Presentation to the Legislative Finance Committee FY19 Appropriation Request Brent Earnest, Secretary December 6, 2017 New Mexico Human Services Department
Today’s day’s Presentat atio ion HSD FY19 Appropriation Request Overview Medicaid Budget and Performance ◦ Enrollment and Cost trends Behavioral Health Budget and Performance Centennial Care 2.0 Update Child Support Enforcement Income Support Division HHS 2020 and the Medicaid Management Information System (MMIS) replacement project 2
HSD SD FY FY 19 Appro propri priat atio ion Req eques est FY 19 Budget Request of $7.085 billion 2.34% increase overall. $1.116 billion from the Fede deral F l Funds ds general fund (increase of 80.37% 37% $83.8 million or 8.12%). ◦ Changes to the Medicaid Budget. $5.694 billion in federal funds (increase of $82.2 Othe her million or 1.46%). State te Fun unds a and nd $274.1 million in other State G Genera ral l Revenue nue Fund nd state funds and other 3.87 3. 87% 15.76% 76% revenue. 3
FY19 Med edicaid Budget get Req eques est t High ghligh ghts ts Enrollment growth trends have slowed. ◦ By June 2018, enrollment is projected to be 877,847, a decrease from June 2017. ◦ FY19 growth of 1% projected, reaching more than 887,000. 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 4
Medicai icaid Enrol ollme ment nt Ex Expansio ion/Other Adult lt G Grou oup 1,000 1, 000,000 00 September 2017 2017 863, 863,516 16 Sate C Covera rage In Insura rance 900 900,000 00 Projected June ne 20 2019 Medic icaid id A Adult lts Proje jected d 800 800,000 00 Enrollm ollment Medic icaid id C Child ildren 700,000 700 00 OAG AG: : llment 255,19 25 192 id Enrollm 600,000 600 00 Med edicaid Ad Adults: 500,000 500 00 267,22 26 229 icaid E 400 400,000 00 Medic Medica Me caid Child ildren: 300,000 300 00 364,64 36 649* 9* 200 200,000 00 100 100,000 00 - - an-13 13 ay-13 13 p-13 an-14 14 ay-14 14 p-14 an-15 15 ay-15 15 p-15 16 an-16 ay-16 16 p-16 an-17 17 ay-17 17 p-17 an-18 18 18 ay-18 p-18 19 an-19 19 ay-19 Sep-1 Sep-1 Sep-1 Sep-1 Sep-1 Sep-1 *children 19-21 y.o. counted in OAG Jan May Jan May Jan May Jan May Jan May Jan May Jan May Se Se Se Se Se Se 5
Medicai icaid: F d: FY 19 Appro propria priatio ion Req eques est Total Medicaid Program spending in FY 19 is projected to be $5.817 billion. $983.9 million from the general fund, an increase of $68.3 million. o Major changes from current year projection include: ($ in millions) Expansion FMAP (drops to 94% in 2018 and 93% in 2019) $14.9 Medicare Buy Ins $4.7 CHIP FMAP Reduction (100% to 72.13%) $30.7 FMAP Change ($7.9) County Support Medicaid and Tobacco Settlement Revenue (reduction) $5.3 Enrollment $12.9 Utilization and Price increases (less than 1% change) $12.5 Other Revenue changes ($4.8) Tota tal $68.3 8.3 6
Cent enten ennial C Care: re: Ma Mana naging ng C Cost G Gro rowth Enrollment up 5%; Per capita costs down 2% 7
Medicai icaid: A d: Admin inis istrat ratio ion The total FY 19 budget request for administration of the Medicaid program is $84.4 million. o $4.864 million increase from FY18. Fede deral F l Funds ds, , o $888.8 thousand increase in general $66.85 M $66. M, , 79% 79% fund need to support contractual services. Medical Assistance Division administrative spending is only 1.43% of the total program budget. Priorities for MAD staff in 2019 include: State G Genera ral l Other er S State e Fund nd, , $15. $15.14 M M, , o Implementation of 1115 Waiver Fund nds, , Renewal 18% 18% $2.42 M 42 M, , 3% 3% o Continued procurement and implementation of replacement MMIS 8
Medicai icaid: M d: MCO HEDIS S Perform rman ance ce Measure res Prenatal Care Visits in the 1 st Trimester Annual Dental Visits 68% 77% 66% 64% 73% 70% 80% 71% 60% 60% 50% 40% 40% 30% 20% 20% 10% 0% 0% HEDIS 14 HEDIS 15 HEDIS 16* HEDIS 14 HEDIS 15 HEDIS 16* *2016 NCQA Nat’l Avg. – 53% *2016 NCQA Nat’l Avg. – 82% Well Child Visits within 1 st 15 mos. 70% 56% 60% 49% 47% 50% 40% 30% 20% 10% 0% HEDIS 14 HEDIS 15 HEDIS 16 *2016 NCQA Nat’l Avg. – 62% 9
