rhode island annual medicaid expenditure report april, 2007 · 2012. 10. 25. · 3 medicaid annual...

Rhode Island Annual Medicaid Expenditure Report

Executive Office of Health and Human ServicesJane A. Hayward, Secretary

April, 2007

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

Executive Office of Healthand Human Services

Hazard Building - 74 West Road, Cranston, Rhode Island 02920(401)462-5274 (voice) (401)462-0241 (fax) TDD: 401/462-3363

A Message from the Secretary

Rhode Island’s Medicaid program, which is funded by a combination of federal and state dollars, has touched the lives of nearly one-third of all our state’s citizens over the past five years. From low-income elders and adults with disabilities to uninsured and underinsured working families and children with special health care needs, Medicaid has provided acute or long-term care services with a state price tag of approximately $760 million (FFY 2005).

This report is a follow-up to the expenditure report submitted to the Governor and the leadership of the General Assembly in December of last year that provided an overview of Medicaid spending for State Fiscal Year (SFY) 2005. It should be noted that the SFY 2006 data reflects the impact of Medicare Part D as well as the integration of former offline payments by MHRH into the Medicaid Management Information System (“MMIS”).

The first report was required as part of the enacted fiscal year 2007 budget, to be prepared and submitted on an annual basis by December 1st, beginning in 2006. In order to meet that deadline for this past December, expenditure data from 2005 had to be used, as data from fiscal year 2006 was not available until after January 1st. To ensure state policymakers have access to the most timely information available, this report summarizes total Medicaid expenditures for SFY 2006 in the state across all agencies administering and financing federally funded Medicaid programs.

As in the first report, because this is the first time Medicaid expenditure information from a number of state agencies has been analyzed and compiled into one document, we have endeavored to establish a standard format for tracking and examining Medicaid trends that will inform policy and planning discussions concerning health care coverage and access. The information contained in these pages will provide a solid foundation for future discussions relative to the complexities of Medicaid financing and service delivery as well as the evolution of the program reflecting budget constraints and/or changes in the needs of Medicaid beneficiaries across the country and in Rhode Island.

Sincerely,

Jane A. Hayward

Secretary

RI Medicaid overview

2

Program Overview

What Is Medicaid?

The medical assistance program jointly funded by the federal government and the states established in 1965 as Title XIX of the U.S. Social Security Act.

Nationwide, Medicaid is the dominant state administered health care program covering low-income children and families, elders and persons with disabilities.

The Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for establishing guidelines to administer the requirements of Title XIX and overseeing their implementation by state Medicaid programs.

Under these federal guidelines, there are specific “mandatory” categories of people and types of benefits that all state Medicaid programs must cover to receive federal matching payments.

States also have the flexibility to tailor certain aspects of the Medicaid program to meet their own needs.

States may obtain federal matching funds for covering several “optional” groups of individuals and services.

Each state has the discretion within federal guidelines to (1) establish its own eligibility process; (2) determine the type, amount, duration, and scope of services; (3) purchase and set payment rates for services; and (4) administer its own program.

Although the scope of state Medicaid programs vary, all are feeling the effects of the continued rise in health costs, the shifts in federal funding and policy priorities, and the increasingly more complex needs of the people they serve.

Notes on 2006 Report:

A portion of MHRH HCBS services in the amount of $7.4 million (formerly paid offline) are captured on this report for the first time.

Medicare Part D was implemented in January 2006. Although Medicare now covers most pharmaceutical costs for those who have both Medicaid and Medicare, the state pays back to the Federal Government a "clawback" which is approximately the amount the state would have paid for pharmacy benefits if Medicare Part D had not been instituted.The clawback amount is included as a pharmacy expenditure throughout this report.

DSH payments are not included unless specifically noted.

3

Medicaid Annual Expenditure Report

Statutory Mandate

R.I.G.L. 42-7.2-5(d), the authorizing statute for the EOHHS, authorizes the Secretary to:

Beginning in 2006, prepare and submit to the governor and to the joint legislative committee for health care oversight, by no later than December 1 of each year, a comprehensive overview of all Medicaid expenditures included in the annual budgets developed by the departments. The directors of the departments shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever resources, information and support shall be necessary.

Purposes of the Expenditure Report

Provide state policymakers with a comprehensive overview of state Medicaid spending to assist in assessing and making strategic choices about program coverage, costs, and efficiency in the annual budget process.

Summarize Medicaid expenditures for eligible individuals and families covered by one or more of the five health and human services departments.

Show enrollment and spending trends for Medicaid coverage groups by service type, care setting, and delivery mechanism.

Identify areas in the Medicaid program where the state has the most flexibility and control over the scope, amount and duration of coverage and services.

Establish a standard format for tracking and evaluating trends in annual Medicaid expenditures within and across departments.

Inform broader policy and planning discussions about the future of the RI Medicaid program, the role it plays in the state’s health care system, and its impact on the larger economy.

