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MEDI-CAL NOVEMBER 2012
LOCAL ASSISTANCE ESTIMATE for
FISCAL YEARS 2012-13 and 2013-14
REGULAR POLICY CHANGES
Fiscal Forecasting and Data Management Branch State Department of Health Care Services
1501 Capitol Avenue, Suite 6069 Sacramento, CA 95814
(916) 552-8550
EDMUND G. BROWN JR.
Governor State of California
Diana Dooley Toby Douglas Secretary Director California Health and Human Services Agency Department of Health Care Services
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November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services
MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX
POLICY CHANGENUMBER POLICY CHANGE TITLE
ELIGIBILITY
1 FAMILY PACT PROGRAM2 TRANSITION OF HFP TO MEDI-CAL3 BREAST AND CERVICAL CANCER TREATMENT4 CHDP GATEWAY - PREENROLLMENT5 MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATES6 BRIDGE TO HFP7 REFUGEES8 MEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATES9 MCHA VS. DHCS AND MRMIB10 LANTERMAN DEVELOPMENTAL CENTER CLOSURE11 250% WORKING DISABLED PROGRAM CHANGES12 LOMELI V. SHEWRY13 CHIPRA - M/C FOR CHILDREN & PREGNANT WOMEN14 NEW QUALIFIED ALIENS15 RESOURCE DISREGARD - % PROGRAM CHILDREN16 PARIS-FEDERAL17 PARIS - VETERANS MATCH18 PARIS-INTERSTATE
AFFORDABLE CARE ACT
19 PRIVATE DSH REPLACEMENT PAYMENT REDUCTION20 DISPROPORTIONATE SHARE HOSPITAL REDUCTION21 RECOVERY AUDIT CONTRACTOR SAVINGS41 FEDERAL DRUG REBATE CHANGE51 MANAGED CARE DRUG REBATES136 PAYMENTS TO PRIMARY CARE PHYSICIANS138 NF-B RATE CHANGES173 COMMUNITY FIRST CHOICE OPTION
BENEFITS
22 ADDITIONAL SERVICES FOR HCBS CLIENTS23 LOCAL EDUCATION AGENCY (LEA) PROVIDERS24 MULTIPURPOSE SENIOR SERVICES PROGRAM-CDA25 CALIFORNIA COMMUNITY TRANSITIONS COSTS
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November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services
MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX
POLICY CHANGENUMBER POLICY CHANGE TITLE
BENEFITS
26 MFP FUNDING TO CDDS AND CDSS FOR CCT27 DENSE BREAST NOTIFICATION SUPPLEMENTAL SCREENING28 SF COMMUNITY-LIVING SUPPORT BENEFIT WAIVER29 QUALITY OF LIFE SURVEYS FOR MFP30 FAMILY PACT RETROACTIVE ELIGIBILITY31 INCREASED FEDERAL MATCHING FUNDS FOR FPACT32 ADHC TRANSITION-BENEFITS33 SCHIP FUNDING FOR PRENATAL CARE34 HEARING AID CAP35 ELIMINATION OF OTC COUGH AND COLD PRODUCTS36 CERVICAL CANCER SCREENING37 PHYSICIAN AND CLINIC SEVEN VISIT SOFT CAP38 CALIFORNIA COMMUNITY TRANSITIONS SAVINGS39 COPAYMENT FOR NON-EMERGENCY ER VISITS
PHARMACY
42 KALYDECO FOR TREATMENT OF CYSTIC FIBROSIS43 NON FFP DRUGS44 BCCTP DRUG REBATES45 MEDICAL SUPPLY REBATES46 PHYSICIAN-ADMINISTERED DRUG REIMBURSEMENT47 FAMILY PACT DRUG REBATES48 AGED AND DISPUTED DRUG REBATES49 STATE SUPPLEMENTAL DRUG REBATES50 LITIGATION SETTLEMENTS52 FEDERAL DRUG REBATE PROGRAM
DRUG MEDI-CAL
58 ANNUAL RATE ADJUSTMENT59 DRUG MEDI-CAL PROGRAM COST SETTLEMENT
MENTAL HEALTH
61 SPECIALTY MENTAL HEALTH SVCS SUPP REIMBURSEMENT62 HEALTHY FAMILIES - SED
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November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services
MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX
POLICY CHANGENUMBER POLICY CHANGE TITLE
MENTAL HEALTH
63 KATIE A. V. DIANA BONTA64 TRANSITION OF HFP - SMH SERVICES65 SOLANO COUNTY66 OVER ONE-YEAR CLAIMS67 SPECIALTY MENTAL HEALTH LAWSUIT68 SISKIYOU COUNTY MENTAL HEALTH PLAN OVERPAYMENT69 IMD ANCILLARY SERVICES70 REIMBURSEMENT IN IMD ANCILLARY SERVICES COSTS71 CHART REVIEW72 INTERIM AND FINAL COST SETTLEMENTS - SMHS204 ELIMINATION OF STATE MAXIMUM RATES
