South Carolina Department of Health and Human Services

Transcription

1 Suth Carlina Department f Health and Human Services Healthcare Financial Management Assciatin Presentatin Nvember 13, 2012 All eligibility, revenue, and expenditure estimates are preliminary prjectins as f Octber 2012 and nt cnsidered final. Estimates will change as mre state and federal data and guidance becmes available. Nvember

2 Table f Cntents Current Status f SC Medicaid FY 2014 Budget Submissin Update n PPS Nvember

3 Current Status f SC Medicaid Nvember

4 Current Status f SC Medicaid FY 2013: 1,000,248 average mnthly enrllment (1.1 millin ttal individuals prjected fr the year) FY 2013: $1.102 billin State Funds; $4.063 billin Federal Funds; $780 millin Other Funds; $5.946 Ttal Funds FY 2013: The Medicaid budget represents abut 18% f SC s ttal State Funds Suth Carlina must cntrl grwth in its current Medicaid prgram, befre cnsidering ACA s ptinal Medicaid expansin FY 2013: The Medicaid budget represents abut 25% f SC s ttal State, Federal and Other Funds Nvember

5 Purchasing Health; Reducing Waste 90% f health and wellbeing is nt the result f health services, but incme, educatin, persnal chices, genetics and envirnment 30% f all health care expenditures in the U.S. in 2009 were actually excess csts that cntribute nthing t health utcmes We can invest in mre health services, r we can invest in better health Remving excess csts frm the system allws investment in ther state pririties Nvember

6 FY 2013 Year t Date Expenditures Current Budget t Year t Date Actual Spending As f Nvember 6, 2012 (Unfficial) Budget by Majr Prgram and Spending Purpse Nvember 2012 FY 2013 Apprpriatin FY 2013 YTD as f 11/6/12 Remaining % Expended SCDHHS Medicaid Assistance Crdinated Care $ 1,710,451,398 $ 641,632,979 $ 1,068,818,419 38% Hspital Services 771,900, ,719,634 $ 531,180,366 31% Disprprtinate Share 461,500, ,619,762 $ 220,880,238 52% Nursing Facilities 514,901, ,977,450 $ 337,923,595 34% Pharmaceutical Services 224,499,959 63,090,835 $ 161,409,124 28% Physician Services 183,047,463 59,006,515 $ 124,040,948 32% Cmmunity Lngterm Care (CLTC) 172,388,507 57,656,956 $ 114,731,551 33% Dental Service 97,915,517 37,216,640 $ 60,698,877 38% Clinical Services 68,255,459 21,109,604 $ 47,145,855 31% Transprtatin Services 49,658,076 17,835,341 $ 31,822,735 36% Medical Prfessinal Services 47,691,730 13,233,057 $ 34,458,673 28% Durable Medical Equipment 41,400,000 11,535,798 $ 29,864,202 28% Lab & XRay Services 28,631,876 9,545,108 $ 19,086,768 33% Family Planning 23,703,720 7,845,448 $ 15,858,272 33% Hspice 16,215,725 4,652,080 $ 11,563,645 29% Prgram f AllInclusive Care (PACE) 17,535,052 3,883,683 $ 13,651,369 22% EPSDT 14,589,856 3,458,796 $ 11,131,060 24% Hme Health Services 10,396,248 1,910,170 $ 8,486,078 18% Integrated Persnal Care (IPC) ****** 9,042,978 2,147,664 $ 6,895,314 24% Optinal State Supplement (OSS) 17,585,826 7,014,915 $ 10,570,911 40% Premiums Matched 198,100,000 67,583,502 $ 130,516,498 34% MMA Phased Dwn Cntributins 82,300,000 27,334,127 $ 54,965,873 33% Premiums 100% State 18,100,000 5,822,328 12,277,672 32% Ttal SCDHHS Medicaid Assistance $ 4,779,810,435 $ 1,721,832,392 $ 3,057,978,043 36% SCDHHS Other Health Prgrams Alchl and Other Drug Abuse Services **** $ 13,249,431 $ 4,422,021 $ 8,827,410 33% Cmmissin fr the Blind 39,805 $ 39,805 0% Cntinuum f Care 6,590,057 2,197,770 $ 4,392,287 33% Crrectins (DOC) 2,333, ,790 $ 1,336,158 43% Disabilities & Special Needs (DDSN) 560,536, ,356,515 $ 370,179,893 34% Educatin (DOE) 50,000,000 10,078,768 $ 39,921,232 20% Health & Envirnmental Cntrl (DHEC) 14,158,264 5,093,016 $ 9,065,248 36% SC First Steps t Schl Readiness $ Juvenile Justice (DJJ) 3,350, ,019 $ 2,885,001 14% Medical University f SC (MUSC) 41,858,252 10,131,760 $ 31,726,492 24% Mental Health (DMH) 155,000,000 62,199,055 $ 92,800,945 40% State Husing Authrity 330,000 $ 330,000 0% Schl fr Deaf & Blind 4,778, ,667 $ 4,008,128 16% Scial Services (DSS) 12,412,716 2,357,145 $ 10,055,571 19% University f Suth Carlina (USC) 5,742, ,365 $ 4,880,735 15% Wil Lu Gray Opprtunity Schl 30,000 10,233 $ 19,768 34% Emtinally Disturbed Children 37,732,690 8,059,633 $ 29,673,057 21% Other Entities Funding 23,960,020 2,941,176 $ 21,018,844 12% MUSC Maxillfacial 225,086 56, ,814 25% State Agencies & Other Entities $ 932,327,592 $ 300,998,205 $ 631,329,388 32% Medical Cntracts Medical Cntracts $ 152,028,949 $ 22,162,560 $ 129,866,389 15% NnRecurring/Capital Prgram * Ttal Medical Cntracts $ 152,028,949 $ 22,162,560 $ 129,866,389 15% SCDHHS Operating Expenditures Persnnel & Benefits $ 63,511,002 $ 20,922,137 42,588,865 33% Other Operating Csts 19,275,106 4,608,349 14,666,757 24% Ttal SCDHHS Operating Expenditures $ 82,786,108 $ 25,530,486 $ 57,255,622 31% Ttal Budget Annual Budget Apprpriatin $ 5,946,953,084 $ 2,070,523,643 $ 3,876,429,441 35% As f Nvember 6 th, 37% f the fiscal year had passed As f Nvember 6 th, SCDHHS had spent 35% f its apprpriatin Differences exist between apprpriated spread and budgeted spread Budgeted amunts are subject t change based upn prjectins. 6

