1. Tuesday, May 25, 2010 Collaborative Research …Humanizing research

2. Medicare/Medicaid DSH Payment Reduction 2 201020112012201320142015201620172018201 9 Medicaid Expansion Accountable Care Organizations Insurance Reforms (Pre-existing conditions for children, no annual / lifetime limits, children on parents insurance until 26) Insurance Reforms (Pre-existing conditions for adults, premium limits) Individual Mandate Health Reform Timeline Health Insurance Exchange— temporary ban on uninsured with pre-existing conditions Health Insurance Exchange— Permanent (Health Risk Exchange)

3. Immediate Changes to Health Care Increase funding to Community Health Centers Increase pay to Primary Care Physicians Reward ‘Medical Homes’ that are certified as Accountable Care Organizations Reform Insurance – temporary fixes o Ban insurance denial to those with pre-existing health condition o Increase family coverage for young adults to age 26 Federal Medicaid Match Expansion Match 100% match for 3 years Scales to 90% by 2017 Current FL Medicaid Match Rate (FMAP): 54% 3

4. Longer-Term Changes to Health Care Expand Medicaid to all individuals under age 65 up to 133% of the Federal Poverty Level Increase Medicaid reimbursement to level of Medicare Help small business (up to 100 employees) buy health insurance Reform Insurance – long term fixes Create single set of rules for eligibility and claims Ban lifetime limits on health coverage Eliminate annual dollar limits on health insurance 4

5. Florida Health Care Reform 1)1115 Research & Demonstration Waiver Demonstration implemented in Broward and Duval Counties in 2006, expanded to Baker, Clay and Nassau Counties in 2007 2) Current legislative session in Florida closed with Medicaid managed care reform vetoed. Hurts financial projections for the Counties. Medicaid is 25% of the budget in Florida. Concerns that implementation of program would cost $3 million in FY 2010. Immediate increase in costs without managed care estimated at $7 million. 5

6. Tuesday, May 25, 2010 6

7. History of Orange County Support for PCAN 7

8. 8 High functioning 22-partner collaborative dedicated to health care access for uninsured and under-insured with leadership from county government Nationally distinctive in containing all elements of continuum of care Since PCAN formed in 2000, the number of uninsured patients has grown from 3% to 50% with minimum increase in expenditure by Orange County government There has been a sustained decrease of 25% in uninsured patients accessing local Emergency Departments Current Assessment

9. Healthcare Reform Impact on PCAN 9 Medicaid reimbursement is due to increase 31% for Community Health Centers with a near doubling of volume Incentives will exist for states to convert to Medicaid managed care Medicaid rates will increase to the Medicare rate by 2013 with a federal: state match of 100% for 3 years (2014-2016), scaled back to 90% by 2017 (currently, Florida matches at 54%) More individuals with chronic or catastrophic conditions will be insured (Florida ranks #3 in the US)

10. 10 Moving Forward Enhance chronic and catastrophic medical case management Recommend restriction to 1-year of Orange County residency for access to Secondary (Specialty) care Develop coalition with risk entity to compete with proprietary Medicaid Managed Care Organizations. Formalize 501 (c) 3 status to directly accept grant funds

11. 11 Strategic Options for PCAN in Era of Health Care Reform

12. PCAN and Dollar Impact on Orange County 1) Enhanced Medicaid reimbursement Increase reimbursement to FQHC by 31% Start: 2012 2) Grants (estimate 3-4 in Year 1, triple that Years 2-4) Each grant at $400-500,000/year for 4-years = $1.6 to $2.0 million with 10% administrative = $160,000 - $200,000 Start: Fall 2011 3) Managed care contracting Dollar amount to be estimated Start: depends on State, 2012 12

13. Collaborative Research, LLC 13 Collaborative Research …Humanizing research www.collaborativeresearch.us www.collaborativeresearch.us Tracy Kulik, President 1-800-893-8276 Jeff Daniel, CFO 1-866- 336-5503