Medicaid. (Title XIX and Title XXI) STATE REPORTS FY 2009 NEVADA. Text7:

Transcription

1 Medicaid STATE REPORTS FY 2009 (Title XIX and Title XXI) Text7:

2 Please READ: General Information about CMS/MSIS2082, main data source of this report: [Based on Center for Medicare and Medicaid Services(CM) description of Medical Statistical Information System(MSIS) data] CMS/MSIS2082 data represent people on the Medicaid rolls, recipients of Medicaid services and the payments for claims adjudicated during the year. The data reflected bills adjudicated, or processed, during the year rather than the services used during the year. States submit individual eligibility and claims data tapes to CMS on a quarterly basis via MSIS (the Medicaid Statistical Information System). Starting FFY1999, CMS started reporting Title XXI funded Medicaid expansion enrollment and expenditures data on MSIS2082 reports. As a result, use caution when comparing FFY1999 and later Medicaid State Reports to prior years. Caveats: The general quality of the data is only as reliable as the data submitted to CMS by States. Federal edits are performed to validate individual data elements, check consistency between data elements and verify reasonableness of distributions between reporting periods. Payments, or vendor payments, from MSIS include dollars for all claims adjudicated during the fiscal year. Vendor payments reported include capitated payments for managed care plans. MSIS payments do not agree with the CMS-64 financial figures because they do not include payments made outside the claims processing system (e.g., payments made to disproportionate share (DSH) hospitals) and differences in accounting time lags. MSIS slightly understates reporting for children under age 1. Many children born in August and September are omitted from MSIS because these newborns may not be added to the State eligibility file until after the end of the fiscal year. State-only SCHIP enrollees are excluded from the tables. There are no Medicaid dollars associated with these individuals while they are in the separate SCHIP program. Refer to CMS document titled MSIS State Data Characteristics/Anomalies Report (accessible from URL: Systems/Computer-Data-and-Systems/MedicaidDataSourcesGenInfo/downloads/ anomalies1.pdf ) for details on state specific data anomalies and other data issues. CONTACT INFORMATION Contact Suk-fong Tang, Department of Practice, with comments about the report; contact Dan Walter or Wendy Chill, Division of State Government Affairs, for Medicaid questions and advocacy advice. FY1994 to FY2008 Medicaid State Reports are also available in Adobe Acrobat PDF format on the AAP Web site, at

3 Medicaid State Report FFY 2009* (October 1, September 30, 2009) I. MEDICAID ENROLLEES AND EXPENDITURES* AZ, CO, ID, MT, NM, NV, UT & WY are included in the Mountain Region A. Federal Medical Assistance Percentage (FMAP)** 50.0%, 65.0% 56.2%, 69.3% (FFY2009 FMAP, Enhanced) (FFY2012 FMAP, Enhanced) B. Total Medicaid Enrollment (FFY2009)*** C. Total Medicaid Expenditures (FFY2009)*** D. Total Medicaid Managed Care^ Enrollment, 07/01/ ,459 ( % of Total Medicaid Enrollment on 07/01/2010) (85.1% of 265,019^^) E. %Medicaid Children(ages 0-20) Enrolled in HMO (FFY2009) 290, % F. Enrollee through Age 20, FFY 2009 Enrollees (as Proportion of Population) Through Age , ,719 ( 103.7% of 175,043 ) ( 113.0% of 153,696 ) Through Age 5 81,858 ( 176.4% of 46,398 ) Infants Ages 1 through 5 Ages 6 through 18 16,194 65,664 91,861 ( 205.7% of 7,872 ) ( 170.4% of 38,526 ) ( 85.6% of 107,298 ) Ages 6 through 14 68,410 ( 100.2% of 68,281 ) Ages 15 through 18 23,451 ( 60.1% of 39,017 ) Ages 19 and 20 7,834 ( 36.7% of 21,347 ) G. Enrollment, Expenditures*** and Per-enrollee Payment, by Age Group, FFY 2009 % Total Enrollees~ % Total Expenditures~ Per Enrollee Payment 62.5% 38.3% $2,481 Through Age % 35.6% $2,410 Through Age % 13.1% $1,886 Infants 5.6% 3.6% $2,645 Ages 1 through % 9.5% $1,699 Ages 6 through % 22.5% $2,877 Ages 6 through % 12.6% $2,173 Ages 15 through % 9.8% $4,934 Ages 19 and % 2.7% $4,051 Age 21 or Older 37.5% 61.7% $6,677 Age 65 or Older 8.9% 17.3% $7,888 H. Non-Blind/Disabled Enrollees: Enrollment and Per-enrollee Payment** FY2009 Number of Enrollees $1,177M Per Enrollee Payment 172,996 $2,007 Through Age ,176 $1,987 Notes: * Includes Title XIX Medicaid programs and Title XXI funded Medicaid expansions. ** Regional and US averages of standard and enhanced FMAPs are weighted by total FFY2009 Title XIX and Title XXI Medicaid total expenditures, respectively. *** Expenditures include Medicaid vendor payments, health plan premiums, capitation and HMO payments reported by the states to CMS. All expenditures include federal and state shares. ^ Includes Primary Care Case Management, medical, dental, mental and other managed care plans. ^^ Point-in-time enrollment on 06/30/2010, at 0.3M, was an estimated 91.2% of 0.3M total annual enrollment state(s) reported to CMS for FY ~Percents may not sum up to 100% due to missing age information for some beneficiaries and unassigned claims.

