We promote and protect the health and safety of Idahoans. 1 Joint Finance-Appropriations Committee Division of Medicaid Medicaid Administration Leslie Clement Administrator January 19, 2010

We promote and protect the health and safety of Idahoans. 2 Division as Component of DHW

We promote and protect the health and safety of Idahoans. 3 Administrative Overhead at 3.8%

We promote and protect the health and safety of Idahoans. 4 Administrative Cost Components

We promote and protect the health and safety of Idahoans. 5 Funding Sources

We promote and protect the health and safety of Idahoans. 6 Holdback Impacts

We promote and protect the health and safety of Idahoans. 7 Funding Source History

We promote and protect the health and safety of Idahoans. 8 Focus on cost containment measures. Medicaid personnel and contractor’s role is to effectively and efficiently manage benefits while preserving quality and access. Legislative Intent Status

We promote and protect the health and safety of Idahoans. 9 Chart of Initiatives StrategyStatus Cost sharingPending rules approval Managed Care contractsNew rates; new RFP posted Transportation BrokerageReviewing RFP responses Utilization ManagementRFP posted Institutional cost driversNegotiating pricing changes Premium AssistanceWaiver amendment initiated National AccreditationImplemented for DDAs Assessment ProviderStreamlined; reduced contract

We promote and protect the health and safety of Idahoans. 10 Reduce waste, fraud, and abuse DHW Medicaid Program Integrity Unit AG’s Medicaid Fraud Control Unit Licensing, certification, & complaint follow-up activities Quality Assurance reviews State and federal audits New MMIS System: Enhanced editing & auditing capabilities Management Strategies to Control Costs

We promote and protect the health and safety of Idahoans. 11 MMIS Operations LBB page 2-56 Decision Unit Planned implementation of June 2010 Full year of new system operations DescriptionTotal FundsGeneral FundsFederal Funds Contracted Mailing expenses (50%) $220,000$110,000 Claims System contracts (75%) $5,428,800$1,357,200$4,071,600 Total on-going Request $5,648,800$1,467,200$4,181,600

We promote and protect the health and safety of Idahoans. 12 MMIS certification LBB page 2-56 Decision Unit One-time funding Contractual payment made to vendors for successful completion of required certification DescriptionTotal FundsGeneral FundsFederal Funds MMIS Certification $3,847,600$961,900$2,885,700 Total One- time Request $3,847,600$961,900$2,885,700

We promote and protect the health and safety of Idahoans. 3 rd Party Recovery Funding LBB page 2-56 Loss of AG position to holdbacks Governor restored funding to operating to obtain these legal services in 2011 Results in cost avoidance of >$700,000 in trustee & benefits payments. OperatingTotal General Funds Federal Funds Legal recovery costs $150,000$75,000

We promote and protect the health and safety of Idahoans. 14 Administration Budget Recommendation Medicaid Administration 2010 Appropriation 2011 Governor’s Recommendation FTP Personnel$18,462,500 GF: $6,817,500 $17,666,800 GF: $6,648,600 Operating$47,455,100 GF: $9,022,900 $42,222,200 GF: $9,827,400 Capitol$0 Trustee & Benefits$2,949,600 GF: $1,311,000 $2,949,600 GF: $1,311,000 Total$68,867,200 GF: $17,151,400 $62,838,600 GF: $17,787,000

We promote and protect the health and safety of Idahoans. 15

We promote and protect the health and safety of Idahoans. 16 Joint Finance-Appropriations Committee Division of Medicaid Medicaid Trustee & Benefits Payments Leslie Clement Administrator January 19, 2010

We promote and protect the health and safety of Idahoans. 17 Division as Component of DHW Spending

We promote and protect the health and safety of Idahoans. 18 Provider Payments 96.2 % of Total

We promote and protect the health and safety of Idahoans. 19 Provider Payments by Plan

We promote and protect the health and safety of Idahoans Per Enrollee Per Month BasicEnhancedCoordinated Cost of Adults $680$1,900$1,500 Number of Adults 17,00025,00015,000 Costs of Children $178$1,300n/a Number of Children 137,00022,0000 Average $ per Plan $232$1,600$1,500 Total Enrollees $154,00047,00015,000

We promote and protect the health and safety of Idahoans. Current Enrollment by Location RegionEnrollment 125, , , , , , ,210 Total202,153

We promote and protect the health and safety of Idahoans. 22 Funding Sources

We promote and protect the health and safety of Idahoans. 23 Holdback Impacts

We promote and protect the health and safety of Idahoans. Permanent Holdback & Adjustments Plans Total Funds General Fund Dedicated Fund Federal Fund Coordinated Page 2-59 Enhanced Page 2-62 $2.6 Basic Page 2-65 Totals $2.6

