Presentation to Legislative Finance Committee Preview of FY19 - - PowerPoint PPT Presentation

New Mexico Human Services Department

Presentation to Legislative Finance Committee Preview of FY19 Appropriation Request Brent Earnest, Secretary October 25, 2017

 HSD FY19 Appropriation Request Overview  Medicaid Budget and Performance

• Enrollment and Cost trends

 Behavioral Health Budget and Performance  Child Support Enforcement  Income Support Division

• Temporary Assistance for Needy Families

 HHS 2020 and the Medicaid Management

Information System (MMIS) replacement project

 Centennial Care 2.0 Update

2

Today’s Presentation Today’s Presentation

HSD FY 19 Appropriation Request HSD FY 19 Appropriation Request

FY 19 Budget Request of $7.085 billion

 2.34% increase overall  $1.116 billion from the

general fund (increase of $83.8 million or 8.12%)

 $5.694 billion in federal

funds (increase of $82.2 million or 1.46%)

 $274.1 million in other

state funds and other revenue

Fede Federa ral Funds l Funds 80.37% 80.37% Othe Other r Sta State e Funds Funds and and Rev Revenue nue 3.87% 3.87% Sta State Gen e General Fund Fund 15.76% 15.76%

3

HSD General Fund Budget Change HSD General Fund Budget Change

15. 15.92% 10. 10.22% 18. 18.48% 12. 12.18%

• 21.

1.87 87%

• 1.
• 1.02%

36. 36.45% 4.5 4.54% 2.9 2.90%

• 2.
• 2.37%

0.6 0.68% 1.5 1.52% 0.15 152% 2% 8.1 8.12%

• 30.00%
• 20.00%
• 10.00%

0.00% 10.00% 20.00% 30.00% 40.00%

FY06 OP BUD FY07 OP BUD FY08 OP BUD FY09 OP BUD FY10 OP BUD FY11 OP BUD FY12 OP BUD FY13 OP BUD FY14 OP BUD FY15 OP BUD FY16 OP BUD FY17 OP BUD FY18 OP BUD FY19 REQUEST

Percent Change in HSD General Fund Budget

*GF adjustment due to ARRA

4

 Enrollment growth trends have slowed

• By June 2018, enrollment projected to be 917,000,

essentially flat from June 2017.

• FY19 growth of 0.8% projected, reaching more than

922,000

 Cost trends in Centennial Care are significantly

lower than regional and national health care inflation

 Uncertainty at the federal level

• FMAP changes
• Reauthorization of CHIP program
• ACA “repeal and replace” legislation
• Enrollment trends

5

FY19 Medicaid Budget Request FY19 Medicaid Budget Request Highlights Highlights

• 100,000

100,000 200,000 200,000 300,000 300,000 400,000 400,000 500,000 500,000 600,000 600,000 700,000 700,000 800,000 800,000 900,000 900,000 1,000,000 1,000,000 Jan-13 Jan-13 May-13 May-13 Sep-13 Sep-13 Jan-14 Jan-14 May-14 May-14 Sep-14 Sep-14 Jan-15 Jan-15 May-15 May-15 Sep-15 Sep-15 Jan-16 Jan-16 May-16 May-16 Sep-16 Sep-16 Jan-17 Jan-17 May-17 May-17 Sep-17 Sep-17 Jan-18 Jan-18 May-18 May-18 Sep-18 Sep-18 Jan-19 Jan-19 May-19 May-19 Medicaid Enrollment Medicaid Enrollment

Expan pansio ion/ n/Other Adu Other Adult G t Grou

• up

Sate Covera Sate Coverage ge Insurance Insurance Medicaid Adults Medicaid Adults Med Medicaid id Ch Chil ildren en June 2019 June 2019 Project Projected d Enr Enrollme ment nt OAG OAG: 275, 275,685* Medi Medicaid Adul Adults: 271, 271,512 Medicaid caid Chil ildre dren: 379, 379,107* *children 19-21 y.o. counted in OAG

Medicaid Medicaid Enrollment nrollment

August 2017 August 2017 911,803 911,803

Projected

6



January 2014 also launched adult expansion of Medicaid—Alternative Benefit Package



Significant enrollment growth in 4 years:

7

58% 42%

2017 2017

43% 57%

2013 2013

Children (<21 Years) Adults (>=21 Years)

