presentation to the disabilities concerns … 080416 item 1 lfc's...disabilities concerns...
TRANSCRIPT
Presentation to the
Disabilities Concerns Subcommittee– August 2016 1
Post-Session Recap ◦ Falling Revenue Projections
◦ General Fund Outlook
Overall DOH Budget Recap
Developmental Disabilities Waiver ◦ Current Budget
◦ Litigation History
◦ Costs per client
Conclusion
2
3
4
5
$4,500
$4,650
$4,800
$4,950
$5,100
$5,250
$5,400
$5,550
$5,700
$5,850
$6,000
$6,150
$6,300
$6,450
FY07 FY08 FY09 Op
Bud
FY09
Solvency
FY10
Solvency
FY11 Post
Sanding &
2nd
Stimulus
FY12 FY13 FY14 FY15 FY16 FY17
mil
lio
ns
Appropriations: General Fund and Temporary Funds
General Fund Federal Funds Other Funds Recurring Revenue
Source: LFC Files
6
Revenue Estimates of "New Money" for FY17 Appropriations (in millions)
$(150.00)
$(100.00)
$(50.00)
$-
$50.00
$100.00
$150.00
$200.00
$250.00
$300.00
August December January February
Series1 $293.00 $231.70 $30.00 $(125.00)
7
Medicaid: $929 million
15% Public Safety: $432 million
7%
Public Schools:
$2,759 million 44%
Higher Education:
$828 million 13%
Other: $1,281 million 21%
FY17 Recurring General Fund Appropriation: $6.23 billion
Source: LFC Files, GAA
$20.9
$13.4
$8.9
$(2
0.0
)
$(2
9.3
)
-$40.0
-$30.0
-$20.0
-$10.0
$0.0
$10.0
$20.0
$30.0
$40.0
Medic
aid
Public
Safe
ty
Public
Schools
Hig
her
Educatio
n
Oth
er
FY17 General Fund Appropriation Increases/Decreases: ($6.05 million)
Source: LFC Files
Facilities and DD Waiver were prioritized
8.3 Percent Growth in OSF
8
$0
$100
$200
$300
$400
$500
$600
FY
12
FY
13
FY
14
FY
15
FY
16
FY
17
Source: LFC Files
DOH Funding FY12-FY17 (in millions)
Federal Funds Other State Funds General Fund
Program Support , $13.8
Public Health , $180.6
Epidemiology and Response ,
$29.0
Laboratory Services ,
$12.9
Facilities Management,
$140.5
Developmental Disabilities
Support , $160.7
Health Certification
Liscensing and Oversight,
$13.0
Medical Cannabis , $1.5
FY17 Total Appropriations by Program
Replaced general fund w/ $6.9 million in patient revenue
ACA is changing the Payor/Patient mix
Rural Primary Health ($1.6 million)
Public Health ($2.5 million)
Facilities ($2.5 million)
9
Measures are insufficient to reduce wait list
FY18 budget cycle likely not improving
$800 K for 40 DD Waiver slots
An Improved Federal FMAP
Non-Reverting Language
No Statewide GF Reduction
Was influenced by dwindling revenue outlook
10
$88
$90
$92
$94
$96
$98
$100
$102
$104
0
1,000
2,000
3,000
4,000
5,000
6,000
FY
13
FY
14
FY
15
FY
16
FY
17
Source: LFC Files
DD General Fund Appropriation versus Waiting List
Clients Served Waiting List General Fund Appropriation
Source: LFC Files
(in m
illions)
$6.8 million 2016 Appropriation for Waldrop lawsuit settlement and Jackson Disengagement
11
Waldrop Jackson
FY 16 1,122.9$ 941.9$
FY 17 1,789.4$ 2,985.8$
TOTAL 2,912.3$ 3,927.7$
Allocation of 2016 GAA
Disengagement and Settlment
Supplemental Appropriation ($6.8
million)
Source: DOH
◦ The court is requiring the state to meet 200 evaluative components to disengage
◦ Some components are completed and more have been started
12
Supports Intensity Scale (SIS) intended to ◦ Reduce costs
◦ Determine needs and appropriate service levels
◦ Help develop individual budgets and service packages
Department’s use of SIS triggers 2014 lawsuit that is settled in 2015 requiring ◦ SIS to be used as it was
◦ An outside review to include
Clinical reviews on all service plans, service requests, and budgets
Requires portion of 2016 supplemental appropriation
Slowed the individual budget review process
13
Federal regulations require the cost of CBS be less than institutional care costs or the DD Waiver could be in violation of federal regulations ◦ In 2010 per enrollee costs were on track to equal
institutional costs
◦ Evaluation recommended measures to reduce per enrollee costs
◦ Evaluation recommends a needs based assessment tool (department subsequently implemented SIS)
14
Significant Sustained Efforts are Needed
Wait list growth outpacing slot availability
Current DD Waiver Wait time is 10.4 years
Annual Waiver Service Registrations of 1,000
Maintaining the current wait list requires 300 new annual allocations
FY15 was the first wait list reduction since at least FY07
15
DD Waiver
Growth Rate
DD Waiver Wait
List Growth Rate
FY09 0% 8%
FY10 -2% 6%
FY11 0% 8%
FY12 -1% 8%
FY13 4% 10%
FY14 0% 5%
FY15 15% -3%
FY16 5% 5%
FY17 2% 0%
Average 3% 5%
Source: LFC Files
DD Waiver and Wait List Growth Rates
Leverage Local Funding ◦ Local funds used in six other states as Medicaid
match
◦ Local funds used in 10 other states for other IDD programs and services
In 2013, 33% of all IDD spending in Ohio was from local funds
◦ In FY14, NM counties held $30.4 million in county indigent fund balances
Statutory changes could require counties to contribute indigent funds for Medicaid Match
16
17
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
Average Waiver Cost per Client
Mi Via DD Waiver
Source: DOH and LFC Files