Joint Legislative Oversight Committee on Medicaid and NC Health Choice Feb. 9, Department of Health and Human Services Medicaid Enrollment

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Beatrice Cameron
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1 Joint Legislative Oversight Committee on Medicaid and NC Health Choice Feb. 9, 2016 Department of Health and Human Services Medicaid Enrollment

Executive Summary Medicaid enrollment was relatively flat for the first half of SFY16, but has accelerated over the last few months Changes at the

g., NC Fast) Additional work is required to fully understand current enrollment trends and develop SFY17 enrollment projections However, analysis

2 Executive Summary Medicaid enrollment was relatively flat for the first half of SFY16, but has accelerated over the last few months Changes at the federal, state and county level are contributing to the atypical enrollment trends Federal changes (e.g., ACA, ex-parte review) State changes (e.g., family planning) Operational / system changes (e.g., NC Fast) Additional work is required to fully understand current enrollment trends and develop SFY17 enrollment projections However, analysis and research done since last month further supports the theories outlined during the last JLOC 2

3 Medicaid Enrollment versus Budget After a decline upon entering this SFY, activity over past several months reflects a return to an upward trend, though still well below budget Sources: Actuals from DMA point-in-time enrollment counts from DMA BIO; Forecasted enrollment from DMA/SAS. 3

4 Impact of Affordable Care Act Since the start of ACA ( ), county and DHHS staff have worked approximately 203k applications for Medicaid through the federal health exchange marketplace. Of those applications, ~180k (or 88%) resulted in disapproval after a caseworker completed a full review, contributing to county caseworker backlog. In all, 23,683 beneficiaries have been approved for coverage through the federal exchange. 11% 8% 67% 14% Applications Approved Already on Medicaid Administrative Denial Withdrawn/ Found Ineligible 4

5 Growth in Medicaid Family Planning Waiver Enrollees (MAF-D) Family Planning Waiver program began to see steady increase in SFY2014: 120, ,000 80,000 Family Planning Enrollment 60,000 40,000 20,000 A B 0 Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Contributing factors: A) NC FAST- rule based assessment system (launch - July 2014) - Assessed potential beneficiaries for eligibility across all program aid categories, including limited coverage programs such as Family Planning B) State Plan (final implementation - September 2014) - Family Planning switched from a waiver program to a state plan program, eliminating the age limit on the program Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 5

6 Overview and Impact of Auto-Extensions Three major events contributed to counties falling behind on eligibility determinations Rollout of a new eligibility system Shift of county caseworkers from Medicaid responsibilities to deal with FNS backlog Increased workload from cases flowing down from healthcare.gov Federal regulation 1 requires states to continue providing Medicaid coverage for individuals until it is determined that the person is ineligible Given the circumstances, DHHS developed an auto-extension option to allow counties to continue working down backlog and providing coverage A review of auto-extended cases indicated that a small percentage (4.49%) of individuals were extended that ultimately were not Medicaid eligible DHHS is taking steps to reduce and eventually eliminate the need for autoextensions Revised policy for allowing auto-extensions that will take effect March 1 Operational Support Team working with counties to ensure progress 42 CFR (Code of Federal Regulations) : Furnishing Medicaid. The agency must (a) Furnish Medicaid promptly to beneficiaries without any delay caused by the agency's administrative procedures; (b) Continue to furnish Medicaid regularly to all eligible individuals until they are found to be ineligible 6

7 Division of Medical Assistance Auto-extension Policy For auto-extensions after February 2016, a county must submit to Associate Director for Beneficiary Services a request with plan that details: Reasons for request and reasons for backlog; Why previously submitted Sustainability/Medicaid Processing Plan was not successful; What steps or process changes have taken place to address workload long-term; Target date county expects backlog of recertifications to be completed; Goals (actions/worker and time frames) to reach current status by target date; Assurance that application processing and other work is not impacted; Submit monthly progress report if target date is beyond March 2016; If monthly goals are not met, reason and steps taken to adjust work flow or processes; and Request and progress reports signed by DSS Director and county governing authority (DSS Board Chair, County Manager) Final approval for auto-extension by Deputy Secretary for Medical Assistance and Deputy Secretary for Human Services Operational Support Team will work with counties to ensure progress is made and goals are met as counties work to reduce backlog and move toward sustainable workload practices. 7

8 Summary Medicaid enrollment has undergone a series of changes that prompted DHHS to perform detailed analyses Changes at the federal, state and county level are contributing to the enrollment variability Analysis conducted up to this point has increased DMA s confidence in initial hypotheses regarding enrollment trends and changes. For several of the issues, DMA has determined the causes and will monitor / manage where appropriate Additional data gathering and analysis is required to fully understand certain enrollment changes and to develop SFY17 enrollment projections Through the Operational Support Team, DMA is working toward an end-game for the auto-extension process (excluding extraordinary circumstances) 8

9 Program Aid Categories Program Aid Category Abbrev. Short Description Medicaid to the Aged M-AA A program of medical assistance for individuals age 65 and over. Medicaid to the Blind M-AB A program of medical assistance for individuals of any age who meet Social Security's definition of blindness. Medicaid to the Disabled M-AD A program of medical assistance for individuals under age 65 who meet Social Security's definition of disability. Medicaid to Families with Dependent Children M-AF A program of medical assistance for children and adults who meet the requirements of eligibility. Related Categories include MAF-D: Medicaid Family Planning Waiver and MAF-W: Breast and Cervical Cancer Medicaid Medicaid to Infants and Children M-IC A program for medical assistance for children under the age of 19 whose countable income falls under a specified percentage of the Federal Poverty Limit. Medicaid for Pregnant Women M-PW A program for medical assistance for pregnant women whose income falls under a specified percentage of the Federal Poverty Limit. Specified Low Income M-QB-B A limited Medicaid program which pays a recipient's Medicare B premiums only. Medicare Beneficiaries Qualified Medicare M-QB-Q A limited Medicaid program that pays a recipient's Medicare premiums, deductibles and copayments only. Beneficiaries Qualifying Individual 1 (QI1) M-QB-E A limited Medicaid program which pays a recipient s Medicare B premiums only. Funding for the program is capped. Refugee Assistance M-RF A medical assistance program for refugees. Medicaid for Special Assistance to the Blind M-SB A medical assistance program for recipients of Special Assistance to the Blind money payments. Qualified Disabled Working Individuals North Carolina Health Choice for Children M-WD NCHC Individual who is eligible for Medicaid payment of Medicare Part A premiums after automatic entitlement to free Part A ends due to individual's earnings and whose income does not exceed 200% of poverty level. This is the only Medicaid benefit covered by this program. A health insurance program for uninsured children under the age of 19 who do not qualify for Medicaid and have family income under 200% of the Federal Poverty Limit. Funding for this program is capped. This program is known as Children s Health Insurance Program (CHIP) at the national level. 9

Department of Health and Human Services ICD-10 Transition & Financial Update

Joint Legislative Oversight Committee on Medicaid and NC Health Choice Feb. 9, 2016 Department of Health and Human Services ICD-10 Transition & Financial Update Agenda ICD-10 update Medicaid financial