4/18/2018. Future of Medicare & Medicaid

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1 Future of Medicare & Medicaid 1

2 Increase in 65+ Population- Impacts Medicaid Enrollment Steepest increase is just beginning! 2017 Source: Minnesota Compass 2

3 Average Lifetime Long Term Care Costs Men Women Everyone $91,100 $182,000 $138,000 Source: Ann Tumlinson Innovations, Tables 4A-4B, Favreault and Dey (2015) 3

4 State Spending Growth on Medicaid % % of State General Fund Spent on Medicaid SFY12-13 SFY14-15 SFY16-17 SFY18-19 State General Fund Spending on Medicaid in Billions 15% Amount of Medicaid Spending on Care Centers & Elderly Waiver Source: Minnesota Department of Human Services Budget Forecast 4

5 Medicaid Spending Will More Than DOUBLE in Next 10 Years Year Total Medicaid $ Federal Medicaid $ State Medicaid $ Average. Medicaid Federal spending % will more than double in the next 2011 $427.4 $270.7 $ % 10 years 2012 $431.0 $248.8 $ % 2013 $456.4 $262.2 $ % 2022 (est) $853.8 $511.1 $ % 2013 CMS Actuarial Report: The Financial Outlook for Medicaid; National Association of State Budget Officers Report of the State Budget Crisis Task Force

6 What are the Waiver Programs Part of the Medicaid Program for clients Eligible to LTC that provides services outside an institution Services include: Adult companion Adult day Chore Extended state plan services Family caregiver supports Home-delivered meals Homemaker Individual community living support (ICLS Respite/ in-home and out-of-home Transportation/mileage Customized (assisted) Living Source: Minnesota Department of Human Services 6

7 Monthly Average Recipients 4/18/2018 Elderly Waiver Enrollment Exceeds Medicaid Nursing Home Recipients 30,000 25,000 20,000 15,000 10,000 5,000 0 Elderly Waiver Nursing Home Source: Minnesota Department of Human Services, Spending Forecast, November

8 Average Monthly Cost per Recipient 4/18/2018 Elderly Waiver is Economical Alternative to Care Centers $6,000 $5,000 $4,000 $3,000 $2,000 Costs Medicaid almost $4,000 less per month $1,000 $0 Elderly Waiver Nursing Home Source: Minnesota Department of Human Services, Spending Forecast, November

9 Potential Threats to the Future of Medicaid End Federal Funding of Medicaid Expansion Cap federal match on state Medicaid spending State policy changes restricting coverage of some services (i.e., assisted living) Implications: less services covered, fewer people covered, reduced provider rates, reduced funding for other govt programs, and/or higher taxes 9

10 Payment Trends Similar in Medicare and Medicaid MEDICARE Integrated Services across all Health Care Settings Payment-Based Performance tied to Outcomes Quality MEDICAID Fee-for-Service Model Bending the Cost Curve Payment-Based on Cost Efficiencies 10

11 Minnesota has highest penetration of Medicare managed care 11

12 Context: Medicare Market Shift in Minnesota Medicare Enrollment in Minnesota Total MN enrollment = ~940,000 Traditional Medicare Fee For Service Part A and B and D Deductibles Coinsurance Enrollment: 237,000 Medicare Supplemental Benefits/Plans Supplements Medicare FFSonly for non- Medicare covered services (deductible, coinsurance, added benefits under purchased plan) Enrollment: 115,000 Minnesota Senior Health Options (MSHO) Specialized plan for dual eligibles over age 65 that integrates MA and Medicare services Oversight by DHS and CMS; administered by health plans Enrollment: 38,000 Group Coverage Retiree coverage from a former employer Similar to Supplemental plan: Medicare pays first and group plan supplements Enrollment: 45,000 Cost Contracts Covers everything Medicare covers Plan is like a pass through with administrative duties Majority of Medicare managed care members in cost but this will change in 2019 as members shift to Medicare Advantage and Med Supplements Enrollment: 380,000 Medicare Advantage Plans Plans at risk keep savings/lose downside Plans have incentive to manage health care costs through disease management and wellcare Historically small percentage of MN Medicare managed care market Also includes Special Needs Plans (dually eligible, chronic disease, and/or care center pop) Enrollment: 126,000 Sources: CMS 2015, DHS 2018, Kaiser Family Foundation

13 Context: Medicare Market Shift in Minnesota Shift from Cost Contract creating significant MN market shift of an older population (av. age 72) Shift either to Medicare Advantage, Fee For Service, or Med Supp markets Minnesota law now allows for-profit HMOs resulting in new health plan entrants (e.g., Aetna, United Health Group) 940,000 Currently Eligible 60,000 Minnesotans turning 65 each year* *Sources: Minnesota State Demographic Center, December

14 Knowledge Center 14