Enrollment and Claims Cost Impact to NH Medicaid from ACA. Notes on Estimates

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1 Enrollment and Claims Cost Impact to NH Medicaid from ACA Office of Medicaid Business and Policy NH DHHS August 27, 2010 Notes on Estimates Costs are just claims costs (no admin, systems, DSH changes, etc.) Nt Net cost factors in some potential ti savings in ACA Net cost presented in General Funds High estimate and a midpoint estimate Range based solely on estimate of potential new enrollees Other uncertain ti factors (e.g., uptake) tk) could make range even greater Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,

2 Estimate Model at a High Level Costs New Enrollees Cost Per Enrollee FMAP Woodwork effect Increased primary care fees Savings Potential Enhancement to FMAP for CHIP Family planning program Elimination of Medicaid eligibility for adults >=133% FPL (serve through Exchange) Possible savings in BCCP program not factored in Both costs and savings are trended Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP, Walkthrough of Estimate Detail 2

3 Parameters Annual Increase for Trend in Uninsured <133% FPL Adults if No Health Reform 2.5% Annual Increase for Medicaid PMPM (Cost and Use) 3.0% Annual Increase forcombined Medicaid PMPMand Enrollment 50% 5.0% Annual Increase for CHIP Combined PMPM and Enrollment 10.0% Woodwork Effect 2.0% Benefit Package/Cost share Level for New Compared to Existing Medicaid 95.0% Program Uptake for New Adult <133%FPL Eligibles % 80% 90% 90% 90% 90% 90% Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP, FMAP New Adult Mandatory Group 100% 100% 100% 95% 94% 93% 90% Existing Mandatory Groups 50% 50% 50% 50% 50% 50% 50% CHIP (Medicaid and CHIP)* 65% 65% 88% 88% 88% 88% *Children >=133% FPL. ACA mandates coverage until We assume continued funding for CHIP though 2019 and that then they move to the exchange in There is an expectation of unmet medical need in the new adult group; rapid enrollment and care for this group is important so that it occurs when there is 100% FMAP Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,

4 Estimate of New Adult Population Current Population Survey Uninsured <133% FPL Age Group Mid Point Estimate 90% Confidence Interval 19 to 34 15, ,104 24, to 49 8,251 1,935 14, to 64 6, ,150 Broken down by age group because as age goes up costs are higher and likelihood of being uninsured is lower CPS estimate is least precise factor in model Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP, Estimate of New Adult Population 2 Using CPS Upper 90% Confidence Interval Age Group to 34 24,610 13,164 23,988 27,661 28,352 29,061 29,788 30, to 49 14,567 7,792 14,198 16,372 16,782 17,201 17,631 18, to 64 11,150 5,964 10,869 12,533 12,846 13,167 13,496 13,834 Total 52,334 26,920 49,054 56,566 57,980 59,430 60,915 62,438 Using CPS Mid Point 19 to 34 15,857 8,482 15,456 17,822 18,268 18,725 19,193 19, to 49 8,251 4,413 8,042 9,274 9,506 9,743 9,987 10, to 64 6,816 3,646 6,644 7,661 7,853 8,049 8,250 8,456 Total 32,930 16,541 30,142 34,757 35,626 36,517 37,430 38, CPS is trended forward and multiplied by uptake percent Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,

5 New Adults Costs per Member per Month Medicaid Total Fund Cost Age Group to 34 $319 $362 $373 $384 $396 $407 $420 $ to 49 $459 $521 $536 $552 $569 $586 $604 $ to 64 $605 $686 $707 $728 $750 $772 $796 $819 State General Fund Share 19 to 34 $0 $0 $0 $20 $24 $29 $43 35 to 49 $0 $0 $0 $28 $35 $42 $62 50 to 64 $0 $0 $0 $37 $46 $56 $ are real costs of TANF/poverty Level non dual adults, excluding pregnancy costs Costs are trended forward and reduced by benefit package factor Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP, Annual State Fund Costs of New Adults in Millions of $ Using CPS Upper 90% Confidence Interval Age Group to 34 $0 $0 $0 $7 $9 $11 $16 35 to 49 $0 $0 $0 $6 $7 $9 $13 50 to 64 $0 $0 $0 $6 $7 $9 $14 Total Cost $0 $0 $0 $18 $23 $28 $43 Using CPS Mid Point 19 to 34 $0 $0 $0 $4 $5 $7 $10 35 to 49 $0 $0 $0 $3 $4 $5 $8 50 to 64 $0 $0 $0 $4 $4 $6 $8 Total Cost $0 $0 $0 $11 $14 $17 $26 Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,

6 Annual State Fund Costs of Other Populations in Millions of $ Cost testimate t of Woodwork keffect $3 $3 $3 $3 $3 $3 $3 Cost Estimate of Covering Former Foster Care Children Through Age 24 Cost Estimate of Primary Care Fee Increase to 100% Medicare Rates* $2 $2 $2 $2 $2 $2 $2 $0 $3 $3 $4 $4 $5 $5 * 100% FMAP in 2013 & Not mandatory to retain after 100% FMAP period ends, but assumes we maintain to help ensure access to care for new population Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP, Annual State Fund Savings in Existing Coverage Areas in Millions of $ Enhancement to 88% FMAP for CHIP Kids % FPL (assume CHIPfundingthrough 2019)* Enhancement to 88% FMAP for CHIP Medicaid Kids >=133%FPL Implementation of Family Planning program in 2011** $7 $7 $8 $9 $15 $11 $12 $13 $13 $21 $1 $2 $2 $2 $2 $2 $2 $2 Eliminate Medicaid Eligibility for >=133%*** $5 $5 $6 $6 $6 $7 $7 Total Savings $1 $7 $7 $26 $27 $29 $31 $45 *Assumes CHIP appropriation for will be made; in 2020 they go to Exchange **Based on prior Family Planning Budget Neutrality waiver calculations ***Eligible for coverage through Exchange instead Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,

7 Net State Fund Cost Estimate in Millions of $ Upper End Estimate $1 $3 $0 $18 $0 $3 $7 $8 Mid Point Estimate $1 $3 $0 $18 $8 $6 $4 $9 Note: Assumes continued CHIP funding through If SCHIP funding is not extended past 2015, and CHIP population moves to the Exchange in 2016, approximately $16M more GF could be saved from Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP, Non provider Payment Cost Implications Change due to income eligibility method and change to definition of Medical Assistance to include 'provision of care' Change (cost?) from drug rebate changes Increased'clawback' liability due to reduction of Part D 'donut hole' Increased administrative and system costs Reduction in DSH payments Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,

8 Disproportionate Share Hospital (DSH) Reduction in Allotment ACA provides for the gradual reduction in state s DSH allotment in contemplation of more covered lives reducing the incidence of uncompensated care. State by state reductions will be calculated based on a formula to be issued by the Secretary. Signals that the rate of DSH allotment reduction will be based, in part, on how true to the purpose of DSH the State managed the payments. Enrollment and Claims Cost Impact to NH Medicaid from ACA NH DHHS, OMBP,