Total $ $ $ 14.7 $ $ 1,046.4 $ $ 20.0 $ $ $ 98.7 $ 5.4 $ Data Source for Actuals: February 2017 BD-701

Transcription

1 Medicaid Program - Fund Level Breakdown ($ millions) Actuals vs. Prior Year (Month-End) (Sorted by Absolute Value of Actual Month-End Expenditures) Actuals - February 2016 (Month-End) Actuals - February 2017 (Month-End) Variance (vs. Prior Year) 1310 Medical Assistance Payments $ $ $ 6.3 $ $ $ $ (18.9) $ $ 74.5 $ 54.3 $ (25.1) $ Medical Assistance Cost Settlements (2.0) Community Care North Carolina (CCNC) (2.4) Contracts and Agreements (16.9) (18.3) 1331 Rebates (9.1) (6.2) - (3.0) (10.2) (7.1) - (3.2) (1.1) (0.9) - (0.2) 1101 Medical Assistance Administration (0.1) 1330 Payment Adjustments (10.9) (6.6) (0.0) (4.2) (2.9) (1.9) (0.0) (1.0) (0.0) Health Information Technology (HIT) Undispositioned Receipts (4.9) (1.6) (2.7) (2.2) - (4.5) Periodic Payments (0.4) - - (0.4) (0.4) - - (0.4) (0.1) - - (0.1) 1993 Prior Year Audits and Adjustments (6.3) (10.4) - (6.3) 10.4 (4.1) 1337 Consolidated Supplemental Hospital Payments Medical Assistance County Administration (Inactive) (0.0) (0.0) (0.0) (0.0) 1991 Federal Indirect Reserve (0.0) (0.1) (0.0) (0.0) 1810 Revenue Clearing - (21.0) (0.0) (0.0) (0.6) (21.6) 1910 Reserves and Transfers (0.1) (0.1) (0.0) 1992 Prior Year Earned Revenue Total $ $ $ 14.7 $ $ 1,046.4 $ $ 20.0 $ $ $ 98.7 $ 5.4 $ 16.7

2 Medicaid Program - Fund Level Breakdown ($ millions) Actuals vs. Prior Year (State Fiscal Year-to-Date) (Sorted by Absolute Value of Actual State Fiscal Year-to-Date Expenditures) Actuals - February 2016 (YTD) Actuals - February 2017 (YTD) Variance (vs. Prior Year) 1310 Medical Assistance Payments $ 7,628.4 $ 4,964.8 $ $ 2,549.6 $ 7,944.2 $ 5,212.9 $ $ 2,627.0 $ $ $ (9.8) $ Consolidated Supplemental Hospital Payments 1, (30.9) (50.7) (233.3) (155.1) (58.5) (19.8) 1331 Rebates (578.4) (393.1) - (185.3) (641.2) (438.5) 52.9 (255.6) (62.8) (45.4) 52.9 (70.3) 1320 Medical Assistance Cost Settlements (7.1) Community Care North Carolina (CCNC) (0.3) 1102 Contracts and Agreements (7.3) 1330 Payment Adjustments (45.8) (30.4) (0.1) (15.4) (30.4) (25.9) (0.1) (4.5) (0.0) Medical Assistance Administration (0.3) Health Information Technology (HIT) (0.1) 1993 Prior Year Audits and Adjustments (16.9) (4.9) 18.0 (30.0) (9.8) (7.6) Undispositioned Receipts (9.6) (48.0) (8.3) (46.6) (0.2) Periodic Payments (2.2) - - (2.2) (5.0) - - (5.0) (2.8) - - (2.8) 1991 Federal Indirect Reserve (0.0) (0.2) (0.5) (0.3) 1210 Medical Assistance County Administration (Inactive) (0.0) (0.0) (0.0) (0.0) 1810 Revenue Clearing (2.4) (4.3) (0.0) (1.9) 1910 Reserves and Transfers (3.0) (0.1) - - (2.9) Prior Year Earned Revenue - (57.9) (75.6) (0.1) (17.7) (31.0) 48.7 Total $ 8,426.8 $ 5,331.4 $ $ 2,317.9 $ 8,627.9 $ 5,472.9 $ $ 2,410.2 $ $ $ (32.8) $ 92.4 Comments on Drivers for YTD State Appropriation Variances: 1. Fund 1992 ($48.7M) - Carryforwards from SFY2015 that were paid in SFY2016 and larger payback of unearned receipts. 2. Fund 1320 ($32.0M) - Retroactive payments made to Vidant Hospital along with settlement activity with hospitals that have ambulance programs.

