The Future of Medicaid

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The Eventual fate of Medicaid. Michigan Relationship of Wellbeing Arrangements Meeting July 18, 2011 Steve Fitton Chief, Restorative Administrations Organization. Subjects. Medicaid Yesterday Medicaid Today The Eventual fate of Medicaid. Medicaid Yesterday. Giving Verifiable Connection. Michigan Medicaid Caseload.

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The Future of Medicaid Michigan Association of Health Plans Meeting July 18, 2011 Steve Fitton Director, Medical Services Administration

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Topics Medicaid Yesterday Medicaid Today The Future of Medicaid

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Medicaid Yesterday Providing Historical Context

Slide 4

Michigan Medicaid Caseload Thousands

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Michigan's Medicaid Eligibility Percentage Per Capita

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Total MI Medicaid Expenditures $'s Millions

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Governors Weigh In "Medicaid is ready to wreak ruin on the state's financial plan for quite a long time to come," Gov. Gary Herbert (R-UT) told a House subcommittee in March, "threatening our capacity to support basic administrations, for example, transportation and education." "Medicaid expenses are escaping control," said Gov. Rick Scott (R-FL), a previous healing center official who has proposed a sensational privatization of the program in his state.

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"One of Medicaid's most concerning issues is mission crawl. . . To put it plainly, a steadily extending Medicaid program is obliterating for the country's and the state's funds, and by spreading itself so thin it neglects to give satisfactory care to the individuals who require it." Sen. Orrin Hatch June 15, 2011

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Scott Gottlieb – Wall Street Journal March 10, 2011 "So why do Medicaid patients toll so gravely? Installment to suppliers has been diminished to actually pennies on every dollar of standard charges as a result of successive rounds of unpredictable rate cuts… .Meanwhile, patients' can't get opportune access to normal and specific medicinal care."

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National Health Expenditures and Their Share of Gross Domestic Product, 1960-2009 Dollars in Billions: 5.2% 7.2% 9.2% 12.5% 13.8% 14.5% 15.4% 15.9% 16.0% 16.1% 16.2% 16.6% 17.6%

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Per Capita Health Care Spending 1970-2009

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Average Annual Premiums for Single and Family Coverage, 1999-2009 * Estimate is factually not quite the same as gauge for the earlier year appeared (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009.

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Health Insurance Coverage and the Uninsured Non-elderly, 2006-2008

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Change in Health Insurance Coverage and Uninsured Non-elderly, 2000-2002 to 2006-2008

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Michigan Medicaid GF Expenditures Actual versus Expected

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Medicaid GF Expenditures as a feature of Michigan's Budget

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Florida Center for Fiscal and Economic Policy "Critical increments in Medicaid enlistment (and in this manner Medicaid spending) and decreases in state income are concurrent outcomes of a similar subsidence. So, Medicaid could address the extra issue while at the same time decreasing the money related weight to the state."

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Medicaid Today

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Michigan Medicaid – Big Program $12 billion apportionment in FY11 Covers 19% of the state populace Covers about 40% of all kids in MI General Fund burning through 21.8% of aggregate

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FY12 Budget No Major Medicaid Reductions Preserves qualification, scope of discretionary administrations without rate diminishments Recognizes key part of Medicaid giving wellbeing scope to helpless subjects Endorses MI Medicaid as a decent speculation Affirms MI Medicaid's dedication to oversaw mind

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Governor's Letter to Rep Upton MI's 2012 "spending plan spends less broad store dollars on the program than 10 years back, because of Michigan's establishment of imaginative, straightforward, and dependable financing strategies". MI has driven the route in changes, including the move of Medicaid recipients to oversaw mind in the 1990s…

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Affirmation ≠ Status Quo FY12 Budget receives numerous activities to push forward (a lot of work to do): -Claims assess substitution for HMO utilize impose -CSHCS changed over to oversaw mind -MiPCT -Integrated administer to double eligibles -Funding for EHR appropriation

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The Future of Medicaid

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Medicaid's Future Goals Future bearings to meet those objectives Federal Impacts – Anticipated, Feared, and Imagined

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Medicaid Goals Triple Aim Improve Health Improve Care Lower Costs Promoted by CMS Adopted by MI Dept of Community Health as reason for our Strategic Priorities

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Future Directions to Meet Goals Preserve and expand on what has worked Pursue both transformative and incremental change methodologies

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Preserve/Build on What Has Worked Managed Care -CSHCS -Dual Eligibles Innovative, Transparent, and Responsible Financing Methods -Continue with Provider Taxes -Claims Tax

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Pursue Improvement Strategies Service mix Value acquiring Technology Fraud, waste, and mishandle

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Service Integration Patient Centered Medical Home (MiPCT) Duals – genuine reconciliation Health Homes Physical Health – Mental Health

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Value Purchasing (i.e., adjust impetuses for results) Bundled Payments Duals MiPCT CSHCS – connect with birth results

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Technology EHR HIE Implications of Health Reform and Exchange on State Systems

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Fraud, Waste, and Abuse Point of elected accentuation bi-fanatic assention DCH Health Services Inspector General Need to comprehend particular contrasts in these terms Point is expanded responsibility and expanded examination

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Federal Impacts Affordable Care Act Deficit Reduction

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Affordable Care Act Expands Medicaid scope to 133%FPL (humble cost to MI in out years) Many diverse cost viability activities/exhibitions Increases essential care repayment to 100% of Medicare in '13 and '14 Exchange – enormous ramifications for Medicaid Basic wellbeing arrangement

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ACA Demonstration and Planning Grant Opportunities Money Follows the Person Health Homes – incessantly sick enrollees Global installment framework for a few doctor's facilities Pediatric ACOs Emergency psych demo extend CHIP heftiness demo Exchange arranging stipends Develop/overhaul MA qualification frameworks

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Deficit Reduction Cost Shift to States (genuine cash) -Blended FMAP -Provider charge imperatives -Block Grants Duals – potential open door for states

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Huge Challenges Affordability – for bosses, people, government and alleviation to general economy Improve strength of the populace Improve care and care forms

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"Medicaid ought to be changed inside the setting of 100% protection scope as a national goal. Leaving 43 million Americans revealed is corrupt, it is uncalled for, and as time goes on it is more costly." "A Vision for a 21 st Century Medicaid Solution" Newt Gingrich, The Center for Health Transformation

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QUESTIONS

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