Presentation to the Legislative Finance Committee FY19 Appropriation - - PowerPoint PPT Presentation

New Mexico Human Services Department

Presentation to the Legislative Finance Committee FY19 Appropriation Request Brent Earnest, Secretary December 6, 2017

 HSD FY19 Appropriation Request Overview  Medicaid Budget and Performance

• Enrollment and Cost trends

 Behavioral Health Budget and Performance  Centennial Care 2.0 Update  Child Support Enforcement  Income Support Division  HHS 2020 and the Medicaid Management

Information System (MMIS) replacement project

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Today’s day’s Presentat atio ion

HSD SD FY FY 19 Appro propri priat atio ion Req eques est

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%).

• Changes to the Medicaid

Budget.

 $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 deral F l Funds ds 80.37% 37% Othe her State te Fun unds a and nd Revenue nue 3. 3.87 87% State G Genera ral l Fund nd 15.76% 76%

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 Enrollment growth trends have slowed.

• By June 2018, enrollment is projected to be 877,847, a

decrease from June 2017.

• FY19 growth of 1% projected, reaching more than 887,000.

 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

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FY19 Med edicaid Budget get Req eques est t High ghligh ghts ts

• 100

100,000 00 200 200,000 00 300 300,000 00 400 400,000 00 500 500,000 00 600 600,000 00 700 700,000 00 800 800,000 00 900 900,000 00 1, 1,000 000,000 00 Jan an-13 13 May ay-13 13 Se Sep-1 p-13 Jan an-14 14 May ay-14 14 Se Sep-1 p-14 Jan an-15 15 May ay-15 15 Se Sep-1 p-15 Jan an-16 16 May ay-16 16 Se Sep-1 p-16 Jan an-17 17 May ay-17 17 Se Sep-1 p-17 Jan an-18 18 May ay-18 18 Se Sep-1 p-18 Jan an-19 19 May ay-19 19 Medic icaid E id Enrollm llment

Ex Expansio ion/Other Adult lt G Grou

• up

Sate C Covera rage In Insura rance Medic icaid id A Adult lts Medic icaid id C Child ildren June ne 20 2019 Proje jected d Enrollm

• llment

OAG AG: : 25 255,19 192 Med edicaid Ad Adults: 26 267,22 229 Me Medica caid Child ildren: 36 364,64 649* 9* *children 19-21 y.o. counted in OAG

September 2017 2017 863, 863,516 16

Medicai icaid Enrol

• llme

ment nt

Projected

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Medicai icaid: F d: FY 19 Appro propria priatio ion Req eques est



Total Medicaid Program spending in FY 19 is projected to be $5.817 billion.

• $983.9 million from the general fund, an increase of $68.3 million.

Major changes from current year projection include:

Expansion FMAP (drops to 94% in 2018 and 93% in 2019) $14.9 Medicare Buy Ins $4.7 CHIP FMAP Reduction (100% to 72.13%) $30.7 FMAP Change ($7.9) County Support Medicaid and Tobacco Settlement Revenue (reduction) $5.3 Enrollment $12.9 Utilization and Price increases (less than 1% change) $12.5 Other Revenue changes ($4.8) Tota tal $68.3 8.3 ($ in millions)

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Enrollment up 5%; Per capita costs down 2%

Cent enten ennial C Care: re: Ma Mana naging ng C Cost G Gro rowth

 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

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Fede deral F l Funds ds, , $66. $66.85 M M, , 79% 79% State G Genera ral l Fund nd, , $15. $15.14 M M, , 18% 18% Other er S State e Fund nds, , $2.42 M 42 M, , 3% 3%

Medicai icaid: A d: Admin inis istrat ratio ion

Medicai icaid: M d: MCO HEDIS S Perform rman ance ce Measure res

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

Annual Dental Visits

47% 49% 56% 0% 10% 20% 30% 40% 50% 60% 70% HEDIS 14 HEDIS 15 HEDIS 16

Well Child Visits within 1st 15 mos.

*2016 NCQA Nat’l Avg. – 53%

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

Prenatal Care Visits in the 1st Trimester

*2016 NCQA Nat’l Avg. – 82% *2016 NCQA Nat’l Avg. – 62%

 $59.6 million overall budget.

• $37.0 million from the General

Fund.

• $22.6 million in federal funds.

 Increased federal funding of $4.6

million for combating opioid addiction and overdose crisis.

 NM overdose death rate improved

relative to other states.

 Improvement in national rankings

for New Mexico – From 44th in 2011 to 21st (2018 Mental Health America report).

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Fede dera ral l Fund unds 38% 38% State G e Gener eral Fund und 62% 62%

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Beh ehavior

• ral Hea

ealth th Spen ending

Total HSD Behavioral Health Spending (excl. administration)

FY17 Actuals FY18 Projection FY19 Projection ($ in millions) GF FF Total GF FF Total GF FF Total Medicaid Behavioral Health $102.85 $396.90 $499.75 $100.71 $384.74 $485.45 $108.24 $389.43 $497.67 Behavioral Health Services Division $37.40 $21.05 $58.45 $37.04 $20.60 $57.64 $37.04 $22.57 $59.61 Total $140.25 $417.95 $558.20 $137.75 $405.34 $543.09 $145.28 $412.00 $557.28 Percent change from prior year 0.47% 5.07% 3.87%

• 1.78%
• 3.02%
• 2.71%

5.47% 1.64% 2.61%

12 145,534 160,843 173,781 50,000 100,000 150,000 200,000

CY14 CY15 CY16

Behaviora ral l Healt lth Perform rman ance ce

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 tisfacti tion with ith Beha havioral H Heal alth h Services

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

Improv roving Follow

• w-Up Services

es a after Disc scharge

7 Day 30 Day

Indi dividua duals served d by BH Collabo aborative ve programs

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Are reas o

• f focus

Centennial Care 2.0 builds on successes achieved during the past four

• years. Improvements and reforms will ensure sustainability of the

program while preserving comprehensive services.