4

Glossary of acronyms

A&D: Aged & disabled

CFMC: Children and families in managed care

CSHCN: Children with special health care needs

DCYF: Department of Children, Youth and Families

DEA: Department of Elderly Affairs

DSH: Disproportionate share hospitals

DHS: Department of Human Services

EOHHS: Executive Office of Health and Human Services

FFY: Federal fiscal year

FMAP: Federal Medicaid assistance percentage

HCBS: Home and community-based services

ICF/MR: Intermediate care facility/mental retardation

LEA: Local education agencies

LTC: Long term care

MHRH: Mental Health, Retardation and Hospitals

MR/DD: Mental retardation/developmental disabilities

MR Facility: Mental retardation facility

PCPM: Per capita per month

SFY: State fiscal year

RI Medicaid 2006

6

Figure 1

Sources of funds,

SFY 2005

State of Rhode Island44%

Federal55%

Insurance premiums1%

The federal government pays for 55% of overall Medicaid spending

7

Figure 2

SFY 2006

Medicaid expenditures total approximately $1.9 billion

All funds

The focus of this report is on Medicaid medical expenseswhich represent 89% of totalMedicaid expenses

Medical expenses$1,664,546,559

Admin & operations -$102,913,653

DSH - $110,026,489

Source: Medicaid claims extract & State budget documents

Note: Does not include psychiatric DSH/uncompensated care pool

Note: Administrative & Operations reflects 2005, because full year 2006 numbers are not yet available

Note: SFY 2006 reflects Medicare Part D “clawback” provisions and $7.4 Million in MHRH offline payments. All figures hereafter reflect these two components.

8

Medicaid benefit spending is spread across a number of state agencies

and local school districts

Figure 3

Spending by department

SFY 2006

DHS - $1,234,321,234

LEA - $20,068,294

MHRH - $410,195,189

DCYF - $139,100,069

DEA - $6,060,262

All fundsSource: Department of Human Services

9

Medicaid spending is spread across a number of state agencies

and local school districts

Source: State budget documents

Note: Does not include psychiatric DSH/uncompensated care pool

Hospital $252,942,922

Regular 142,916,434 DSH/uncompensated care 110,026,488

Long Term Care $328,948,897

Nursing Facilities 298,497,104 Community-based long term care 30,451,793

Managed care $403,074,108

Rite care - core 307,802,191 Rite share 7,477,488 Substitute care 7,746,462 CSHCN’s 20,877,334 Out-of-plan (N/I rehab) 59,170,634

Pharmacy $92,975,249

Claims payments 136,000,000 Rebates (49,292,870)Medicare Phased-down Contribution 17,800,000Drug Receivable (11,531,881)

Treatment and rehabilitation $80,390,850

Physician 19,072,728 Oral health 21,845,655 Rehabilitative services 39,472,467

Medicare premiums $29,239,958

Other $46,738,508

Special education $20,068,294

Restricted receipt $10,741

TOTAL DHS $1,254,389,528

Eleanor Slater Hospital system $106,141,003

Elenor Slater Hospital 102,241,076 Zambarano group homes 3,899,927

MR/DD waiver $236,068,068

Public providers 48,532,736 Private providers 186,114,878 Supported living arrangements 1,420,454

Integrated behavioral health $67,986,118

Community-based behavioral health 59,991,664 Substance abuse treatment 5,524,430 Other 2,470,024

TOTAL MHRH $410,195,189

Psychiatric hospital $9,152,084

Rehab services $106,292,622

Managed care $23,655,363

TOTAL DCYF $139,100,069

Case management $438,244

Personal care in assisted living $841,666

Community supports $4,780,352

Home Care 4,454,125 Assistive Devices 2,350 Home Modifications 16,135Other 307,742

TOTAL DEA $6,060,262

TOTAL HEALTH $1,096,515

STATEWIDE TOTAL $1,810,841,563

DH

S

MH

RH

DC

YF

DE

A

Table 1

10

School districts participating in the Medicaid programLocal Education Agency

BarringtonBristol / Warren BurrillvilleCentral Falls CharihoCoventryCranstonCumberlandE. Greenwich E. Providence Exeter-W. Greenwich FosterFoster/GlocesterGlocesterJamestownJohnstonLincolnNarragansettNew Shoreham NewportNewport County Reg. N.KingstownN.ProvidenceN.SmithfieldPawtucketProvidenceSchool for the Deaf ScituateSmithfieldS.KingstownWarwick W. Warwick Westerly Wm. M. Davies Woonsocket Kinston Hill AcademyPaul Cuffee SchoolEast Bay Educational CollabMet Career & Tech CtrInternational Charter SchoolBlackstone Academy CharterCVS Highlander Charter SchoolCompass Charter SchoolBeacon Charter SchoolThe Learning CommunityTotals

