2013-14 Enacted Budget

  • Presentation is also available in Portable Document Format (PDF, 397KB)

Medicaid Proposals and Global Cap Update

New York State Department of Health
NYS Division of the Budget

April 23, 2013
11:00 a.m. - 12:00 p.m.

Overview

  • Enacted Budget Highlights
  • Medicaid Investment and Savings Proposals
  • Global Cap Results through February 2013

Enacted Budget Highlights

Enacted Budget Highlights

  • Advances Care Management for All:
    • Eliminates statutory barriers for Care Management for All.
    • Allows nursing home duals to enroll in FIDA.
    • Authorizes OPWDD FIDA Demo and DISCOs.
  • Extends Global Cap through March 2015:
    • Medicaid State Operations spending is consolidated within the Global Cap.
  • Implements statutory framework for ACA.
  • Advances Care Management for All:
    • Eliminates statutory barriers for Care Management for All.
    • Allows nursing home duals to enroll in FIDA.
    • Authorizes OPWDD FIDA Demo and DISCOs.
  • Identifies $1.1 billion for OPWDD rate solution:
    • $730 million in DOH savings.
    • $340 million in OPWDD savings (additional Federal incentive funds and provider rate reductions).
  • Authorizes incentive payments for public hospitals participating in Federal DSRIP program.
  • Restores 2% across-the-board reduction in 14-15 $714M gross; $357M state).
  • Authorizes new Indigent Care methodology.
  • County relief:
    • Advances enhanced FMAP earned under the ACA associated with childless adults to local districts ($86 million).
  • SUNY Downstate restructuring plan:
    • Authorizes SUNY to establish a sustainability plan for University Hospital of Brooklyn to facilitate restructuring necessary to achieve its continued fiscal viability.

Medicaid Proposals

Medicaid Proposals

$ in Millions -- Investments (Savings) 2013-14
Gross		 2013-14
State		 2014-15
Gross		 2014-15
State
Supportive Housing ($5) ($5) $0 $0
VAP/Safety Net $52 $26 $24 $12
Balance Incentive Program $20 $10 $0 $0
Accelerate MRT Initiatives ($49) ($24) ($104) ($52)
Other Reforms/Savings ($149) ($100) ($208) ($144)
Federal Revenue from Additional Emergency MA/Other $0 ($250) $0 ($85)
2012‐13 Global Cap Underspending ($200) ($200) $0 $0
Restore 2% ATB Reduction $0 $0 $714 $357
All Other Investments/(Savings) Initiatives ($20) ($24) ($62) ($69)
Federal Health Care Reform ($493) ($163) ($708) ($520)
Repeal Family Health Plus $0.80 $0.40 ($118) ($59)
Medicaid Benchmark Plan $0 $0 $0 $115
Net Medicaid Proposals ($842) ($730) ($462) ($445)

Supportive Housing

  • Dedicates $86 million to expand access to supportive housing services:
    • Continues $70 million in MRT dollars to fund various supportive housing initiatives.
    • New funding of $12.5 million (when resources are available).
    • Designates $4 million from Medicaid savings derived from the closure of hospital and nursing home beds.

VAP/Safety Net

  • Increases funding for Essential Community Provider Network and Vital Access Providers:
    • Total VAP/SN Pool will increase to $182 million in 2013-14 and $153 million in 2014-15.
    • Includes reallocation of $30 million from the NH Financially Disadvantaged Program to the VAP/SN Pool for Nursing Homes.

Balance Incentive Program

  • Balance Incentive Program implementation:
    • BIP is a provision of ACA to provide enhanced community long term care services which will allow NYS to receive significant enhanced FMAP ($599 million from April 2013 through September 2015).
    • 1 year funding of $20 million in state operations costs.

Accelerate MRT Initiatives --
$24 million in Savings

  • PCMH savings from eliminating 2008 Level 2 payments and reducing Level 3 payments ($7 million).
  • FIDA savings from Community DUAL eligible (Medicare/Medicaid) receiving > 120 days ($7 million in 13-14 growing to $28 million in 14-15).
  • Stricter utilization management by Transportation Manager ($6 million).
  • Accelerate MLTC enrollment ($3 million).
  • Implement appropriateness edits on emergency Medicaid pharmacy claims ($2 million).
  • Accelerate BHO/IMD ($12 million in 14-15).

Other Reforms/Savings --
$100 million in Savings

  • Managed Care efficiencies ($25 million).
    • Reducing hospital readmissions, emergency department use, and other avoidable health care costs.
  • Accounts receivable recoveries ($50 million in 13-14 growing to $80 million in 14-15).
  • Increase manual review of FFS claims ($8 million).
  • Gold STAMP Program to reduce pressure ulcers ($6 million).
  • Discontinue coverage for Functional Electrical Stimulators that are deemed to be not clinically effective ($5 million).

Federal Revenue/Underspending/
Restoration -- $450 million in Savings

  • Federal revenue from additional emergency Medicaid claiming and other possible efforts ($250 million savings).
  • 2012-13 Global Cap underspending ($200 million savings).
    • Lower than expected utilization/costs in various COS ($130M); additional local administration savings ($40M); lower state operations spending ($30M).
  • Restore 2% Across-the-Board reduction ($714 million gross in 14-15; $357 million state).

Federal Health Care Reform --
$163 million in Savings

  • Revised enrollment/phase-in of Medicaid eligibility enrollees January 2014 (drives $163 million in lower costs in 13-14).
  • Repeal Family Health Plus ($59 million in state savings in 14-15):
    • Savings results from FHP enrollees (with incomes between 138% of FPL and 150%) moving to the Exchange or to a QHP.
  • Define Medicaid Benchmark Plan as the Current Medicaid Benefit ($115 million in State costs in 14-15):
    • Provides enrollees with benefits currently not received under FHP.

Results through February 2013

Results through February 2013

  • Medicaid expenditures through February 2013 are $192
    million or 1.3% below projections.
Medicaid Spending February 2013
(dollars in millions)
Category of Service Estimated Actual Variance
Total Fee For Service $10,477 $10,362 ($114)
   Inpatient $2,836 $2,793 ($43)
   Outpatient/Emergency Room $484 $452 ($32)
   Clinic $570 $563 ($8)
   Nursing Homes $3,156 $3,142 ($13)
   Other Long Term Care $1,660 $1,669 $9
   Non‐Institutional $1,771 $1,743 ($28)
Medicaid Managed Care $8,879 $8,887 $9
Family Health Plus $885 $874 ($11)
Medicaid Administration Costs $490 $450 ($40)
Medicaid Audits ($247) ($251) ($4)
All Other $912 $881 ($31)
Local Funding Offset ($6,729) ($6,729) $0
   TOTAL $14,666 $14,474 ($192)

2012-13 Global Cap Update

  • Advanced spending actions creating an avail for 2013-14:
    • Medicare Part D Clawback ($79 million).
    • Medicare Premiums ($53 million).
    • SUNY IGT Advance ($64 million).

A/R Balance: March 2013

Balance (Millions)
Inpatient $56
Clinic $72
Home Care $86
Nursing Homes $158
Other $28
Total  $400
  • The accounts receivable balance declined by $148 million during SFY 2012-13.
  • Balance as of March 31, 2013 is $400 million.
  • DOH will continue to work with providers asking for voluntary payment of outstanding liabilities:
    • Avoids interest costs; and
    • Mitigates adverse impact on Global Cap.

Additional Information