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Larry E. Tisdale Vice-President of Finance

Larry E. Tisdale Vice-President of Finance. Medicaid Redesign. Better for Idaho’s taxpayers, businesses, and patients. =. Where we stand. Community Health Centers. Who are the “medically indigent”?. Working Idahoans Self-employed & Small Business Employees

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Larry E. Tisdale Vice-President of Finance

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  1. Larry E. Tisdale Vice-President of Finance

  2. Medicaid Redesign Better for Idaho’s taxpayers, businesses, and patients

  3. \=

  4. Where we stand • Community Health Centers

  5. Who are the “medically indigent”? • Working Idahoans • Self-employed & Small Business Employees Idaho’s minimum wage = $15,080/year Idaho average salary = $38,000/year Annual Cost of Living * * U.S. Bureau of Labor Statistics - averages are based on 2.6 person households

  6. Idaho has a choice

  7. Status Quo High cost Forecast Spent County Indigent Fund – supported entirely by property taxes

  8. Status Quo High cost Forecast Appropriated State Catastrophic Fund – supported entirely by income taxes

  9. Low Value • Status Quo

  10. Financial Risk • Status Quo

  11. Financial Risk • Status Quo

  12. Status Quo

  13. Idaho has a choice

  14. MedicaidRedesign Eliminate Waste Over $1 billion in tax dollars from 2014 - 2024 Half fiscal year

  15. Coverage for Working Idahoans MedicaidRedesign 68% of those who qualify have at least one full-time worker in the household; 16% have one or more part-time workers

  16. Provide Coverage for Working Idahoans Medicaid Redesign • Provides coverage to adults earning <138% of FPL or a family of four must have income less than $32,500 • Adults age 19-64 • Must be legal Idaho residents Idaho minimum wage = $7.25/hr or $15,080/yr

  17. Redesign the System • Medicaid Redesign • Personal responsibility and accountability • Coordinated Care • Managed Care for chronic conditions • Reduce waste through technology and electronic health records

  18. Medicaid Redesign

  19. Far Reaching Effects….. for Idaho’s Economy • Status • Quo Medicaid Redesign $12.3-18.5 million in federal penalties for businesses Healthier Workforce Rising taxes or budget cuts to critical programs 16,000 new jobs Not attractive to new businesses Bringing Idaho taxes back to Idaho

  20. Status • Quo Medicaid Redesign $1.5 Billion $85 Million

  21. Only one choice www.TheRightMedicineForIdaho.org

  22. Potential Legislative Activity • Medicaid Expansion ? • Insurance Exchange • Time Sensitive Emergencies • Hospital Tax Exemptions • Managed Care for Dual Eligibles HB351 • Battery of Health Care Workers • Medically Indigent Statute changes • Idaho Physician Shield Act (IMA) • Transparency • State Health Innovation Plan (SHIP)

  23. Medicaid Expansion • Not a current initiative for the 2014 Legislative Session • Governor Otter “current Medicaid system is broken” • Currently exploring 1115 waiver possibilities

  24. Insurance Exchange • Passed by last year’s Legislature • Current exchange is federally supported • This is mostly a political fight

  25. Time Sensitive Emergencies • TSE is a statewide system for the coordinating and delivering evidence based care • Includes trauma, strokes and heart attacks (STEMI) • Hospital designation and participation is voluntary • Allows billing for trauma team activation • Certified by American College of Surgeons • Designated by the State

  26. Hospital Tax Exemptions • Largely a political misinformation campaign • CEO Compensation • Physician Employment • Profit Margins • Increasing taxes on community hospitals will not lower the cost of health care

  27. Managed Care for Medicaid/Medicare • HB351 Manditory or Voluntary enrollment? • In response to HB260 from 2011 • Largest issue may be with nursing facility payments • UPL • Quality Incentives

  28. Battery of Health Care Workers • Carryover from last year • Makes it a felony to assault hospital workers • New version includes non-licensed workers • Lesser punishment than first responder assault • Tough sell with the Legislature

  29. Medically Indigent Statute Changes Two potential Proposals: • Eliminate funding over 100% of federal poverty level • Remove money to fund “community clinics”

  30. Idaho Physician Shield Act • Ensures that no guideline or metrics established by the PPACA shall be used as a basis for establishing community standards of care • IHA has no formal position at this time

  31. Transparency • Again? • IHA opposes transparency based solely on pricing data • States’ websites that have pricing information go largely unused • IHA would support transparency of quality data

  32. State Health Innovation Plan (SHIP) • There is potential for a resolution supporting the design model • The design grant ended in December 2013 • The Department of Health and Welfare is in the process of applying for a testing grant

  33. Questions

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