7 FY 2013 Reserves/Carry Frward Ptential Use f Reserve/Carry Frward Funds ACA csts CMS has nt prvided guidance n several key issues State made assumptins n the participatin rate f eligibles FY 2012 Obligatins Outstanding gds and services that have been received but nt paid Supprt f SelfFunded Initiatives Belw are ne time state funds available in FY 2013: Reserve Fund: $62,111,894 Carry Frward: $62,860,131 Authrity: Prvis 21.1 and Prvis Nvember

8 FY 2014 Budget Submissin Nvember

9 Recent Medicaid Grwth Cmparisn f Unique Medicaid Members t Per Member Per Mnth (PMPM) Csts $ $ $ ,063,164 1,200,000 1,000, ,000 Unique members grew 21% frm FY 2007 t FY $ $ ,391 $ $194 $ , ,000 PMPM csts declined 13.4% frm FY 2010 t FY $ $ $ ,000 0 PMPM csts are prjected t grw 6.5% frm FY 2013 t FY PMPM Unique Members Surce: Truven Advantage Suite and Milliman Spring 2013 Update. Data is current as f Octber Unique members are calculated as f June 30 th f each fiscal year. FY unique members and PMPM are based n prjectins with FY based n actual expenditures and members. The FY 1314 estimates d nt include expansins assciated with the Affrdable Care Act. Nvember 2012 $194 9

10 Cmpnents f FY 2014 Budget Submissin Majr Cmpnents f FY 2014 Request: Inflatin and natural enrllment grwth Replacement f lst cigarette tax revenue Mandated ACA enrllment Nvember