3 Medicaid Program - Fund Level Breakdown ($ millions) Actuals vs. Authorized Budget (Month-End) (Sorted by Absolute Value of Actual Month-End Expenditures) Auth. Budget - February 2017 (Month-End) Actuals - February 2017 (Month-End) Variance (vs. Auth. Budget) 1310 Medical Assistance Payments $ $ $ 14.6 $ $ $ $ (18.9) $ $ 3.6 $ 3.1 $ (33.4) $ Medical Assistance Cost Settlements (6.3) (7.2) Community Care North Carolina (CCNC) (0.8) (0.5) - (0.3) 1102 Contracts and Agreements (16.9) (0.5) (0.6) 20.1 (20.0) 1331 Rebates (29.7) (17.0) 4.4 (17.1) (10.2) (7.1) - (3.2) (4.4) Medical Assistance Administration (0.1) (0.1) 0.0 (0.0) 1330 Payment Adjustments (8.1) (5.9) - (2.2) (2.9) (1.9) (0.0) (1.0) (0.0) Health Information Technology (HIT) (1.8) (1.8) - (0.0) 1340 Undispositioned Receipts (1.6) (2.7) (1.6) (2.7) 1350 Periodic Payments (0.4) - - (0.4) (0.4) - - (0.4) 1993 Prior Year Audits and Adjustments (10.4) (10.4) 1337 Consolidated Supplemental Hospital Payments Medical Assistance County Administration (Inactive) Federal Indirect Reserve (0.1) (0.1) 1810 Revenue Clearing (0.0) (0.6) (0.0) (0.6) 1910 Reserves and Transfers (0.1) (5.0) - (4.9) (0.1) 1992 Prior Year Earned Revenue Total $ 1,016.4 $ $ 38.2 $ $ 1,046.4 $ $ 20.0 $ $ 29.9 $ 22.4 $ (18.2) $ 25.8

4 Medicaid Program - Fund Level Breakdown ($ millions) Actuals vs. Authorized Budget (State Fiscal Year-to-Date) (Sorted by Absolute Value of Actual State Fiscal Year-to-Date Expenditures) Auth. Budget - February 2017 (YTD) Actuals - February 2017 (YTD) Variance (vs. Auth. Budget) 1310 Medical Assistance Payments $ 8,249.3 $ 5,416.2 $ $ 2,716.5 $ 7,944.2 $ 5,212.9 $ $ 2,627.0 $ (305.0) $ (203.3) $ (12.4) $ (89.4) 1337 Consolidated Supplemental Hospital Payments 1, (59.9) (50.7) (121.8) (130.4) (0.6) Rebates (654.5) (459.4) 35.3 (230.4) (641.2) (438.5) 52.9 (255.6) (25.2) 1320 Medical Assistance Cost Settlements (3.0) (107.4) (80.8) (54.5) Community Care North Carolina (CCNC) (3.9) (2.3) - (1.7) 1102 Contracts and Agreements (7.2) (9.8) 21.2 (18.5) 1330 Payment Adjustments (65.0) (47.4) - (17.6) (30.4) (25.9) (0.1) (4.5) (0.1) Medical Assistance Administration (1.0) (0.8) 0.3 (0.5) 1103 Health Information Technology (HIT) (17.0) (16.8) - (0.2) 1993 Prior Year Audits and Adjustments (9.8) (9.8) 1340 Undispositioned Receipts (8.3) (46.6) (8.3) (46.6) 1350 Periodic Payments (5.0) - - (5.0) (5.0) - - (5.0) 1991 Federal Indirect Reserve (0.5) (0.5) 1210 Medical Assistance County Administration (Inactive) Revenue Clearing (4.3) (4.3) 1910 Reserves and Transfers (0.1) (39.8) - (39.7) (0.1) 1992 Prior Year Earned Revenue (75.6) (0.1) (75.6) (0.1) 75.7 Total $ 9,179.3 $ 5,928.9 $ $ 2,486.3 $ 8,627.9 $ 5,472.9 $ $ 2,410.2 $ (551.4) $ (456.0) $ (19.4) $ (76.0) Comments on Drivers for YTD State Appropriation Variances: 1. Funds 1310/1331 ($114.7M) - Lower net fee-for-service and capitation payments includes a $53M carryforward for unearned federal funds. 2. Fund 1992 ($75.7M) - A larger payback of unearned receipts in a non-budgeted accounting fund. 3. Fund 1340 ($46.6M) - Undispositioned receipts sitting in the cash clearing fund wil fluctuate throughout the year. This is a non-budgeted account.

