Alabama Medicaid Agency July 18, 2016 FLAKE OAKLEY CHIEF FINANCIAL - - PowerPoint PPT Presentation

Alabama Medicaid Agency

July 18, 2016

FLAKE OAKLEY CHIEF FINANCIAL OFFICER ALABAMA MEDICAID AGENCY

December 10, 2014

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AGENDA DA

• Current Environment
• FY 2017 Budget
• Alabama Medicaid at a Crossroad

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Current Environment

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Medicaid Cr Critical P Points

• Medicaid is a bare bones, minimal program
• Medicaid has been successful in controlling costs
• f delivering services
• Medicaid has limited ability to control enrollment

and other cost drivers

• Medicaid is funded 68% by Federal Government

and 32% by the state including only 11% from the General Fund

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Medicaid Co Cost D Drivers

• Recipient Enrollment
• Medical Inflation
• Federal Matching Rate (FMAP) - Federal

Contribution

• Covered Services

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FY 2015 Percent of Population Annually Eligible for Medicaid by County

Highest Percentage

• Wilcox 57%
• Greene 51%
• Perry 51%
• Lowndes 50%
• Dallas 50%

Lowest Percentage

• Shelby 13%
• Madison 18%
• Lee 19%
• Limestone 20%
• Baldwin 20%

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Enrollment a and A Annual al C Cost Per E Enrol

• llee

lee 2 2008-2015

756,564 803,187 851,199 912,767 939,576 947,594 1,012,125 1,050,117 $5,813 $6,027 $6,238 $5,741 $5,989 $5,895 $5,714 $5,783 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 600,000 700,000 800,000 900,000 1,000,000 1,100,000 1,200,000 2008 2009 2010 2011 2012 2013 2014 2015 Annual Expenditures Per Enrollee Average Monthly Enrollees Number of Monthly Average Enrollees Annual Cost per Enrollee

Annual Compound Growth Rate of Enrollees 4.8% 7

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Medicaid FY 2017 Budget

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FY 17 B Budget Re Request Summa mary

In millions General Fund 2016 $685 Additional funding to support 2016 expenditures Carryforward used in 2016 37 One time funding used in 2016 36 73 TOTAL 2016 funding necessary to match expenditure level $758 Additional funding to support 2017 expenditures Inflation and utilization increases 22 Increase in paybacks 12 Other, Rounding

• 2

32 TOTAL 2017 without RCOs $790 Incremental RCO costs 2017 Increase in RCO capitated rates over current spend 37 Funding of claim runoff 15 52 Total 2017 with RCOs $842

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Service Activity FY 2015 Expense State Share Overall Amount General Fund Amount

Nursing Homes* $945 $293 $179 Pharmacy 685 256 148 Physician 517 159 121 Health Insurance* 335 99 93 Administration 257 93 53 Alternative Care 364 113 53 Health Support 222 69 30 Hospital* 2,146 666 5 Family Planning 59 6 3 Mental Health 462 143 CHIP-All Services 81 18 Grand Total $6,073 $1,915 $685 *Controlled by State Statute or Federal Requirement

FY 2015 Medica caid F Funding A Analysis

(in m n millions) s)

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Pr Programs S Subject to to C Cuts ts

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Potential Program Cuts Total State and Federal Share in millions* General Fund Overall Amount in millions*

End Primary Care bump (8/1/16) $ 49.2 $14.7 Eliminate adult eyeglasses $0.8 $0.3 Eliminate outpatient dialysis $12.3 $3.7 Eliminate Prosthetics and Orthotics $1.8 $0.5 Eliminate PACE Program $6.8 $2.0 Eliminate Health Home and Physician case management fees $55.5 $16.6 Reduction in Administrative Costs $13.6 $3.5 Eliminate Drug Coverage for Adults $323 to $388 $50 to $60 Implement Pharmacy preferred provider – net of loss of Rx tax $93.3 to $130 $19 to $30 Implement rate reductions to most providers $0 to $169.6 $0 to $50.1 *Estimated

Med edicaid a at C t Cross Roa

• ads

With adequate funding:

• Case Management and Care Coordination through

Regional Care Organizations

• Improved Population Health
• $748 million in federal dollars for Health System

improvement

Without adequate funding:

• Access to Care
• Shifting cost burden to hospitals (e.g. emergency room,

kidney dialysis)

• Lack of preventive care, more urgent care
• Lost opportunity to reform Medicaid system
• Loss of up to $748 million in federal waiver dollars

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