1. 2014 New Mexico Data Users Conference Bureau of Business & Economic Research November 13, 2014 Lucinda Sydow New Mexico Human Services Department – Medical Assistance Division

2. Information to Share Today ∙Medicaid Data Universe ∙A brief history of Medicaid ∙Patient Protection & Affordable Care Act ∙Federal and State Relationship ∙Summary Public Data – Medicaid Enrollment ∙Summary Public Data – Medicaid Expenditure

3. Medicaid Recipient Demographic Data Health Encounter - Claims

4. ∙Collected by Income Support Division ∙Supports Eligibility Determinations ∙Collect ∙Income ∙Household Size ∙Age ∙Disability Determinations ∙Record for every Medicaid Recipient Demographic Data

5. ∙Collected by the Medical Assistance Division ∙Record for each visit to a provider ∙Provider ∙Date ∙Procedures ∙Cost ∙Millions of claim records Health Encounter Claims

6. Medicaid Recipient Demographic Data Health Encounter - Claims Health Insurance Portability and Accountability Act (HIPPA) Requirements

7. A (Very) Brief History ∙The Social Security Act was signed into law August 14, 1935 by President Roosevelt. ∙Medicare and Medicaid signed into law July 30, 1965 as part of President Johnson’s Great Society Programs. They were enacted as amendments to the Social Security Act. ∙Medicare for the elderly (over 65) - Title XVIII ∙Medicaid for low-income families with dependent children and other individuals - Title XIX 7

8. Eligibility and intended services under Medicaid was initially somewhat limited: ∙Basic health insurance for low-income families and individuals with disabilities ∙Long-term care services for older Americans and those with disabilities; and ∙Supplemental coverage for low-income Medicare beneficiaries.

9. ∙1981 - Freedom of Choice (1915[b]) and Home and Community-Based Waivers (1915[c]) waivers created. ∙1997: Creation of State Children’s Health Insurance Program (SCHIP). ∙1999: Working Disabled category created under Ticket to Work and Work Incentives Improvement Act. ∙2010: Patient Protection and Affordable Care Act.

10. ∙Signed into Law March 23, 2010 by President Obama. ∙Also known as Affordable Care Act (ACA) and ObamaCare. ∙Key impacts ∙Individual Mandate ∙Voluntary Expansion of Medicaid

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12. November 13, 2014

13. ∙Program Oversight ∙Centers for Medicare and Medicaid Services (CMS) – under U.S. Department of Health & Human Services ∙Children, pregnant women, parents, seniors and individuals with disabilities are mandatory eligibility groups. ∙State administered – Each State Unique ∙Federal Approval of State Plans

14. ∙Fiscal Oversight ∙Medicaid is under a cost-sharing framework ∙Nationally, the Federal Government pays about 60% of all Medicaid costs.

15. ∙Federal Financial Participation (FFP) rates ∙ Primary FFP rate – Federal Medical Assistance Percentage (FMAP), ∙Determined by state per capita income versus the national per capita income ∙Can range from 50% to current high,73.58% ∙Current rate for New Mexico is 69.65% ∙Expansion/Newly Eligible Adult Population – States receive 100% federal match

16. ∙Non-federal state share ∙General Fund Appropriations ∙Inter Governmental Transfers ∙Other Revenue: Drug Rebate

17. ∙Method of Rendering Services ∙Fee-for-Service (FFS) ∙Managed Care ∙January 1, 2014 State implemented Centennial Care ∙Four Managed Care Organizations ∙Blue Cross Blue Shield ∙Molina ∙Presbyterian ∙United HealthCare

18. November 13, 2014

21. Children Native Americans By County Children Native Americans Managed Care Organization List of all the Medicaid Categories of Eligibility

22. Source: New Mexico Medicaid June 2014 Enrollment Projection

23. November 13, 2014

24. Medicaid Budget Projections Three State Fiscal Years Expenditures by Method of Service FFS or Managed Care Show actual expenditure to date and projections

25. Health Visit – Claim Paid Or Premium Paid FFSOutpatient HospitalDentalManaged CarePhysical HealthBehavioral Health Long Term Services and Supports

26. Federal Share State Share

27. New Mexico Human Services Department http://www.hsd.state.nm.us/ Medicaid Advisory Committee (MAC) Kaiser State Health Facts Site: http://kff.org/statedata/ CMS ◦ http://medicaid.gov/ http://medicaid.gov/

28. ∙http://www.cms.gov/http://www.cms.gov/ ∙Medicaid Statistical Information System (MSIS) ∙http://www.cms.gov/Research-Statistics- Data-and-Systems/Computer-Data-and- Systems/MedicaidDataSourcesGenInfo/ind ex.html

29. ∙http://www.cms.gov/http://www.cms.gov/ ∙CMS-64 Report – Expenditure Report by Federal Reporting Categories ∙http://www.cms.gov/Research-Statistics-Data- and-Systems/Computer-Data-and- Systems/MedicaidBudgetExpendSystem/CMS- 64-Quarterly-Expense-Report.htmlhttp://www.cms.gov/Research-Statistics-Data- and-Systems/Computer-Data-and- Systems/MedicaidBudgetExpendSystem/CMS- 64-Quarterly-Expense-Report.html ∙CMS – 21 Report ∙http://www.cms.gov/Research-Statistics-Data- and-Systems/Computer-Data-and- Systems/MedicaidBudgetExpendSystem/Quarterl y-CHIP-Statement-of-Expenditures-CMS- 21.htmlhttp://www.cms.gov/Research-Statistics-Data- and-Systems/Computer-Data-and- Systems/MedicaidBudgetExpendSystem/Quarterl y-CHIP-Statement-of-Expenditures-CMS- 21.html

30. Where to find Medicaid Enrollment Reports www.hsd.state.nm.us Click on “Looking for Information” at the top of the page Click on General Information (left column) Click on State Plans and Reports (sub-category) Click on Medicaid Eligibility Reports http://www.hsd.state.nm.us/LookingForInf ormation/medicaid-eligibility.aspx

31. http://www.hsd.state.nm.us/Meetings.a spx http://www.hsd.state.nm.us/Meetings.a spx Human Services Department Website Click on “About us” at the top of the page Click on Medicaid Advisory Committee (left column) Click on “Meetings”