$59.6 million overall budget. ◦ $37.0 million from the General Fund. ◦ $22.6 million in federal funds. Increased federal funding of $4.6 Fede dera ral l State G e Gener eral million for combating opioid Fund unds Fund und addiction and overdose crisis. 38% 38% 62% 62% NM overdose death rate improved relative to other states. Improvement in national rankings for New Mexico – From 44 th in 2011 to 21 st (2018 Mental Health America report). 10
Beh ehavior oral Hea ealth th Spen ending Total HSD Behavioral Health Spending (excl. administration) FY17 Actuals FY18 Projection FY19 Projection ($ in millions) GF FF Total GF FF Total GF FF Total Medicaid Behavioral Health $102.85 $396.90 $499.75 $100.71 $384.74 $485.45 $108.24 $389.43 $497.67 Behavioral Health Services Division $37.40 $21.05 $58.45 $37.04 $20.60 $57.64 $37.04 $22.57 $59.61 Total $140.25 $417.95 $558.20 $137.75 $405.34 $543.09 $145.28 $412.00 $557.28 Percent change from prior year 0.47% 5.07% 3.87% -1.78% -3.02% -2.71% 5.47% 1.64% 2.61% 11
Behaviora ral l Healt lth Perform rman ance ce Sati tisfacti tion with ith Improv roving Follow ow-Up Services es a after Beha havioral H Heal alth h Services Disc scharge 100% 61.92% 61.65% 80% 70% 60% 52.40% 86.40% 87.10% 84.02% 83.50% 40% 48.50% 60% 20% 42.24% 39.11% 50% 0% 33.28% 100% 29.84% 80% 40% 60% 88.00% 87.70% 86.40% 86.44% 40% 30% 20% 0% 20% 2014 2015 2016 2017 SFY14 SFY15 SFY16 SFY17 Adult Family/Caregiver 7 Day 30 Day Indi dividua duals served d by BH Collabo aborative ve programs 173,781 200,000 160,843 145,534 150,000 100,000 50,000 0 CY14 CY15 CY16 12
Centennial Care 2.0 builds on successes achieved during the past four years. Improvements and reforms will ensure sustainability of the program while preserving comprehensive services. Are reas o of focus Care coordination Behavioral health integration Long-Term Services and Supports (LTSS) Payment reform Member engagement and personal responsibility Administrative simplification through refinements to benefits and eligibility 13
Centennial ial Care re 2.0 0 Updat date The final 1115 waiver renewal application is being submitted this week. It will be available at: http://www.hsd.state.nm.us/centennial-care-2- 0.aspx Key Changes from the draft application include: ◦ Expanded services for substance use disorder: Screening, Brief Intervention and Referral to Treatment (SBIRT) and adult residential treatment ◦ Premiums only for higher income adults in the Adult Expansion group ($10/month); ◦ Restructures copayments for two services—non emergent use of ER and use of non- preferred drug when a preferred drug is available ◦ Phases out retroactive coverage by 2020, instead of eliminating in 2019. Preliminary Estimates of Costs and Savings of Changes (Part of Budget Neutrality) One Year Average 5 Year Total General Fund Total General Fund Increases $57,829,643 $8,178,064 $86,049,672 $19,002,006 Decreases $(22,437,783) $(20,990,776) $(101,196,120) $(109,097,834) Net $35,391,860 $(12,812,712) $(15,146,448) $(90,095,828) 14
Child ild Suppo pport rt Enforce rcement Divi vision on COLLECTIONS $30.97 million total 95% budget request Went to $140 Million o $7.64 million from the general families child support fund, $545k more for FY19 (5% reimbursed to collected in FY17 public assistance dollars) o Reduce the vacancy rate o Replace other revenue o $20.31 million from federal funding $$$ o $3 million from other revenue 70,273 child support $3.26 is collected cases = 102,662 by the Child children Support Program $ For every $1.00 spent 15
Child ild Suppo pport rt Enforce rcement Perform rman ance ce 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Obligated Cases Current Support Paternity Cases Paying on Owed that is Establishment Arrears Collected SFY16 SFY17 16
Income ome Support t Divi vision n - Program $875.6 million overall budget ◦ Mostly federal funding for SNAP benefits Increase of $398.5 thousand Fede deral F l Funds ds 98.49% 49% in General Fund needed to m aintain State SNAP Supplement ($25 per month). ISD programs also includes funding for homeless (meals and shelters), food banks, school lunches, energy State G Genera ral l assistance, and cash Fund nd assistance. 1. 1.51 51% 17
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