5 Health Choice Program - Fund Level Breakdown ($ millions) Actuals vs. Prior Year (Month-End) (Sorted by Absolute Value of Actual Month-End Expenditures) Actuals - February 2016 (Month-End) Actuals - February 2017 (Month-End) Variance (vs. Prior Year) 1310 Health Choice Payments $ 12.9 $ 12.8 $ - $ 0.1 $ 15.9 $ 15.9 $ - $ 0.1 $ 3.0 $ 3.0 $ - $ (0.0) 1311 Community Care North Carolina (CCNC) (0.2) (0.1) Prior Year Audits and Adjustments (0.2) (0.3) (0.2) - (0.1) (0.3) (0.4) Contracts and Agreements (0.0) 1320 NCHC Cost Settlements (0.1) (0.1) - (0.0) (0.1) (0.1) - (0.0) 1340 Undispositioned Receipts Health Choice Administration Rebates (0.0) (0.0) - (0.0) (0.0) (0.0) - (0.0) Payment Adjustments (0.0) (0.0) - (0.0) (0.0) (0.0) - (0.0) 1350 Periodic Payments (0.0) - - (0.0) (0.0) - - (0.0) Reserves and Transfers (0.0) (0.0) - - (0.0) Revenue Clearing - (0.4) (0.2) (0.2) Total $ 13.5 $ 13.5 $ 0.0 $ 0.1 $ 16.3 $ 16.1 $ 0.0 $ 0.2 $ 2.8 $ 2.7 $ (0.0) $ 0.1

6 Health Choice Program - Fund Level Breakdown ($ millions) Actuals vs. Prior Year (State Fiscal Year-to-Date) (Sorted by Absolute Value of Actual State Fiscal Year-to-Date Expenditures) Actuals - February 2016 (YTD) Actuals - February 2017 (YTD) Variance (vs. Prior Year) 1310 Health Choice Payments $ $ 96.7 $ - $ 10.7 $ $ $ - $ 0.5 $ 17.9 $ 28.1 $ - $ (10.2) 1311 Community Care North Carolina (CCNC) (0.3) 1320 NCHC Cost Settlements (1.2) (1.2) - (0.0) (1.2) (1.2) - (0.0) 1102 Contracts and Agreements (0.1) 1993 Prior Year Audits and Adjustments (1.0) (0.3) (0.2) - (0.1) (0.3) (0.5) (0.8) Payment Adjustments (0.3) (0.2) - (0.1) (0.3) (0.3) - (0.0) (0.0) (0.1) Rebates (0.2) (0.2) - (0.0) (0.2) (0.2) - (0.0) 0.0 (0.0) Undispositioned Receipts (0.0) - - (0.0) (0.1) (0.1) (0.1) (0.1) 1101 Health Choice Administration (0.0) (0.0) Periodic Payments (0.0) - - (0.0) (0.0) - - (0.0) Reserves and Transfers (0.0) (0.0) - - (0.0) Revenue Clearing - (0.4) (0.0) (0.4) 1992 Prior Year Earned Revenue (0.1) - (0.0) (0.1) Total $ $ $ 0.8 $ 10.3 $ $ $ 0.0 $ 0.4 $ 17.2 $ 27.9 $ (0.8) $ (9.9)

