Ohio Medicaid Budget Variance Report – December 2019 The Ohio Medicaid Budget Variance Report provides a monthly review of actual Medicaid expenditures compared to disbursement estimates for FY20. Through December 2019, the total variance of the Medicaid Program was 1.1% under the $14.2 billion estimate. The state share of spending from the GRF 651525 line item, the primary funding source for services, was under estimate by $44.7 million (-1.9%) through December. Total payments for the month of December were over estimate due to timing of DODD payments and managed care payments that were higher than originally planned. Spending will be monitored closely for the rest of the fiscal year, as the budget is very tight.

Managed Care is running within 0.2% of estimate year-to-date. December payments were over estimate by $45.6 million or 2.9%. CMS has strict requirements that rates must be actuarially sound. The managed care population continues to have a significant degree of higher than anticipated morbidity, concentrated in the Covered Families and Children (CFC) population and the Group VIII expansion. This has resulted in a retrospective rate adjustment made for CY2019 that totals $232.7 million. A total of $66 million was paid in December and the balance of $166.7 million will pay out in January.

The morbidity issue is also driving higher than anticipated managed care rates for CY2020. Overall, the 2020 managed care rates are approximately three percent higher than assumed in the budget. MyCare rates are lower than projected for CY2020. Because the FMAP rate is much higher on the managed care program, the net state share impact is estimated to be neutral, but will likely result in higher than anticipated federal share spending for the rest of the fiscal year into FY21.

The variance in 651525 is disproportionately federal for the month. The release of managed care incentives, while close to budget in total, had a higher federal share than anticipated. This resulted in state share spending of $20 million less than projected, while federal share was $20 million higher than estimate.

The most significant variance for the month of December occurred in DODD services. This is due to the timing of county board settlements that were paid in December but were originally estimated for November. Year-to-date payments for DODD services are right on budget.

Medicare Premium Assistance Payments were under estimate by $13.2 million, or 2.4%, through the month of December. Medicare Buy In is driving $9.3 million of variance in this category.

The waterfall graph below indicates the sources of the budget variance through December:

There was very little variance in total caseload for the month of November. Overall caseload was

8,427 (-0.30%) under estimate for the month. Covered Families and Children (CFC) enrollment was under projections by 11,598 (-0.73%) and Expansion enrollment was over projections by 6,129 (1.02%). ABD/MBIWD/Dual enrollment was 486 (0.10%) over estimate. Other categories make up the remainder of the variance.

All Agency Medicaid Budget Variance - SFY 2020

Budget Status By Appropriation Line Item

As of Jan 6, 2020 (Month closed)

Source: OAKS GL Table December December December YTD YTD YTD

AGY FUND ALI Description Budget Expenditures Variance % Budget Expenditures Variance %

AGY FUND GRF Services

MCD GRF State 651525 Medicaid/Health Care Services 473,086,561$ 450,994,676$ (22,091,885)$ -4.67% 2,333,950,224$ 2,289,250,149$ (44,700,076)$ -1.92%

MCD GRF Federal 651525 Medicaid/Health Care Services 1,047,274,280$ 1,108,555,049$ 61,280,769$ 5.85% 5,421,450,662$ 5,427,191,102$ 5,740,440$ 0.11%

651525 Total 1,520,360,841$ 1,559,549,725$ 39,188,884$ 2.58% 7,755,400,886$ 7,716,441,251$ (38,959,635)$ -0.50%

MCD GRF State 651426 Positive Education -$ -$ -$ 2,500,000$ -$ (2,500,000)$ -100.00%

MCD GRF State 651526 MEDICARE PART D 39,768,343$ 38,821,208$ (947,136)$ -2.38% 236,907,897$ 233,023,501$ (3,884,396)$ -1.64%

MCD GRF State 651529 Brigid's Path Progam -$ -$ -$ 500,000$ -$ (500,000)$ -100.00%

MCD GRF State 651533 Food Farmacy Pilot Project -$ -$ -$ 250,000$ -$ (250,000)$ -100.00%

