Health Care in Maine:

1

• Health Care in Maine
• Dirigo and Medicaid
• Steven Michaud, President
• Maine Hospital Association

2
Dirigo

• The Fundamentals
• Taxpayer-Subsidized Insurance Plan for Small
  Businesses DirigoChoice
  
• Cost Containment
• Quality
• Medicaid Expansion
• Comprehensive State Control and Oversight of
  Capital in Maine
  

3
DirigoChoice

• GOAL Expand Coverage to Uninsured/Reduce
  Uncompensated Care
  
• 31,000 25,000 uninsured 6,000 insured
• Small Businesses (50 or fewer)/Individuals
• Subsidies (Up to 300 of FPL)/Medicaid
  Eligibility
  
• Funding
• 53 million Federal Fiscal Relief Funds
• Employer/Employee Premium payments (60/40)
• Savings Offset Payment

4
Cost Containment

• State Health Plan
• Expenditure targets
• Certificate of Need
• Capital Investment Fund
• Voluntary Cost Cap 3.5 CPAD
• Voluntary Consolidated Margin Cap 3
• Public Reporting
• Hospital Study Commission (Global Budgets)

5
Dirigo Health Cost Containment

• State Health Plan
• Develop State Health Plan (5/2004)
• Assess healthcare costs, quality, access
• Development benchmarks/priorities
• Capital investment priorities
• Health systems change
• Cost drivers
• Public health
• Statewide Health Expenditures Budget
• Annual Report
• Advisory Council on Health Systems Development
• Informs CON
• Major Substantive Rules

6
Dirigo Health Cost Containment

• CERTIFICATE OF NEED
• ASUs (Single Specialties No Longer Exempt)
• Private Physician Offices (New technology)
• Linked to State Health Plan
• Quality Outcomes, Inappropriate Service
  Utilization
  
• Automatic Inflation Adjustment (1.2 M for
  equip./2.4 capital)
  

7
Dirigo Health Cost Containment

• CERTIFICATE OF NEED
• CON Moratorium
• CON Cap (Capital Investment Fund)
• 3rd Year Capital Operating Expenses
• Major Substantive Rules

8
Hospital Study Commission

• Rate Setting
• Global Budgets
• 5,000 layoffs
• Hospital Closures
• Regionalization

9
Hospital Costs
10
Maine Hospital Facts
11
Dirigo Health Quality

• Quality Forum
• Advisory Council
• Research (Evidenced-based Medicine, Quality,
  Patient Safety)
  
• Quality Performance Measures
• Consumer Education
• Technology Assessments

12
Medicaid

• 1.2 billion 04-05 shortfall
• 300 million in supplemental budgets in 04ALL
  Medicaid
  
• 750 million shortfall
• Borrowed 450 million to cover current expenses
  AND THE SAME DAY expanded Medicaid again

13
Medicaid

• Increasing largest line item in state
  governmenteducationthis biennium and next
  
• Expanding 2nd largest line itemMedicaid
• 350 million owed to hospitals
• Maine Ranks Tops in Taxes in U.S. Again Bangor
  Daily News

14
Medicaid Enrollees in Maine
15
Medicaid Expanded Again April 1st

• Up to 50,000 moreup to 1 in 4 Mainers!
• Family of 5 45,200
• With the expansion , Dirigo will be able to
  cover nearly 10,000 new patients while reducing
  bad debt and charity care for people who
  previously had no health coverage, the governor
  said. Resulting savings of 10 million are
  sufficient to cover the expense of this
  expansion, Baldacci said.

16
Annual Hospital Payment Shortfallsby State
Fiscal Year
Totaling 350 Million
177 Million
164 Million
114 Million
17
Dirigo What Does the Future Hold?

• Dirigo Health Insurance Plan/Medicaid Expansions
• Commercial Health Insurance Premiums
• Medicaid/Medicare Shortfalls
• Healthcare Cost Drivers
• Bad Debt/Charity Care Reductions
• Hospital Cost Efficiency
• State Controls/Government Involvement
• Quality