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The National Medicaid Congress “Medicaid Managed Care: Opportunities and Implications of State Expansions” Brian Coyne Senior Vice President Federal Government.

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Presentation on theme: "The National Medicaid Congress “Medicaid Managed Care: Opportunities and Implications of State Expansions” Brian Coyne Senior Vice President Federal Government."— Presentation transcript:

1 The National Medicaid Congress “Medicaid Managed Care: Opportunities and Implications of State Expansions” Brian Coyne Senior Vice President Federal Government Relations AMERIGROUP Corporation June 6, 2006

2 AMERIGROUP Overview Multi-State Medicaid Managed Care 9 states and District of Columbia Approximately 1.1 million lives covered Multi-Products –Families & Kids (TANF & CHIP) –Elderly and Disabled (SSI) –Dual Eligibles (Special Needs Plan/Medicare Advantage Plan)

3 AMERIGROUP Overview

4 Personal Experience 1992 Small State, Big Ideas: RIte Care Coverage of Children 0 to 6 (“All kids enter school healthy and ready to learn”) Linked to Managed Care Foundation for Continued Coverage Expansion

5 Medicaid Managed Care Enrollment (In millions) States Adopt Managed Care Source: Kaiser Family Foundation

6 Medicaid Spending FY 2003: $283B Sources: CMS, Kaiser Family Foundation and Lewin Group 36% 5.5% 42.5% 16%

7 Medicaid Managed Care Medicaid Managed Care Spending as percent of Medicaid Source: Lewin Group

8 Managed Care Expansion Opportunities: Non-Duals $75 Billion Expenditures available for Capitation (excluding duals): –Nearly 1/3 of all Medicaid spending not currently in capitation arrangements $46 Billion from SSI (non-duals) –60% of potential expenditures available for capitation from SSI-only program Source: Lewin Group

9 Managed Care Expansion Opportunities: Dual Eligibles Over 40% Medicaid Spending for Dual Eligibles 2/3 Expenditures for LTC Services Special Needs Plus (SNP) potential for acute care coordination with Medicaid

10 Barriers/Challenges Upper Payment Limit (UPL) Integrating Medicare/Medicaid through SNP Recognizing savings associated with Managed Care Long-Term Care Actuarial Soundness Medicaid Reform (Expand or Contract)

11 Large and Growing Program $335B $161B Medicaid Expenditures $724B 2016E 2006 1996 Source: The Congressional Budget Office

12 Source: 2003 State Expenditures Report, National Association of State Budget Officers Fastest Growing State Expenditure 8.0% Medicaid E&S Education Transportation Higher Education All Other Public Assistance Corrections

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