a forecast for the changing environment for medicaid and managed care michigan association health...
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A Forecast for the Changing Environment for
Medicaid and Managed Care
Michigan Association Health Plans Summer Conference
July 18, 2015
Employer-Sponsored172 million
48%
Medicaid70 million20%
Medicare54 Million 15%
Private20 Million
6%
Uninsured28 million 8%
CHIP6 million2%
Source: HMA estimates 2015.
Medicaid: The Nation’s Largest Single Health Program Insurance Status of Americans, 2015
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1965
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Chart Title
1975:
Medicaid Enrollment: A 50 – Year Look at America’s Largest Single Health Program
Millions of U.S. Medicaid Beneficiaries.Growth by decade.
SOURCE: 1966 – 2010: HMA analysis of CMS and CBO historical data and Medicaid projections, 2015.
2005
1995
1985
Projected
0% +64%
+64%
+52%
2015:70 Million
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Jan-99 Jul-99 Jan-00 Jul-00 Jan-01 Jul-01 Jan-02 Jul-02 Jan-03 Jul-03 Jan-04 Jul-04 Jan-05 Jul-05 Jan-06 Jul-06 Jan-07 Jul-07 Jan-08 Jul-08 Jan-09 Jul-09 Jan-10 Jul-10 Jan-11 Jul-11 Jan-12 Jul-12 Jan-13 Jul-13 Jan-14 Jul-14 Jan-15
1,000,000
1,100,000
1,200,000
1,300,000
1,400,000
1,500,000
1,600,000
1,700,000
1,800,000
1,900,000
2,000,000
2,100,000
2,200,000
2,300,000
2,400,000
Total Michigan Medicaid En-rollment
2000 - 2015
Source: HMA, based on data from Michigan Departments of Human Services and Community Health. Note: data does not include individuals enrolled only in “Plan First.”
Note: Excludes 50,000 to 90,000 individuals enrolled in Family Planning Waiver but includes children enrolled in Medicaid-expansion CHIP (fewer than 10,000).
2000 2005 2010 2015
1.1 Million
2.3 Million
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1,500,000
1,600,000
1,700,000
1,800,000
1,900,000
2,000,000
2,100,000
2,200,000
2,300,000
2,400,000
Michigan Medicaid Enrollment2012 - 2015
Total, With “Healthy Michigan Plan”
Without “Healthy Michigan”April2014
May2015
January2013
Note: Does Not Include “Plan First”
1,866,000
2,341,000
1,748,000
Projection of U.S. Medicaid Enrollment to 2025
2000 2005 2010 2015 2020 202530
40
50
60
70
80
90
Projected
76 Million
86 Million
6
SOURCE: HMA estimates, based on CMS Medicaid projections, 2015.
Millions of U.S.Medicaid and CHIPBeneficiaries
52 Million
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A Majority of All Americans Will Soon Obtain Coverage through Four Public Programs
2015 2020
54 63
7078
6
712
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CHIP
Medicaid
Medicare
Exchange
Source: HMA, 2015.
Millions of Beneficiaries142 Million (44% of Americans)
172 Million(51% of Americans)
Medicaid Spending Over 50 years: 1965 - 2015
0
100
200
300
400
500
600
$316
2015 $529 Bil.
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$13$41
$160.
Note: Includes CHIP 1998 - 2015. Source: HMA, based on CMS, Office of the Actuary, 2015.
19673.1 Bil.
$Billions
Projection of Medicaid Spending, by Type of Payment, to 2025
2000 2005 2010 2015 (Proj.) 2020 (Proj.) 2025 (Proj.)34 59
104201
317
480
79131
142
150
178
208
68
93
113
118
142
168
26
33
42
60
64
89
DSH - Other
LTSS FFS
Acute FFS
Capitation
$402
$529
$701
9
Sources: 2000 – 2020, CMS Actuary, July 2015. For 2025, HMA estimate.
$206
$316
$945
$Billions
Medicaid Spending, by Type of Payment 2000 to 2025
2000 2005 2010 2015 (Proj.) 2020 (Proj.) 2025 (Proj.)
34 59104
201
317
480
79
131142 150
178 208
6893
113 118142
168
26 33 4260 64
89
FFS Acute and Primary Care
LTSS FFS
DSH - Other
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Sources: 2000 – 2020, CMS Actuary, 2014 Actuarial Report, July 2015. For 2025, HMA estimate.
$Billions
CapitationPaymentsActual Projection
Total Spending on Medicaid and K–12 Education as % of Total State Spending
Average State Percentages, 2008 – 2014
2008 2009 2010 2011 2012 2013 201419%
20%
21%
22%
23%
24%
25%
26%
22.0%
20.0% 19.9%19.5%20.5%
23.7%
24.4%
25.8%Medicaid
K-12 Education
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Note; Medicaid share of state GF spending was 19% in 2014. Source: HMA, based on data in: NASBO, State Expenditure Report, 2014 and Earlier Years.