7 Health Choice Program - Fund Level Breakdown ($ millions) Actuals vs. Authorized Budget (Month-End) (Sorted by Absolute Value of Actual Month-End Expenditures) Auth. Budget - February 2017 (Month-End) Actuals - February 2017 (Month-End) Variance (vs. Auth. Budget) 1310 Health Choice Payments $ 14.0 $ 14.0 $ - $ 0.0 $ 15.9 $ 15.9 $ - $ 0.1 $ 1.9 $ 1.9 $ - $ Community Care North Carolina (CCNC) (0.0) 1993 Prior Year Audits and Adjustments (0.3) (0.2) - (0.1) (0.3) (0.2) - (0.1) 1102 Contracts and Agreements (0.0) (0.0) 1320 NCHC Cost Settlements (0.1) (0.1) - (0.0) (0.1) (0.1) - (0.0) 1340 Undispositioned Receipts (0.0) - - (0.0) Health Choice Administration (0.1) (0.1) (0.0) (0.0) 1331 Rebates (0.0) (0.0) - (0.0) (0.0) (0.0) - (0.0) Payment Adjustments (0.0) (0.0) - (0.0) (0.0) (0.0) - (0.0) Periodic Payments (0.0) - - (0.0) (0.0) - - (0.0) 1910 Reserves and Transfers (0.0) (0.0) (0.0) 1810 Revenue Clearing (0.2) (0.2) Total $ 14.8 $ 14.8 $ 0.0 $ 0.1 $ 16.3 $ 16.1 $ 0.0 $ 0.2 $ 1.5 $ 1.4 $ (0.0) $ 0.1

8 Health Choice Program - Fund Level Breakdown ($ millions) Actuals vs. Authorized Budget (State Fiscal Year-to-Date) (Sorted by Absolute Value of Actual State Fiscal Year-to-Date Expenditures) Auth. Budget - February 2017 (YTD) Actuals - February 2017 (YTD) Variance (vs. Auth. Budget) 1310 Health Choice Payments $ $ $ - $ 0.2 $ $ $ - $ 0.5 $ 7.3 $ 7.0 $ - $ Community Care North Carolina (CCNC) (0.1) 1320 NCHC Cost Settlements (1.2) (1.2) - (0.0) (1.2) (1.2) - (0.0) 1102 Contracts and Agreements (0.5) (0.1) - (0.4) 1993 Prior Year Audits and Adjustments (0.3) (0.2) - (0.1) (0.3) (0.2) - (0.1) 1330 Payment Adjustments (0.1) (0.1) - (0.0) (0.3) (0.3) - (0.0) (0.2) (0.2) - (0.0) 1331 Rebates (0.3) (0.3) - (0.0) (0.2) (0.2) - (0.0) Undispositioned Receipts (0.1) - - (0.1) (0.1) (0.1) (0.0) (0.0) 1101 Health Choice Administration (1.1) (0.8) (0.2) (0.2) 1350 Periodic Payments (0.0) - - (0.0) (0.0) - - (0.0) 1910 Reserves and Transfers (0.0) (0.0) (0.0) 1810 Revenue Clearing (0.0) (0.0) Prior Year Earned Revenue (0.0) (0.0) Total $ $ $ 0.2 $ 0.8 $ $ $ 0.0 $ 0.4 $ 4.5 $ 5.0 $ (0.2) $ (0.4)

9 Per Member Per Month Expenditures by Category of Service (February 2017 Month-End) Category of Service Medicaid Health Choice Ambulatory Surgery Center $ 0.72 $ 0.39 Ambulance Buy-in/Dual Eligible CAP for Disabled Adults (CAP/DA) CAP for Children (CAP/C) Clinic Dental Durable Medical Equipment Health Check High Tech Imaging Home Health Hospice Hospital Emergency Room Hospital Inpatient Hospital Outpatient Lab LME/MCO Non-Emergency Medical Transportation Services (NEMT) Optical Programs of All-Inclusive Care for the Elderly (PACE) Personal Care Services (PCS) Physician Practitioner Non-Physician Skilled Nursing Facilities Other Services Subtotal $ $ Pharmacy Gross Expenditures $ $ Rebates (5.19) (0.04) Net Pharmacy $ $ Total PMPM $ $ Enrollment for February 2017: 1,973,084 90,391 Notes 1. Calculation for each PMPM is derived from claims expenditure dollars per the BD-701 (Funds 1310 and 1331) divided by total enrollment. 2. Enrollment data as of January 31, These individuals were eligible for benefits in February Medicaid Transformation Legislative Reporting - Prepared by DMA Financial Planning & Analysis on March 15, 2017