11 Affrdable Care Act Budget Impact FY 2014 MANDATORY ACA IMPACTS GENERAL EAR MARKED FEDERAL TOTAL Physician Fee Schedule: Currently Enrlled FS/MHN (nndual) Physician Services (FFS) $ 533,520 $ 12,266,480 $ 12,800,000 Currently Enrlled MCOs (nndual) Care Crdinatin (Payment f E/M Cdes) $ 1,541,280 $ 35,058,720 $ 36,600,000 Currently Eligible CrwdOut Ppulatin Care Crdinatin (Currently crwdut ppulatins (MCO)) $ 266,760 $ 6,133,240 $ 6,400,000 Eligible but Unenrlled SSI Children $ $ Care Crdinatin (Adults) $ 88,920 $ 1,811,080 $ 1,900,000 Care Crdinatin (SSI Federal Funds) $ 29,640 $ 470,360 $ 500,000 Dual Eligibles Physician Services (FFS) $ 12,000,000 $ 12,000, % Federally Funded $ TOTAL PHYSICIAN FEE SCHEDULE INCREASE $ 2,460,120 $ $ 67,739,880 $ 70,200,000 Increased Csts Withut Expansin: Crwdut Ppulatin Currently Eligible Children/Parents Care Crdinatin (Children/Parents) 78,733 enrllees $ 29,640,000 $ 70,360,000 $ 100,000, % State Funded and 70.36% Federally Funded $ Eligible but Unenrlled Children/Parents Children $ $ $ Care Crdinatin (Adults) 40,102 enrllees $ 27,535,560 $ 65,364,440 $ 92,900, % State Funded and 70.36% Federally Funded $ SSI Eligible (State and Federal) $ $ Care Crdinatin (SSI Federal Funds) 7,326 enrllees $ $ 23,000,000 $ 23,000, % Federally Funded $ Health Insurer Assessment Fee (State and Federal) $ Care Crdinatin (Health Insurer Assessment Fee) $ 7,498,920 $ 17,801,080 $ 25,300, % State Funded and 70.36% Federally Funded $ TOTAL INCREASE COSTS WITHOUT EXPANSION $ 64,674,480 $ $ 176,525,520 $ 241,200,000 Administrative Csts Withut Expansin: Administrative Cst 4% f Increased Csts withut Expansin $ 2,586,979 $ 7,061,021 $ 9,648, % State Funded and 70.36% Federally Funded $ TOTAL ADMINISTRATIVE COSTS $ 2,586,979 $ 7,061,021 $ 9,648,000 TOTAL MANDATORY ACA IMPACTS $ 69,721,579 $ $ 251,326,421 $ 321,048,000 FY 2014 request des nt include ACA s ptinal Medicaid expansin Still, $69 millin in General Funds will be required t cver new Medicaid enrllees due t ACA Actuarial estimates have been received as f Octber 12, 2012; hwever, this chart represents figures as f the September 27, 2012 budget submissin. Octber

12 FY 2014 SelfFunded Initiatives Cmmunity Care Access: State General Funds $5,611,263 Expansin f Cmmunity Chices Waiver by 500 slts t address the 1,908 Nvember 2012 applicants n the waiting list Expansin f the Children s Cmmunity Care, by adding 104 slts t address the applicants n waiting lists Additinal 20 slts fr each f the tw Prgrams fr AllInclusive Care (PACE) rganizatins and a rate adjustment fr the dual eligible rate schedules Targeted Case Management: State General Funds $1,046,025 Additinal 1,430 new participants in FY 2014 and will cntinue t add slts as needed in future years After Hurs Reimbursement: State General Funds $148,200 Recently allwed enrllment f Cnvenient Care Clinic prviders Plans t enhance the ffice visit reimbursement fr prviders wh extend ffice hurs t evenings, weekends and hlidays Health Imprvement Initiatives: State General Funds $1,822,860 Obesity Hypertensin Diabetes Cmmunity Health Wrkers Substance Abuse Preventin and Treatment Capacity Building: (Amunt t be determined) Expand infrastructure and training t deliver mre services t ppulatins in need Expand pharmacy lckin prgram The Department cntinues t invest in strategies t reduce csts and imprve utcmes Several f these initiatives will be funded thrugh savings btained by SCDHHS thrugh imprved peratins and better management f medical csts 12

13 Prspective Payment System Cntinue t wrk with Milliman actuaries t develp a fair and equitable starting pint. Tw scenaris being recalculated n new rates that went int effect n Nvember 1 Based slely n Medicare rates Based n average rate f mst recently audited cst reprts Milliman t prvide recalculated rates and step by step prcess t agency tentatively scheduled fr December 3rd Cntrlling health csts in a fair and equitable manner is key t ensuring financial viability f the Medicaid prgram Nvember