We promote and protect the health and safety of Idahoans.

1

Joint Finance-Appropriations Committee

Division of MedicaidMedicaid Administration

Leslie ClementAdministrator

January 19, 2010

We promote and protect the health and safety of Idahoans.

2

Division as Component of DHW

Medicaid$1,656 Million

79.1%

Family and Community Services

$99.8 Million4.8%

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%

We promote and protect the health and safety of Idahoans.

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%

We promote and protect the health and safety of Idahoans.

4

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%

We promote and protect the health and safety of Idahoans.

5

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

We promote and protect the health and safety of Idahoans.

6

Holdback Impacts

Federal Funds$712,800

General Funds$711,800

We promote and protect the health and safety of Idahoans.

7

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 EstimatedExpenses

SFY 2011Recommendation

Receipts

Dedicated Funds

Federal Funds - ARRA

Federal Funds

General Funds

Total Funds$42.8 Million

Total Funds$61.4 Million

Total Funds$68.8 Million

Total Funds$62.8 Million

Dedicated Funds for all years - $0.2 Million

We promote and protect the health and safety of Idahoans.

8

• Focus on cost containment measures.

• Medicaid personnel and contractor’s role is to effectively and efficiently manage benefits while preserving quality and access.

Legislative Intent Status

We promote and protect the health and safety of Idahoans.

9

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; reduced contract

We promote and protect the health and safety of Idahoans.

10

• Reduce waste, fraud, and abuse• DHW Medicaid Program Integrity Unit• AG’s Medicaid Fraud Control Unit• Licensing, certification, & complaint

follow-up activities• Quality Assurance reviews• State and federal audits• New MMIS System: Enhanced editing &

auditing capabilities

Management Strategies to Control Costs

We promote and protect the health and safety of Idahoans.

11

MMIS Operations LBB page 2-56

•Decision Unit 12.01•Planned implementation of June 2010•Full year of new system operations

Description Total Funds General Funds

Federal Funds

Contracted Mailing expenses (50%)

$220,000 $110,000 $110,000

Claims System contracts (75%)

$5,428,800 $1,357,200 $4,071,600

Total on-goingRequest

$5,648,800 $1,467,200 $4,181,600

We promote and protect the health and safety of Idahoans.

12

MMIS certification LBB page 2-56

• Decision Unit 12.02• One-time funding• Contractual payment made to vendors for successful completion of required certification

Description Total Funds General Funds Federal Funds

MMIS Certification $3,847,600 $961,900 $2,885,700

Total One-time Request $3,847,600 $961,900 $2,885,700

We promote and protect the health and safety of Idahoans.

3rd Party Recovery Funding LBB page 2-56

• Loss of AG position to holdbacks• Governor restored funding to operating to obtain these legal services in 2011• Results in cost avoidance of >$700,000 in trustee & benefits payments.

Operating TotalGeneral Funds

Federal Funds

Legal recovery costs $150,000 $75,000 $75,000

We promote and protect the health and safety of Idahoans.

14

Administration Budget RecommendationMedicaid Administration

2010 Appropriation

2011 Governor’s Recommendation

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

We promote and protect the health and safety of Idahoans.

15

We promote and protect the health and safety of Idahoans.

16

Joint Finance-Appropriations Committee

Division of MedicaidMedicaid Trustee & Benefits Payments

Leslie ClementAdministrator

January 19, 2010

We promote and protect the health and safety of Idahoans.

17

Division as Component of DHW Spending

Medicaid$1,656 Million

79.1%

Family and Community Services

$99.8 Million4.8%

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%

We promote and protect the health and safety of Idahoans.

18

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%

We promote and protect the health and safety of Idahoans.

19

Provider Payments by Plan

Basic PlanTrustee and Benefits

$449.5 Million28.2%

Enhanced PlanTrustee and Benefits

$663.5 Million 41.7%

Coordinated PlanTrustee and Benefits

$479.7 Million30.1%

We promote and protect the health and safety of Idahoans.

2011 Per Enrollee Per Month

Basic Enhanced Coordinated

Cost of Adults $680 $1,900 $1,500

Number of Adults

17,000 25,000 15,000

Costs of Children

$178 $1,300 n/a

Number of Children

137,000 22,000 0

Average $ per Plan

$232 $1,600 $1,500

Total Enrollees

$154,000 47,000 15,000

We promote and protect the health and safety of Idahoans.

Current Enrollment by Location

Region Enrollment

1 25,268

2 11,479

3 44,217

4 40,982

5 27,526

6 24,471

7 28,210

Total 202,153

We promote and protect the health and safety of Idahoans.

22

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

We promote and protect the health and safety of Idahoans.

23

Federal Funds$62.3 Million

General Funds$35.2 Million

Holdback Impacts

We promote and protect the health and safety of Idahoans.

