medicaid expenditure trends and projections; smiles for...
TRANSCRIPT
Medicaid Expenditure Trends and Projections; Smiles for
Children Dental Program
Presentation to the:
Senate Finance Committee
Patrick W. Finnerty, DirectorDepartment of Medical Assistance Services
May 23, 2007Richmond, Virginia
2
Presentation Outline
Medicaid Program Overview
FY 2007 Projections
FY 2007 Year-to-Date Trends
Smiles for Children Dental Program
3
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Medicaid Enrollment Trends
Notes: Average monthly enrollment in the Virginia Medicaid Program
731,137
4
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Fee ForService
CapitatedManagedCareTotalEnrollment
Medicaid Enrollment Trendsby Service Delivery Type
Notes: Average monthly enrollment in the Virginia Medicaid ProgramCapitated Care consists of the Options and Medallion II programs
58%
42%
5
$4.8 billion
$.0 billion
$1.0 billion
$2.0 billion
$3.0 billion
$4.0 billion
$5.0 billion
$6.0 billion
1992 1994 1996 1998 2000 2002 2004 2006
State Fiscal Year
Medical Expenditure Trends
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$4.8 billion
$.0 billion
$1.0 billion
$2.0 billion
$3.0 billion
$4.0 billion
$5.0 billion
$6.0 billion
1992 1994 1996 1998 2000 2002 2004 2006
Fee ForService
ManagedCare
TotalExpenditures
Medical Expenditure Trendsby Service Delivery Type
State Fiscal Year
77%
23%
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Medicaid Enrollment & ExpendituresFY 2006
Children
Children
Adults
Adults
Blind & Disabled
Blind & Disabled
AgedAged
Recipients Expenditures
10%
20%
14%
56%
23%
46%
9%
22%
8
Presentation Outline
Medicaid Program Overview
FY 2007 Projections
FY 2007 Year-to-Date Trends
Smiles for Children Dental Program
9
2006 Consensus Medicaid Forecast
Historical and Projected Expenditures for General Medicaid, Long-Term Care and Mental Health Services($billions)
$0.0$1.0$2.0$3.0$4.0$5.0$6.0
$ B
illio
ns
Historical 1.96 2.07 2.14 2.24 2.5 2.76 2.85 3.29 3.57 4.06 4.432006 Forecast 4.83 5.2 5.542005 Forecast 4.47 4.82 5.18% Growth 6% 6% 3% 5% 12% 11% 3% 15% 9% 14% 9% 9% 8% 7%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
% Growth reflects annual growth of historical expenditures and the 2006 forecast.
10$2,489,932,917 ($4,026,675)$2,493,959,592 State Appropriation$2,332,804,518 ($5,571,675)$2,338,376,193 Federal Funding$4,822,737,435 ($9,598,350)$4,832,335,785 Total Medicaid Expenditures
303,873,4610303,873,461Total Mental Health1,421,375,107(8,689,696)1,430,064,803Total Long-Term Care
689,948,989(190,000)690,138,989All Other Acute Services180,508,202(718,654)181,226,856Pharmacy153,169,5280153,169,528Physician Services109,437,2250109,437,225Outpatient Hospital 763,086,0740763,086,074Inpatient Hospital
$1,201,338,848$0$1,201,338,848Managed CareAppropriationAmendmentsForecast
CurrentChapter 847Official
FY 2007 Funding Amendments
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Presentation Outline
Medicaid Program Overview
FY 2007 Projections
FY 2007 Year-to-Date Trends
Smiles for Children Dental Program
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-50,000
100,000150,000200,000250,000300,000350,000400,000450,000
FY19
92
FY19
93
FY19
94
FY19
95
FY19
96
FY19
97
FY19
98
FY19
99
FY20
00
FY20
01
FY20
02
FY20
03
FY20
04
FY20
05
FY20
06
Medicaid Enrollment Trends
Non-Disabled Adults & Children
Aged, Blind &
Disabled
Area enlarged
below
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200,000
225,000
250,000
275,000
300,000
Sep-
05
Oct
-05
Nov
-05
Dec
-05
Jan-
06
Feb-
06
Mar
-06
Apr
-06
May
-06
Jun-
06
Jul-0
6
Aug
-06
Sep-
06
Oct
-06
Nov
-06
Dec
-06
Jan-
07
Feb-
07
Mar
-07
Apr
-07
May
-07
350,000
375,000
400,000
425,000
450,000
Medicaid Enrollment Trends
Non-Disabled Adults & Children
Aged, Blind & Disabled
Implementation of federal DRA citizenship and identity requirements
Age
d, B
lind
& D
isab
led
Enro
llmen
t Non-D
isabled Adults &
Children
Enrollment
Creation of Consensus Medicaid Forecast
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FY 2007 Year-to-Date Expenditures
YTDYTD
