George A. Ralls M.D. Health Services Department December 1 st, 2009 Medicaid Update 2009

George A. Ralls M.D.Health Services Department

December 1st, 2009

Medicaid Update 2009

• Brief History

• Florida Medicaid Program

• Medicaid & the Economy

• Current Situation

• Summary

Overview

• Brief History

• Florida Medicaid Program

• Medicaid & the Economy

• Current Situation

• Summary

Overview

• In 1965, the Federal Social Security Act was amended to establish two major national health care programs:– Title XVIII (Medicare)– Title XIX (Medicaid)

• Medicaid is an open-ended, means-tested entitlement program financed jointly by the Federal Government and States

Medicaid

• Federal Medicaid laws mandate certain benefits for certain populations

• To qualify for Federal funds states administer their programs under federally approved state plans:– A waiver is required is state plans

deviated from certain provisions of the Social Security Act

Medicaid

• Medicaid programs vary considerably from state to state, and within states over time– Optional services covered

differ– Limits on mandatory and

optional services differ– Level provider reimbursement

Medicaid

• Omnibus Budget Reconciliation Act 1989:– Mandates states to extend

Medicaid coverage to children & pregnant women

Medicaid

• Federal Medicaid Spending:– expected to be about $216

billion in FY 2009 (7% of federal spending), rising to $287 billion in 2013 (8.4% of the federal budget)

• 44 million people in low-income families

• 14 million elderly and disabled people

Medicaid

• Brief History

• Florida Medicaid Program

• Medicaid & the Economy

• Current Situation

• Summary

Overview

• Florida implemented the Medicaid program in 1970 to provide medical services to indigent people

• SOBRA greatly expanded services to include pregnant women and children

• Medicaid program administered by AHCA

Florida Medicaid

Florida Medicaid

2009

Florida Medicaid

• Primary Care• Screening & Preventative

care• Laboratory, X-ray & other

diagnostics• Specialist referrals• Inpatient

care/Hospitalization• Dental, Vision, Orthotics,

Ambulance Transports• Nursing home and long

term care

Florida Medicaid

Medicaid Eligibility Levels by Annual Income and FPL (2009)

Florida Medicaid

Federal

OtherState

$ 14.4 Billion

Florida Medicaid

FY07

Other

Florida Medicaid

FY07

• Local County funds

• Cigarette Taxes

F.S. 409.915:  County contributions to Medicaid

Florida Medicaid

• F.S. 409.915– The Department of Financial Services shall

withhold from the cigarette tax receipts or any other funds to be distributed to the counties the individual county share that has not been remitted within 60 days after billing

Florida Medicaid

• Brief History

• Florida Medicaid Program

• Medicaid & the Economy

• Current Situation

• Summary

Overview

Medicaid & the Economy

Medicaid & the Economy

Kaiser Commission on the Uninsured & Medicaid 2008

1% in National Unemployment

Medicaid & the Economy

Kaiser Commission on the Uninsured & Medicaid 2008

Unemployment

GDP Decline

Medicaid & the Economy

7% 9%10%

16%

21%

28%

32%

97% Increase in Medicaid enrollment in 4 years

*Monthly case load in thousands

Medicaid & the Economy

Medicaid & the Economy

• Increase in unemployment since beginning of current recession expected to result in: – 4.8 million more

Medicaid/CHIP enrollees– 5 million more uninsured

• Improvement in unemployment rates & Medicaid will lag behind other economic indicators

• Brief History

• Florida Medicaid Program

• Medicaid & the Economy

• Current Situation

• Summary

Overview

126K

145K

2008 2009

Orange County Medicaid Eligible

FY08 = $9M

FY09 = ?FY09 = 12.4M

Current Situation

Current Situation

Shortfall covered by:• $ 1.9 million from PCAN• $ 700K from DJJ• $ 500K from Health Services

Current Situation

38% increase from 2008 to 2009

Orange County Medicaid Expenditure

Current Situation

13% in 1 year

10% in 5 months

*In thousands; AHCA

Current Situation

Current Situation

Current Situation

Current Situation

• Proposed an increase in county contribution for Medicaid nursing home care – From $ 55 to $ 202 per

month per person– $ 66 Million from counties– Has not changed in 39 years

AHCA

Current Situation

Additional $ 3M to Orange County Medicaid expenditure

Medicaid Expansion

Federal Match

Cost to State

Cost to Counties

Healthcare Reform

• Brief History

• Florida Medicaid Program

• Medicaid & the Economy

• Current Situation

• Summary

Overview

Summary

• Medicaid enrollment is increasing significantly

• Mandated expenditure for Medicaid was $3.1 Million over budgeted amount for FY2008-09

• Projected Medicaid expenditure for FY2009-10 is $15.8 Million– Adopted budget for Medicaid $9.3M

Summary

• Economic recovery may be on horizon but Medicaid improvements will lag behind

• Changes in State law may further exacerbate budget shortfall

• House and Senate Healthcare reform proposals advocate extending Medicaid to more individuals

George A. Ralls M.D.Health Services Department

December 1st, 2009

Medicaid Update 2009