Medicaid Medicaid Cat Category gory Enrollm Enrollment June ent June 2013 2013 Enrollm Enrollment ent August 2017 August 2017 Perc Percenta entage Increas Increase Parents/Caretaker Adults (0-47% FPL) 40,776 77,734 91% Other Adults (48% - 138% FPL) 36,812 (SCI) 268,723 (Adult Expansion) 629% All Medicaid All Medicaid 575,908 575,908 911,803 911,803 58% 58%

Medicaid Enrollment Transformation Medicaid Enrollment Transformation

8

Enrollment up 5%; Per capita costs down 2%

Centennial Care: Managing Cost Growth Centennial Care: Managing Cost Growth

Medicaid: FY 19 Appropriation Medicaid: FY 19 Appropriation Request Request (as of Sept. 1)

(as of Sept. 1)



Total Medicaid Program spending in FY 19 is projected to be $5.892 billion.

• $997.2 million from the general fund, an $81.5 million increase.

Major changes from FY18 include:

FY19 base - additional general fund above FY18 appropriation $15.82 Expansion FMAP (drops to 94% in 2018 and 93% in 2019) $14.70 Enrollment $11.73 Utilization and Price increases (less than 1% change) $11.66 Medicare Part B $2.62 CHIP FMAP Reduction (100% to 72.13%) $31.23 FMAP Change (71.90 to 72.13) ($7.18) County Support Medicaid and Tobacco Settlement Revenue (reduction) $5.34 Other Revenue changes ($4.38) Total Total $81.54 $81.54 ($ in millions)

9

 The total FY 19 budget request

for administration of the Medicaid program is $84.4 million

• $4.864 million increase from FY18
• $888.8 thousand increase in general

fund need to support contractual services.

 Medical Assistance Division

administrative spending is only 1.43% of the total program budget.

 Priorities for MAD staff in 2019

include:

• Implementation of 1115 Waiver

Renewal

• Continued procurement and

implementation of replacement MMIS

10

Fede Federa ral Funds, l Funds, $66.85 M, 79% $66.85 M, 79% Sta State Gen e General Fund, $15.14 M, Fund, $15.14 M, 18% 18% Othe Other r Sta State e Funds Funds, $2.42 M, $2.42 M, 3% 3%

Medicaid: Administration Medicaid: Administration

Medicaid: MCO HEDIS Medicaid: MCO HEDIS Performance Measures Performance Measures

11

64% 66% 68% 0% 10% 20% 30% 40% 50% 60% 70% HEDIS 14 HEDIS 15 HEDIS 16

Annual Dental Visits

47% 52% 57% 0% 10% 20% 30% 40% 50% 60% 70% HEDIS 14 HEDIS 15 HEDIS 16

Well Child Visits within 1st 15 mos.

47% 52% 54% 0% 10% 20% 30% 40% 50% 60% 70% HEDIS 14 HEDIS 15 HEDIS 16

Asthma Medication Management

48 49 48 45 10 20 30 40 50 60 HEDIS 14 HEDIS 15 HEDIS 16 SFY17 Preliminary

ER Visits per 1,000

12

73% 71% 77% 0% 20% 40% 60% 80% HEDIS 14 HEDIS 15 HEDIS 16

Prenatal Care Visits in the 1st Trimester

Medicaid: MCO HEDIS Medicaid: MCO HEDIS Performance Measures Performance Measures

52% 46% 56% 0% 10% 20% 30% 40% 50% 60% HEDIS 14 HEDIS 15 HEDIS 16

Received greater than 81% of expected prenatal visits

7% 7% 7% 6% 0% 2% 4% 6% 8% CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3

Reduction in hospital readmissions for children within 30 days of discharge

13% 12% 10% 10% 0% 5% 10% 15% CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3

Reduction in hospital readmissions for adults within 30 days of discharge

13

Behavioral Health Spending Behavioral Health Spending

 FY19 request for BHSD is $59.6 million, $37.0 million from

the General Fund.