11.5%10.1%1,810,538,9591,992,678,130$2,489,932,917 State Appropriation6.1%3.4%1,810,398,7971,872,845,884$2,332,804,518 Federal Funding8.8%6.8%$3,620,937,757 $3,865,524,014 $4,822,737,435
Total Medicaid Expenditures
17.3%16.9%210,411,541245,905,434303,873,461Mental Health Services12.4%9.6%1,043,063,5861,142,916,5781,421,375,107Long-Term Care Services33.3%46.5%379,478,940555,987,342689,948,989All Other Acute Services
-47.0%-53.4%327,216,991152,490,536180,508,202Pharmacy-0.5%-5.4%127,515,030120,663,728153,169,528Physician Services-4.9%-7.6%93,878,82786,757,360109,437,225Outpatient Hospital 10.7%5.6%538,373,409568,703,933763,086,074Inpatient Hospital 10.1%10.1%$900,999,433$992,099,102$1,201,338,848Managed Care
GrowthGrowthFY 2006FY 2007AppropriationExpenseFundedYTDCurrent
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Presentation Outline
Medicaid Program Overview
FY 2007 Projections
FY 2007 Year-to-Date Trends
Smiles for Children Dental Program
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Access to/Utilization of Dental Services Needed to Improve
87%
13%
Not ParticipatingParticipating
Low participation of dentists (620 of 4,786) in the Medicaid/FAMIS program was a major problem– Low reimbursement– Administrative “hassles”– Patient no-shows
Dentist Participation in Medicaid/SCHIP*
* FY 2003
In FY 2003, only 23.4% of all eligible children actuallyreceived any dental services
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Key Stakeholders Worked Together for Change
Advocacy Groups
MCOs
OrganizedDentistry
Medicaid/SCHIP Agency
Governor
Legislature
New Medicaid/ FAMIS Dental
Program
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New Program Structure and a 30% Increase In Fees
General Assembly/Governor authorized DMAS to develop an entirely new program structure
Also approved a 30% increase in dental fees– 28% on July 1, 2005; additional 2% in May, 2006
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A New Day for Dental! Smiles for Children
Effective date: July 1, 2005
All children (Medicaid & FAMIS) are enrolled in a single program administered by Doral Dental USA
Limited medically necessary diagnostic/oral surgery services for adults
DMAS retains policymaking authority and closely monitors contractor activities along with Dental Advisory Committee
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Key Program Enhancements
Old Program Smiles for Children
Different credentialing processes
Complicated Administration
Limited local representation on program decisions
Enrollee transfer betweenplans can disrupt care
Single Vendor (Doral)
Streamlined Credentialing
Easy, Industry-Standard Administration
Va. Based Peer ReviewCommittee & DentalAdvisory Committee
Multiple Vendors
All enrollees in Smiles forChildren program
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Value-Added Benefits for Providers
Toll-free phone number for providers
Call center specialists– Member Placement– Eligibility, benefits, authorizations– Claims issues– Addressing patient “no-shows”
Multiple claim submission options……free, electronic filing
Timely and accurate payments
Automated, web-integrated or live eligibility verification (24/7)
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Program Changes = Increased Provider Network
326 new dentists are participating (53% increase)– Network continues to
expand– 6 localities that previously
had no participating dentists now have access
– Percentage of contracted providers who are billing for services has increased from 50% to 80%
Very high level of provider satisfaction
620
946
0100200300400500600700800900
1000
Jul-05 Apr-07
Participating Providers
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…..And Increased Access to Care
0.0%5.0%
10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%
Ages 0-20 Ages 3-20
FFY 2005 FFY 2006
Percentage of Children Receiving Necessary Dental Care
30% Increase
33% Increase
24% 32% 30% 39%
Source: CMS 416 Report for Virginia
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Smiles for Children Has Received National Attention
14th Annual Medicaid Managed Care Congress
2006 & 2007
THANK YOU!!