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Alabama Medicaid 2021 Budget Hearing
January 23, 2020
STEPHANIE MCGEE AZAR COMMISSIONER ALABAMA MEDICAID AGENCY
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AGENDA
- Overview
- 2021 Budget
- Medicaid Quality Initiatives
Alabama Medicaid 2021 Budget Hearing January 23, 2020 STEPHANIE - - PowerPoint PPT Presentation
Alabama Medicaid 2021 Budget Hearing January 23, 2020 STEPHANIE - - PowerPoint PPT Presentation
Alabama Medicaid 2021 Budget Hearing January 23, 2020 STEPHANIE MCGEE AZAR COMMISSIONER ALABAMA MEDICAID AGENCY 1 AGENDA Overview 2021 Budget Medicaid Quality Initiatives 2 Medicaid Overview 3 Who D o Doe oes Alabama M
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Medicaid Overview
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Who D
- Doe
- es Alabama M
Medicaid Se Serve?
FY 2018 2018 by Da Date of S Service
$11,804
Per Member Per Year
$2,614
Per Member Per Year
$10,457
Per Member Per Year
$3,772
Per Member Per Year
Disabled and Blind
Any Age
Most determined by the Social Security Office and have automatic Medicaid eligibility.
Children
Age 0-18
Children in families below 146% of the Federal Poverty Rate.
Aged
Age 65 and Over
Adults who are in poverty. Almost all are also covered by Medicare.
% of Expenditures % of Expenditures % of Expenditures % of Expenditures
Other Categories
Age 19-64
Other adults including pregnant women, parent caretakers, and family planning services.
% of Members % of Members % of Members % of Members
22% 47% 17% 17% 52% 9% 25% 11% Expenditures, dates of service, include claims, capitations, and access payments based on dates of service in FY 2018. PMPY calculations not for the purpose of determining managed care rates and do not align to date paid numbers. 4
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Hospital $2,524 36% Nursing Home $999 14% Pharmacy $823 12% Physicians $574 8% Mental Health $487 7% Alternative Care $372 5% Admin Costs $248 4% Other $955 14%
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FY Y 2019 M Medicaid Ex Expenditure Analysis
Benefit P Paymen ents and Ad Administrative Co e Costs ( (in m millions)
Total Expenditures $6.982 Billion
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Federal Funds $4,984 71%
Other State Share Sources $1,246 18% General Fund $752 11%
State Funds $1,998 29%
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FY 2 Y 2019 Medicaid Funding A g Analysis
St State a e and F Feder ederal F Fun unding (in n millions ns)
FY 19 Source of Funds: $6.982 Billion
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800000 850000 900000 950000 1000000 1050000 1100000 2012 2013 2014 2015 2016 2017 2018 2019 2020 YTD
Alabama Medicaid Agency Monthly Average Eligibles
Total
Monthly A Aver erage E e Eligibles 201 es 2012-2020*
* Fiscal Year 2020 YTD through October, 2019
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2021 Budget
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Alabama Medicaid 2021 State Funding Need
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- Total Funding Need
$842 million
- Less Projected Carryforward
$ 37 million
- General Fund Request
$805 million
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Inflationa
- nary I
Increa eases es
(In In m millions)
2021 vs. 2020
Recurring inflation increases
Pharmacy including Clawback
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Nursing Homes
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Insurance
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Total Benefit Cost
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- Carryforward
- Recurring inflationary increases
- Pharmacy
- Nursing Homes
- Medicare Part B Insurance
- FMAP changes – reduces state share requirement
- Impact shared with existing state share funding, such as hospitals;
- ther state agencies; and teaching hospitals
- Paybacks
- CHIP state share increase
- Hospital conditional funding
- Quality initiatives
Fac actors Af Affecting 2021 vs. 2 2020 R Reque quest
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Medicaid Quality Initiatives
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Medicaid id Q Qualit lity I Initia tiativ ives
Alabama Coordinated Health Network (ACHN)
- Implemented October 1, 2019; Case management began November 1, 2019.
- Single care coordination delivery system combining Health Home and Maternity
programs while also serving the Plan First population.
- Affects approximately 750,000 recipients.
- Rewards the achievement of quality benchmarks in the areas of childhood obesity,
reduction of infant mortality, and substance use disorder.
- Quality improvement projects, submitted by the networks, are currently being
reviewed by the Agency.
Integrated Care Network (ICN)
- Implemented October 1, 2018.
- A unique system of care management for the Long Term Care (LTC) population that
helps prepare for the population growth in LTC that is expected due to the aging of baby boomers.
- Manages the population and determines if the recipient is better served with home
and community-based services (HCBS) or in a nursing home.
- Allows for more comprehensive and integrative Case Management that drives
person-centered planning, enhances quality of life and improves health outcomes.
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Questions
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