DDD GRF State 653407 MEDICAID SERVICES 52,988,434$ 51,656,898$ (1,331,536)$ -2.51% 344,270,886$ 344,241,927$ (28,958)$ -0.01%

Subtotal GRF Services 1,613,117,618$ 1,650,027,831$ 36,910,213$ 2.29% 8,339,829,668$ 8,293,706,679$ (46,122,989)$ -0.55%

AGY FUND GRF Administration

MCD GRF State 651425 MEDICAID PROGRAM SUPPORT STATE 13,781,650$ 8,657,238$ (5,124,412)$ -37.18% 78,408,153$ 68,624,823$ (9,783,330)$ -12.48%

MHA GRF State 652321 MEDICAID SUPPORT 113,298$ 51,393$ (61,905)$ -54.64% 736,446$ 699,935$ (36,512)$ -4.96%

DDD GRF State 653321 MEDICAID PROGRAM SUPPORT STATE 544,375$ 516,205$ (28,170)$ -5.17% 3,820,282$ 3,820,282$ (0)$ 0.00%

DOH GRF State 654453 MEDICAID-HC QUALITY ASSURANCE 359,757$ 353,842$ (5,914)$ -1.64% 2,196,528$ 2,193,534$ (2,993)$ -0.14%

JFS GRF State 655425 MEDICAID PROGRAM SUPPORT 1,314,460$ 1,286,299$ (28,161)$ -2.14% 6,569,422$ 5,605,159$ (964,264)$ -14.68%

JFS GRF State 655522 MEDICAID PROGRAM SUPPORT-LOCAL 3,186,285$ 3,631,648$ 445,363$ 13.98% 26,106,470$ 25,864,648$ (241,823)$ -0.93%

JFS GRF State 655523 MEDICAID PRGRM SUPP- LOC TRNSP 3,900,000$ 4,062,731$ 162,731$ 4.17% 18,172,647$ 22,011,539$ 3,838,892$ 21.12%

AGE GRF State 656423 LONG TERM CARE BUDGET - STATE 455,000$ 358,221$ (96,779)$ -21.27% 2,556,244$ 2,191,966$ (364,278)$ -14.25%

EDU GRF State 657401 Medicaid in Schools 20,274$ 28,620$ 8,346$ 41.16% 162,500$ 147,147$ (15,354)$ -9.45%

Subtotal GRF Administration 23,675,099$ 18,946,198$ (4,728,901)$ -19.97% 138,728,692$ 131,159,031$ (7,569,662)$ -5.46%

Total GRF 1,636,792,717$ 1,668,974,029$ 32,181,312$ 1.97% 8,478,558,361$ 8,424,865,709$ (53,692,651)$ -0.63%

Total GRF State 589,518,437$ 560,418,980$ (29,099,457)$ -4.94% 3,057,107,699$ 2,997,674,607$ (59,433,092)$ -1.94%

Total GRF Federal 1,047,274,280$ 1,108,555,049$ 61,280,769$ 5.85% 5,421,450,662$ 5,427,191,102$ 5,740,440$ 0.11%

AGY FUND Non GRF Services

MCD 5R20 651608 MEDICAID Nursing Facilities -$ -$ -$ 104,716,500$ 104,677,555$ (38,945)$ -0.04%

MCD 3F00 651623 HEALTH CARE FEDERAL 432,838,355$ 426,173,970$ (6,664,384)$ -1.54% 2,778,535,776$ 2,774,320,877$ (4,214,899)$ -0.15%

MCD 5FX0 651638 Medicaid Services - Payment Withholding 1,000,000$ 544,743$ (455,257)$ -45.53% 6,000,000$ 4,388,410$ (1,611,590)$ -26.86%

MCD 5DL0 651639 Medicaid Revenue and Collections 67,341,343$ 31,641,583$ (35,699,760)$ -53.01% 487,406,243$ 448,217,262$ (39,188,981)$ -8.04%

