1 / 41

The Past, Present, and Future of Medicaid in Missouri

The Past, Present, and Future of Medicaid in Missouri. American College of Physicians Updates in Internal Medicine September 25, 2010 Ian McCaslin, M.D., M.P.H. Director, MO HealthNet Missouri Dept. of Social Services. Overview. Medicaid – Current Status Health Care Reform

lotus
Télécharger la présentation

The Past, Present, and Future of Medicaid in Missouri

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Past, Present, and Future of Medicaid in Missouri American College of Physicians Updates in Internal Medicine September 25, 2010 Ian McCaslin, M.D., M.P.H. Director, MO HealthNet Missouri Dept. of Social Services

  2. Overview • Medicaid – Current Status • Health Care Reform • Global Payment Reform • MO HITECH

  3. How is Medicaid Viewed by Doctors? • Many Challenges from the Provider View • Medicaid Pays Poorly • Administrative Burdens • These Patients Are Hard to Take Care Of • Many Problems from the Taxpayer View • “It’s Not Health Care, It’s Welfare” • Out of Control Waste, Fraud, and Abuse

  4. What is the Patient’s View? Baseline of Low Health Literacy High Prevalence Rates: - Advanced Cardiovascular Disease - Serious Mental Illness - Poorly-controlled Diabetes, Asthma, etc. Limited Access to Coordinated Quality Care

  5. MO HealthNet: The Need for Change Historical View Claims Payer Lots of Paper Little Informed Clinical Input Not Data-driven Health Systems View Evidence-based Best Practices Embrace Technology Patient-centered Medical Home

  6. The Role Of Public Insurance • Medicaid • CHIP

  7. Medicaid Is Not One Program, But Several, Each with a Key Role • Health insurance for low-income families, persons with disabilities and the elderly • Assistance to low-income Medicare beneficiaries • Long-term care, including home and community services • Support for safety net providers who serve the uninsured • Financial support for other state programs such as mental health Vern Smith, HMA, 02.09

  8. Medicaid Holds It Together: Local Health Care Safety Nets • Mental health, public health and schools • Over half of publicly financed mental health care • Community Health Centers • Medicaid averages 40% of Health Center revenues • Hospitals that serve the uninsured • $16 billion in Medicaid “DSH” payments • Medicare • Medicaid-paid premiums, copays, deductibles, long-term care and other benefits for over 7 million low-income “duals” account for about 40% of Medicaid spending • Altogether, Medicaid is 1/6 of all U.S. health spending and 2.5% of U.S. GDP Vern Smith, HMA, 02.09

  9. Medicaid Expenditures by Service, 2007 DSH Payments 5.0% Inpatient 15.0% Home Health and Personal Care 15.0% Physician/ Lab/ X-ray 3.7% Mental Health 1.5% Outpatient/Clinic 7.4% Long-Term Care 35.1% Acute Care 59.9% ICF/MR 3.9% Drugs 4.7% Nursing Facilities 14.8% Other Acute 6.7% Payments to Medicare 3.5% Payments to MCOs 19.0% Total = $319.7 billion NOTE: Total may not add to 100% due to rounding. Excludes administrative spending, adjustments and payments to the territories. SOURCE: Urban Institute estimates based on data from CMS (Form 64), prepared for the Kaiser Commission on Medicaid and the Uninsured.

  10. Missouri Medicaid: 892,261 Enrolled • 538,365 children • More covered Missouri births than any other payer • 28,477 pregnant women • 81,688 adults in families • Very low-income • 165,852 persons with disabilities • Most are permanently and totally disabled • 77,879 low income elderly As of 06.30.10

  11. MO HealthNet Coverage Compares Favorably withFederally-Mandated Eligibility Levels (% FPL) TANF level is required. In Missouri, TANF is 19% FPL. 300% 300% 300% Missouri Federally- Mandated Levels 185% 200% 133% 133% 85% 100% 100% 74% 19% 0% 0% 19% 0% Pregnant Preschool School - Age Seniors & Custodial Childless (1) Women Children Children Persons with Parents Adults Disabilities

  12. Medicaid FFS Eligibles Per Member Per Year Cost, SFY09 $15,406

  13. Items funded with General Revenue: • MO HealthNet ($1.6 billion) • Elem. and Second. Education ($2.4 billion) • Higher Education ($921.6 million) • Non-Medicaid DSS ($354 million) • Corrections ($604.8 million) • Mental Health ($591.8 million) • Judiciary ($162.7 million) Gov. rec. FY2010

  14. % Total Eligibles Enrolled in Managed Care Medicaid Managed Care Trends Source: CMS as of 06/08; DSS Monthly Management Reports, Table 23

  15. Looking Ahead: What Must Be Done • Patient-centered Medical Homes • Coordination of Behavioral and Physical Care • Define, Measure, Improve Upon Quality of Care • Children Constitute the Majority of Enrollees • But Must be Balanced with those Driving the Costs • Permanently and Totally Disabled • Low Income Elderly • Seriously Mentally Ill

  16. The Finish Line

  17. Expanding Medicaid is a Key Element in Health Reform Universal Coverage By 2019 – 92% coverage Medicaid Coverage (up to 133% FPL) Exchanges (subsidies 133-400% FPL) Individual Responsibility Health Insurance Market Reforms Employer-SponsoredCoverage Note: 133% FPL is about $14,000 for an individual and $29,000 for a family of four

  18. Key Medicaid Coverage Provisions Expands Medicaid to individuals with incomes to 133% of the federal poverty level in 2014 Provides subsidy for newly eligible individuals 100% covered by federal funds for 2014-2016, phases down to 90% by 2020 Estimated $ 2 billion in new funds for Missouri Simplifies enrollment and coordinates with Health Insurance Exchange - “No Wrong Door”

  19. Share of Uninsured Adults At or Below 133% FPL by State, 2007-2008 NH VT ME WA ND MT MN MA OR NY ID WI SD RI MI CT WY PA NJ IA NE OH NE NV IN DE IL WV UT VA MD CO KY CA MO KS NC DC TN OK SC AR AZ NM GA MS AL TX LA AK FL HI 30 - 41% (17 states) 42 - 45% (16 states including DC) 46 - 58% (18 states) SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements).

