program
State Catastrophic Fund
Emergency
Departments
Charitable Orgs.Communit
y Health Centers
Who are the “medically indigent”?
Working IdahoansSelf-employed & Small Business
Employees
Idaho’s minimum wage = $15,080/yearIdaho average salary = $38,000/year
$7,164 Groceri
es$10,820
Rent$3,476 Utilities
$2,748 Gasolin
e$24,208
Annual Cost of Living *
* U.S. Bureau of Labor Statistics - averages are based on 2.6 person households
Idaho has a choice
Status Quo
MedicaidRedesign
High costStatus Quo
County Indigent Fund – supported entirely by property taxes
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
County Medically Indigent Funding
Forecast
Spent
High costStatus Quo
State Catastrophic Fund – supported entirely by income taxes
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
$0$10,000,000$20,000,000$30,000,000$40,000,000$50,000,000$60,000,000$70,000,000
Catastrophic Health Care Fund
Appropriated
Forecast
Low ValueStatus Quo
Expe
nsiv
e>$60 million
Inef
fect
ive<6k
served
Staf
fing100
employees
Financial RiskStatus Quo
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
County Indigent State CAT
Financial RiskStatus Quo
• 45,000 qualified but not enrolled
Enrollee
Growth
• $394 million over 10 years
Budget
Status Quo
LowValue
$60+ million budget =
expensive, episodic
treatment for <6k
HighCost
$60 mil/yr budget from
county and state taxes
Financial Risk
45k qualified Idahoans joining Medicaid = $394 million over 10
years
Idaho has a choice
Status Quo
MedicaidRedesign
MedicaidRede
signEliminate Waste
20142015201620172018201920202021202220232024$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
$140,000,000
Projected County and State Indigent Care Savings
Over $1 billion in tax dollars from
2014 - 2024
Half fiscal year
68% of those who qualify have at least one full-time worker in the household;16% have one or more part-time workers
MedicaidRede
signCoverage for Working
Idahoans
Provides coverage to adults earning <138% of FPL or a family of four must have income less than $32,500
Adults age 19-64 Must be legal Idaho residents
2013 Federal Poverty Limits <100% FPL 100% to 125% FPL 125% to 138% FPL
Annual Income - Individual $0 - $11,490 $11,491 - $14,362 $14,363 -$15,856
Annual Income - Family of 4 $0 - $23,550 $23,551 - $29,437 $29,438 - $32,499
Medicaid
Redesign
Provide Coverage for Working Idahoans
Idaho minimum wage = $7.25/hr or
$15,080/yr
Personal responsibility and accountability
Coordinated CareManaged Care for chronic
conditionsReduce waste through
technology and electronic health records
Medicaid
Redesign
Redesign the System
Eliminate Waste
Save Idaho taxpayers $1
billion by eliminating two
government programs
Cover Working Idahoans
Provide health care to 149,000
low income Idahoans
System Redesign
Construct a system focused
on personal responsibility.
Medicaid
Redesign
for Idaho’s Economy
StatusQuo
Medicaid Redesig
n
Far Reaching Effects…..
Rising taxes or budget cuts to critical programs
16,000 new jobs
Bringing Idaho taxes back to Idaho
Not attractive to new businesses
$12.3-18.5 million in federal penalties for
businesses
Healthier Workforce
Costs / Savings2014-2024
State Medicaid Increases + $394 Million + $1,043 Million
State CAT Program costs/savings + $540 Million - $540 Million
County Indigent Programcosts/savings
+ $478 Million - $478 Million
DHW mental healthcosts/savings + $110 Million - $110 Million
Total costs/savings
StatusQuo
Medicaid
Redesign
$1.5 Billion
$85 Million
Only one choice
Status Quo• Spend $394
million + keep $1B in inefficient gov’t programs
Medicaid Redesign• Save $85 million &
cover 149,000 Idahoans
www.TheRightMedicineForIdaho.org
Potential Legislative Activity
Medicaid Expansion ?Insurance ExchangeTime Sensitive EmergenciesHospital Tax ExemptionsManaged Care for Dual Eligibles HB351Battery of Health Care WorkersMedically Indigent Statute changesIdaho Physician Shield Act (IMA)TransparencyState Health Innovation Plan (SHIP)
Medicaid Expansion
Not a current initiative for the 2014 Legislative Session
Governor Otter “current Medicaid system is broken”
Currently exploring 1115 waiver possibilities
Insurance Exchange
Passed by last year’s Legislature
Current exchange is federally supported
This is mostly a political fight
Time Sensitive EmergenciesTSE is a statewide system for the coordinating
and delivering evidence based care
Includes trauma, strokes and heart attacks (STEMI)
Hospital designation and participation is voluntary
Allows billing for trauma team activation◦ Certified by American College of Surgeons◦ Designated by the State
Hospital Tax ExemptionsLargely a political misinformation
campaign◦CEO Compensation◦Physician Employment◦Profit Margins
Increasing taxes on community hospitals will not lower the cost of health care
Managed Care for Medicaid/Medicare
HB351 Manditory or Voluntary enrollment?
In response to HB260 from 2011
Largest issue may be with nursing facility payments◦UPL◦Quality Incentives
Battery of Health Care Workers
Carryover from last yearMakes it a felony to assault
hospital workersNew version includes non-
licensed workersLesser punishment than first
responder assaultTough sell with the Legislature
Medically Indigent Statute Changes
Two potential Proposals:Eliminate funding over 100% of
federal poverty level
Remove money to fund “community clinics”
Idaho Physician Shield ActEnsures that no guideline or
metrics established by the PPACA shall be used as a basis for establishing community standards of care
IHA has no formal position at this time
Transparency
Again?
IHA opposes transparency based solely on pricing data
States’ websites that have pricing information go largely unused
IHA would support transparency of quality data
State Health Innovation Plan (SHIP)There is potential for a resolution
supporting the design model
The design grant ended in December 2013
The Department of Health and Welfare is in the process of applying for a testing grant
Questions