Combined 2003

273,520$377,482$400,939$

1,316,540$160,478$519,432$

1,879,510$658,270$287,979$

1,258,055$343,448$48,016$85,800$

109,100$116,752$602,726$403,557$261,650$

$ -606,795$636,288$775,152$461,637$204,443$

2,950,817$5,574,770$

234,600$105,600$314,875$764,661$

2,248,409$578,538$590,123$

$ -1,125,643$

5,000$1,900$-$-$-$-$-$-$-$-$

26,282,505$

Combined 2004

298,792$473,470$319,067$

1,727,250$390,468$623,113$

2,160,765$642,289$338,539$

1,273,826$330,473$68,107$81,049$

175,654$73,160$

811,928$450,300$271,989$

-$750,265$660,482$825,333$607,115$198,697$

2,416,996$5,622,819$

149,747$159,423$308,725$916,998$

1,970,802$674,276$601,282$

-$1,217,711$

-$3,500$

15,400$141,769$

-$-$-$-$-$-$

27,751,579$

333,656$401,322$359,845$

1,385,015$207,971$734,688$

1,134,916$673,816$341,179$

1,085,027$292,897$40,758$72,352$

151,474$104,652$770,654$711,074$174,248$

-$649,141$525,864$768,272$744,100$203,084$

1,744,351$4,476,397$

210,434$180,350$265,862$700,393$

1,717,850$535,998$446,200$

5,805$1,173,791$

-$100$

18,500$178,271$13,800$33,530$14,407$-$-$-$

23,651,643$

Combined 2005

24,102,867$

Combined 2006Table 2

Source:Department of Human Services

337,692382,262300,680

1,312,106331,266525,756

1,574,162683,936412,980

1,365,421263,713

75,60328,090

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

183,895130,851817,585697,667157,372

877,949

-488,811

608,410772,673208,345

2,001,764

98,1793,862,974

158,533267,991942,369

1,861,235497,747413,58854,802

1,072,628-4,560

23,802183,467

8,91248,98448,7497,4097,948-

11

Disproportionate share (DSH) Medicaid payments are made to subsidize

the costs of providing care to indigent and very low income people

$35,111,439

$4,238,027

$7,095,546

$11,436,667

$9,639,511

$4,135,413

$7,905,360

$1,952,477

$7,665,172

$2,560,448

$6,002,694

$79,317

$8,828

$12,205,589

Rhode Island

Newport

Roger Williams

Women & Infants

Memorial

Landmark

St.Joseph

South County

Miriam

Westerly

Kent

Bradley

Butler

Slater

Figure 4

DSH/uncompensated care distribution by hospital

SFY 2006

Note: Does not include Psychiatric & Graduate medical education DSH poolSource: Department of Human Services

12

Enrollmentby subgroup

Expensesby subgroup

$225,000,000 … 13.5%

$342,700,000 … 20.6%

$638,700,000 … 38.4%

$457,700,000 … 27.5%

Children andfamilies in

managed care

Adults withdisabilities

Elderly

Children w/special health

care needs12,353 … 6.3%

129,111 … 70%

27,334 … 14.4%

18,166 … 9.7%

Figure 5

Medicaid enrollment / expense comparison by subgroup

SFY 2006

Approximately 30% of Medicaid beneficiaries are responsible

for 79% of total spending

Source: Medicaid claims extract

13

$2,300,000

$3,400,000

$6,400,000

$4,600,000

Children withspecial health

care needs

Children and families inmanaged care

Adults with disabilities Elderly

Figure 6

Value of 1% change in spending

by beneficiary group

SFY 2006

Each beneficiary group contributes to Medicaid’s costs at different rates

• For example it takes nearly a 2% increase in spending within the children and families inmanaged care population to equal a 1% increase in the adults with disabilities category


14

$18,225

$2,656

$23,367$25,196

Children withspecial health

care needs

Children and families inmanaged care

Adults with disabilities Elderly

Figure 7

Per member average annual Medicaid Costs

SFY 2006

There is a significant difference in average Medicaid costs

across populations


• Adults with disabilities & the elderly may also participate in Medicare

15

Figure 8

Medicaid expenses by service provider

SFY 2006

Hospital

ICF/MR

Physicianand other

professional

Pharmacy

Behavioral health

Acutecare

Longtermcare

Subtotal

acute

$754,100,000

Subtotal

long-term

$910,400,000

Nursing facility

Slater

Home and community-based

services

$313,000,000

$116,800,000

$165,600,000

$158,500,000

$8,000,000

$321,000,000

$108,900,000

$472,900,000

Three provider groups represent 66.5% of total Medicaid spending

• 54.7% of Medicaid spending is to provide long term care to individuals

Note: HCBS includes both services in consumers’ homes and group home settings


16

Figure 9

Fee for service vs managed care

SFY 2006

Managed care17.6%

Fee for service72.4%

The majority of RI’s Medicaid program expenditures

are purchased through fee for service arrangements


17

Mandatory

Mandatory

Optional

Optional

PopulationS

ervi

ces

$695,400,000 $650,800,000

$170,800,000 $120,900,000

Figure 10

Incurred expense, by population and service group

SFY 2006

Approximately 40% of Medicaid spending is mandated by federal law,

the remaining spending is a function of state law

Note: Federal guidelines require optional populations receive the same services as mandatory populations

