Louisiana Medicaid Update
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1 Louisiana Medicaid Update HFMA Region 9 Conference November 15, 2015 Origins of Medicaid Means tested entitlement program Established 1965 by Title XIX of the Social Security Act Public health coverage for low income people unable to work (AFDC or SSI + Medicaid) Low income children and their parents or caretaker relatives, the elderly, the blind, and individuals with disabilities. Compliment to Employer Sponsored Insurance for workers (wages + commercial insurance) Adopted by Louisiana in
2 Evolution of Medicaid Additional Services 1971 Facilities for individuals with developmental disabilities (ICF/DDs) 1981 Disproportionate Share Hospital payments 1981 Home and Community Based Waivers 1988 Medicare Part A and B Premiums for dual eligibles <100% FPL 1989 Federally Qualified Health Centers 1990 Medicare Part A and B Premiums for dual eligibles % FPL 2003 Medicare Part D premiums for dual eligibles Additional Populations 1989 Pregnant women and children to age 6 with family incomes <133% FPL 1997 Children to 200% FPL (CHIP) 1999 Working disabled up to 250% FPL 2010 All adults ages <133% FPL Louisiana Medicaid Today As of October 2015, 31% of Louisiana s 4.6 million residents are enrolled in Medicaid Medicaid accounts for 34% of the total State budget for SFY 15 $8.63B of $25.14B 2
3 Mandatory Populations Children under age 6 below 133% FPL Children age 6 and older below 100% FPL Parents below state s AFDC limit from July 1996 (11% of FPL for a family of 4 or $2,800/year) Pregnant women 133% FPL Elderly and disabled SSI beneficiaries with income 74% FPL Certain working disabled Medicare Buy In individuals 5 Optional Populations Low income children above 100% FPL who are not mandatory by age (CHIP) Pregnant women >133% FPL (CHIP) Disabled and elderly below 100% FPL, but above SSI level Long term care facilities residents above SSI levels, but below 300% of SSI Individuals at risk of needing nursing facility or ICF/DD care under HCBS waiver Certain working disabled (>SSI levels) Medically needy Adults up to 138% FPL for family planning services Women under age 65 diagnosed with breast and cervical cancer (or a precancerous condition) up to 200% FPL 6 3
4 Mandatory Services Inpatient and Outpatient Hospital Physician Laboratory and X Ray Prescription Drugs for children, pregnant women and nursing home residents Long Term Care Facilities (Nursing Homes) for those over age 21 Home Health for those over age 21 who are eligible for nursing facility services (including medical supplies and equipment) Family Planning Services for early and periodic screening, diagnosis and treatment (EPSDT) of those under age 21 Transportation necessary to ensure an enrollee s access to care Rural Health Clinics and Federally Qualified Health Centers Pediatric and Family Nurse Practitioner and Nurse Midwife 7 Optional Services Adult Dentures Prescription Drugs for Adults Hemodialysis Intermediate Care Facilities for the Developmental Disabled (ICF/DDs) Home and Community Based Waivers Long Term Personal Care Services Case Management Program for All Inclusive Care for the Elderly (PACE) Pediatric Day Health Centers Inpatient Mental Health and Psychiatric Rehabilitation Rehabilitation Services Hospice Certified RN Anesthetists (CRNA) 8 4
5 Other Payments Mandatory Medicare Part A, B and D Premiums for Medicare Medicaid Dual Eligibles Optional Disproportionate Share Hospital Payments Supplemental (UPL) Payments 9 SFY 2015/16 Budget as Appropriated 5
6 October 2015 Expenditure Forecast 6
7 Cost Drivers Medicare Part B Premiums ($15.4M) Originally, a 52% increase, from $ to $ on January 1, 2016 Now, with the Congressional fix, a 15% increase, from $ to $ Home and Community Based Waivers ($32M) Bayou Health ($495M) Enrollment growth From 7/14 to 7/15, Family & Children population grew by 76,130 or 9.6% Family & Children population accounts for 85% of total Bayou Health enrollment Specialized Behavioral Health services utilization 12/1/15 carve into Bayou Health 7
8 Medicaid Share? Fix? TBD. Adult Dentures 3.70% ($152,171) Ambulatory Surgical Clinics 11.10% ($163,400) Case Management Services 3.70% ($345,049) Durable Medical Equipment 12.70% ($810,284) EPSDT (Screening and Early Diagnosis) 5.70% ($10,002,359) Early Steps 0.00% ($225,665) Family Planning 5.70% ($539,687) Federal Qualified Health Centers 3.40% ($7,534) Hemodialysis Services 10.70% ($1,419,461) Home Health Services 13.70% ($1,634,126) Hospice Services 0.00% ($1,443,070), Hospital Inpatient Services 21.70% ($78,841,076) Hospital Outpatient Services 16.70% ($21,818,799) ICF DD Community Homes 9.50% ($9,156,912) Laboratory and X Ray Services 14.82% ($7,673,333) LT PCS 12.60% ($20,626,859) Mental Health Inpatient Services 5.80% ($958,395) Mental Health Rehabilitations 4.92% ($2,659,054) Nursing Homes 17.50% ($69,512,945) PACE 5.09% ($668,117) Pharmaceutical Products and Services 0.00% ($32,436,980) Physician Services 3.40% ($29,496,635) Transportation: Emergency Ambulance 53.25% ($3,550,246) Transportation: Non Emergency Ambulance 7.00% ($634,257) Transportation: Non Emergency Non Amb 10.30% ($330,876) Waiver: Adult Day Health 0.00% ($273,992) Waiver: Children's Choice 4.75% ($673,362) Waiver: EDA/Community Choice 0.00% ($3,943,323) Waiver: Family Planning 8.70% ($564,545) Waiver: NOW DD Community Services 0.00% ($22,267,055) Waiver: Residential Options (ROW) 0.00% ($96,765) Waiver: Supports 5.35% ($711,375) Other Private Providers 3.70% ($318,866) Totals ($323,956,573) Provider Rate Reductions? Cumulative since
9 New Federal Reg Makes Future Rate Reductions Tough Sell Supreme Court Bumps Enforcement of Rate Sufficiency to CMS 9
10 New Procedure for CMS Approval of Rate Changes Ongoing Review Required 10
11 If We Can t Cut Rates, What Else Can We Do? Mandatory Programs & Populations Private and Public Programs: Mandatory Services for Mandatory Populations 11
12 Mandatory Medicare Buy In Programs Medicare Buy In Premiums Optional Populations Private and Public Programs: Optional Populations 12
13 Optional Programs Private and Public Programs: Optional Services for Mandatory & Optional Populations Optional Supplemental Pmts to Hospitals, Ambulances & Physicians Private and Public Programs: Supplemental Payments 13
14 Optional Uncompensated Care Programs UCC/DSH Program What About Medicaid Expansion? 14
15 LFO Projected $52M SGF Savings in SFY16 15
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20 Jen Steele Deputy Medicaid Director, Chief Financial Officer (337) Louisiana Department of Health and Hospitals 628 North 4th Street, Baton Rouge, Louisiana (225)
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