MCD R055 651644 Refunds & Reconciliation 47,544$ -$ (47,544)$ -100.00% 762,279$ 228,489$ (533,790)$ -70.03%

MCD 6510 651649 Medicaid Services - HCAP -$ -$ -$ 249,167,065$ 252,046,000$ 2,878,936$ 1.16%

MCD 5GF0 651656 MEDICAID HOSPITAL 30,314,463$ 30,991,179$ 676,716$ 2.23% 30,624,117$ 31,026,964$ 402,847$ 1.32%

MCD 5SC0 651683 Medicaid Services - Physician UPL -$ -$ -$ -$ -$ -$

MCD 5TN0 651684 Medicaid Services-HIC Fee 75,869,460$ 110,869,460$ 35,000,000$ 46.13% 379,347,300$ 414,347,300$ 35,000,000$ 9.23%

MCD 5AN0 651686 CARE INNOVA & COMM IMRPRV PRG 9,042,084$ 9,042,084$ (0)$ 0.00% 31,969,821$ 31,969,820$ (1)$ 0.00%

MCD 5DL0 651690 Multi-system Youth Custody Relinquishment -$ 285,934$ 285,934$ -$ 1,253,593$ 1,253,593$

All Agency Medicaid Budget Variance - SFY 2020

Budget Status By Appropriation Line Item

As of Jan 6, 2020 (Month closed)

Source: OAKS GL Table December December December YTD YTD YTD

AGY FUND ALI Description Budget Expenditures Variance % Budget Expenditures Variance %

DDD 5GE0 653606 ICF/IID & WAIVER MATCH 3,808,269$ 4,082,979$ 274,710$ 7.21% 14,834,218$ 15,144,476$ 310,258$ 2.09%

DDD 1520 653609 DC&RESIDENTIAL OPERATING SRVCS 622,404$ 1,498,959$ 876,555$ 140.83% 3,954,372$ 3,974,935$ 20,563$ 0.52%

DDD 5Z10 653624 COUNTY BOARD WAIVER MATCH 32,622,614$ 34,429,848$ 1,807,233$ 5.54% 164,126,040$ 168,104,082$ 3,978,042$ 2.42%

DDD 4890 653632 DC DIRECT CARE SERVICES 317,295$ 897,189$ 579,894$ 182.76% 2,003,405$ 1,940,769$ (62,636)$ -3.13%

DDD 3A40 653654 Medicaid Services 161,652,783$ 233,537,698$ 71,884,915$ 44.47% 1,038,843,530$ 1,032,497,229$ (6,346,301)$ -0.61%

Subtotal Non GRF Services 815,476,615$ 883,995,628$ 68,519,013$ 8.40% 5,292,290,666$ 5,284,137,762$ (8,152,904)$ -0.15%

AGY FUND Non GRF Administration

MCD 3ER0 651603 Medicaid Health Information Tech 2,271,247$ 632,694$ (1,638,553)$ -72.14% 11,052,326$ 2,075,924$ (8,976,401)$ -81.22%

MCD 4E30 651605 Resident Protection Fund 296,082$ 658,274$ 362,192$ 122.33% 1,497,383$ 2,036,151$ 538,768$ 35.98%

MCD 3F00 651624 Medicaid Program Support Fed 34,381,860$ 20,749,644$ (13,632,216)$ -39.65% 228,271,691$ 145,603,068$ (82,668,623)$ -36.22%

MCD 5AJ0 651631 Money Follows the Person -$ -$ -$ 1,813,763$ 2,701,131$ 887,368$ 48.92%

MCD 5DL0 651685 Medicaid Recoveries -Support 1,276,186$ 441,306$ (834,880)$ -65.42% 15,032,399$ 7,432,877$ (7,599,522)$ -50.55%

MCD 3FA0 651680 Health Care Grants Federal -$ -$ -$ 12,250$ 12,250$ -$ 0.00%

MHA 3B10 652636 COMM MEDICAID LEGACY SUPPORT 200,000$ -$ (200,000)$ -100.00% 1,171,887$ 271,887$ (900,000)$ -76.80%

DDD 3A40 653655 Medicaid Support 2,618,228$ 10,622,170$ 8,003,941$ 305.70% 34,050,151$ 31,159,678$ (2,890,472)$ -8.49%