10 Per Member Per Month Expenditures by Category of Service (February State Fiscal Year-to-Date) Category of Service Medicaid Health Choice Ambulatory Surgery Center $ 0.68 $ 0.52 Ambulance Buy-in/Dual Eligible CAP for Disabled Adults (CAP/DA) CAP for Children (CAP/C) Clinic Dental Durable Medical Equipment Health Check High Tech Imaging Home Health Hospice Hospital Emergency Room Hospital Inpatient Hospital Outpatient Lab LME/MCO Non-Emergency Medical Transportation Services (NEMT) Optical Programs of All-Inclusive Care for the Elderly (PACE) Personal Care Services (PCS) Physician Practitioner Non-Physician Skilled Nursing Facilities Other Services Subtotal $ $ Pharmacy Gross Expenditures $ $ Rebates (41.26) (0.30) Net Pharmacy $ $ Total PMPM $ $ Total Member Months for February 2017: 15,538, ,333 Notes: 1. Calculation for each PMPM is derived from claims expenditure dollars per the BD-701 (Funds 1310 and 1331) divided by total member months. 2. Enrollment data as of January 31, These individuals were eligible for benefits in February Medicaid Transformation Legislative Reporting - Prepared by DMA Financial Planning & Analysis on March 15, 2017

11 COUNTY NAME AGED BLIND DISABLED TANF (AFDC) UNDER 21 TANF (AFDC) 21 AND OVER ENROLLMENT AS OF JANUARY 31, 2017 BY PROGRAM AID CATEGORY - COUNTY LEVEL FOSTER CHILDREN PREGNANT WOMEN FAMILY PLANNING INFANTS AND CHILDREN MCHIP MQBQ MQBB MQBE BCC REFUGEES ALAMANCE 2, ,501 8,610 2, ,136 7,328 2, ,819 1,703 ALEXANDER , , , ALLEGHANY , ANSON ,340 1, , , ASHE , , , AVERY , BEAUFORT ,258 2,981 1, , , BERTIE ,284 1, , BLADEN ,744 2, , , BRUNSWICK 1, ,174 5,779 2, ,850 4,371 1, , BUNCOMBE 3, ,733 9,206 4, ,619 9,298 3, , ,974 2,569 BURKE 1, ,863 5,608 2, ,552 3,675 1, ,733 1,031 CABARRUS 1, ,938 8,667 3, ,089 8,798 3, ,226 2,201 CALDWELL 1, ,792 5,155 2, ,076 3,540 1, , CAMDEN , CARTERET ,770 2,351 1, ,691 2, , CASWELL , , CATAWBA 1, ,055 7,492 2, ,898 7,286 2, ,454 1,831 CHATHAM ,104 2, , , CHEROKEE ,078 1, , , CHOWAN , CLAY , CLEVELAND 1, ,502 7,576 3, ,721 4,754 1, , COLUMBUS 1, ,201 4,971 1, ,106 2, , CRAVEN 1, ,034 4,798 1, ,433 3,725 1, , CUMBERLAND 3, ,553 22,838 10, ,363 14,185 3, ,903 2,454 CURRITUCK , DARE , , , DAVIDSON 2, ,602 8,169 3, ,691 7,474 2, ,978 1,682 DAVIE , , , DUPLIN 1, ,959 3,738 1, ,976 1, , DURHAM 2, ,799 13,387 4, ,101 12,726 3, ,153 2,839 EDGECOMBE 1, ,472 5,666 2, ,248 3, , FORSYTH 3, ,687 19,626 6, ,764 18,908 5, , ,762 3,211 FRANKLIN ,876 3,227 1, ,262 2,819 1, , GASTON 3, ,620 13,132 5, ,391 9,309 2, , ,914 1,720 GATES , GRAHAM , GRANVILLE ,450 2, , , GREENE , , , GUILFORD 5, ,936 30,940 10, ,032 9,015 23,471 6, , , ,279 4,487 HALIFAX 1, ,027 3,971 1, ,076 2, , HARNETT 1, ,483 6,619 2, ,948 5,702 1, ,614 1,153 HAYWOOD 1, ,256 3,111 1, ,206 2, , HENDERSON 1, ,550 3,573 1, ,687 1, ,542 1,115 HERTFORD ,321 1, , , HOKE ,708 4,637 1, ,061 2, , HYDE , IREDELL 1, ,732 6,421 2, ,264 5,989 2, ,542 1,656 LEGAL ALIENS NON- QUALIFIED ALIENS COUNTY TOTAL HEALTH CHOICE

