larry e. tisdale vice-president of finance

Larry E. TisdaleVice-President of Finance

Medicaid RedesignBetter for Idaho’s taxpayers, businesses, and patients

\=

Required

Optional – at

State’s Discreti

on

Medicaid

Expansion in

PPACA

Where we stand

Health care

options for Idaho’s

low income workers

MedicaidCounty Indigent Program

State Catastrophic Fund

Emergency

Departments

Charitable Orgs.Communit

y Health Centers

Who are the “medically indigent”?

Working IdahoansSelf-employed & Small Business

Employees

Idaho’s minimum wage = $15,080/yearIdaho average salary = $38,000/year

$7,164 Groceri

es$10,820

Rent$3,476 Utilities

$2,748 Gasolin

e$24,208

Annual Cost of Living *

* U.S. Bureau of Labor Statistics - averages are based on 2.6 person households

Idaho has a choice

Status Quo

MedicaidRedesign

High costStatus Quo

County Indigent Fund – supported entirely by property taxes

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

$0

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

County Medically Indigent Funding

Forecast

Spent

High costStatus Quo

State Catastrophic Fund – supported entirely by income taxes

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

$0$10,000,000$20,000,000$30,000,000$40,000,000$50,000,000$60,000,000$70,000,000

Catastrophic Health Care Fund

Appropriated

Forecast

Low ValueStatus Quo

Expe

nsiv

e>$60 million

Inef

fect

ive<6k

served

Staf

fing100

employees

Financial RiskStatus Quo

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

County Indigent State CAT

Financial RiskStatus Quo

• 45,000 qualified but not enrolled

Enrollee

Growth

• $394 million over 10 years

Budget

Status Quo

LowValue

$60+ million budget =

expensive, episodic

treatment for <6k

HighCost

$60 mil/yr budget from

county and state taxes

Financial Risk

45k qualified Idahoans joining Medicaid = $394 million over 10

years

Idaho has a choice

Status Quo

MedicaidRedesign

MedicaidRede

signEliminate Waste

20142015201620172018201920202021202220232024$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

Projected County and State Indigent Care Savings

Over $1 billion in tax dollars from

2014 - 2024

Half fiscal year

68% of those who qualify have at least one full-time worker in the household;16% have one or more part-time workers

MedicaidRede

signCoverage for Working

Idahoans

Provides coverage to adults earning <138% of FPL or a family of four must have income less than $32,500

Adults age 19-64 Must be legal Idaho residents

2013 Federal Poverty Limits <100% FPL 100% to 125% FPL 125% to 138% FPL

Annual Income - Individual $0 - $11,490 $11,491 - $14,362 $14,363 -$15,856

Annual Income - Family of 4 $0 - $23,550 $23,551 - $29,437 $29,438 - $32,499

Medicaid

Redesign

Provide Coverage for Working Idahoans

Idaho minimum wage = $7.25/hr or

$15,080/yr

Personal responsibility and accountability

Coordinated CareManaged Care for chronic

conditionsReduce waste through

technology and electronic health records

Medicaid

Redesign

Redesign the System

Eliminate Waste

Save Idaho taxpayers $1

billion by eliminating two

government programs

Cover Working Idahoans

Provide health care to 149,000

low income Idahoans

System Redesign

Construct a system focused

on personal responsibility.

Medicaid

Redesign

for Idaho’s Economy

StatusQuo

Medicaid Redesig

n

Far Reaching Effects…..

Rising taxes or budget cuts to critical programs

16,000 new jobs

Bringing Idaho taxes back to Idaho

Not attractive to new businesses

$12.3-18.5 million in federal penalties for

businesses

Healthier Workforce

Costs / Savings2014-2024

State Medicaid Increases + $394 Million + $1,043 Million

State CAT Program costs/savings + $540 Million - $540 Million

County Indigent Programcosts/savings

+ $478 Million - $478 Million

DHW mental healthcosts/savings + $110 Million - $110 Million

Total costs/savings

StatusQuo

Medicaid

Redesign

$1.5 Billion

$85 Million

Only one choice

Status Quo• Spend $394

million + keep $1B in inefficient gov’t programs

Medicaid Redesign• Save $85 million &

cover 149,000 Idahoans

www.TheRightMedicineForIdaho.org

Potential Legislative Activity

Medicaid Expansion ?Insurance ExchangeTime Sensitive EmergenciesHospital Tax ExemptionsManaged Care for Dual Eligibles HB351Battery of Health Care WorkersMedically Indigent Statute changesIdaho Physician Shield Act (IMA)TransparencyState Health Innovation Plan (SHIP)

Medicaid Expansion

Not a current initiative for the 2014 Legislative Session

Governor Otter “current Medicaid system is broken”

Currently exploring 1115 waiver possibilities

Insurance Exchange

Passed by last year’s Legislature

Current exchange is federally supported

This is mostly a political fight

Time Sensitive EmergenciesTSE is a statewide system for the coordinating

and delivering evidence based care

Includes trauma, strokes and heart attacks (STEMI)

Hospital designation and participation is voluntary

Allows billing for trauma team activation◦ Certified by American College of Surgeons◦ Designated by the State

Hospital Tax ExemptionsLargely a political misinformation

campaign◦CEO Compensation◦Physician Employment◦Profit Margins

Increasing taxes on community hospitals will not lower the cost of health care

Managed Care for Medicaid/Medicare

HB351 Manditory or Voluntary enrollment?

In response to HB260 from 2011

Largest issue may be with nursing facility payments◦UPL◦Quality Incentives

Battery of Health Care Workers

Carryover from last yearMakes it a felony to assault

hospital workersNew version includes non-

licensed workersLesser punishment than first

responder assaultTough sell with the Legislature

Medically Indigent Statute Changes

Two potential Proposals:Eliminate funding over 100% of

federal poverty level

Remove money to fund “community clinics”

Idaho Physician Shield ActEnsures that no guideline or

metrics established by the PPACA shall be used as a basis for establishing community standards of care

IHA has no formal position at this time

Transparency

Again?

IHA opposes transparency based solely on pricing data

States’ websites that have pricing information go largely unused

IHA would support transparency of quality data

State Health Innovation Plan (SHIP)There is potential for a resolution

supporting the design model

The design grant ended in December 2013

The Department of Health and Welfare is in the process of applying for a testing grant

Questions