DMAS UPDATESENATE FINANCE AND

APPROPRIATIONS COMMITTEEHHR SUBCOMMITTEE

January 27, 2020

KAREN KIMSEYDIRECTOR,

Department of Medical Assistance Services

Agenda

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Medicaid overview

Medicaid Expansion update

DMAS priorities in the Governor’s 2020 Budget

672,000

Who Does Medicaid Serve?

Expansion Adults

Children

Pregnant Women and Parents

Older Adults

Individuals with Disabilities

Medicaid plays a critical role in the lives of nearly 1.5 million Virginians

123,000

76,000

145,000

383,500

3

4

14%

46%7%

21%

18%

10%61%

23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Enrollment Expenditures

Medicaid Enrollees and Expenditures, SFY 2019

Children

Pregnant Women and Parents

Older Adults

Individuals with Disabilities

Medicaid Expenditures by Population, Where General Funds are Used (Excludes Expansion Adults)

Enrollment and expenditure totals do not include expansion adults or limited benefit members.

Funding for these populations is split almost equally between federal and general funds

67% of Medicaid spending is on behalf of older adults and individuals with disabilities, (21% of the population).

5

22%8%

11% 42%6%

20%

13%

9%48%

21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Enrollment Expenditures

Medicaid Enrollees and Expenditures, SFY 2019

Children

Pregnant Women and Parents

Older Adults

Individuals with Disabilities

Expansion Adults

There are no general fund dollars spent on expenditures for Expansion Adults; these are funded with Federal and Special Funds

Medicaid Expenditures by Population, Including GF and non-GF

Expansion enrollment began January 1, 2019.

Managed Care Programs

96% of full-benefit Medicaid members are in managed care

Births, vaccinations, well child doctor visits, sick doctor visits, acute care, pharmacy, ARTS, behavioral health services, including community mental health rehabilitation services Excludes LTSS

Serving infants, children, pregnant women, caretaker adults, and newly eligible adults

Medallion 4.01,101,000 Members

Commonwealth Coordinated Care Plus (CCC Plus)245,000 Members

Full continuum of services (same as Medallion) Long-term services and

supports (LTSS) in the community and in nursing facilities and hospice

Serving older adults, disabled children, disabled adults, medically complex newly eligible adults Medicare and Medicaid (full-

benefit duals)

Covered Groups

Covered Benefits

DMAS Monthly Enrollment as of January 1, 20206

Medicaid Expansion: Who Is Eligible?

*Percent income may vary by locality

Pre-Expansion Eligibility

205% FPL ($43,727)Children 0-18(family of 3)

80% FPL ($9,992)Person With Disability

33% FPL* ($8,112)Parents(Family of 3)

Childless Adults

Pregnant Women(family of 3)

205% FPL ($43,727)

138% FPL ($17,237)

138% FPL ($29,436)

138% FPL ($17,237)

Expansion Eligibility

age 19 – 64 and not Medicare eligible

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Medicaid Expansion: Status Update

8 Approximate totals based on DMAS Enrollment and Claims Data as of 1/15/20. Due to natural claims lag, we expect these numbers to continue to rise as claims continue to be submitted.

383,500 newly eligible adults are enrolled

329,800 Medicaid expansion members have received a Medicaid service and 254,000 have had a general office visit

22,000 have received care through the Addiction and Recovery Treatment Services (ARTS) program

Treatment for other chronic and life-threatening conditions include: Cancer (5,800); Diabetes (26,000); Hypertension (46,000)

Expansion Access and Utilization Dashboard

9 http://dmas.virginia.gov/#/accessdashboard as of 1/15/2020

Medicaid Expansion: Expenditures Update

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Overview of Current State: 1115 Waiver

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Status of 1115 Waiver Components

On December 30, 2019, CMS approved the extension of the existing Addiction Recovery and Treatment Services (ARTS) and former foster youth coverage provisions of the 1115 waiver through December 31, 2024.

Negotiations for the housing and employment supports benefit for high-needs Medicaid enrollees is still underway, and once finalized, funding will be requested through the legislature

Negotiations for the work and community engagement requirements and monthly premium requirements are on pause at this time, pending the decision of the legislature

Approved

In Progress

Paused

On December 3rd, 2019, in response to Governor Northam’s instructions, DMAS asked the Centers for Medicare and Medicaid Services (CMS) to delay action on portions of the 1115 demonstration waiver related to work requirements and cost sharing in order to allow the state’s new leadership to make a determination about the best next steps for Virginians.