Note: Excludes $26 M in waiver costs; Includes $7.4 million in MHRH offline payments; Optional/Optional quadrant includes $64 million in EPSDT


18

Medicaid mandatory and optional populations & services - 1 of 2

• Recipients of Supplemental Security Income (SSI) or Supplemental Security Disability Insurance (SSDI) ;

• Low income Medicare beneficiaries; • Individuals who would qualify for Aid to

Families with Dependent Children Program (AFDC) today under the state’s 1996 AFDC eligibility requirements ;

• Children under age six and pregnant women with family income at or below 133 percent of federal poverty guidelines;

• Children born after September 30, 1983, who are at least age five and live in families with income up to the federal poverty level;

• Infants born to Medicaid-enrolled pregnant women;

• Children who receive adoption assistance or who live in foster care, under a federally-sponsored Title IV-E program.

Federal mandatory populations

• Inpatient hospital services

• Outpatient hospital services

• Rural health clinic services

• Federally qualified health center services

• Laboratory and x-ray services

• Nursing facility services for individuals 21 and older

• Early & periodic screening, diagnostic and treatment services (EPSDT) for individuals under age 21

• Family Planning services

• Physicians’ services

• Home health services for any individual entitled to nursing facility care

• Nurse-midwife services to the extent permitted by State law

• Services of certified nurse practitioners and certified family nurse practitioners to the extent they are authorized to practice under State law

Federal mandatory services

• Podiatrists’ services

• Optometrists services

• Dental services

• Prescribed drugs

• Dentures

• Prosthetic devices

• Eyeglasses

• Diagnostic services

• Preventive services

• Rehabilitative services

• Services in an IMD for individuals age 65 and over

• Inpatient psychiatric services for individuals under age 21

• NF services for individuals under age 21

• Personal care services

• Transportation services

• Case management services

• Hospice services

• TB services for certain TB infected individuals

Optional services

Table 3

19

Medicaid mandatory and optional populations & services - 2 of 2

• Low-income elderly adults or adults with disabilities;

• Individuals eligible for Home and Community Based Services waiver programs;

• Children up to 250 percent and parents up to 185 percent of the federal poverty level, including children funded through the State Children’s Health Insurance Program;

• Individuals determined to be “medically needy” due to low income and resources or to large medical expenses;

• Children under 18 with a disabling condition severe enough to require institutional care, but who live at home (the “Katie Beckett” provision);

• Women eligible for Breast and Cervical Cancer program.

Optional populations

• Inpatient hospital services

• Outpatient hospital services

• Rural health clinic services

• Federally qualified health center services

• Laboratory and x-ray services

• Nursing facility services for individuals 21 and older

• Early & periodic screening, diagnostic and treatment services (EPSDT) for individuals under age 21

• Family Planning services

• Physicians’ services

• Home health services for any individual entitled to nursing facility care

• Nurse-midwife services to the extent permitted by State law

• Services of certified nurse practitioners and certified family nurse practitioners to the extentthey are authorized to practice under State law

Federal mandatory services

• Podiatrists’ services

• Optometrists services

• Dental services

• Prescribed drugs

• Dentures

• Prosthetic devices

• Eyeglasses

• Diagnostic services

• Preventive services

• Rehabilitative services

• Services in an IMD for individuals age 65 and over

• Inpatient psychiatric services for individuals under age 21

• NF services for individuals under age 21

• Personal care services

• Transportation services

• Case management services

• Hospice services

• TB services for certain TB infected individuals

Optional services

Table 4

20

Mandatory populations and services represent a significant portion

of state Medicaid spending

Optional

Mandatory

Enrollment by mandatory/optional

populationSFY 2006

38.3%

59.1%

Spending by mandatory/optional

populationSFY 2006

47.1%

52.9%

Spending by mandatory/optional

servicesSFY 2006

17.8%

82.2%

Figure 11


Note: Excludes some waiver enrollment

21

A category of optional spending is in community-based waivers

providing alternatives to mandatory institutional care

Those 18 andover who areaged or have adisability thatresults in theneed for helpwith ADLs andIADLs

Those 65and olderwho needhelp withADLs andIADLs

People of any age whomeet DevelopmentalDisability criteria:substantial functionallimitation in major lifeareas caused bypermanent mentaland/or physicalimpairment that beginsbefore age 22.