• Increased federal funding for combating opioid addiction and overdose

crisis Total HSD Behavioral Health Spending (excl. administration)

FY17 Actuals FY18 Op Bud* FY19 Request ($ in millions) GF FF Total GF FF Total GF FF Total Medicaid Behavioral Health $107.49 $393.62 $501.11 $115.58 $424.3 $539.87 $107.48 $394.36 $501.83 Behavioral Health Services Division $37.4 $21.05 $58.45 $37.04 $20.6 $57.64 $37.04 $22.57 $59.61 Total $144.89 $414.67 $559.56 $152.62 $444.9 $597.52 $144.52 $416.93 $561.44 Percent change from prior year

• 1.24%

3.40% 2.15% 5.33% 7.29% 6.78%

• 5.31%
• 6.29%
• 6.04%

Note: *FY18 Operating Budget for MAD BH is overstated. Adjustments to the Medicaid appropriation were not included in the MAD BH program appropriation.

14

2,699 3,682 4,890 SFY 15 SFY 16 SFY17 3.5% 5.7% 1.7% 3.8% 3.7% 10.2% 4.4% 5.7% 1.4% 2.2%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%

SFY12 SFY13 SFY14 SFY15 SFY16

5th Grade Reading 5th Grade Reading 8th Grade Math 8th Grade Math

Number of persons serve Number of persons served through through Telehealth in rural Telehealth in rural and fronti and frontier counti counties Indivi Individual duals ser s served by ed by BH BH Collaborativ Collaborative programs programs

145,534 160,843 173,781 50,000 100,000 150,000 200,000

CY14 CY15 CY16

Re Reductio ction in n in Proficien iciency Ga Gaps

Behavioral Health Performance Behavioral Health Performance

15

29.84% 39.11% 33.28% 42.24% 48.50% 61.92% 52.40% 61.65% 20% 30% 40% 50% 60% 70% SFY14 SFY15 SFY16 SFY17

Improving Follow-Up Services after Improving Follow-Up Services after Discharg Discharge

7 Day 30 Day

87.70% 88.00% 86.40% 86.44% 86.40% 87.10% 83.50% 84.02%

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% 2014 2015 2016 2017 Adult Family/Caregiver

Sati Satisfac sfacti tion with

• n with

Behavioral Behavioral Health Service Health Services

Behavioral Health Performance Behavioral Health Performance

Child Support Enforcement Child Support Enforcement Division Division

 $30.97 million total budget

request

• $7.64 million from the general fund
• Reduce the vacancy rate
• Replace other revenue
• $20.31 million from federal funding
• $3 million from other revenue

 69,127 child support cases in

FY17

 Key priorities

• Implement Business process model

to ensure more efficient and effective service

• Replacement of the old Child

Support Enforcement IT system

16

$132.1 M $137.1 M $140.1 M $140.8 M $139.6 M $126. M $128. M $130. M $132. M $134. M $136. M $138. M $140. M $142. M FY13 FY14 FY15 FY16 FY17

Child Support Collections (in millions)

Income Support Division Income Support Division

 $965.0 million overall budget  Increase of $398.5 thousand in

General Fund needed to maintain Senior SNAP Supplement

($25 per month).

 The increase in Federal funds

is primarily due to an increase in SNAP caseload and higher projected spending in the LIHEAP Program- 100% Federal funding.

17

Fede Federa ral Funds l Funds 95.38% 95.38% Sta State Gen e General Fund Fund 4.55% 4.55% Othe Other Sta r State e Funds Funds 0.07% 0.07%

SNAP Participation SNAP Participation

18

130,000 150,000 170,000 190,000 210,000 230,000 250,000 17,000,000 18,000,000 19,000,000 20,000,000 21,000,000 22,000,000 23,000,000 24,000,000 Oct 2009 Dec 2009 Feb 2010 Apr 2010 Jun 2010 Aug 2010 Oct 2010 Dec 2010 Feb 2011 Apr 2011 Jun 2011 Aug 2011 Oct 2011 Dec 2011 Feb 2012 Apr 2012 Jun 2012 Aug 2012 Oct 2012 Dec 2012 Feb 2013 Apr 2013 Jun 2013 Aug 2013 Oct 2013 Dec 2013 Feb 2014 Apr 2014 Jun 2014 Aug 2014 Oct 2014 Dec 2014 Feb 2015 Apr 2015 Jun 2015 Aug 2015 Oct 2015 Dec 2015 Feb 2016 Apr 2016 Jun 2016 Aug 2016 Oct 2016 Dec 2016 Feb 2017 Apr 2017 Jun 2017

Total SNAP Households in New Mexico Total SNAP Households in the US

SNAP: Monthly Number of Households

National Households New Mexico Households

19

Supplemental Nutrition Assistance Supplemental Nutrition Assistance Program Program

87.1% 93.3% 95.6% 92.5% 96.9% 82.5% 90.0% 97.4% 92.4% 97.1% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% 2014 2015 2016 2017 2018 (1st Qtr.)

