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2. 2 West Virginia Beneficiaries by Enrollment Group Beneficiary Group Total Eligible % Eligible Elderly31,1448.33% Blind & Disabled 91,19024.39% Adults60,23316.11% Children191,31651.17% 31,144 91,190 60,233 191,316

3. 3 West Virginia Beneficiaries by Expenditures WEST VIRGINIA MEDICAID BENEFICIARIES AND EXPENDITURES BY ENROLLMENT GROUP, FFY 2003 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 51.17% 27.36% 16.11% 7.48% 24.39% 44.16% 21.00% 8.33% Beneficiaries Expenditures Elderly (31,144) Blind & Disabled (91,190) Adults (60,233) Children (191,316) Source: CMS 2082 Data from MMIS System Note: Beneficiaries are enrollees who received a Medicaid service. Blind & Disabled includes adults, children, and elderly who qualify based on a disability.

4. 4 Recent History of West Virginia Medicaid Year Total Expenditures FY 2001$1.48B FY 2002$1.59B FY 2003$1.76B FY 2004$1.94B Annual growth of 7-9% each year. Year Total Expenditures FY 2001$1.48B FY 2002$1.59B FY 2003$1.76B FY 2004$1.94B Annual growth of 7-9% each year.

5. 5 Recent History of West Virginia Medicaid - Continued West Virginia has not expanded eligibility Rolls have grown by 37,365 or 12% since 2001 Cost-containment achieved by cutting reimbursement West Virginia has not expanded eligibility Rolls have grown by 37,365 or 12% since 2001 Cost-containment achieved by cutting reimbursement

6. 6 Development of the West Virginia Medicaid Redesign Steering committee and workgroup included staff, providers, advocates and consumers Met publicly Will use focus groups for some components Public forums on the final application Steering committee and workgroup included staff, providers, advocates and consumers Met publicly Will use focus groups for some components Public forums on the final application

7. 7 Goals of West Virginia Medicaid Redesign Streamline administration Tailor benefits to population needs Coordinate care, especially for members with chronic conditions Provide members with the opportunity and incentives to maintain and improve their health Streamline administration Tailor benefits to population needs Coordinate care, especially for members with chronic conditions Provide members with the opportunity and incentives to maintain and improve their health

8. 8 Streamlining Administration Reduce 29 eligibility categories to 4 All mandatory coverage groups and previously eligible individuals continue to be covered Reduce 29 eligibility categories to 4 All mandatory coverage groups and previously eligible individuals continue to be covered

9. 9 Flexible Benefits Ensure that participants receive the right care, at the right place, at the right time by the right provider through care coordination Use evidence-based medicine to manage services by duration, scope and severity Ensure that participants receive the right care, at the right place, at the right time by the right provider through care coordination Use evidence-based medicine to manage services by duration, scope and severity

10. 10 Medicaid Member Agreement Members agree to: Keep medical appointments, take medications as prescribed, etc. Share in program costs through co-pays Pay lower co-pays and receive incentives for success Try to live a healthy life Be aware of their rights Members agree to: Keep medical appointments, take medications as prescribed, etc. Share in program costs through co-pays Pay lower co-pays and receive incentives for success Try to live a healthy life Be aware of their rights

11. 11 Healthy Rewards Accounts Fixed amount of credits per quarter per member are deposited in the account Used to cover medical and pharmaceutical co- pays Higher co-pays for inappropriate use of ER Bonus credits added for meeting health goals Can use credits remaining at the end of the year to purchase non-covered services Fixed amount of credits per quarter per member are deposited in the account Used to cover medical and pharmaceutical co- pays Higher co-pays for inappropriate use of ER Bonus credits added for meeting health goals Can use credits remaining at the end of the year to purchase non-covered services

12. 12 Electronic Health Information Electronic medical records Medicaid, Medicare and commercial claims Public health data Nursing home MDS data Electronic medical records Medicaid, Medicare and commercial claims Public health data Nursing home MDS data

13. 13 Long-term Care Single point of entry with a needs assessment Placement in most integrated setting Resource Management Contract Single point of entry with a needs assessment Placement in most integrated setting Resource Management Contract

14. 14 Quality Outcomes and Outcome Measurements Set performance goals Assess progress in meeting goals Identify areas needing improvement and on-going monitoring Set performance goals Assess progress in meeting goals Identify areas needing improvement and on-going monitoring

15. 15 Contacts Shana Phares, Deputy Secretary WV Department of Health and Human Resources sphares@wvdhhr.org (304) 558-3985 Nancy Atkins, Commissioner WVDHHR Bureau for Medical Services nancyatkins@wvdhhr.org (304) 558-1700