Overview Medicaid Expansion and the 1115 Waiver Program May 9, 2013

Potential Medicaid Expansion Estimated Financial Impact for Dallas County

Potential Medicaid Expansion Affordable Care Act Under the Affordable Care Act, the Federal government has offered 100% funding for expansion of the Texas Medicaid program program expansion would cover Texas residents who earn up to 138% of the Federal Poverty Level (FPL) the 100% Federal funding would be provided through 2016, after which time the Federal share declines to 90% funding by

Dallas County Impact Demographic Impact Dallas County has approximately 600,000 uninsured residents. The Affordable Care Act will provide subsidies to uninsured residents which - absent Medicaid expansion, should reduce the number of uninsured to approximately 465,000. Medicaid expansion would reduce the number to approximately 334,000 meaning, an additional 131,000 Dallas County residents would receive Medicaid coverage As a result, Dallas County healthcare providers would be paid $580 million Today these must be covered by safety net hospitals Source: Center for Public Policy Priorities 4

Impact for Dallas County Providers Financial Impact on Providers Although overall base payments would increase $580 million Other supplemental payments (Uncompensated Care / UC) currently received would be reduced Net Dallas County providers would realize approximately $351 million. Statewide this would result in additional provider payments of over $1.6 billion/year Without Medicaid expansion there will be no incremental Medicaid payments Costs fall to the taxpayers and charity programs Texan’s tax dollars go to fund other states’ Medicaid Expansion Programs 5

The 1115 Waiver

The 1115 Waiver is known as the Transformation Waiver The intent is to change healthcare in Texas to provide better care at less cost The Waiver is divided into two parts Uncompensated Care DSRIP The Waiver is organized into 20 Regions Dallas County is in Region 9 Region 9 includes Dallas, Denton and Kaufman Counties

Regional Healthcare Partnership (RHP) Formation – Region 9

 Region Nine defined on August 3 rd to include Dallas, Denton and Kaufman counties  Organization of RHP Plan participants is well under way –Short list of eight potential IGT Entities in addition to Parkland and UT Southwestern –Organizing meeting of IGT Entities planned for September 7 th  Active RHP Work Groups: –UC Task Force: focused on financial implications and mechanics –RHP Plan Writing Work Group: composed of “authorized representatives” of each participant and charged with writing the RHP Plan  Continue to target a mid- to late-September completion and submission date –Each Work Group is proceeding with known facts, draft rules and guidance Regional Healthcare Partnership (RHP) Formation – Region 9

Funds Flow Mechanics

Anchor Responsibilities General Duties  Serves as single point of contact for the RHP with HHSC  Facilitates RHP meetings with interested IGT contributors in the region and communicates function and purpose of RHPs  Includes other stakeholders in RHP discussions  Ensures public meeting as part of development of RHP and prior to submission of final plan RHP Plan  Ensures inclusion of key stakeholders in RHP Plan development  Coordinates, develops and provides RHP plan to HHSC based on IGT contributing projects consistent with project menus and on IGT contributors’ input Administration of DSRIP Projects  Coordinates required reporting of all project milestones and metrics within RHP for DSRIP to HHSC  Provides technical assistance to participating providers

OVERVIEW Hospital o 700 Adult Beds o 65 NICU Beds Community Outpatient Care o 13 Centers o 11 School Based Clinics o 4 Mobile Units Parkland Community Health Plan Since 1999 o 200,000 Enrollees Dallas County Jail System Health Care Parkland Foundation

HISTORY Second Largest Civilian Burn Unit in U.S. Leader in Disaster Preparedness and Response Admissions from 200 of 254 Texas Counties in 2012

STATISTICS ED’s average 490 patients per day More than 1,000 radiology procedures per day More than 1/3 of the total births in Dallas County each year In the past 2 years… –Parkland’s outpatient pharmacies have filled nearly 4.2M prescriptions Averaging more than 5700 fills per day

PHHS-UTSW Partnership Primary Teaching Hospital for the University of Texas Southwestern Medical Center Since ,506 Faculty 1,561 Residents in 105 ACGME Programs UTSW to Graduate 500 Students in June 2013 UTSW Represents 1,470 of 1,660 Medical Staff Members Fifty Percent of Physicians in Dallas Trained at Parkland

Questions?

Parkland Coping with Change- How Healthcare Providers Are Meeting the Demands of TomorrowCoping with Change- How Healthcare Providers Are Meeting the Demands of Tomorrow