Presentation to Legislative Finance Committee Preview of FY19 Appropriation Request Brent Earnest, Secretary October 25, 2017 New Mexico Human Services Department
Today’s Presentation Today’s Presentation HSD FY19 Appropriation Request Overview Medicaid Budget and Performance ◦ Enrollment and Cost trends Behavioral Health Budget and Performance Child Support Enforcement Income Support Division ◦ Temporary Assistance for Needy Families HHS 2020 and the Medicaid Management Information System (MMIS) replacement project Centennial Care 2.0 Update 2
HSD FY 19 Appropriation Request HSD FY 19 Appropriation Request FY 19 Budget Request of $7.085 billion 2.34% increase overall $1.116 billion from the Federa Fede ral Funds l Funds 80.37% 80.37% general fund (increase of $83.8 million or 8.12%) $5.694 billion in federal State Gen Sta e General Fund Fund funds (increase of $82.2 15.76% 15.76% million or 1.46%) Other Othe r $274.1 million in other State Sta e Funds and Funds and state funds and other Rev Revenue nue revenue 3.87% 3.87% 3
HSD General Fund Budget Change HSD General Fund Budget Change Percent Change in HSD General Fund Budget 40.00% 36.45% 36. 30.00% 18. 18.48% 20.00% 15. 15.92% 12.18% 12. 10.22% 10. 8.12% 8.1 10.00% 4.54% 4.5 2.9 2.90% 1.5 1.52% 0.15 0.6 0.68% 152% 2% 0.00% FY06 OP BUD FY07 OP BUD FY08 OP BUD FY09 OP BUD FY10 OP BUD FY11 OP BUD FY12 OP BUD FY13 OP BUD FY14 OP BUD FY15 OP BUD FY16 OP BUD FY17 OP BUD FY18 OP BUD FY19 REQUEST -10.00% -1. -1.02% -2.37% -2. -20.00% -21. 1.87 87% -30.00% *GF adjustment due to ARRA 4
FY19 Medicaid Budget Request FY19 Medicaid Budget Request Highlights Highlights Enrollment growth trends have slowed ◦ By June 2018, enrollment projected to be 917,000, essentially flat from June 2017. ◦ FY19 growth of 0.8% projected, reaching more than 922,000 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 5
Medicaid Medicaid Enrollment nrollment August 2017 911,803 August 2017 911,803 Expan pansio ion/ n/Other Adu Other Adult G t Grou oup 1,000,000 1,000,000 Sate Coverage Sate Covera ge Insurance Insurance Projected 900,000 900,000 June 2019 June 2019 Medicaid Adults Medicaid Adults Projected Project d 800,000 800,000 Enr Enrollme ment nt Medicaid Med id Ch Chil ildren en 700,000 700,000 OAG: OAG Medicaid Enrollment Medicaid Enrollment 275, 275,685* 600,000 600,000 Medicaid Adul Medi Adults: 500,000 500,000 271,512 271, 400,000 400,000 Medicaid caid Chil ildre dren: 300,000 300,000 379,107* 379, 200,000 200,000 100,000 100,000 - - Jan-13 Jan-13 May-13 May-13 Sep-13 Sep-13 Jan-14 Jan-14 May-14 May-14 Sep-14 Sep-14 Jan-15 Jan-15 May-15 May-15 Sep-15 Sep-15 Jan-16 Jan-16 May-16 May-16 Sep-16 Sep-16 Jan-17 Jan-17 May-17 May-17 Sep-17 Sep-17 Jan-18 Jan-18 May-18 May-18 Sep-18 Sep-18 Jan-19 Jan-19 May-19 May-19 *children 19-21 y.o. counted in OAG 6
Medicaid Enrollment Transformation Medicaid Enrollment Transformation January 2014 also launched adult expansion of Medicaid—Alternative Benefit Package Significant enrollment growth in 4 years: Medicaid Medicaid Cat Category gory Enrollment June Enrollm ent June Enrollm Enrollment ent Perc Percenta entage 2013 2013 August 2017 August 2017 Increase Increas Parents/Caretaker Adults 40,776 77,734 91% (0-47% FPL) Other Adults 36,812 268,723 629% (48% - 138% FPL) (SCI) (Adult Expansion) All Medicaid All Medicaid 575,908 575,908 911,803 911,803 58% 58% 2013 2013 2017 2017 Children (<21 Years) 42% 43% 57% 58% Adults (>=21 Years) 7
Centennial Care: Managing Cost Growth Centennial Care: Managing Cost Growth Enrollment up 5%; Per capita costs down 2% 8
Medicaid: FY 19 Appropriation Medicaid: FY 19 Appropriation Request Request (as of Sept. 1) (as of Sept. 1) Total Medicaid Program spending in FY 19 is projected to be $5.892 billion. $997.2 million from the general fund, an $81.5 million increase. o Major changes from FY18 include: ($ in millions) FY19 base - additional general fund above FY18 appropriation $15.82 Expansion FMAP (drops to 94% in 2018 and 93% in 2019) $14.70 Enrollment $11.73 Utilization and Price increases (less than 1% change) $11.66 Medicare Part B $2.62 CHIP FMAP Reduction (100% to 72.13%) $31.23 FMAP Change (71.90 to 72.13) ($7.18) County Support Medicaid and Tobacco Settlement Revenue (reduction) $5.34 Other Revenue changes ($4.38) Total Total $81.54 $81.54 9
