ACA Symposium December 16, 2013 Esther L. Muña, MHA, Interim CEO The ACA and CHCC ACA Symposium December 16, 2013 Esther L. Muña, MHA, Interim CEO

Additional ACA funds huge help in funding CHCC operations Prior to ACA: Approximately $6M Medicaid cap 50% Federal Matching funds ACA: Allowed more funding to CHCC, above Medicaid Cap Additional 5% Federal Matching (beneficial for CPE)

Certified Public Expenditure (CPE) Matching Requirement – CHCC cannot be reimbursed for services without a CNMI local match. In FY 2012, only $2.5M in local appropriation was available for the entire CNMI health care providers. As of January 2012, CPE methodology was approved by Medicaid and it allowed CHCC to be reimbursed WITHOUT local match and allowed Medicaid to use funds beyond the CAP and the ACA funds Based on actual costs of treating Medicaid- eligible

COST of HEALTH CARE FY 2012: CHC Hospital alone cost $32M & RHC & THC cost about $3M combined FY 2013: CHC Hospital costs were $36M $3M combined for RHC/THC

ACA and Medicaid In 2012, $10M of Medicaid/ACA funds paid to CHCC Represents $18M of actual costs; $8M not reimbursed In 2013, approximate $800K paid to CHCC monthly Represents $1.4M of actual monthly costs; $600K not reimbursed

What Next In 2013, approx. 400 patients applied for CHCC Indigent program; more patients applying for program. There’s a need to fund the unmatched funds. A loss of $600K per month is not sustainable. Strategic Plan needs to consider the end of ACA funding support - when match returns to 50% match instead of current 45% and when CAP is again enforced.

Thank You Si Yu’us ma’åsi’ yan Ghilisoow!