Those 18 andolder who havesevere physicaland/or cognitivedisabilitiesresulting in the need for ongoing skilled services or 24 hour supports

Those 18 andolder whorequireassistancewith ADLsand IADLs

Those 18 and older who require assistance with ADLs and IADLs and who are able to manage their own services or have a representative to manage services on their behalf

Target

population

Consumer-

directed

(Personal Choice)

Assisted

living

HabilitativeDevelopmental

disability

ElderAged and

disabled

Waiver:

Table 5

Selected RI waiver populations

22

HCBS Waiver Services

Case management

Homemaker

Personal care

Home delivered meals

Minor assistive devices

Minor home mod.

Emergency responsesystem

Assisted living

Senior companion

Respite

Adult foster care

Consumer directed

goods & services

Residential habilitation

Day habilitation

Specialized homemaker

Supported employment

Rehabilitation

Aged anddisabled

DEAAssisted

livingHabilitative MR/DD

Consumerdirected

X X X X X X

X X X X

X X X X X

X X X X

X X X X X X

X X X X X

X X X X

X X

X X

X

X

X X

X X

X X

X

X X

X

Table 6

23

RI Home and Community-based Medicaid Waiver summary

*Assisted Living annual cap is 350 people but any given month the cap cannot exceed 200 people.

MHRHDHSDHS/PARIDEA/DHSDEADHSAdministering

agency

3,21125992467421,823SFY 2005

participants

350025150200*9501,750Daily cap

ICF/MR Level ofCare:

DevelopmentalDisability

Hospital Level ofCare:

Disability

NF Level ofCare:

Age & Disability

NF Level ofCare:Age &

Disability

NF Levelof Care:

Age

NF Level ofCare:Age &

Disability

Population

characteristics

198320021986199919881983Year started

MR/DDHabilitativeConsumer

directed

(Personal Choice)

Asst livingDEAA&DWaiver

Table 7

NOTE: Consumer directed waiver was replaced by Personal Choice Cash and Counseling waiver effective March 1, 2007

24

Home and community-based services waiver participant per capita

per month Medicaid expenditures

Figure 12

HCBS waiver

PCPM expenditures

CMS 372 Reporting

FY 2006

Waiver PCPM services All other PCPM Medicaid services

Aged & Adults w/ Disabilitiestotal: $1,266

DEAtotal: $800

MR/DDtotal: $7,273

Assisted livingtotal: $1,330

Consumer Directedtotal: $3,389

Habilitationtotal: $3,975

$561

$705

$536

$264

$6,846

$427

$840

$490

$2,195

$1,194

$3,737

$238

Source: Department of Human Services

RI Medicaid trends

26

Federal State

41.76%

58.24%

44.62%

55.38%

45.55%

54.45%

47.65%

52.35%

FFY 2004* FFY 2005 FFY 2006 FFY 2007

Figure 13

Federal Medicaid matching rates

RI is paying for an increasing share of Medicaid expenditures

• Lowest FMAP possible is 50%• Every 1% change in Federal portion of FMAP equals approximately $18 million

in state general funds

Source: Department of Human Services*Notes federal windfall based on special legislation, Jobs and Economic Tax Relief Reconciliation Act of 2003

27

Declining federal assistance increases the cost of the Medicaid

program for Rhode Island regardless of medical expense trends

Figure 14

Value of change in FMAP

FFY 2004 - FFY 2007

$40,000,000

$42,034,000

$15,500,000

$35,000,000

2004 2005 2006 2007

Increase in spending

Decrease in spendingSource: Department of Human Services

28

Medicaid enrollment’s average annual growth rate since 2003 is 1.5%

Figure 15

Enrollment trends


178,810

SFY 2003

183,980

SFY 2004

186,495

SFY 2005 SFY 2006

186,964

29

Figure 16

Total Medicaid spending

(all funds)