4 MEDICAID STATE REPORT FOR, FFY2009* Page 2 II. MEDICAID* SERVICE UTILIZATION, FFY2009 A. Payments by Age and Type of Service** Physician Services Dental Services Clinic Services Other Practitioner Services Outpatient Hospital Inpatient Hospital Intermediate Care Facilities (ICF-MRs)^ Nursing Home Mental Health Facility Services Personal Care Services Home Health Services Lab and X-Ray Prescribed Drugs Capitated Payment Primary Care Case Management Services Sterilization Services Other Care Services~ Total~~ B. Average Payments per User of Service and Percent of Enrollees Using Each Service** CHILDREN Under 21 ADULTS 2.2% 4.8% 1.1% 0.6% 3.6% 1.5% 0.3% 0.1% 0.6% 1.7% 4.2% 8.4% 0.4% 1.0% 0.2% 13.7% 3.3% <.05% 7.0% 9.4% 0.2% 0.1% 0.9% 1.2% 2.3% 5.9% 10.9% 4.7% 0.0% 0.0% <.05% 0.1% 1.3% 8.5% 38.3% 61.7% CHILDREN Under 21 ADULTS Per-user %Use+ Per-user %Use+ Physician Services $ % $1, % Dental Services $ % $ % Clinic Services $2, % $1, % Other Practitioner Services $ % $ % Outpatient Hospital $ % $ % Inpatient Hospital $4, % $7, % Intermediate Care Facilities (ICF-MRs)^ $148,048 <.05% $131, % Nursing Home $126,011 <.05% $37, % Mental Health Facility Services $34, % $11,262 <.05% Personal Care Services $4, % $5, % Home Health Services $14, % $2, % Lab and X-Ray $ % $ % Prescribed Drugs $ % $1, % Capitated Payment $ % $ % Primary Care Case Management Services NA 0.0% NA 0.0% Sterilization Services $ % $1, % Other Care Services~ $2, % $4, % Total $2, % $7, % * Includes Title XIX Medicaid programs and Title XXI funded Medicaid expansions. ** Services included in each service category are defined in the CMS document: MSIS Tape Specifications and Data Dictionary, p (URL: ). ~ May include, but are not limited to, Home and Community Waiver, prosthetic devices and eyeglasses. ~~ Expenditures do not sum to 100% due to unassigned claims and missing service recipient data. + Sum of percents may exceed 100% since enrollees may use multiple services. ^ for the mentally-retarded. 'na' Data unavailable. 'NA' Not applicable.

5 SOURCES: IA. Federal medical assistance percentages and enhanced Federal medical assistance percentages, effective October 1, 2008-September 30, 2009 (Fiscal year 2009) Federal Register: Volume 72, Number 228 (November 28, 2007; URL: ) Federal medical assistance percentages and enhanced Federal medical assistance percentages, effective October 1, 2011-September 30, 2012 (Fiscal year 2012) Federal Register: Volume 75, Number 217 (Wednesday, November 10, 2010; URL: ) Net Reported Medicaid and CHIP Expenditures, FFY2009 (URL: Systems/Computer-Data-and-Systems/MedicaidBudgetExpendSystem/ Quarterly-CHIP-Statement-of-Expenditures-CMS-21.html ) IB-C. Medicaid Statistical Information System (MSIS) State Summary Datamart. ID. Medicaid Managed Care Enrollment as of July 1, Available at URL: Topics/Data-and-Systems/Medicaid-Managed-Care/Downloads/managedcare-enrollment pdf.pdf 1E-F. Medicaid Statistical Information System (MSIS) State Summary Datamart. Interim State Projections of Population by Single Year of Age: July 1, 2004 to Population Division, US Census Bureau. Available at URL: IIA,B. Medicaid Statistical Information System (MSIS) State Summary Datamart.