DDD 5S20 653622 MEDICAID ADMIN & OVERSIGHT 1,888,507$ 1,645,602$ (242,905)$ -12.86% 13,034,331$ 11,794,594$ (1,239,737)$ -9.51%

DDD 5EV0 653627 MEDICAID PROGRAM SUPPORT 136,578$ 210,537$ 73,959$ 54.15% 901,033$ 918,463$ 17,430$ 1.93%

DOH 3GD0 654601 MEDICAID PROGRAM SUPPORT 2,320,816$ 2,193,582$ (127,234)$ -5.48% 14,495,383$ 18,612,704$ 4,117,321$ 28.40%

JFS 3F01 655624 MEDICAID PROGRAM SUPPORT 19,426,111$ 17,739,914$ (1,686,197)$ -8.68% 88,208,381$ 98,330,631$ 10,122,250$ 11.48%

AGE 3C40 656623 LONG TERM CARE BUDGET- FEDERAL 386,645$ 180,233$ (206,412)$ -53.39% 2,554,787$ 1,203,794$ (1,350,994)$ -52.88%

AGE 5TI0 656624 Provider Certification -$ -$ -$ -$ -$ -$

AGE 5T40 656625 HEALTHCARE GRANTS -STATE -$ -$ -$ 181,998$ 86,896$ (95,102)$ -52.25%

EDU 3AF0 657601 Schools Medicaid Admin Claims -$ -$ -$ 61,993$ 61,993$ -$ 0.00%

PRX 4K90 658605 OARRS Integration - State 8,000$ 5,834$ (2,166)$ -27.08% 186,668$ 186,348$ (320)$ -0.17%

PRX 3HH0 658601 OARRS Integration - Federal 74,300$ 55,178$ (19,122)$ -25.74% 1,634,822$ 1,731,665$ 96,842$ 5.92%

Subtotal Non GRF Administration 65,284,560$ 55,134,967$ (10,149,594)$ -15.55% 414,161,245$ 324,220,054$ (89,941,191)$ -21.72%

Subtotal Non GRF 880,761,175$ 939,130,594$ 58,369,419$ 6.63% 5,706,451,911$ 5,608,357,815$ (98,094,095)$ -1.72%

Grand Total 2,517,553,892$ 2,608,104,623$ 90,550,731$ 3.60% 14,185,010,271$ 14,033,223,525$ (151,786,746)$ -1.07%

Total Service 2,428,594,233$ 2,534,023,459$ 105,429,226$ 4.34% 13,632,120,334$ 13,577,844,441$ (54,275,893)$ -0.40%

Total Administration 88,959,659$ 74,081,165$ (14,878,494)$ -16.72% 552,889,937$ 455,379,084$ (97,510,853)$ -17.64%