Medicaid spending has grown by an average annual rate of 8.72%


$1,247,641,259

SFY 2003

$1,372,470,404

SFY 2004

$1,520,299,523

SFY 2005 SFY 2006

$1,664,546,558

30

Medicaid spending has grown substantially faster than caseloads

across all beneficiary groups


Figure 17

Average Annual Change in Enrollment

SFY 2003 - SFY 2006

Figure 18

Average Annual Change in Spending

SFY 2003 - SFY 2006

10%Children with special

health care needs

6.7%Elderly

8.7%Medicaid total

Adults with disabilities 8.8%

10.4%Children and families in

managed care

0%Elderly

1.3%Medicaid total

2.1%Adults with disabilities

1.5%Children and families in

managed care

Children with specialhealth care needs

2.8%

31

populationsMandatory

-.6%

Figure 19

Change in enrollment

mandatory versus optional populations

SFY 2003 - SFY 2006

Figure 20

Change in spending

mandatory versus optional populations

SFY 2003 - SFY 2006

Emphasis on expanding coverage has driven enrollment

growth but spending increases are across all populations


1.5%enrollment

Total

5.2%populations

Optional

8.7%enrollment

Total

8.5%populations

Optional

8.9%populationsMandatory

32

Adults with disabilities represent 39% of the overall spending

increase in Medicaid over the last three years

Figure 21

Spending change by beneficiary category

SFY 2003 - SFY 2006

CSHCN - $56,034,527

Adults w/ disabilities - $143,070,725

Elderly - $81,092,841

Children and families in managed care - $88,433,107


+$368,631,200

Spending analysis by beneficiary category

34

Figure 22

Change in Medicaid spending - children with special health care needs

by service provider SFY 03 to SFY 06

In the children with special health care needs population behavioral

health expenses are the largest contributor to acute care cost increases


Decrease in spendingSource: Medicaid claims extract

Hospital Physician &professional

Pharmacy Behavioral

$64,604,369 $995,067$2,117,427

$15,670,608 $87,206,715

$3,819,244

Change by service provider

Acute Total SFY 2003


35

Figure 23

Change in Medicaid spending - children with special health care needs


In the children with special health care needs population

home and community-based service expenses (HCBS) are

the largest contributor to long-term care cost increases

ICF/MR Nursingfacility

Slater HCBS

$104,491,748 $390,173 $-5,271 $404,618

$32,642,661 $137,923,929




LTC Total SFY 2003

LTC Total SFY 2006

36


Pharmacy Behavioral

$237,305,313

$43,171,752$19,860,791

$10,568,995 $8,847,723 $319,754,574

Figure 24

Change in Medicaid spending - children and families in managed care


In the children and families in managed care population hospital

expenses are the largest contributor to acute care cost increases






37

Figure 25

Change in Medicaid spending - adults with disabilities



Pharmacy Behavioral

$213,699,159

$41,631,460 $5,739,858$13,382,522 $10,154,728 $284,607,727

In the adults with disabilities population hospital expenses are

the largest contributor to acute care cost increases






38

Figure 26

Change in Medicaid spending - adults with disabilities

by service provider SFY '03 to SFY '06

• Reflects impact of Medicare Part D and related "clawback" provisions in SFY '06

In the adults with disabilities population home and community-based

service expenses (HCBS) are the largest contributor to long-term care

cost increases


Slater HCBS

$282,033,009 $629,135 $6,517,097$16,303,663

$354,195,166$48,712,262



Decrease in spendingNOTE: Includes MHRH HCBS funding that was previously offlineSource: Medicaid claims extract

LTC Total SFY 2003

LTC Total SFY 2006

39

Figure 27

Change in Medicaid spending - elderly


In the elderly population hospital expenses are the largest contributor

to acute care cost increases

$54,618,330

$6,348,142 $565,162 $158,796 $838,377 $62,528,807


Pharmacy Behavioral




• Reflects impact of Medicare Part D and related "clawback" provisions



40

Figure 28

Change in Medicaid spending - elderly


In the elderly population nursing facility expenditures are

the largest contributor to long-term care cost increases

LTC Total SFY 2003


Slater HCBS

$322,022,899 $18,429

$48,564,978

-$3,544,526

$28,143,483 $395,205,263




LTC Total SFY 2006

41

Overall across all beneficiary categories, acute care spending, primarily

with hospitals, is growing faster than long term care costs

Figure 29

Average Annual Change in Medicaid Spending

by type of care

SFY 2003 - SFY 2006

Figure 30

Average Annual Change in Medicaid Spending

by service provider

SFY 2003 - SFY 2006

8.7%

7.8%

9.7%

TotalMedicaid

Long termcare

Acute care

9.8%

4.4%

6.5%

5%

6%

5.9%

10.2%

13.6%

HCBS

Slater

Nursing facility

ICF/MR

Behavioral health

Pharmacy

Physician and other professional

Hospital


42

Approximately 58% of the spending increase in the last two years

is within two provider categories

Figure 31

Spending increase by provider

SFY 2003 - SFY 2006


$105,772,279

$115,397,958

$55,095,813

$26,225,441

$29,798,773

$21,772,644

$13,158,146

$1,037,945ICF/MR

Slater

Behavioral health

Physician & other professional

Pharmacy

Nursing facility

Home and communitybased services

Hospital

Spending analysis by beneficiary category

& fastest growing provider groups

44

Increased spending for hospitals by adults with disabilities

represents nearly 50% of the total increase in overall hospital

spending – the fastest growing provider expenditure category

Elderly - $6,348,142

Adults with disabilities$41,631,460


Children with special health care needs - $995,067

Figure 32

Contribution of hospital spending increase

by beneficiary category

SFY 2003 - SFY 2006

+$92,146,421

Source: Medicaid claims extractNote: Changes in children and families in managed care includes a classification of behavioral health inpatient expenses.