Governor’s 2020 Budget Overview

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Maternal and Other Population Health Initiatives

Proposals to Improve Behavioral Health and Substance Use Disorder Services

Ensuring Medicaid Is Paying for Value

Proposals to Improve Long Term Support Services

Governor’s Introduced Budget

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FY2021 FY2022GF NGF GF NGF

Extend FAMIS MOMS eligibility from 60 days to 12 months postpartum (Item 313 AAAA)

$1,114,936 $2,120,272 $2,116,376 $3,930,412

Increase FAMIS MOMS access to treatment for a substance use disorder (Item 313 WWW)

$307,500 $626,900 $356,775 $662,550

Home Visits: Implement a home visiting benefit for pregnant women at risk and postpartum women at risk of poor health outcomes (Item 313 BBBB. 1 &2.)

$1,054,300 $3,514,556 $11,750,159 $34,216,923

Maternal and Other Population Health Initiatives

Governor’s Introduced Budget

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FY2021 FY2022GF NGF GF NGF

Eliminate 40 Quarter Work Requirement for Lawful Permanent Residents (Item 313 XXX)

$1,172,091 $6,519,419 $3,289,890 $9,548,955

Justice Involved: Provide services for individuals who are Medicaid eligible and have pending release from incarceration within 30 days (Item 313 FFFF)

$347,803 $11,398,558 $465,440 $16,404,809

Maternal and Other Population Health Initiatives

Governor’s Introduced Budget

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FY2021 FY2022GF NGF GF NGF

Funding for the Enhancement of Behavioral Health Services (Item 313 YYY)

$3,028,038 $4,127,378 $10,273,553 $14,070,322

Proposals to Improve Behavioral Health and Substance Use Disorder Services

Implementation January 2021

Multi-Systemic TherapyFunctional Family Therapy

Assertive Community Treatment

Implementation July 2021Comprehensive Crisis

ServicesPartial HospitalizationIntensive Outpatient

Governor’s Introduced Budget

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FY2021 FY2022GF NGF GF NGF

Incentive DSH payments to support increased TDO utilization in private acute care hospitals (Item 313 RR. 3)

$0 $32,523,924 $0 $32,523,924

Proposals to Improve Behavioral Health and Substance Use Disorder Services

• Current DSH: $26 million, $13 million existing GF• New TDO incentive: $32 million, $16 million needed in revenue from Provider Rate

Assessment• This proposal uses an incentive of $5,400 per Medicaid TDO admitted to a hospital,

starting July 1, 2020.• Leaves existing DSH payment methodology unchanged.• Requires no GF dollars.

Governor’s Introduced Budget

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FY2021 FY2022GF NGF GF NGF

Expand the Preferred Office-Based Opioid Treatment (OBOT) model to allow for all Substance Use Disorders (Item 313 ZZZ)

$421,476 $620,156 $1,273,633 $1,873,300

Increase rates for outpatient services provided by licensed mental health providers to the equivalent of 110 percent of 2019 Medicare rates (Item 313 EEEE)

$2,374,698 $4,370,186 $2,458,479 $4,488,751

Funding for Medicaid costs associated with the implementation of STEP-VA

$486,951 $486,951 $2,293,826 $2,293,826

Proposals to Improve Behavioral Health and Substance Use Disorder Services

Governor’s Introduced Budget

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FY2021 FY2022

GF NGF GF NGF

Proposed funding for DOJ Settlement Agreement, including more than 1,100 new DD waiver system slots (Item 313 J)

$16,985,260 $16,985,260 $24,828,805 $24,828,805

Rate increases for DD waiver system services (Item 313 DDDD)

$3,639,663 $3,639,663 $3,748,853 $3,748,853

Rate increases for skilled and private duty nursing services (Item 313 #69g, Governor’s amendment)

$2,578,387 $2,578,387 $2,578,387 $2,578,387

Proposals to Improve Long Term Support Services

Governor’s Introduced Budget

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FY2021 FY2022GF NGF GF NGF

Episodic Care: Innovative payment models aimed at incentivizing high quality maternity care and care for other health conditions (Item 313 CCCC)

$151,915 $174,266 $249,415 $271,766

MCO Contract Changes: Implement 14 Contract changes outlined in Item 313 E. 2.

$2,226,600 $2,226,600 $2,428,350 $2,428,350

Ensuring Medicaid Is Paying for Value

Minimum Wage

• At least 15 bills have been introduced (as of January 23, 2020). Those with specified amount generally increase minimum wage to $15 per hour. Implementation timing differs by bill.

• DMAS estimates five provider types that are currently paid rates below $15 per hour. Minimum wage increases will increase provider rates for these services.

• DMAS expects that minimum wage increases may impact other provider rates, such as nursing facility rates and other providers nominally above minimum wage.

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Provider Type NoVA Hourly Rate Rest of VA Hourly Rate

Attendant care $12.17 $9.40

Adult day health care $15.55 $11.53

In-home residential $13.53 $10.87

Community engagement Rates vary based on group size

Day support Rates vary based on group size