WAIVER--MH/UCD & BTR
73 BTR - LIHP - MCE74 MH/UCD & BTRDSH PAYMENT75 BTR DPH DELIVERY SYSTEM REFORM INCENTIVE POOL76 MH/UCD & BTRPRIVATE HOSPITAL DSH REPLACEMENT77 BTRSAFETY NET CARE POOL 78 BTRLOW INCOME HEALTH PROGRAM - HCCI79 MH/UCD & BTRPRIVATE HOSPITAL SUPPLEMENTAL PAYMENT80 LIHP MCE OUT-OF-NETWORK EMERGENCY CARE SVS FUND81 BTRINCREASE SAFETY NET CARE POOL82 MH/UCD & BTRDPH & NDPH PHYSICIAN & NON-PHYS. COST83 MH/UCDSTABILIZATION FUNDING84 MH/UCDDPH INTERIM & FINAL RECONS85 NDPH DELIVERY SYSTEM REFORM INCENTIVE POOL 86 BTR LIHP INPATIENT HOSP. COSTS FOR CDCR INMATES87 MH/UCD & BTRCCS AND GHPP88 BTR - LIHP - DSRIP HIV TRANSITION PROJECTS89 MH/UCD & BTRDPH INTERIM RATE GROWTH90 MH/UCDSAFETY NET CARE POOL91 NDPH SAFETY NET CARE POOL 92 MH/UCDHEALTH CARE COVERAGE INITIATIVE93 BTRDESIGNATED STATE HEALTH PROGRAMS94 MH/UCD & BTRNDPH SUPPLEMENTAL PAYMENT95 MH/UCDDISTRESSED HOSPITAL FUND
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November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services
MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX
POLICY CHANGENUMBER POLICY CHANGE TITLE
WAIVER--MH/UCD & BTR
96 MH/UCD & BTRMIA-LTC97 MH/UCD & BTRBCCTP98 MH/UCD & BTRDPH INTERIM RATE99 MH/UCDFEDERAL FLEX. & STABILIZATION - SNCP ARRA100 BTRINCREASE DESIGNATED STATE HEALTH PROGRAMS101 DRG - INPATIENT HOSPITAL PAYMENT METHODOLOGY102 ELIMINATE NDPH SUPPLEMENTAL PAYMENT103 MH/UCDFEDERAL FLEX. & STABILIZATION-SNCP104 ELIMINATE NDPH IGT SUPPLEMENTAL PAYMENTS105 NDPH IP FFS PAYMENT METHODOLOGY CHANGE106 HOSPITAL STABILIZATION 107 BTRHEALTH CARE COVERAGE INITIATIVE ROLLOVER FUNDS
MANAGED CARE
111 MANAGED CARE PUBLIC HOSPITAL IGTS112 MANAGED CARE RATE RANGE IGTS113 TRANSFER OF IHSS COSTS TO CDSS114 RETRO MC RATE ADJUSTMENTS FOR FY 2011-12116 MANAGED CARE COST BASED REIMBURSEMENT CLINICS120 INCREASE IN CAPITATION RATES FOR GROSS PREMIUM TAX121 NOTICES OF DISPUTE/ADMINISTRATIVE APPEALS123 CAPITATED RATE ADJUSTMENT FOR FY 2013-14125 MANAGED CARE IGT ADMIN. & PROCESSING FEE126 GENERAL FUND REIMBURSEMENTS FROM DPHS127 FUNDING ADJUSTMENT OF GROSS PREMIUM TAX TO GF128 FFS COSTS FOR MANAGED CARE ENROLLEES129 SCAN TRANSITION TO MANAGED CARE130 DISCONTINUE UNDOCUMENTED BENEFICIARIES FROM PHC131 MANAGED CARE DEFAULT ASSIGNMENT132 MANAGED CARE EXPANSION TO RURAL COUNTIES133 POTENTIALLY PREVENTABLE ADMISSIONS134 ALIGN MANAGED CARE BENEFIT POLICIES135 TRANSITION OF DUAL ELIGIBLES-LONG TERM CARE207 EXTEND GROSS PREMIUM TAX - INCR. CAPITATION RATES208 EXTEND GROSS PREMIUM TAX-FUNDING ADJUSTMENT209 EXTEND GROSS PREMIUM TAX
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November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services
MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX
POLICY CHANGENUMBER POLICY CHANGE TITLE
MANAGED CARE
212 STABLE ENROLLMENT PROGRAM213 MANAGED CARE EFFICIENCIES214 TRANSITION OF DUAL ELIGIBLES-MANAGED CARE PAYMENTS215 CCI-IHSS FUNDING ADJUSTMENT
PROVIDER RATES
137 FQHC/RHC/CBRC RECONCILIATION PROCESS139 10% PYMT REDUCTION RESTORATION FOR AB 1629 FAC.140 LTC RATE ADJUSTMENT141 AB 1629 RATE ADJUSTMENTS DUE TO QA FEE INCREASE142 AIR AMBULANCE MEDICAL TRANSPORTATION143 ANNUAL MEI INCREASE FOR FQHCS/RHCS144 HOSPICE RATE INCREASES145 QUALITY AND ACCOUNTABILITY PAYMENTS PROGRAM146 SB 90 PRESERVING CONTRACT HOSPITALS147 DENTAL RETROACTIVE RATE CHANGES148 LABORATORY RATE METHDOLOGY CHANGE149 REDUCTION TO RADIOLOGY RATES 150 NON-AB 1629 LTC RATE FREEZE151 ELIMINATE 2012-13 RATE INCREASE & SUPP. PAYMENT 152 10% PAYMENT REDUCTION FOR LTC FACILITIES153 10% PROVIDER PAYMENT REDUCTION
SUPPLEMENTAL PMNTS.