45

Increased spending for pharmacy by adults with disabilities represents

nearly 51% of the total increase in overall pharmacy spending

Elderly - $158,796



CSHCN - $2,117,427

Figure 33

Contribution to pharmacy spending increase


SFY 2003 - SFY 2006

+$26,227,740

• Reflects impact of Medicare Part D and related "clawback" provisions


46

Increased spending for physicians and other medical professionals by

children and families in managed care represents 67% of the total

increase in overall medical professionals spending

Elderly - $565,162



Children with special health care needs - $3,819,244

Figure 34

Contribution to physician and other medical services

increase by beneficiary category

SFY 2003 - SFY 2006

+$29,985,055


47

Increased spending for home and community based services (HCBS)

by adults with disabilities represents 42% of the total increase

in overall HCBS spending

Elderly - $28,143,483


7.4 million – not reported before

CFMC - $5,991,111

Children with special healthcare needs - $32,642,661

Figure 35

Contribution to HCBS spending increase


SFY 2003 - SFY 2006

+$115,489,517


Appendix

Co

mp

reh

en

siv

e M

ed

icaid

bu

dg

et

(Act

ual)

(Act

ual)

(Est

imat

ed)

(Act

ual)

(Act

ual)

(Est

imat

ed)

FY

2004

FY

2005

FY

2006

FY

2004

FY

2005

FY

2006

Ho

spit

al23

2,00

0,57

924

4,24

4,91

625

2,94

2,92

210

0,73

3,10

411

1,85

6,81

811

7,31

0,16

3

Reg

ular

124,

715,

403

135,

513,

759

142,

916,

434

53,5

54,1

8163

,344

,714

67,1

93,0

97D

SH

107,

285,

176

108,

731,

157

110,

026,

488

47,1

78,9

2348

,512

,104

50,1

17,0

66

Lo

ng

Ter

m C

are

318,

256,

798

321,

836,

550

328,

948,

897

131,

234,

190

143,

282,

532

148,

798,

529

Nur

sing

Hom

es29

1,98

1,42

629

2,75

7,26

529

8,49

7,10

412

0,39

9,45

813

0,33

6,35

313

5,02

3,80

0C

omm

unity

-bas

ed L

ong

Term

Car

e26

,275

,372

29,0

79,2

8530

,451

,793

10,8

34,7

3212

,946

,179

13,7

74,7

29

Man

aged

Car

e30

7,38

5,92

335

5,96

0,57

240

3,07

4,10

912

4,80

2,08

415

6,40

1,66

317

1,13

2,27

5

RIte

Car

e -

Cor

e25

2,79

3,27

527

1,64

3,57

130

7,80

2,19

110

2,33

0,55

311

8,99

2,44

113

0,51

5,69

1R

Ite S

hare

5,30

0,00

06,

888,

549

7,47

7,48

82,

181,

596

3,05

6,26

73,

187,

823

Sub

stitu

te C

are

6,40

0,00

06,

800,

000

7,74

6,46

22,

634,

380

3,01

6,98

03,

302,

493

CS

HC

N's

6,79

8,00

015

,393

,030

20,8

77,3

342,

798,

206

6,82

9,48

08,

900,

482

Out

-of-

Pla

n (N

/I R

ehab

)36

,094

,648

55,2

35,4

2259

,170

,634

14,8

57,3

4924

,506

,495

25,2

25,7

86

Ph

arm

acy

124,

903,

059

124,

815,

840

92,9

75,2

4951

,432

,581

55,4

90,6

2652

,159

,704

Cla

ims

Pay

men

ts15

9,74

7,55

816

9,85

8,86

513

6,00

0,00

065

,780

,849

75,5

15,8

5461

,924

,265

Reb

ates

(34,

844,

499)

(45,

043,

025)

(49,

292,

870)

(14,

348,

268)

(20,

025,

228)

(22,

338,

543)

Med

icar

e P

hase

d-do

wn

Con

trib

utio

n17

,800

,000

17,8

00,0

00D

rug

Rec

eiva

ble

(11,

531,

881)

(5,2

26,0

18)

Trea

tmen

t an

d R

ehab

ilita

tio

n66

,731

,456

70,9

91,7

3080

,390

,850

27,4

78,6

7931

,561

,503

36,4

31,5

25

Phy

sici

an17

,214

,756

18,3

88,9

0819

,072

,728

7,08

8,69

28,

175,

341

8,64

3,37

9O

ral H

ealth

17,4

10,4

4618

,312

,655

21,8

45,6

557,

169,

273

8,14

1,44

09,

900,

014

Reh

abili

tativ

e S

ervi

ces

32,1

06,2

5434

,290

,167

39,4

72,4

6713

,220

,713

15,2

44,7

2217

,888

,133

Med

icar

e P

rem

ium

s20

,463

,968

22,8

78,8

6229

,239

,958

8,42

6,65

310

,171

,484

13,2

50,9

64

Oth

er20

,959

,051

47,9

56,2

3146

,738

,508

8,63

0,51

821

,320

,381

22,3

50,9

64

Sp

ecia

l Ed

uca

tio

n33

,119

,199

19,2

38,8

9120

,068

,294

13,2

67,4

29

Res

tric

ted

Rec

eip

t8,

981

5,43

710

,741

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

TO

TAL

DH

S1,

123,

829,

014

1,20

7,92

9,02

91,

254,

389,

528

466,

005,

238

530,

085,

007

561,

434,

125

dsh

ad

j1,

099,

197,

872

1,14

4,36

3,04

048

1,57

2,90

351

1,31

7,05

9

4.11

%6.