Medicaid: Administration Medicaid: Administration The total FY 19 budget request for administration of the Medicaid program is $84.4 million o $4.864 million increase from FY18 Fede Federa ral Funds, l Funds, o $888.8 thousand increase in general fund need to support contractual $66.85 M, 79% $66.85 M, 79% services. Medical Assistance Division administrative spending is only 1.43% of the total program budget. Priorities for MAD staff in 2019 Othe Other r include: State Sta e Sta State Gen e General Funds, Funds Fund, $15.14 M, Fund, $15.14 M, o Implementation of 1115 Waiver Renewal $2.42 M, $2.42 M, 18% 18% o Continued procurement and 3% 3% implementation of replacement MMIS 10
Medicaid: MCO HEDIS Medicaid: MCO HEDIS Performance Measures Performance Measures Well Child Visits within 1 st 15 mos. Annual Dental Visits 68% 66% 64% 70% 70% 57% 60% 60% 52% 47% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% HEDIS 14 HEDIS 15 HEDIS 16 HEDIS 14 HEDIS 15 HEDIS 16 ER Visits per 1,000 Asthma Medication Management 60 70% 49 48 48 45 54% 50 60% 52% 47% 40 50% 30 40% 30% 20 20% 10 10% 0 0% HEDIS 14 HEDIS 15 HEDIS 16 SFY17 Preliminary HEDIS 14 HEDIS 15 HEDIS 16 11
Medicaid: MCO HEDIS Medicaid: MCO HEDIS Performance Measures Performance Measures Reduction in hospital readmissions for Received greater than 81% of children within 30 days of discharge expected prenatal visits 56% 8% 7% 7% 7% 60% 52% 6% 46% 50% 6% 40% 4% 30% 20% 2% 10% 0% 0% CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3 HEDIS 14 HEDIS 15 HEDIS 16 Reduction in hospital readmissions for adults Prenatal Care Visits in the 1 st within 30 days of discharge Trimester 77% 73% 15% 13% 71% 80% 12% 10% 10% 60% 10% 40% 5% 20% 0% 0% CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3 HEDIS 14 HEDIS 15 HEDIS 16 12
Behavioral Health Spending Behavioral Health Spending Total HSD Behavioral Health Spending (excl. administration) FY17 Actuals FY18 Op Bud* FY19 Request ($ in millions) GF FF Total GF FF Total GF FF Total Medicaid Behavioral Health $107.49 $393.62 $501.11 $115.58 $424.3 $539.87 $107.48 $394.36 $501.83 Behavioral Health Services Division $37.4 $21.05 $58.45 $37.04 $20.6 $57.64 $37.04 $22.57 $59.61 Total $144.89 $414.67 $559.56 $152.62 $444.9 $597.52 $144.52 $416.93 $561.44 Percent change from prior year -1.24% 3.40% 2.15% 5.33% 7.29% 6.78% -5.31% -6.29% -6.04% Note: *FY18 Operating Budget for MAD BH is overstated. Adjustments to the Medicaid appropriation were not included in the MAD BH program appropriation. FY19 request for BHSD is $59.6 million, $37.0 million from the General Fund. Increased federal funding for combating opioid addiction and overdose ◦ crisis 13
Behavioral Health Performance Behavioral Health Performance Number of persons serve Number of persons served through through Indivi Individual duals ser s served by ed by BH BH Telehealth in rural and fronti Telehealth in rural and frontier counti counties Collaborativ Collaborative programs programs 173,781 200,000 160,843 SFY17 4,890 145,534 150,000 SFY 16 100,000 3,682 50,000 SFY 15 2,699 0 CY14 CY15 CY16 Re Reductio ction in n in Proficien iciency Ga Gaps 5th Grade Reading 5th Grade Reading 8th Grade Math 8th Grade Math 12.0% 10.2% 10.0% 8.0% 5.7% 5.7% 6.0% 3.8% 3.7% 4.0% 4.4% 2.0% 3.5% 2.2% 1.4% 1.7% 0.0% SFY12 SFY13 SFY14 SFY15 SFY16 14
Behavioral Health Performance Behavioral Health Performance Improving Follow-Up Services after Improving Follow-Up Services after Satisfac Sati sfacti tion with on with Discharge Discharg Behavioral Health Service Behavioral Health Services 70% 100% 87.10% 86.40% 84.02% 83.50% 61.92% 61.65% 80% 60% 60% 52.40% 40% 48.50% 50% 20% 42.24% 39.11% 40% 0% 33.28% 100% 87.70% 88.00% 86.40% 86.44% 29.84% 30% 80% 60% 20% 40% SFY14 SFY15 SFY16 SFY17 20% 0% 7 Day 30 Day 2014 2015 2016 2017 Adult Family/Caregiver 15
Child Support Enforcement Child Support Enforcement Division Division Child Support Collections $30.97 million total budget (in millions) request $142. M o $7.64 million from the general fund $140. M $140.8 M Reduce the vacancy rate $140.1 M o $139.6 M $138. M Replace other revenue o o $20.31 million from federal funding $136. M $137.1 M o $3 million from other revenue $134. M 69,127 child support cases in FY17 $132. M $132.1 M $130. M Key priorities $128. M ◦ Implement Business process model to ensure more efficient and $126. M effective service FY13 FY14 FY15 FY16 FY17 ◦ Replacement of the old Child Support Enforcement IT system 16
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