The Past, Present, and Future of Medicaid in Missouri - PowerPoint PPT Presentation

Loading...

PPT – The Past, Present, and Future of Medicaid in Missouri PowerPoint presentation | free to download - id: 3f962e-YjFhN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

The Past, Present, and Future of Medicaid in Missouri

Description:

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. – PowerPoint PPT presentation

Number of Views:116
Avg rating:3.0/5.0
Slides: 42
Provided by: acponline
Learn more at: http://www.acponline.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: The Past, Present, and Future of Medicaid in Missouri


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
(No Transcript)
4
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
  • Its Not Health Care, Its Welfare
  • Out of Control Waste, Fraud, and Abuse

5
(No Transcript)
6
(No Transcript)
7
What is the Patients 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
8
MO HealthNet The Need for Change
  • Health Systems View
  • Evidence-based Best Practices
  • Embrace Technology
  • Patient-centered Medical Home
  • Historical View
  • Claims Payer
  • Lots of Paper
  • Little Informed Clinical Input
  • Not Data-driven

9
(No Transcript)
10
  • The Role Of Public Insurance
  • Medicaid
  • CHIP

11
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
12
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
13
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
Acute Care 59.9
Long-Term Care 35.1
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.
14
(No Transcript)
15
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
16
MO HealthNet Coverage Compares Favorably
with Federally-Mandated Eligibility Levels ( FPL)
  1. TANF level is required. In Missouri, TANF is 19
    FPL.

17
Medicaid FFS Eligibles Per Member Per Year Cost,
SFY09
15,406
18
  • 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
19
(No Transcript)
20
Medicaid Managed Care Trends
Total Eligibles Enrolled in Managed Care
Source CMS as of 06/08 DSS Monthly Management
Reports, Table 23
21
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

22
(No Transcript)
23
The Finish Line
24
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-Sponsored Coverage
Note 133 FPL is about 14,000 for an individual
and 29,000 for a family of four
25
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

26
Share of Uninsured Adults At or Below 133 FPL by
State, 2007-2008
NH
VT
ME
WA
ND
MT
MN
MA
NY
OR
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
NE
NV
IN
DE
IL
WV
UT
VA
MD
CO
KY
MO
CA
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).
27
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.
28
Key Medicaid Benefits Provisions
  • 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

29
Key Medicaid Payment Reform Provisions
  • 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

30
Medicaid Long-Term Care Provisions
  • 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

31
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

32
(No Transcript)
33
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

34
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

35
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

36
MO HITECH Meaningful Use
37
Health Information Exchange
Current Confusion Evolving and Competing
Landscape
Future Vision Improved Access and Use of Health
Information
38
Statewide Network of Diverse Qualified
Organizations
NHIN Gateway Interstate Connectivity
Clinic
Clinic
Labs
Hospitals
Physician Groups
Clinics
Public Health
Hospital System
Lab Enterprise
Private Network
Payers
Long Term Care
EHR Light
Missouri Statewide Health Information Exchange
Network
FQHC
Providers
Hospital
RHC
Labs
RHIO
RHIO
Medicaid
MMIS
Clinical
Eligibility
Paid Claims
Hospital
Lab
RHC
FQHC
Hospital
Lab
RHC
Cyber Access
39
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 states 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 states health IT vision for the future.
  • The proposed pathway to achieve that vision.
  • Program oversight, including program integrity
    and audit functions.

40
Missouri HIT Assistance Center
41
Thank you for the Invitation
About PowerShow.com