18%

3.85

%5.

91%

Ele

ano

r S

late

r H

osp

ital

Sys

tem

100,

857,

726

101,

954,

122

106,

141,

003

41,4

72,8

2145

,432

,071

48,2

09,0

17

Ele

anor

Sla

ter

Hos

pita

l97

,340

,644

98,7

25,3

0710

2,24

1,07

640

,026

,846

43,9

95,2

0546

,436

,936

Zam

bara

no G

roup

Hom

es3,

517,

082

3,22

8,81

53,

899,

927

1,44

5,97

51,

436,

866

1,77

2,08

1

MR

/DD

Wai

ver

221,

415,

251

221,

096,

865

236,

068,

068

91,1

22,8

9098

,186

,886

107,

196,

011

Pub

lic P

rovi

ders

46,2

08,6

2245

,425

,121

48,5

32,7

3619

,002

,915

20,0

60,5

0322

,198

,135

Priv

ate

Pro

vide

rs17

3,90

1,45

217

4,28

6,96

718

6,11

4,87

871

,582

,503

77,5

10,7

3984

,354

,126

Sup

port

ed L

ivin

g A

rran

gmen

ts1,

305,

177

1,38

4,77

71,

420,

454

537,

472

615,

644

643,

750

Adu

lt F

oste

r C

are

Inte

gra

ted

Beh

avio

ral H

ealt

h63

,881

,099

65,2

59,3

4567

,986

,118

26,3

32,7

3829

,011

,960

30,8

05,0

19

Com

mun

ity-b

ased

Beh

avio

ral H

ealth

57,0

60,1

2957

,912

,588

59,9

91,6

6423

,483

,423

25,7

46,2

4827

,182

,585

Sub

stan

ce A

buse

Tre

atm

ent

5,29

5,97

05,

099,

557

5,52

4,43

02,

177,

670

2,26

9,15

22,

507,

455

Oth

er1,

525,

000

2,24

7,20

02,

470,

024

671,

645

996,

560

1,11

4,97

9__

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

____

____

_T

OTA

L M

HR

H38

6,15

4,07

638

8,31

0,33

241

0,19

5,18

915

8,92

8,44

917

2,63

0,91

718

6,21

0,04

7

Psy

chia

tric

Ho

spit

al24

,100

,953

22,2

98,9

279,

152,

084

9,66

4,62

29,

932,

218

4,15

8,63

6

Reh

ab S

vs93

,742

,378

86,7

73,7

3710

6,29

2,62

237

,591

,237

38,6

50,0

9548

,298

,542

Man

aged

Car

e8,

692,

898

16,4

30,3

3223

,655

,363

3,48

5,90

37,

318,

273

10,7

48,8

13

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

TO

TAL

DC

YF

126,

536,

229

125,

502,

996

139,

100,

069

50,7

41,7

6255

,900

,586

63,2

05,9

91

Cas

e M

anag

emen

t43

8,24

419

9,62

0

(Per

son

al C

are

in)

Ass

iste

d L

ivin

g89

,016

168,

862

841,

666

36,5

1475

,346

383,

379

Co

mm

un

ity

Su

pp

ort

s3,

261,

313

4,26

0,82

34,

780,

352

1,33

7,79

01,

901,

179

2,04

3,27

3

Hom

e C

are

3,21

9,70

84,

240,

986

4,45

4,12

51,

320,

724

1,89

2,32

82,

028,

854

Ass

istiv

e D

evic

es2,

571

4,23

62,

350

1,05

41,

890

7,07

0H

ome

Mod

ifica

tions

39,0

3415

,601

16,1

3516

,012

6,96

17,

349

othe

r__

____

____

___

____

____

_30

7,74

2__

____

____

___

____

____

___

____

____

_T

OTA

L D

EA

3,35

0,32

94,

429,

685

6,06

0,26

21,

374,

304

1,97

6,52

52,

626,

272

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

____

____

___

TO

TAL

HE

ALT

H-

-1,

096,

515

--

494,

857

STA

TE

WID

E T

OTA

L1,

639,

869,

648

1,72

6,17

2,04

21,

810,

841,

563

677,

049,

753

760,

593,

035

813,

971,

292

4.91

%7.

02%

Pro

gra

m E

xpen

dit

ure

s -

Sta

te F

un

ds

HEALTH

Pro

gra

m E

xpen

dit

ure

s -

All

Fu

nd

s

DHS MHRH DCYF DEA

rhode island annual medicaid expenditure report april, 2007 · 2012. 10. 25. · 3 medicaid annual...

Documents