AHCCCS Update AHCCCS Tribal Consultation Meeting October 27, 2010 Sells, Arizona
Topics to Cover � Tribal Consultation Policy � Budget � Health Care Reform
Tribal Consultation � AHCCCS Tribal Consultation Policy AHCCCS and Indian Tribes in the State of Arizona share the common goal of decreasing health disparities and maximizing access to critical health services. In order to achieve this goal, it is essential that the AHCCCS Administration and Indian Tribes engage in open, continuous, and meaningful consultation on a government-to-government basis. � Agency has regular Tribal Consultations � 9 in current Calendar Year – Second meeting on Tribal lands � 7 in 2009 � 6 from 2006-2008 � All information from previous meetings is available on web
American I ndians in AZ & AHCCCS American I ndians in AZ & AHCCCS Arizona Residents AHCCCS Members Arizona population: 6,343,952 AHCCCS members: 1,374,653 � � 285,183 AI Arizona residents 141,432 AI AHCCCS members � � Source: U.S. Census Bureau, 2006-2008 American Community Survey Source: AHCCCS, October 1, 2010
100% Federal Indian Health Service & Tribal Facility Payments (In Millions) 400 350 300 250 200 150 100 50 0 FY 2004 FY 2005FY 2006 FY 2007FY 2008FY 2009 FY 2010
AHCCCS Population as of July 1, 2010 1985 – 2010 1,400,000 1,352,908 1,200,000 1,047,982 1,000,000 800,000 600,000 508,917 456,385 400,000 318,383 200,000 144,450 - 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 2010 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 .
AHCCCS/TOTAL MEDICAID STATE MATCH SFY2006-SFY2015 $4,500,000,000 $4,000,000,000 $3,500,000,000 $3,000,000,000 Stimulus $2,500,000,000 Other County Tobacco $2,000,000,000 General $1,500,000,000 $1,000,000,000 $500,000,000 $0 SFY06 SFY07 SFY08 SFY09 SFY10 SFY11 SFY12 SFY13 SFY14 SFY15
AHCCCS/TOTAL MEDICAID STATE MATCH SFY2006-SFY2015 $4,500,000,000 $4,000,000,000 $3,500,000,000 $3,000,000,000 Other $2,500,000,000 County Tobacco $2,000,000,000 General $1,500,000,000 $1,000,000,000 $500,000,000 $0 SFY06 SFY07 SFY08 SFY09 SFY10 SFY11 SFY12 SFY13 SFY14 SFY15
Expenditure Changes FY 2007-FY 2011 *Medicaid numbers assume regular FMAP 9
AHCCCS Budget � 3 Options for Policy Makers when dealing with AHCCCS budget reductions � Eligibility – Limit - Health Care Reform � Payment Rates – Limit–Network & Access to Care � Benefits – Limit – Federal Requirements � Each has limitations but to date all have been utilized � Program today is over $800 million less as a result of policy decisions
AHCCCS Budget changes to Date � AHCCCS Program is $800 million less as a result of policy changes � $413 million in provider reductions � $241 m in institutional rate freezes � $121 m in eligibility reductions � $39 m in benefit changes � $29.5 m in admin reductions � $28 m in increased member cost sharing
AHCCCS Benefit Changes � Federal government establishes mandatory and optional benefits � October 1, 2010 Benefit Changes - $10 m General Fund � Adult Emergency Dental Care � Services provided by Podiatrist � Select Transplants - Well Exams - Orthotics � Limit Physical Therapy to 15 visits per year � State has been trying to secure benefit waiver for IHS and 638 Pass through payments
AHCCCS Budget � FY 2012 - $1 billion shortfall for FMAP � FY 2012 AHCCCS funding will be one of the biggest issues facing new legislature � Population Growth Slowing – � CY 2008 - 65,000 � CY 2009 - 210,000 � CY 2010 – (18,000) – Base up 30,900 - KidsCare (19,600) -FES (29,300)
AHCCCS Budget Cont. � AHCCCS will be implementing provider reductions on April 1, 2011 � Hospitals up to 5% � Other Providers being evaluated � Looking to establish limit on number of Inpatient Days � Cost Sharing/Copays - Agency working to maximize � Mandatory copays implemented 10-1-10 � Injunction has prevented implementation for Prop 204 pop. � Provider Tax continues to be discussed by stakeholders
Health Care Reform � PPACA expands Medicaid to 133% of the federal poverty limit on January 1, 2014. � Nationally Medicaid is estimated to grow by 16 million lives � Create Health Exchange � provide tax credit subsidy for individuals from 133% to 400% � Nationally Exchanges are expected to cover 24 million lives by 2019 � State needs to determine who will operate Exchange � Established Individual Mandate
Health Care Reform Several Components exist in Arizona � Population Expansion – Childless adults � Appropriate Payment to ensure access � Emphasize home and community services � Develop models to meet challenges of dual eligible population
Health Insurance Exchange � Nationally anticipated to enroll up to 24 m � Provide electronic marketplace for those receiving subsidy � Legislation establishes variety of plans � Exchange is responsible for regulating plans offered � Exchange is responsible for interfacing with Medicaid to determine if eligible
Health E-Arizona Applications 450,000 400,000 350,000 300,000 250,000 Public 200,000 Subscriber 150,000 100,000 50,000 0 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010
Exchange Policy Questions � Should the State Run an Exchange? � If Yes where should it be housed? – Insurance – AHCCCS – New Entity � How do we get a decision by the Spring of 2011? � What is role of AHCCCS in exchange and can current member enrollment infrastructure be leveraged? � How can product on the Exchange be established to meet unique needs of American Indians? � With Exchange implementation on 1-1-2014 has the purpose for HCG ended?
May-10 Mar-10 Jan-10 Nov-09 Sep-09 AHCCCS Staffing Levels Jul-09 May-09 Mar-09 Employees Jan-09 Nov-08 Sep-08 Jul-08 May-08 Mar-08 Jan-08 Nov-07 Sep-07 Jul-07 May-07 Mar-07 Jan-07 1500 1400 1300 1200 1100 1000 900 800
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