We promote and protect the health and safety of Idahoans. Impact of Holdbacks on Providers Provider TypeHoldback% of total Hospitals$16.229% Long-term Care$ 8.415% Pharmacy$ 2.2 4% Mental Health$ % Medical/Dental$ 7.013% Developmental Disability Services $ % Other$ % All Providers$54.8 M Total$11.4 General Funds

We promote and protect the health and safety of Idahoans. 26 History of Funding

We promote and protect the health and safety of Idahoans. 27 Focus on cost containment measures. Medicaid personnel and contractor’s role is to effectively and efficiently manage benefits while preserving quality and access. Legislative Intent Status

We promote and protect the health and safety of Idahoans. 28 Chart of Initiatives StrategyStatus Cost sharingPending rules approval Managed Care contractsNew rates; new RFP posted Transportation BrokerageReviewing RFP responses Utilization ManagementRFP posted Institutional cost driversNegotiating pricing changes Premium AssistanceWaiver amendment initiated National AccreditationImplemented for DDAs Assessment ProviderStreamlined; reduced contract

We promote and protect the health and safety of Idahoans. 29 Four primary avenues to control costs: 1.Reduce Prices 2.Limit/Eliminate Benefits 3.Limit/Eliminate Eligibility categories 4.Management Cost Containment Strategies

We promote and protect the health and safety of Idahoans. 30 Pricing Federal law: Imposes significant requirements Sets certain provider rates Requires that payment is consistent with efficiency, economy, and quality of care. Requires that payment must attract enough providers so that Medicaid services are available to the same extent as non-Medicaid services States have some flexibility subject to approval

We promote and protect the health and safety of Idahoans. 31 Benefits Federal law: Requires certain benefits Requires states cover EPSDT Requires certain standards States have some flexibility: Define scope, amount and duration

We promote and protect the health and safety of Idahoans. 32 Eligibility- MOE No changes permissible at this time States cannot reduce eligibility and receive the increased FMAP Proposed health legislation States cannot reduce eligibility for adults until 12/2013; certain exceptions are allowed for non-pregnant, non-disabled adults States cannot reduce eligibility for children until 09/2019

We promote and protect the health and safety of Idahoans. 33 Management Strategies Improve: Technology tools: front-end edits Payment methodology Assessment Benefit Design Utilization & case management Communications Sharing costs

We promote and protect the health and safety of Idahoans Forecasted Expenditures: Shortfall Supplemental 4.31 LBB page 2-53 Plan Total Fund General Fund Dedicated/ Other Fund Federal Fund Basic Page 2-65 $15.0$2.8 $13.3 Enhanced Page 2-62 $36.5$7.6 $29.5 Coordinated Page $13.1$3.5 $ 10.0 Total$64.6$13.9 $52.8

We promote and protect the health and safety of Idahoans. 35 Nursing Facility Provider Assessment Supplemental 4.36 LBB page 2-59 Plan Total Fund Dedicated Fund Federal Fund Coordinated$11.5$2.4$9.1 Total$11.5$2.4$9.1

We promote and protect the health and safety of Idahoans. 36 Benefit Plan Maintenance LBB page 2-52 Plans Total Funds General Funds Dedicated Funds Federal Funds Basic$32.4$20.3$.7$11.4 Enhanced$72.4$52.4$1.9$18.1 Coordinated$21.8$21.9$ $.07 Total$126.9$94.6$2.4$29.5

We promote and protect the health and safety of Idahoans. Mid-Year FMAP Change LBB page 2-52 Plan Other State Funds Federal Fund Basic$13.8 Enhanced$39.8 Coordinated$17.6 Total$71.2

We promote and protect the health and safety of Idahoans. 38 …….. Basic Plan Recommendation Basic Plan 2010 Appropriation 2011 Recommendation Enrollment148,000154,000 General Fund$63,375,900$ 72,192,500 Dedicated Fund Other Funds $41,110,000 $ 23,789,700 $ 30,786,000 Federal Fund$299,607,300$322,729,400 Total$404,093,200$449,497,600

We promote and protect the health and safety of Idahoans. Enhanced Plan Recommendation Enhanced Plan 2010 Appropriation 2011 Recommendation Enrollment45,40047,400 General Fund$133,430,200$145,184,000 Dedicated Fund Other $39,137,000 $ 42,080,900 $ 38,975,100 Federal Fund$421,460,900$437,253,600 Total$594,028,100$663,493,600

We promote and protect the health and safety of Idahoans. Coordinated Plan Recommendation Coordinated Plan 2010 Appropriation 2011 Recommendation Enrollment15,06515,575 General Fund$95,220,770$101,641,600 Dedicated Fund Other $10,922,500 $ 20,157,800 $ 10,226,700 Federal Fund$334,097,600$347,667,700 Total Funds$440,240,800$479,693,800

We promote and protect the health and safety of Idahoans. Questions? Leslie Clement