Permanent Holdback & Adjustments

PlansTotal Funds

General Fund

Dedicated Fund

Federal Fund

Coordinated

Page 2-59

<$6.9> <$1.4> <$5.5>

EnhancedPage 2-62

<$39.5> <$10.3> $2.6 <$31.8>

Basic Page 2-65

<$2.0> < $ .4> <$1.6>

Totals<$48.3> <$12.1> $2.6 <$38.9>

We promote and protect the health and safety of Idahoans.

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 Disability Services

$ 7.0 12.5%

Other $ 7.0 12.5%All Providers $54.8 M Total $11.4 General Funds

We promote and protect the health and safety of Idahoans.

26

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 EstimatedExpenses

SFY 2011Recommendation

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 Funds2008 - $2.9 Million2009 - $6.2 Million2010 - $15.1 Million

We promote and protect the health and safety of Idahoans.

27

• Focus on cost containment measures.

• Medicaid personnel and contractor’s role is to effectively and efficiently manage benefits while preserving quality and access.

Legislative Intent Status

We promote and protect the health and safety of Idahoans.

28

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; reduced contract

We promote and protect the health and safety of Idahoans.

29

Four primary avenues to control costs:1. Reduce Prices2. Limit/Eliminate Benefits3. Limit/Eliminate Eligibility categories4. Management

Cost Containment Strategies

We promote and protect the health and safety of Idahoans.

30

Pricing

Federal 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 available to the same extent as non-Medicaid services

States have some flexibility subject to approval

We promote and protect the health and safety of Idahoans.

31

Benefits

Federal law:• Requires certain benefits • Requires states cover EPSDT• Requires certain standardsStates have some flexibility:• Define scope, amount and duration

We promote and protect the health and safety of Idahoans.

32

Eligibility- MOE

No changes permissible at this time• States cannot reduce eligibility and

receive the increased FMAPProposed health legislation• States cannot reduce eligibility for adults

until 12/2013; certain exceptions are allowed for non-pregnant, non-disabled adults

• States cannot reduce eligibility for children until 09/2019

We promote and protect the health and safety of Idahoans.

33

Management Strategies

Improve:• Technology tools: front-end edits• Payment methodology• Assessment• Benefit Design• Utilization & case management• Communications• Sharing costs

We promote and protect the health and safety of Idahoans.

2010 Forecasted Expenditures: Shortfall

Supplemental 4.31 LBB page 2-53

PlanTotal Fund

General Fund

Dedicated/Other Fund

Federal Fund

BasicPage 2-65

$15.0 $2.8 <$1.1> $13.3

EnhancedPage 2-62

$36.5 $7.6 <$ .7> $29.5

CoordinatedPage 2 -59

$13.1 $3.5 <$.3> $ 10.0

Total $64.6 $13.9 <$2.1> $52.8

We promote and protect the health and safety of Idahoans.

35

Nursing Facility Provider Assessment

Supplemental 4.36 LBB page 2-59

PlanTotal Fund

Dedicated Fund

Federal Fund

Coordinated $11.5 $2.4 $9.1

Total $11.5 $2.4 $9.1

We promote and protect the health and safety of Idahoans.

36

Benefit Plan Maintenance LBB page 2-52

PlansTotal Funds

General Funds

Dedicated Funds

Federal Funds

Basic $32.4 $20.3 $.7 $11.4

Enhanced $72.4 $52.4 $1.9 $18.1

Coordinated $21.8 $21.9 $<.2> $.07

Total $126.9 $94.6 $2.4 $29.5

We promote and protect the health and safety of Idahoans.

Mid-Year FMAP Change LBB page 2-52

PlanOther State

FundsFederal Fund

Basic $13.8 <$13.8>

Enhanced $39.8 <$39.8>

Coordinated $17.6 <$17.6>

Total $71.2 <$71.2>

We promote and protect the health and safety of Idahoans.

38

……..

Basic Plan Recommendation

Basic Plan2010

Appropriation2011

Recommendation

Enrollment 148,000 154,000

General Fund $63,375,900 $ 72,192,500

Dedicated FundOther 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

We promote and protect the health and safety of Idahoans.

Enhanced Plan Recommendation

Enhanced Plan2010

Appropriation2011

Recommendation

Enrollment 45,400 47,400

General Fund $133,430,200 $145,184,000

Dedicated FundOther

$39,137,000$ 42,080,900$ 38,975,100

Federal Fund $421,460,900 $437,253,600

Total $594,028,100 $663,493,600

We promote and protect the health and safety of Idahoans.

Coordinated Plan Recommendation

Coordinated Plan

2010 Appropriation

2011 Recommendation

Enrollment 15,065 15,575

General Fund $95,220,770 $101,641,600

Dedicated FundOther

$10,922,500$ 20,157,800$ 10,226,700

Federal Fund $334,097,600 $347,667,700

Total Funds $440,240,800 $479,693,800

We promote and protect the health and safety of Idahoans.

Questions?

Leslie Clementclementl@dhw.idaho.gov

208-364-1804