Regular - 30 Day Expedited - 7 Day 82.1% 88.8% 92.4% 92.2%

80.0% 85.0% 90.0% 95.0% 100.0%

Tim Timeliness o liness of a applica icatio tion p processin essing Percen rcent o t of e eligib igible ch le child ildren en part rticipa icipatin ing in g in SN SNAP

TANF Participation TANF Participation

20

5,000 7,000 9,000 11,000 13,000 15,000 17,000 19,000 21,000 23,000 950,000 1,050,000 1,150,000 1,250,000 1,350,000 1,450,000 1,550,000 1,650,000 1,750,000 1,850,000 1,950,000 Oct‐05 Feb‐06 Jun‐06 Oct‐06 Feb‐07 Jun‐07 Oct‐07 Feb‐08 Jun‐08 Oct‐08 Feb‐09 Jun‐09 Oct‐09 Feb‐10 Jun‐10 Oct‐10 Feb‐11 Jun‐11 Oct‐11 Feb‐12 Jun‐12 Oct‐12 Feb‐13 Jun‐13 Oct‐13 Feb‐14 Jun‐14 Oct‐14 Feb‐15 Jun‐15 Oct‐15 Feb‐16 Jun‐16 Oct‐16 Feb‐17

Total TANF Cases in New Mexico Total TANF Cases in the US

TANF: Monthly Number of Families

US: Number of TANF Families New Mexico: Number of TANF Families

Temporary Assistance for Needy Temporary Assistance for Needy Families – Families – (TANF) TANF)

 FY19 TANF appropriation

request of $136.3 million:

• TANF block grant of $109.9

million and $25.5 million of current carry over balances.

• Cash assistance, flat with FY18

OpBud.

 Includes restoring (increasing) monthly cash assistance grant by 7.5%

• Maintains support of programs

at other agencies

• Continues support services

programs, such as attaining high school equivalency and employment programs.

21

Cash Cash Assis Assistance ce, $51.1 M, 38% $51.1 M, 38% Admin Administra strati tion

• n,

$11.5 M, 8% $11.5 M, 8% Sup Support Ser Services, , $19.7 M, 14% $19.7 M, 14% Othe Other Age r Agencies, es, $54. M, $54. M, 40% 40%

TANF Work Participation Rate TANF Work Participation Rate



Caseload has decreased

• In 2012, HSD had an average caseload
• f 18,201
• In 2017, the average was 11,055



Increase of child only cases

• In 2012, the average child only cases

was 37.1% of the caseload.

• In 2017, the average child only cases

was 45.3% of the caseload.



1 parent household has decreased

• In 2012, the average number of one

parent households was 56.2% of the caseload.

• In 2017, the average number of one

parent households had dropped to 47.2% of the caseload.

22

34.4% 33.5% 36.6% 48.4% 51.9% 46.0% 51.7% 39.3% 36.1% 54.7%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 2012 2013 2014 2015 2016

FFY Work Participation Rates

US Average New Mexico

Job Readiness Activities

 ISD remains focused on helping TANF

recipients prepare for and find employment

• CareerLinks
• Wage Subsidy
• High School Equivalency Credential Program
• Vocational Training Program

 Partnership with the Department of Workforce

Solutions

23

Temporary Assistance for Needy Temporary Assistance for Needy Families – Families – (TANF) TANF)

Temporary Assistance for Needy Temporary Assistance for Needy Families – Families – (TANF) TANF)

 Admin Includes: Income Support Administration and Program Support Administration  Cash Assistance Includes: Cash Assistance, Clothing Allowance, Diversion Payments, Wage

Subsidy and State Funded Legal Aliens

 Support Services Include: NM Works Program, Transportation, Career Links, High School

