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

December 10, 2014 Alabama Medicaid Agency July 18, 2016 FLAKE OAKLEY CHIEF FINANCIAL OFFICER ALABAMA MEDICAID AGENCY 1

AGENDA DA • Current Environment • FY 2017 Budget • Alabama Medicaid at a Crossroad 2

Current Environment 3

Medicaid Cr Critical P Points • Medicaid is a bare bones, minimal program • Medicaid has been successful in controlling costs of 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 4

Medicaid Co Cost D Drivers • Recipient Enrollment • Medical Inflation • Federal Matching Rate (FMAP) - Federal Contribution • Covered Services 5

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% 6

Enrollment a and A Annual al C Cost Per E Enrol ollee lee 2 2008-2015 1,200,000 $7,000 $6,238 $6,027 $5,989 $5,895 $5,813 1,100,000 $5,741 $6,000 $5,714 $5,783 Annual Expenditures Per Enrollee 1,050,117 Average Monthly Enrollees 1,000,000 $5,000 1,012,125 947,594 939,576 900,000 $4,000 912,767 Annual Compound Growth Rate of Enrollees 4.8% 851,199 800,000 $3,000 803,187 756,564 700,000 $2,000 600,000 $1,000 2008 2009 2010 2011 2012 2013 2014 2015 Number of Monthly Average Enrollees Annual Cost per Enrollee 7

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Medicaid FY 2017 Budget 9

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 22 Inflation and utilization increases Increase in paybacks 12 Other, Rounding -2 32 TOTAL 2017 without RCOs $790 Incremental RCO costs 2017 37 Increase in RCO capitated rates over current spend Funding of claim runoff 15 52 Total 2017 with RCOs $842 10

FY 2015 Medica caid F Funding A Analysis (in m n millions) s) State Share General Fund Service Activity FY 2015 Expense Overall Amount 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 0 CHIP-All Services 81 18 0 Grand Total $6,073 $1,915 $685 *Controlled by State Statute or Federal Requirement 11

Programs S Pr Subject to to C Cuts ts Total State and General Fund Federal Share in Overall Amount Potential Program Cuts millions* in millions* $ 49.2 $14.7 End Primary Care bump (8/1/16) 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 $55.5 $16.6 case management fees Reduction in Administrative Costs $13.6 $3.5 Eliminate Drug Coverage for Adults $323 to $388 $50 to $60 Implement Pharmacy preferred $93.3 to $130 $19 to $30 provider – net of loss of Rx tax Implement rate reductions to most $0 to $169.6 $0 to $50.1 providers *Estimated 12

Med edicaid a at C t Cross Roa oads 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 13