George A. Ralls M.D. Health Services Department February 7, 2012 Legislative Update 2012 Medicaid DOH Reorganization

F.S : County contributions to Medicaid 35% of inpatient hospitalization costs Days 11 to 45 $55 per month, per Medicaid recipient in a nursing home Medicaid 60 Days to pay State can withhold revenue sharing funds if not paid

Medicaid Billed/Paid FY07-11 Medicaid Orange County

Recovery of last 4 years of previously denied bills Collection of Unpaid Bills Changes the way Medicaid costs are assigned to each County Attributing Costs to Counties Eliminates our ability to scrutinize bills and deny payment Payment Method Medicaid: Proposed Changes

Balance between what we’ve paid and 75% of total billed – Approximately $20 Million Dollars 36 monthly installments directly out of revenue sharing dollars –$556,000 per month Collection of Unpaid Bills for last 4 Years Medicaid: Proposed Changes

County’s eligible recipients will be determined solely on the address listed in the DCF system If no address, eligibility is based on the county where services were rendered –Tertiary referral centers –High risk obstetrics –Neonatal intensive care centers Attributing Costs to Counties Medicaid: Proposed Changes

Beginning Dec. 2012: –Future unpaid billings will be taken from revenue sharing after 6 months –Counties will be paying the entire bill –No reconciliation process or “re-billing” Payment Method Medicaid: Proposed Changes

$20 Million in past denied bills Loss of our ability to determine County residence Services rendered at any of our tertiary referral centers may contribute to costs Mandate to pay entire bill submitted to us –2011 billed amount was $29.5 M, versus $17.4 M paid Summary of local impact: Medicaid: Proposed Changes

DOH Reorganization HB 1263 Rep. Matt Hudson

HB Department of Health (DOH) DOH Reorganization

All CHDs have responsibilities in three functional areas: –Infectious disease prevention & control Surveillance, diagnosis, treatment, risk reduction –Basic family health care services Primary care, pre-natal care, school based health care –Environmental health services Sanitary nuisances, on-site sewage disposal systems, water well monitoring DOH Reorganization

Orange County Health Department: –Neighborhood Centers for Families –HUG-Me Program –Office of Community Health Health Disparities Chronic Disease and Tobacco Prevention Risk Communication Prevention Research, Informatics, and Health Education Center (PRIHEC) “All In” –PCAN Partner DOH Reorganization

OCHD FY10 Annual Report Orange County Health Dept Revenues $45 M$45.6 M Expenditures DOH Reorganization

$12.5 million State Revenue $10.8 Million Federal Revenue $21.7 Million Local Revenue FY10 OCHD Revenue Sources DOH Reorganization

$31.2 million Salaries $6.2 million Misc. Expenses $3.5 Million Contractural Services FY10 OCHD Expenditures DOH Reorganization

Summary of HB 1263: –Counties to take over local health depts Health dept employees become county employees –DOH contracts with counties to maintain primary health department functions Environmental Health Communicable Disease Primary Care –State block grants will offset county costs DOH Reorganization

A significant shift of responsibilities. A significant increase in the County workforce. Will services be compromised? Will State block grants offset the added County costs? Amount based on population No mention of funding formula yet Concerns: DOH Reorganization

George A. Ralls M.D. Health Services Department February 7, 2012 Legislative Update 2012 Medicaid DOH Reorganization