  20. Estimated Changes in State and Federal Costs from Medicaid Expansion in Health Reform 2014-2019 $21.1 Billion $443.5 Billion Total $464.7 Billion SOURCE: Holahan, John and Irene Headen. Medicaid Coverage and Spending in Health Reform. KCMU, May 2010.

  21. Mandatory and optional benefits Improvements prior to 2014 Allows concurrent hospice and acute treatment services for children (2010) Requires coverage of smoking cessation programs (2010) Establishes “Health Home” state plan option for persons with chronic conditions (2011) Provides a payment increase to states that cover recommended prevention services and eliminate cost sharing (2013) In 2014, provides all newly-eligible adults with a benefit package that meets the minimum essential health benefits available in the Health Insurance Exchange Key Medicaid Benefits Provisions

  22. Funds the Medicaid and CHIP Payment and Access Commission (MACPAC) Creates Center for Medicare and Medicaid Innovation to test both payment and health care delivery methods Funds demonstration programs and grants related to delivery system and payment reform Increases Medicaid payments for primary care to 100% of the Medicare rates for 2013 and 2014 with 100% federal financing for the increase Reduces Disproportionate Share Hospital (DSH) payments starting in 2014 Key Medicaid Payment Reform Provisions

  23. Individuals with Medicare and Medicaid (dual eligibles) are disproportionately costly and have high needs Federal Coordinated Health Care Office (CHCO) in CMS to coordinate policies for Medicare/Medicaid duals (2010) Incentives for new community based long-term care options Community First Choice Option in Medicaid (2011): Option for states to provide attendant services to individuals with incomes up to 150% FPL with no caps or waitlists permitted with a six percentage point increase in federal matching rate for these services State Incentives Balancing Program (2011-2015): $3 billion available with enhanced match for administrative and structural changes to increase community based long-term care Community Living Assistance Services & Supports - CLASS Program effective in 2011 and benefits paid in 2017 Medicaid Long-Term Care Provisions

  24. Outlook • State Budget Pressures will Persist • States are Responsible for Implementation of Medicaid Provisions in Health Reform • Large increases in eligibility, particularly for low-income adults; no longer solely for parents • Conducting outreach and enrollment • Integrating Medicaid enrollment with the Exchanges • Workforce Workforce Workforce • Ensuring access and driving quality

  25. Innovative Payment Options • Bundled Payments • Accountable Care Organizations • Patient-centered Medical Home • A Number of Unknowns and Precautions • Any Large Scale Transition to Global Payment Should Be Undertaken Slowly

  26. Global Payment Reform:Key Considerations for Physicians • Support for Primary Care is Mandatory • Address Needs of Small Practices for IT Support • Support Physician-Patient Autonomy • Professional Liability and Antitrust Reforms - Don't Let Up the Pressure • Reliable, Valid Data from Payers to Help Physicians Manage their “Panel” is Necessary • Patients' Health Status Must be Risk-Adjusted

  27. Global Payment Reform:The Payer Perspective • There Will Be Incessant Downward Pressure on Revenue • Driving Most Groups and Organizations to Eliminate Waste Throughout the System • Physicians will Increasingly Participate in Risk-sharing Arrangements • Performance Risk • Not Insurance Risk

  28. MO HITECH & Meaningful Use

  29. Health Information Exchange Pharmacies Pharmacies Labs Hospitals Labs Hospitals Health Info Exchange Physicians Physicians Clinics Clinics Government Consumers Government Payers Payers Consumers • Current Confusion • Evolving and Competing • Landscape • Future Vision • Improved Access and Use of • Health Information

  30. Statewide Network of Diverse Qualified Organizations NHIN Gateway Interstate Connectivity Hospitals Physician Groups Clinics Clinic Clinic Labs Hospital System Public Health Lab Enterprise Private Network Payers Long Term Care EHR Light Missouri Statewide Health Information Exchange Network FQHC Providers Hospital RHC Labs RHIO Medicaid RHIO Clinical Lab Lab MMIS Eligibility Paid Claims Hospital RHC Hospital RHC FQHC Cyber Access

  31. EHR Incentive Program – State Requirements • CMS Requires States to Provide Detailed Information Across FIVE Key Areas: • Medicaid EHR Incentive Program Implementation Plan: eligibility determinations, provider enrollment, ensuring participants meet payment criteria, and processing payment. • The state’s current health IT landscape across units, departments, programs and activities. Survey eligible providers to determine number, EHR adoption to date, intent to participate in incentives program. • The state’s health IT vision for the future. • The proposed pathway to achieve that vision. • Program oversight, including program integrity and audit functions.

  32. Missouri HIT Assistance Center

  33. Thank you for the Invitation

More Related