Note: Amounts exclude transfers and non appropriated Local funding

All Agency Medicaid Budget Variance - SFY 2020

December As of 1/6/2020

Month Projection Expenditure Variance %

July 2,248,172,800$ 2,248,172,800$ -$ 0.00%

August 2,507,263,087$ 2,454,004,546$ (53,258,541)$ -2.12%

September 2,554,735,108$ 2,508,499,731$ (46,235,377)$ -1.81%

October 2,133,320,667$ 2,100,074,032$ (33,246,634)$ -1.56%

November 2,223,964,718$ 2,114,367,792$ (109,596,926)$ -4.93%

December 2,517,553,892$ 2,608,104,623$ 90,550,731$ 3.60%

Total Projection 14,185,010,271$ 14,033,223,525$ (151,786,746)$ -1.07%

Year-To-Date Analysis - Source GL Table

Category Projection Expenditure Variance %

ODM FFS 2,161,541,719$ 2,105,823,450$ (55,718,270)$ -2.58%

DDD Services 1,568,032,451$ 1,565,903,418$ (2,129,032)$ -0.14%

Subtotal FFS 3,729,574,170$ 3,671,726,868$ (57,847,302)$ -1.55%

Managed Care - ABD 1,419,028,859$ 1,403,906,078$ (15,122,781)$ -1.07%

Managed Care - ABD/ADFC Kids 459,939,713$ 461,615,793$ 1,676,080$ 0.36%

Managed Care - MyCare 1,326,630,822$ 1,348,996,842$ 22,366,020$ 1.69%

Managed Care - CFC 2,957,733,814$ 2,938,599,302$ (19,134,512)$ -0.65%

Managed Care - Group VIII 2,175,390,144$ 2,198,719,666$ 23,329,522$ 1.07%

Managed Care Withholding Release 204,482,188$ 204,196,650$ (285,538)$ -0.14%

Subtotal Managed Care 8,543,205,540$ 8,556,034,331$ 12,828,791$ 0.15%

Hospital UPL 109,585,885$ 102,326,909$ (7,258,976)$ -6.62%

Hospital HCAP 669,444,021$ 680,646,323$ 11,202,302$ 1.67%

CICIP FFS 17,462,801$ 17,462,801$ -$ 0.00%

Subtotal Hospital/Physician UPL/HCAP 796,492,707$ 800,436,033$ 3,943,326$ 0.50%

Medicare Buy In 325,940,020$ 316,623,708$ (9,316,312)$ -2.86%

Medicare Part D 236,907,897$ 233,023,501$ (3,884,396)$ -1.64%

Subtotal Medicare Premium Assistance 562,847,917$ 549,647,208$ (13,200,708)$ -2.35%

All Agency Administration 552,889,937$ 455,379,084$ (97,510,853)$ -17.64%

Subtotal Administration 552,889,937$ 455,379,084$ (97,510,853)$ -17.64%

Total YTD Vs. Projection 14,185,010,271$ 14,033,223,525$ (151,786,746)$ -1.07%

Analysis for the Month - Source GL Table

Category Projection Expenditure Variance %

ODM FFS 373,504,586$ 367,919,597$ (5,584,989)$ -1.50%

DDD Services 252,011,800$ 326,103,572$ 74,091,772$ 29.40%

Subtotal FFS 625,516,386$ 694,023,169$ 68,506,783$ 10.95%

Managed Care - ABD 237,979,018$ 231,223,237$ (6,755,781)$ -2.84%

Managed Care - ABD/ADFC Kids 76,989,293$ 79,907,765$ 2,918,472$ 3.79%

Managed Care - MyCare 223,197,571$ 219,544,043$ (3,653,528)$ -1.64%

Managed Care - CFC 491,967,361$ 505,518,644$ 13,551,283$ 2.75%

Managed Care - Group VIII 363,104,150$ 400,990,010$ 37,885,860$ 10.43%

Managed Care Withholding Release 204,482,188$ 206,121,289$ 1,639,101$ 0.80%

Subtotal Managed Care 1,597,719,581$ 1,643,304,988$ 45,585,407$ 2.85%

Hospital UPL 108,492,077$ 102,202,273$ (6,289,804)$ -5.80%

Subtotal Hospital/Physician UPL/HCAP 108,492,077$ 102,202,273$ (6,289,804)$ -5.80%

Medicare Buy In 57,097,845$ 55,671,821$ (1,426,025)$ -2.50%

Medicare Part D 39,768,343$ 38,821,208$ (947,136)$ -2.38%

Subtotal Medicare Premium Assistance 96,866,188$ 94,493,028$ (2,373,160)$ -2.45%

All Agency Administration 88,959,659$ 74,081,165$ (14,878,494)$ -16.72%

Subtotal Administration 88,959,659$ 74,081,165$ (14,878,494)$ -16.72%

Total Month Vs. Projection 2,517,553,892$ 2,608,104,623$ 90,550,731$ 3.60%

Note: Subject to change for accounting updates.