1. County Medicaid Contributions Heather Wildermuth3/15/12

2. Agenda Introduction – Chris Holley Explanation of the backlog and HB 5301 – Heather Wildermuth Medicaid Veto Plan – Cragin Mosteller Medicaid Legal Discussion – Ginger Delegal Conclusion – John Wayne Smith 4/28/2015 2

3. County Medicaid Contributions – SB 1988 and HB 5301 Medicaid Budget Conforming Bill. Adds the children of state employees among those eligible for Florida KidCare. Directs the Department of Children and Families and the Agency for Health Care Administration to work cooperatively to develop a new system of eligibility determination for Medicaid and the Children’s Health Insurance Program consistent with federal and state laws. Limits payment for emergency room services for non- pregnant Medicaid recipients 21 years of age or older to 6 visits per fiscal year. Significantly amends Sec. 409.915, F.S., County Contributions to Medicaid. 4/28/2015 3

4. County Medicaid Contributions (Continued) Removes the requirement that the state work “in consultation” with the counties to determine who is an “eligible recipient” of that county. Stipulates that each county’s eligible recipients will be determined by the address contained in the Medicaid eligibility system maintained by DCF. 4/28/2015 4

5. County Medicaid Contributions - Backlog By August 1, 2012, AHCA must certify each county’s “backlog” which includes disputed bills occurring between November 1, 2001 – April 30, 2012. Each county has 1 month after certification (September 1, 2012) to contest the certified amount. This procedure is the exclusive method to challenge the amount certified. Burden of proof – A preponderance of the evidence. 4/28/2015 5

6. County Medicaid Contributions (Backlog Continued) By September 15, 2012, AHCA will certify to the Department of Revenue: – For each county that files a petition the total amount certified. – For each county that does not file a petition, an amount equal to 85% of the total amount certified. Filing a petition will not stay or stop the DOR from reducing your revenue sharing. If you are able to demonstrate that the amount certified should be reduced, AHCA will notify DOR of the amount of the reduction. DOR will adjust all future monthly distributions in a manner that results in the remaining total being applied in equal monthly amounts. 4/28/2015 6

7. County Medicaid Contributions (Backlog Continued) For 12 months beginning with the October 2012 distribution, DOR will reduce each county’s revenue sharing by a third of the amount certified. The remaining two-thirds will be spread over 4 years, beginning with the October 2013 distribution. In total, counties will be paying on the backlog for 5 years. The state cannot withhold more than 50% of your revenue sharing due to bonding issues. 4/28/2015 7

8. Questions? The phone will be taken off mute for questions on the backlog. The prospective payments will be covered in the next section. 4/28/2015 8

9. County Medicaid Contributions - Prospective Payments Beginning May 1, 2012, AHCA will certify to DOR by the 7 th of each month the amount of the monthly Medicaid statement for each county. DOR will reduce your ½ cent sales tax distribution by that certified amount. Again, there are provisions to ensure that each county can make timely bond payments if that situation exists. 4/28/2015 9

10. Questions? The phone will be taken off mute for questions on the prospective payments. 4/28/2015 10

11. County Medicaid Contributions – Credits AHCA, DOR and FAC will work in consultation to develop a process for “refund” requests which: – Allows counties to submit a written refund request to the Agency. – Requires that the Agency determine whether the refund is appropriate and should be approved. Once approved, they will certify the refund to DOR. – Requires DOR to issue a refund for the certified amount to the county from GR. The “refund” is issued in the form of a credit against reductions to be applied to subsequent monthly distributions. 4/28/2015 11

12. County Medicaid Contributions – New Authority The Agency is now authorized to adopt rules to administer this section of law. New authority in Section 13 of the bill includes the following: The Agency for Health Care Administration and the Department of Children and Family Services, in consultation with hospitals and nursing homes that serve Medicaid recipients, shall develop a process to update a recipient's address in the Medicaid eligibility system at the time a recipient is admitted to a hospital or nursing home. If a recipient's address information in the Medicaid eligibility system needs to be updated, the update shall be completed within 10 days after the recipient's admission to a hospital or nursing home. 4/28/2015 12

13. Questions? The phone will be taken off mute for questions on HB 5301 4/28/2015 13

14. Medicaid Veto Plan Veto letters Veto video Veto website Member support – County resolutions – Sample veto letters Op-Ed Ongoing media push for editorials – Local reporters Action Items – Send sample veto letter – Talk to reporters 4/28/2015 14

15. Questions? The phone will be taken off mute for questions on public relations attempts to veto bill. 4/28/2015 15

16. Legal Options 4/28/2015 16

17. Questions? The phone will be taken off mute for questions on legal options. 4/28/2015 17

18. Conclusion 4/28/2015 18

19. Questions? The phone will be taken off mute for final questions. 4/28/2015 19