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FY 2013 Medicaid Budget Overview

This overview outlines the FY 2013 Medicaid budget, including provider reimbursement, allocation increases for various programs, and cost containment measures to manage spending. It highlights adjustments to control costs while enhancing service provisions.

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FY 2013 Medicaid Budget Overview

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  1. FY 2013 Medicaid BudgetOverview Medicaid Advisory Committee January 23, 2012

  2. FY 2013 Medicaid Budget Allowance • Provider Reimbursement …. $7 B ($2.5B GF, .9M SF) • MCHP ………………………. $200 M ($ 64.2M GF) • Kidney ………………………. $11.9 M ($8.5M GF) • Administration ……….…….. $103 M ($ 24.9M GF) • Total ………………….....….. $7.3 B ($2.6B GF, .9M SF) 3% increase or $ 238M TF increase over FY 2012 appropriation

  3. FY 2013 Allowance Additions (GF) • Increase in funding for OAW slots …………..……….. $4.5M • Increase in funding for LAHW slots …………..……… $4.5M • Increase in NH rates by 1% …………………………….$5.5M • Increase in Community Provider rates by 1.5% ………..$2.8M • Physician fee increase to bring E&M codes up to………$17M Medicare levels per Federal guidelines • Allocation of funds for internal staff to support implementation of a new MMIS system ………............ $0.5M

  4. FY 2013 Allowance Additions (GF) cont’d • Additional funds for MHCC’s Primary Care …………$.7M Medical Home project • Fund the Chronic Health Home project …………...… $1.5M • Additional funds for personal care services………... ..$2.6M through use of funding available from eliminating the Nursing Facility bedhold payments • Keep PAC open……………………………………….$7.4M

  5. Cost Containment and Adjustments Included in FY 2013 Allowance (GF) • MCO 1% reduction ……………………………..… $15.9 M • Accelerate the MCO MLR recovery to 100% ……. $3M • Reduce the medically needy inpatient hospital benefit package …………………………………. $36M • Implement tiered outpatient rates which means different rates for different types of services …… $30M • Implement a DSH pool …………………………... $9.1M • Continue freeze in rates for DC and non HSCRC hospitals ………………………………………… $1.5M

  6. Cost Containment and Adjustments Included in FY 2013 Allowance (GF) cont’d • Eliminate NH communicable disease ………………. $5.8M care payments • Reduce durable medical equipment payments to 90% of Medicare …………………………………$1M • Implement the In Home Supports Assurance Program. $2.8M • Move ESRD to Medicare ……………………………..$1M • Identify dual eligibles and apply for Medicare ………. $1M • Review denied Medicare services which should not be billed to Medicaid ………………………... $1M

  7. Cost Containment and Adjustments Included in FY 2013 Allowance (GF) cont’d • Move MCHP eligible children from Medicaid ……. $1.5M • Continue SSI project with DHR which compares SSI recipients with the federal approved lists ………………………………… $3.6M • Pharmacy initiatives in the area of antipsychotic medications (i.e., improve use of generics; dose optimization; and new peer to peer UR) ………..….. $5M

  8. Increase in Provider Assessment Rates • Nursing Home increased from 5.5% to 6% …………………………. $5.5 M • New Medical Day Care of 5.5% ……………………………… $3.4 M

  9. Thank you, members of MAC • Your work, last fall, directly led to: • Major rebalancing initiatives • Savings in areas of DME, DMS • Improved approach to hospital OPD • Elimination of communicable disease add-on • Protecting PAC eligibility • Investment in Chronic Health Home • Accountability of ISAS

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