Tuesday, May 25, 2010

Collaborative Research

…Humanizing research

Medicare/Medicaid DSH Payment Reduction

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2010 2011 2012 2013 2014 2015 2016 2017 2018 201 9

Medicaid Expansion

Accountable Care Organizations

Insurance Reforms (Pre-existing conditions for children, no annual / lifetime limits, children on parents insurance until 26)

Insurance Reforms (Pre-existing conditions for adults, premium limits)

Individual Mandate

Health Reform Timeline

Health Insurance Exchange—temporary ban on uninsured with pre-existing conditions

Health Insurance Exchange—Permanent (Health Risk Exchange)

Immediate Changes to Health CareIncrease funding to Community Health CentersIncrease pay to Primary Care PhysiciansReward ‘Medical Homes’ that are certified as

Accountable Care OrganizationsReform Insurance – temporary fixes

o Ban insurance denial to those with pre-existing health conditiono Increase family coverage for young adults to age 26

Federal Medicaid Match Expansion Match

100% match for 3 years Scales to 90% by 2017

Current FL Medicaid Match Rate (FMAP): 54%

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Longer-Term Changes to Health Care

Expand Medicaid to all individuals under age 65 up to 133% of the Federal Poverty Level

Increase Medicaid reimbursement to level of Medicare

Help small business (up to 100 employees) buy health insurance

Reform Insurance – long term fixesCreate single set of rules for eligibility and claims Ban lifetime limits on health coverage Eliminate annual dollar limits on health insurance

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Florida Health Care Reform1) 1115 Research & Demonstration Waiver

Demonstration implemented in Broward and Duval Counties in 2006, expanded to Baker, Clay and Nassau Counties in 2007

2) Current legislative session in Florida closed with Medicaid managed care reform vetoed.Hurts financial projections for the Counties. Medicaid is25% of the budget in Florida. Concerns that implementation of program would cost $3 million in FY 2010. Immediate increase in costs without managed care estimated at $7 million.

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Tuesday, May 25, 2010

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History of Orange County Support for PCAN

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High functioning 22-partner collaborative dedicated to health care access for uninsured and under-insured with leadership from county government

Nationally distinctive in containing all elements of continuum of care

Since PCAN formed in 2000, the number of uninsured patients has grown from 3% to 50% with minimum increase in expenditure by Orange County government

There has been a sustained decrease of 25% in uninsured patients accessing local Emergency Departments

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Medicaid reimbursement is due to increase 31% for Community Health Centers with a near doubling of volume

Incentives will exist for states to convert to Medicaid managed care

Medicaid rates will increase to the Medicare rate by 2013 with a federal: state match of 100% for 3 years (2014-2016), scaled back to 90% by 2017 (currently, Florida matches at 54%)

More individuals with chronic or catastrophic conditions will be insured (Florida ranks #3 in the US)

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Enhance chronic and catastrophic medical case management

Recommend restriction to 1-year of Orange County residency for access to Secondary (Specialty) care

Develop coalition with risk entity to compete with proprietary Medicaid Managed Care Organizations.

Formalize 501 (c) 3 status to directly accept grant funds

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PCAN and Dollar Impact on Orange County1) Enhanced Medicaid reimbursement

Increase reimbursement to FQHC by 31% Start: 2012

2) Grants (estimate 3-4 in Year 1, triple that Years 2-4) Each grant at $400-500,000/year for 4-years = $1.6 to $2.0 million with 10% administrative = $160,000 - $200,000 Start: Fall 2011

3) Managed care contracting Dollar amount to be estimated Start: depends on State, 2012

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Collaborative Research, LLC

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Collaborative Research…Humanizing research

www.collaborativeresearch.usTracy Kulik, President

1-800-893-8276Jeff Daniel, CFO1-866- 336-5503