DEPARTMENT OF MEDICAL ASSISTANCE SERVICES JUNE 8, 2017 A Time of - PowerPoint PPT Presentation

OVERVIEW OF VIRGINIA MEDICAID AND POTENTIAL FEDERAL CHANGES DEPARTMENT OF MEDICAL ASSISTANCE SERVICES JUNE 8, 2017

A Time of Major Change in Health Care Complex Environment Consistent Themes of Policy Change • Addressing access to Growing Costs Dynamic Policy Debate health care • Controlling health care cost growth New Processes New Regulations • Shifting responsibility to states and localities New Technologies Individual Impacts 2

Holding Steady in the Face of Uncertainty Our mission has not changed… …but how we meet the mission may be changing… Success depends on all of us to partner together 3

DMAS Mission Ensure Virginia’s Medicaid Enrollees Receive Quality Health Care Superior Care Cost Effective Continuous Improvement 4

Virginians Covered by Medicaid/CHIP 1 in 8 Virginians rely on Medicaid covers 1 in 3 2 in 3 nursing facility Medicaid births in Virginia residents are supported by Medicaid Medicaid is the primary 33% of children in 62% of long-term services payer for behavioral Virginia are covered by and supports spending is in Medicaid & CHIP the community health services Medicaid plays a critical role in the lives of over 1.3 million Virginians 5

Who Medicaid Serves Growing Kids: Every baby deserves a healthy start and DMAS focuses on keeping children healthy through the Family Access to Medical Insurance Security programs (FAMIS). FAMIS covers the medical and dental care that growing children need. Pregnant Women: Good health care during pregnancy is important for both mother and baby. The FAMIS Moms Program assists pregnant women with regular prenatal and dental care to increase the likelihood for healthy birth outcomes. Older Adults: Medicaid is the primary payer for long term services and supports for Virginia’s aging population. The use of home and community based waivers allow individuals to receive the care and support they need in the comfort of their own home. People with Behavioral Health Conditions: Virginia Medicaid provides an array of behavioral health and addiction and recovery treatment services to all enrollees. Individuals in the Community: Home and Community-Based Services (HCBS), like the Community Living Waiver, help enrollees transition to community settings of their choice as an alternative to institutionalization. 6 6

Benefits: Covered Groups and Services Long Term Services & Medicaid coverage is primarily Supports available to Virginians who meet Acute specific income thresholds and Behavioral Care Health other eligibility criteria, including: • children • pregnant women Addiction Primary and • adults Care Recovery Treatment • the aged, blind, and Services Dental Care individuals with disabilities (limited) Eligibility is complex and not all Virginians with low income are covered 7

Innovative Programs Serve Virginians in Need Addiction Recovery Governor’s Access Program Treatment Services Serving low-income adults with Combatting the opioid Serious Mental Illness epidemic in Virginia Dental Coverage Behavioral Health Homes Expanding dental coverage for Improving care coordination and pregnant women access for adults with behavioral health needs 8

Home and Community-Based Services Waivers The Medicaid home and community based waivers offer individuals who require assistance with activities of daily living and/or supportive services the opportunity to receive care in the community rather than in a facility setting Waiver Features Alzheimer’s Provides assistance with activities of daily living, housekeeping, and supervision; medication administration; Assisted Living nursing evaluations and weekly activity program based on needs and interests. Waiver Provides 24/7 services and supports for adults and some children with exceptional medical and/or behavioral Community Living support needs. This includes residential supports and a full array of medical, behavioral, and non-medical supports. Waiver Family and Provides supports for children and adults living with their families, friends, or in their own homes, including Individual Supports supports for those with some medical or behavioral needs. Waiver Building Provides supports for adults able to live independently in the community with housing subsidies and/or other Independence types of support. The supports available in this waiver will be periodic or provided on a regular basis as needed. Waiver Elderly or Disabled Provides supports for elderly and disabled individuals including adult day health care; medication monitoring, with Consumer personal care services; respite care; personal emergency response systems, transition coordination and services. Direction Waiver Provides supports for children and adults who are chronically ill or severely impaired and require both a medical Technology device and substantial and ongoing skilled nursing care to avert further disability or to sustain their lives Assisted Waiver 9