Equivalency program, Vocational Training Program and Employment Related Costs

 Other Agencies Include: CYFD Pre K, CYFD Child Care, CYFD Home Visiting, CYFD

Supportive Housing and PED Pre K

PR PROGR OGRAM ($ in m in millio illions) ns) GF FF TO TOTAL TAL GF FF TOTAL General Funds in HSD for TANF 0.09

• 0.09

0.09

• 0.09

Unspent balances from prior periods

• 69.7

69.7

• 48.3

48.3 TANF Block Grant

• 109.9

109.9

• 109.9

109.9 TANF Contingency

• TO

TOTAL TAL RE REVENUE 0.09 179.6 179.7 0.09 158.2 158.3 ADMIN TOTAL

• 11.5

11.5

• 11.5

11.5 Cash Assistance 0.09 51.2 51.3 0.09 51.0 51.1 Support Services

• 20.7

20.7

• 19.7

19.7 Other Agencies

• 54.0

54.0

• 54.0

54.0 TO TOTAL TAL 0.09 137.4 137.5 0.09 136.2 136.3 Ca Calculated Ca Carryo yover Ba r Balance 42.3 21.9 FY18 O 18 OP BUD BUD FY19 RE 19 REQUEST

24

 Program Support provides administrative

support to the program divisions of HSD

 The FY19 budget request for Program Support

is $53.3 million, with $15.8 million requested from the General Fund

 Key projects and results

• ASD: Unqualified opinion from independent auditors

(FY16); FY17 in progress and on track

• ITD: Maintain and support critical and large-scale,

statewide IT systems

• ITD: MMIS and CSES replacement projects in progress

25

Program Support and Information Program Support and Information Technology Technology

26

 System processes 10 million transactions, totaling $6 billion

in medical care for 900,000 New Mexicans through 27,675 providers and 4 MCOs.

 Aligns with federal requirements

• Risk of reduced federal funding for non‐compliant system

 90% Federal ‐ 10% State funding  Creates a client‐centric business solution and is the

foundation for additional development within New Mexico’s Health & Human Services (HHS) enterprise.

• Connecting existing services in HSD with DOH, CYFD, and ALTSD to

deliver a customer‐centric focus through shared technology

 Unified Portal and Consolidated Customer Service Center and Data Services

Medicaid Management Information Medicaid Management Information System Replacement (MMISR) System Replacement (MMISR)

27

 Undertaking five procurements to implement MMISR

• System Integrator (SI) -- in contract negotiation
• Data Services (DS) -- finalizing vendor selection
• Quality Assurance (QA) -- release RFP in November 2017
• Benefit Management Services (BMS) -- release RFP in February 2018
• Financial Services (FS) -- release RFP in May 2018

 HSD requests $6.8 million in State General Fund to support the

continuation of the $175.6 million MMISR project.

• The legislature has appropriated $87.09 million (Federal and State

share) in project funds to date.

• The project received approval of an Advanced Planning Document

Update Budget from CMS in June 2017.

Category or Account Description FY17 & Prev Actual FY18 Budgeted FY19 Request FY20 Estimate FY21 Estimate Total General Fund $1,699.0 $7,010.0 $6,801.9 $2,033.4 $3.6 $17,845.9 Federal Funds $15,636.2 $62,744.7 $64,445.3 $14,838.3 $33.1 $157,758.3 Total $17,335.2 $69,754.7 $71,605.9 $16,871.7 $36.7 $175,604.2

MMISR Costs and Budget MMISR Costs and Budget

 Next Public Meeting: Albuquer

Next Public Meeting: Albuquerque – que – Monday, October 30, 2017,

• nday, October 30, 2017,

5:30 to 5:30 to 7:30 pm 7:30 pm

• National Hispanic Cultural Center
• By phone: 1-888-757-2790, participant code 991379#

 Additional info:

• http://www.hsd.state.nm.us/centennial-care-2-0.aspx

 To submit comments:

• Email to HSD-PublicComment@state.nm.us
• Mail to Human Services Department, ATTN: HSD Public

Comments, PO Box 2348, Santa Fe, NM 87504-2348

 Commen

Comments wil s will be accepte be accepted unti until 5:00pm MST on Monday, 5:00pm MST on Monday, Nov November 6, mber 6, 2017 2017

28

Centennial Care 2.0 Information Centennial Care 2.0 Information

Questions?

29