Medicaid Reporting and Trend Review

1. Medicaid Reporting and Trend Review Department of Social Services Division of Financial Services October 10, 2014

2. Medicaid Reporting and Trend Review • Expenditure Reporting Update • New Legislative Report • Review of Major Medicaid Enrollment and Expenditure Trends • Enrollment Trends • Expenditure Trends • Per Member Per Month Costs

3. Medicaid - New Legislative Expenditure Report New Report Initiated at End of SFY 2014 Joint Effort with the Office of Fiscal Analysis and the Office of Policy and Management Currently Shared with Committee Leadership (Appropriations & Human Services) 3

4. Medicaid - New Legislative Expenditure Report Prior Medicaid Expenditure Report Category of Service Focus Did not Separate Expenditures by HUSKY Component (A,C, D) Prior to Net Funding of Medicaid 4

5. Medicaid - New Legislative Expenditure Report Prior Format 5

6. Medicaid - New Legislative Expenditure Report Enhancements in the New Report Format changes to traditional category of service section HUSKY A, C and D expenditures with monthly detail Quarterly enrollment, expenditures, and per member per month (PMPM) by HUSKY A,C,D 6

7. Medicaid - New Legislative Expenditure Report Other Considerations Why quarterly versus monthly? Trends more apparent and monthly variations are “normalized” Reporting is based upon date of payment consistent with general State expenditure reporting practices 7

8. Medicaid - New Legislative Expenditure Report New Format – Category of Service Expenditures by Component (A, C, D) 8

9. Medicaid - New Legislative Expenditure Report Added Quarterly Enrollment by Program Significant increase in HUSKY A and D coincides with Exchange implementation HUSKY A + 8.6% HUSKY D +52.5% HUSKY C enrollment remains steady 9

10. Medicaid - New Legislative Expenditure Report Added Quarterly Expenditures Expenditures are generally consistent with enrollment increases Steady for HUSKY A since December Steady for HUSKY C Large increase for HUSKY D 10

11. Medicaid - New Legislative Expenditure Report Added Quarterly PMPM Remarkably steady per member per month (PMPM) costs across the board with a sizable decrease in the PMPM for the HUSKY D population HUSKY C PMPM is clearly the highest at $2,398 PMPM with HUSKY A the lowest at $328 PMPM 11

12. Medicaid – Latest Trends in Enrollment Overall Medicaid enrollment has surpassed 753,000 This is an increase of 20% in the nine months since December 2013 12

13. Medicaid – Latest Trends in Expenditures As a result, Connecticut has experienced an increase in overall Medicaid spending The overall increase in CT Medicaid spending between SFY 2013 and SFY 2014 was 9.4% 13

14. Medicaid – Latest Trends in Per Member Per Month Costs The overall Medicaid per member per month trendline has been relatively stable PMPM decreased from SFY 2012 to 2013 by -0.7% PMPM increased from SFY 2013 to 2014 by 1.8% Average two year growth rate of approximately 0.5% 14

15. Medicaid – Latest TrendsExpenditures & Enrollment In this side-by-side review, enrollment growth can be clearly seen as exceeding overall expenditure growth trends For this period, the enrollment growth trend was 20%, compared to the trend in overall expenditure growth which was 13.6% 15

16. Medicaid – Composition of Enrollment HUSKY D HUSKY C HUSKY A

17. Medicaid – Composition of Expenditures HUSKY D HUSKY C HUSKY A Enrollment: HUSKY A 65.6%; HUSKY C 13.6%; HUSKY D 20.7%

18. Closing • National Medicaid trend information - latest CMS Actuarial report cites national PMPM in the range of 5% for FFY 2013 • Favorable cost trends - combination of efforts and factors • Costs carefully managed while access and improved outcomes have also been achieved