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Human Services & Medicaid Issues Staff Presentation to the House - PowerPoint PPT Presentation

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Human Services & Medicaid Issues Staff Presentation to the House Finance Committee April 21, 2010 1 PDF created with pdfFactory trial version www.pdffactory.com Human Services l Programs and services for: u Children and parents u Adults

  1. Human Services & Medicaid Issues Staff Presentation to the House Finance Committee April 21, 2010 1 PDF created with pdfFactory trial version www.pdffactory.com

  2. Human Services l Programs and services for: u Children and parents u Adults with disabilities u Elderly u Veterans 2 PDF created with pdfFactory trial version www.pdffactory.com

  3. Departments l Office of Health and Human Services l Human Services l Mental Health, Retardation & Hospitals l Children, Youth and Families l Elderly Affairs l Health 3 PDF created with pdfFactory trial version www.pdffactory.com

  4. Human Service Programs l Entitlements l ARRA Requirements l Mandatory/Optional Populations l Mandatory/Optional Services l RI vs. US Medicaid Spending l State’s Medicaid Program l Other Entitlements l Other Programs 4 PDF created with pdfFactory trial version www.pdffactory.com

  5. Entitlements l Entitlements: Qualify for the program if eligibility criteria is met u Medicaid u Rhode Island Works u Subsidized Child Care u Supplemental Security Income Program 5 PDF created with pdfFactory trial version www.pdffactory.com

  6. Entitlements – Medicaid l Title XIX of Social Security Act l Citizen or 5 yrs of legal permanent residency l Federal/State Partnership u Mandatory populations & services that states must provide u Optional populations & services that states chose to provide 6 PDF created with pdfFactory trial version www.pdffactory.com

  7. Entitlements – Medicaid l Federal government shares in cost u Medicaid (FMAP) match rate u Based on 3-yr avg. of states ’ per capita income l ARRA – enhanced rate until 1/1/2011 l Still not extended l FY 2011 rate at 58.54% if not extended u Governor ’ s budget includes 64.19% assuming extension 7 PDF created with pdfFactory trial version www.pdffactory.com

  8. Entitlements – Medicaid l Children ’ s Health Insurance Program u States receive a higher Medicaid match to cover additional populations u RI – children above 133 % to 250% of poverty level u FY 2010 CHIP match rate – 66.83% u FY 2011 CHIP match rate – 67.02% 8 PDF created with pdfFactory trial version www.pdffactory.com

  9. Human Service Programs l Entitlements l ARRA Requirements l Mandatory/Optional Populations l Mandatory/Optional Services l RI vs. US Medicaid Spending l State’s Medicaid Program l Other Entitlements l Other Programs 9 PDF created with pdfFactory trial version www.pdffactory.com

  10. ARRA Enhanced Rate l FY 2010 General Revenue Savings: u $194.8 million l FY 2011 General Revenue Savings: u $196.7 million u Governor includes $95.3 million more from the extension l FY 2012: General Revenues u Add $208.0 million to adjust for lower rate 10 PDF created with pdfFactory trial version www.pdffactory.com

  11. ARRA Requirements Maintenance of Effort Requirement: l States cannot adopt eligibility standards, methodologies or procedures that are more restrictive than those in place July 1, 2008 u Example: Cannot reduce eligibility for RIte Care to parents from the current rate of 175 % of the poverty level to 150 % of the poverty level 11 PDF created with pdfFactory trial version www.pdffactory.com

  12. ARRA Requirements Maintenance of Effort Requirement l Cannot institute or increase premiums that restrict, limit or delay eligibility u Example: Cannot increase the RIte Care monthly cost sharing requirement 12 PDF created with pdfFactory trial version www.pdffactory.com

  13. ARRA Requirements Maintenance of Effort Requirement l Cannot change methods of eligibility redetermination u Example: RIte Care family eligibility is evaluated annually. State cannot change that to every 6 months 13 PDF created with pdfFactory trial version www.pdffactory.com

  14. ARRA Requirements Maintenance of Effort Requirement l Can limit scope, duration and amount of services available u Decrease services, institute waiting lists, decrease reimbursements u Examples: Limit the # of days an elderly person can attend an adult day facility or l imit the number of residential placements 14 PDF created with pdfFactory trial version www.pdffactory.com

  15. Medicaid (FMAP) Rate FFY SFY 2012 Projected 52.14 % 52.35% 2011 Enhanced 64.27% 64.19% 2010 Enhanced 63.93% 63.92% 2009 Enhanced (1/1/09) 63.89% 61.04% FY 2008 52.51% 52.59 % 15 PDF created with pdfFactory trial version www.pdffactory.com