• Care coordination
• Behavioral health integration
• Long-Term Services and Supports (LTSS)
• Payment reform
• Member engagement and personal responsibility
• Administrative simplification through refinements to benefits and

eligibility

 The final 1115 waiver renewal application is being submitted this week.  It will be available at: http://www.hsd.state.nm.us/centennial-care-2-

0.aspx

 Key Changes from the draft application include:

• Expanded services for substance use disorder: Screening, Brief Intervention and Referral

to Treatment (SBIRT) and adult residential treatment

• Premiums only for higher income adults in the Adult Expansion group ($10/month);
• Restructures copayments for two services—non emergent use of ER and use of non-

preferred drug when a preferred drug is available

• Phases out retroactive coverage by 2020, instead of eliminating in 2019.

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Centennial ial Care re 2.0 0 Updat date

Preliminary Estimates of Costs and Savings of Changes (Part of Budget Neutrality) One Year Average 5 Year Total General Fund Total General Fund Increases $57,829,643 $8,178,064 $86,049,672 $19,002,006 Decreases $(22,437,783) $(20,990,776) $(101,196,120) $(109,097,834) Net $35,391,860 $(12,812,712) $(15,146,448) $(90,095,828)

Child ild Suppo pport rt Enforce rcement Divi vision

• n

 $30.97 million total

budget request

• $7.64 million from the general

fund, $545k more for FY19

• Reduce the vacancy rate
• Replace other revenue
• $20.31 million from federal

funding

• $3 million from other revenue

 70,273 child support

cases = 102,662 children

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95% Went to families

(5% reimbursed to public assistance dollars)

$140 Million

child support collected in FY17

COLLECTIONS

For every $1.00 spent $3.26 is collected by the Child Support Program

$ $$$

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Child ild Suppo pport rt Enforce rcement Perform rman ance ce

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Obligated Cases Current Support Owed that is Collected Paternity Establishment Cases Paying on Arrears SFY16 SFY17

Income

• me Support

t Divi vision n - Program

 $875.6 million overall

budget

• Mostly federal funding for SNAP

benefits

 Increase of $398.5 thousand

in General Fund needed to maintain State SNAP

Supplement ($25 per month).

 ISD programs also includes

funding for homeless (meals and shelters), food banks, school lunches, energy assistance, and cash assistance.

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Fede deral F l Funds ds 98.49% 49% State G Genera ral l Fund nd 1. 1.51 51%

Income

• me Support

t Divi vision n - Admi mini nistr trati tion

• n

 $89.4 million overall budget.  General Fund remains flat to

FY18 Op Bud.

 Secured additional federal

funding to support the workforce and customer service improvements.

 ISD Admin cost allocation

changes which increased the

• verall blended rate for ISD

eligibility determination from 60% to 67%.

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Fede deral F l Funds ds 64.94% 94% State G Genera ral l Fund nd 34.29% 29% Other er S State e Fund nds 0. 0.78 78%

SNAP AP P Part rtici icipation tion

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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

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Suppl pplemental al Nutrit ritio ion Assis istan ance Program ram

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%

Timeline ness ss of appl plicat ation n processi sing ng Percent o t of elig ligib ible c chil ildren partic ticipati ting i in SNAP AP

Tempo porary rary Assis istan ance ce f for Needy y Fa Families – (TANF) NF)

 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.

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Cash sh Ass Assistance, , $51. $51.1 M M, , 38% 38% Admin inis istra ratio ion, , $11. $11.5 M M, , 8% 8% Suppo pport rt S Serv rvices, , $19. $19.7 M M, , 14% 14% Othe her A Agenc ncies, , $54. $54. M M, , 40% 40%

TANF F Part rticip icipat atio ion

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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

 ISD remains focused on helping TANF recipients prepare for and find

employment.

• CareerLinks
• At the end of SFY17, 596 individuals were placed in employment.
• One-half of those individuals were transitioned to unsubsidized employment
• Wage Subsidy
• Approximately one-fourth of the total served were transitioned to unsubsidized

employment at the end of SFY17.

• High School Equivalency Credential Program
• In SFY17, 231 individuals were referred by SL Start, of which one-third completed the

program.

• Vocational Training Program
• 169 Individuals participated in the program in SFY17.
• 98 participants completed the training at the end of SFY17.
• Partnership with the Department of Workforce Solutions.

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Tempo porary rary Assis istan ance ce f for Needy y Fa Families – (TANF) NF)

Tempo porary rary Assis istan ance ce f for Needy y Fa Families – (TANF) NF)

 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

PROGRAM ($ in in m millio illions) GF GF FF FF TOTAL GF GF FF 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

• TOTAL R

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 TOTAL 0.09 137.4 137.5 0.09 136.2 136.3 Cal alculat ated C Car arryover B Bal alan ance 42.3 21.9 FY18 O OP B BUD FY19 R REQUEST

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 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 submitted on time.

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

statewide IT systems.

• ITD: MMIS and CSES replacement projects in progress.

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Program ram Suppo pport rt and d Informatio ion Technol nology gy

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 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

Medicai icaid d Manag agement Inform rmat atio ion System Replace placement (MMISR) SR)

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 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

MMIS MMISR Costs and nd Bud udget

Questions?

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