Funding Medicaid Coverage $ Enrollment vs. Expenditure SFY 2016 State Receives 100% State Parents, 12% Federal Match Appropriates Caregivers & (50% Match Rate) General 28% Pregnant Funds 80% 20% Women Children in Low Income Families 60% DMAS 49% 49% Individuals with 40% 25% 75% Disabilities DMAS Pays for Member Health Care Services 20% 17% Older Adults 19% 6% 0% 1.3 million $8.41 billion enrolled expenditures Fee-For-Service (FFS) Managed Care: MCO Providers Paid Coordinates Care and Contracts Directly with Providers to Deliver Services 10

Major Initiatives of Virginia Medicaid Launch Commonwealth Coordinated 1 Care Plus for ABDs in August 2017 Procure Managed Care for pregnant 2 women & children (Medallion 4.0) in 2017 Procure many technology changes 3 (Medicaid Enterprise System) 2017-18 Substance Use Services (ARTS) in 4 2017 5 Advance Delivery System Reforms 90% of Virginia Medicaid enrollees will soon be in managed care (currently 75%) 11

Strategic Focus: Transitioning to Managed Care Medallion 4.0 CCC Plus  Serving infants, children,  Serving older adults and pregnant women, care taker disabled  Includes Medicaid-Medicare adults  760,000 individuals eligible  216,000 individuals  Births, vaccinations, well visits,  Long-term services and sick visits, acute care supports in the community and  Incorporating community facility-based, acute care  Incorporating community mental health mental health  New procurement 2017  Implementation starts Aug 2017  Building on two decades of  Implemented statewide by managed care experience Jan 2018 Incorporating the best care networks in our state to improve access, increase cost predictability and provide a platform for future innovations 12

Driving Efficiencies on Multiple Fronts Improving LTC Program Uniform Assessment Instrument Eligibility Screening Managing Program Enforcement Standards Reporting & Analytics Integrity Evolving Performance Incentive Award Incentives Report Cards Decreasing Preventable Trend Analysis Utilization Enhanced Financial Profit Cap Policy Revisions Financial Statement Reporting Review Modernizing our Medicaid Enterprise System Infrastructure modernization Maintaining Low DMAS administrative costs remain low Admin. Cost The Medicaid program continues to make changes to realize greater efficiencies 13

STATE OF THE HEALTH CARE DEBATE

AHCA Puts Virginians in Harms Way The proposed American Health Care Act (AHCA) has significant impacts to Virginia Makes health care less affordable for Reduces Medicaid funding by $709 people who need it most –affecting million, leaving state lawmakers to those who are older, poorer and sicker either cut services or raise taxes. Decreases patient protections Increases risk of destabilizing individual insurance market The AHCA will pressure states to make difficult decisions that will negatively impact health and quality of life for the sickest and most vulnerable Virginians 15

Fails To Address Cost Drivers of Health Care Misses a window of opportunity to address health care costs Cost drivers of health care, like skyrocketing drug costs, should Addressing true cost drivers not just be the states’ problem in health care requires joint leadership between federal and state governments We must address true cost drivers in health care, and not by shifting the problem to states The AHCA increases responsibility for care to individuals, providers, plans and states without creating more efficient care that pays for what works 16

Virginia Benefited From the ACA ► Cost Savings : Medicaid drug rebates, public health funding, and lower uncompensated care costs created savings for the Commonwealth More Virginians gained health care coverage ► Consumer Protections : Critical insurance protections guaranteed minimum • 378,900 Virginians accessed health standards and improved transparency coverage through the Federal Marketplace ► Economic Gains: Economic activity was generated by new spending for health • 1/3 fewer Virginians without care services and out-of-pocket costs insurance* were reduced for Virginians ► Workforce : Health coverage built a *“By The Numbers” The Commonwealth Institute, March 2017 labor force that is ready to work Even without the added benefit of Medicaid expansion, Virginia experienced a tremendous positive impact from the ACA 17