  16. Medicaid Global Waiver l State flexibility to provide Medicaid funded services u Restructure long term care services u Provide services in the least restrictive settings u Provide services in the most appropriate setting u Address high cost cases 16 PDF created with pdfFactory trial version www.pdffactory.com

  17. Medicaid Global Waiver l Allows the state to make program changes to address costs u Established levels of care u Mandatory enrollment in managed care plans u Allow selective contracting u Durable medical equipment u Transportation 17 PDF created with pdfFactory trial version www.pdffactory.com

  18. Human Service Programs l Entitlements l ARRA Requirements l Mandatory/Optional Populations l Mandatory/Optional Services l RI vs. US Medicaid Spending l State’s Medicaid Program l Other Entitlements l Other Programs 18 PDF created with pdfFactory trial version www.pdffactory.com

  19. Medicaid - Populations l Mandatory : u Low Income Medicare Beneficiaries u Individuals who would qualify under 1996 AFDC eligibility standards (50% of poverty) u SSI or SSDI recipients u Children under 6 and pregnant women at or below 133% of poverty u Infants born to Medicaid enrolled pregnant women 19 PDF created with pdfFactory trial version www.pdffactory.com

  20. Medicaid - Populations l Mandatory : u Children 6 to 19 at or below 100% of the poverty level u Children who receive adoption assistance or who live in foster care under a federally sponsored Title IV-E program 20 PDF created with pdfFactory trial version www.pdffactory.com

  21. Medicaid - Populations l Optional : u Low income elderly or adults with disabilities u Individuals eligible for home and community based waiver services u Children and Parents above federal limits • RI: Children to 250% and parents to 175% 21 PDF created with pdfFactory trial version www.pdffactory.com

  22. Medicaid - Populations l Optional : u Individuals who are medically needy • Not eligible for Medicaid except for large medical bills u Children under 18 who would otherwise need institutional care (Katie Beckett) u Women eligible for breast and cervical cancer program 22 PDF created with pdfFactory trial version www.pdffactory.com

  23. Human Service Programs l Entitlements l ARRA Requirements l Mandatory/Optional Populations l Mandatory/Optional Services l RI vs. US Medicaid Spending l State’s Medicaid Program l Other Entitlements l Other Programs 23 PDF created with pdfFactory trial version www.pdffactory.com

  24. Medicaid – Mandatory Acute Care Benefits l Physician Services l Rural Health Clinic Services l Lab & X-ray l In/Outpatient l Nurse Midwife Hospital Services as state l EPSDT law permits l Family Planning l Certified Pediatric & Services & Supplies family nurse l Federally Qualified practitioner services Health Centers 24 PDF created with pdfFactory trial version www.pdffactory.com

  25. Medicaid – Optional Acute Care Benefits l Durable medical l Prescription Drugs equipment l Rehabilitation & Other therapies l TB – related services l Clinic Services Medical/ remedial l l Dental, dentures care provided by l Prosthetic devices, other licensed eyeglasses professionals l Case management 25 PDF created with pdfFactory trial version www.pdffactory.com

  26. Medicaid - Long Term Care Benefits Mandatory Optional Institutional § Nursing facility § Intermediate Care Facility services for those 21 or § 65 + in an IMD older needing that level § inpatient psych hospital of care services for under 21 Home and Community Services § Home health care § Home & comm based services for those § Targeted case mgt entitled to nursing § Hospice- personal care home care § PACE program 26 PDF created with pdfFactory trial version www.pdffactory.com

  27. Medicaid - Long Term Care Benefits l State must provide nursing home care u Highest level of care l State also provides residential services: u Children in DCYF custody u Adults with developmental disabilities u Adults with behavioral health issues 27 PDF created with pdfFactory trial version www.pdffactory.com

  28. Human Service Programs l Entitlements l ARRA Requirements l Mandatory/Optional Populations l Mandatory/Optional Services l RI vs. US Medicaid Spending l State’s Medicaid Program l Other Entitlements l Other Programs 28 PDF created with pdfFactory trial version www.pdffactory.com

  29. State vs. US Medicaid Spending l Four Categories u Children: RIte Care u Adults: RIte Care u Blind/Disabled: Includes Children u Elderly l RI: 76.4% of expenses for 32.3% of population u Elderly, blind and disabled categories 29 PDF created with pdfFactory trial version www.pdffactory.com

  30. US Medicaid Spending US* Share of Cost Percent Per Enrollment Enrollee (millions) Children 48.9% $57,110 19.4% $2,435 Adults 23.1% $39,700 13.5% $3,586 Disabled 17.7% $126,700 43.0% $14,858 Aged 10.4% $70,900 24.1% $14,058 Total 100.0% $294,400 100.0% $6,120 * Based on 2007 data 30 PDF created with pdfFactory trial version www.pdffactory.com

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