Medicaid: The largestsource of federal funds to states: 51%
How Will Medicaid Change Over the Next Decade?
– What direction for payment and delivery system reform? – Medicaid’s role in population health and social determinants?– Will innovations achieve value, access, quality, accountability,
performance, cost savings?– Will integration of care achieve results for persons with
disabilities, chronic conditions, behavioral health, long term care and duals?
– Will role of managed care continue to grow? What impact from the proposed managed care regs?
– Can Medicaid be fiscally sustainable for states and feds?– What new strategies will states use under Section 1332?– What will a new President and Congress do to Medicaid?
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Our Panel:
Lindsey Browning, NAMDMark Hamelburg, AHIP
Jeff Myers, MHPA
Michigan Association of Health Plans Summer Conference
A Forecast of the Changing Environment for Medicaid and Managed Care
July 18, 2015Mark Hamelburg
America’s Health Insurance Plans (AHIP) is the national trade association representing the health insurance industry. AHIP’s members provide health and supplemental benefits to more than 200 million Americans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. AHIP advocates for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality and innovation.
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Overview
• 50th Anniversary• CMS Vision of the Future: Proposed
Regulationo What does it look like? 7 key themeso What does it mean?
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CMS Vision• Alignment with Other Programs• Quality • Financial Rules• Oversight• Beneficiary Information• Managed Long Term Services and Supports
(MLTSS)• State Role
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What Does it Mean?• Some Improvements, Some Concerns• Increased Federal Expectations for Plans and
Stateso Costs o Riskso Relationship Between Plans and Regulators
• This is a lot of change at once - and more coming
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50 Years of Medicaid Evolution
Jeff M. MyersPresident and CEOMedicaid Health Plans of AmericaJuly 8th, 2015
Copyright Medicaid Health Plans of America. MHPA, 2015©
EverybodyKnows That
Copyright Medicaid Health Plans of America. MHPA, 2015©
What Everybody Knows
20102011
20122013
2014
2015 (pro
jected)
53.955.7
58.660.1
68.576.3
Medicaid/CHIP Enrollment
Source: Actuarial Report on the Financial Outlook for Medicaid 2010; CMS projection from CMS Presentation by B. Edwards.
$380.6B FY2009
Source: Actuarial Report on the Financial Outlook for Medicaid 2011-2014; Dec 2014 Enrollment Report; CMS projection from CMS Presentation
$546B FY2015 Projected
Copyright Medicaid Health Plans of America. MHPA, 2015©
MNNJNYOHORPATNTXWA
AZCAFLGAKYLAMDMI
ARDCDEIAILKSUT
MOMSNENDNHRIWV
COINKYMA
NMNVSCWIVA
AKALCTIDME
MTNCOKSDWYVT
>80
0K400-
800K <400
K
>50M and
23M and Source: State of Medicaid 2014; PricewaterHouseCoopers,
What You May Not Know – Part 1
Copyright Medicaid Health Plans of America. MHPA, 2015©
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CBO 2015 Es-timate FFS
CBO 2015 Esti-mate MCO+CBO 2015 Esti-mate MCO+CBO 2015 Esti-mate MCO+
CBO 2013 Es-timate FFS
CBO 2013 Esti-mate MCO+
Note Delta between CBO 2105 MCO+ Estimate
andCBO 2015 FFS Estimate
Copyright Medicaid Health Plans of America. MHPA, 2015©
Federal Spending in Billions
Source: Medicaid Spending and Enrollment Detail; CBO May 2013 baseline and CBO March 2105 Baseline
What You May Not Know – Part 2
Copyright Medicaid Health Plans of America. MHPA, 2015©
Underlying Trend #2: Managing the Most Frail
Duals hit 342K Enrollees!
All States
Underperforming!
CAILMAOHVA
129,306 57,686 17,608 64,594 26,176
MI 9,632NY 7,215 SC 1,698TX 28,212
Underlying Trend #2: Managing the Most Frail
Copyright Medicaid Health Plans of America. MHPA, 2015©
Not Quite
Copyright Medicaid Health Plans of America. MHPA, 2015©
Coordination of Medicaid MCOs with other forms of Insurance
MLTSS Roadmap for States IMD expansion State options on Network Adequacy and Quality
Measures Focus on Rate Adequacy
Nationwide MLR provisions Beneficiary protections or Provider Profit
Protections? Can State Medicaid Systems handle CMS data
requests?
Copyright Medicaid Health Plans of America. MHPA, 2015©
Bottom Line:
• Expect Significant Input from Stakeholders;
• Significant detail to those comments;
• Broad impact on a Variety of Stakeholders
= May be a longer than expected Review Time
Copyright Medicaid Health Plans of America. MHPA, 2015©
Copyright Medicaid Health Plans of America. MHPA, 2015©
THOUGHTS OR QUESTIONS?