12 COUNTY NAME AGED BLIND DISABLED TANF (AFDC) UNDER 21 TANF (AFDC) 21 AND OVER ENROLLMENT AS OF JANUARY 31, 2017 BY PROGRAM AID CATEGORY - COUNTY LEVEL FOSTER CHILDREN PREGNANT WOMEN FAMILY PLANNING INFANTS AND CHILDREN MCHIP MQBQ MQBB MQBE BCC REFUGEES JACKSON ,029 2, , , JOHNSTON 2, ,916 9,886 3, ,896 9,193 3, ,929 2,424 JONES , LEE ,881 3,431 1, ,253 3,697 1, , LENOIR 1, ,161 4,573 1, , , LINCOLN ,995 3,680 1, ,226 2, , MACON ,073 1, , , MADISON , , MARTIN ,174 1, , , MCDOWELL ,705 2,662 1, , , MECKLENBURG 9, ,213 53,268 19, ,406 24,558 42,659 12, ,576 1, , ,684 7,187 MITCHELL , MONTGOMERY , , , MOORE 1, ,182 3,467 1, , , NASH 1, ,991 6,203 2, ,325 4,368 1, ,734 1,000 NEW HANOVER 2, ,843 8,466 3, ,425 6,688 1, ,773 1,073 NORTHAMPTON ,289 1, , ONSLOW 1, ,332 8,575 4, ,473 6,748 1, ,024 1,084 ORANGE ,313 3,267 1, ,291 3,405 1, ,100 1,057 PAMLICO , PASQUOTANK ,456 2, , , PENDER ,666 2,913 1, ,337 2, , PERQUIMANS , PERSON ,319 2, , , PITT 2, ,067 9,642 3, ,950 7,216 2, ,540 1,470 POLK , RANDOLPH 1, ,242 7,880 3, ,680 7,221 2, ,634 1,736 RICHMOND ,703 4,208 1, ,210 2, , ROBESON 3, ,249 14,438 5, ,657 8,872 2, ,729 1,367 ROCKINGHAM 1, ,779 5,442 2, ,124 1, , ROWAN 1, ,447 8,820 3, ,298 6,534 2, ,293 1,316 RUTHERFORD 1, ,722 3,879 1, ,256 2, , SAMPSON 1, ,334 4,861 1, ,500 4,131 1, , SCOTLAND ,194 3,814 1, , , STANLY ,781 2,747 1, ,022 2, , STOKES ,281 2, , , SURRY 1, ,611 3,631 1, ,903 1, , SWAIN , , TRANSYLVANIA , , , TYRRELL UNION 1, ,148 7,410 2, ,409 7,842 3, ,493 2,258 VANCE 1, ,032 4,317 1, ,357 3, , WAKE 6, ,282 30,294 10, ,512 31,491 10, , , ,522 7,552 WARREN ,053 1, , WASHINGTON , , WATAUGA , , WAYNE 1, ,107 9,163 3, ,722 6,689 1, ,342 1,142 WILKES 1, ,586 3,473 1, ,198 1, , WILSON 1, ,608 5,215 2, ,605 4,839 1, , YADKIN ,032 1, , , YANCEY , TOTALS 124,197 1, , , ,686 6,074 17, , , ,519 8,347 43,719 20, , ,973,084 90,391 LEGAL ALIENS NON- QUALIFIED ALIENS COUNTY TOTAL HEALTH CHOICE