154 HOSPITAL QAF - HOSPITAL PAYMENTS155 HOSPITAL OUTPATIENT SUPPLEMENTAL PAYMENT156 FFP FOR LOCAL TRAUMA CENTERS157 FREESTANDING CLINICS SUPPLEMENTAL PAYMENTS158 CAPITAL PROJECT DEBT REIMBURSEMENT159 NDPH IGT SUPPLEMENTAL PAYMENTS160 CERTIFICATION PAYMENTS FOR DP-NFS161 IGT FOR NON-SB 1100 HOSPITALS162 MEDI-CAL REIMBURSEMENTS FOR OUTPATIENT DSH163 MEDI-CAL REIMBURSEMENTS FOR OUTPATIENT SRH164 STATE VETERANS' HOMES SUPPLEMENTAL PAYMENTS
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November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services
MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX
POLICY CHANGENUMBER POLICY CHANGE TITLE
SUPPLEMENTAL PMNTS.
165 GEMT SUPPLEMENTAL PAYMENT PROGRAM203 HOSPITAL QAF PROGRAM CHANGES206 EXTEND HOSPITAL QAF - HOSPITAL PAYMENTS
OTHER
170 ARRA HITECH - PROVIDER PAYMENTS171 AB 97 INJUNCTIONS174 ICF-DD TRANSPORTATION AND DAY CARE COSTS- CDDS180 AUDIT SETTLEMENTS181 CDDS DENTAL SERVICES182 ICF-DD ADMIN. AND QA FEE REIMBURSEMENT - CDDS183 NONCONTRACT HOSP INPATIENT COST SETTLEMENTS186 INDIAN HEALTH SERVICES188 CIGARETTE AND TOBACCO SURTAX FUNDS189 CLPP FUNDS190 HOSPITAL QAF - CHILDREN'S HEALTH CARE191 FIRST 5 CALIFORNIA FUNDING 192 TRANSFER OF IHSS COSTS TO DHCS193 OPERATIONAL FLEXIBILITIES194 FI COST CONTAINMENT PROJECTS195 OVERPAYMENTS - INTEREST RATE CHANGE196 MEDICARE BUY-IN QUALITY REVIEW PROJECT197 ANTI-FRAUD ACTIVITIES FOR PHARMACY AND PHYSICIANS198 TRANSITION OF DUAL ELIGIBLES - MEDICARE SAVINGS199 FQHC/RHC AUDIT STAFFING200 REDUCTION IN IHSS AUTHORIZED HOURS201 3.6% IHSS REDUCTION205 EXTEND HOSPITAL QAF - CHILDREN'S HEALTH CARE
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$617,121,000$617,121,000$617,121,000$617,121,000
0.00 %0.00 %0.00 %0.00 %
$462,704,100$462,704,100$462,704,100$462,704,100$154,416,900$154,416,900$154,416,900$154,416,900
$154,416,900$154,416,900$154,416,900$154,416,900$617,121,000$617,121,000$617,121,000$617,121,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$598,091,000$598,091,000$598,091,000$598,091,000
0.00 %0.00 %0.00 %0.00 %
$448,435,700$448,435,700$448,435,700$448,435,700$149,655,300$149,655,300$149,655,300$149,655,300
$149,655,300$149,655,300$149,655,300$149,655,300$598,091,000$598,091,000$598,091,000$598,091,000
Purpose:ThispolicychangeestimatesthecostsoffamilyplanningservicesprovidedbytheFamilyPlanning,Access,Care,andTreatment(PACT)program.Authority:Welfare&InstitutionsCode14132(aa)InterdependentPolicyChanges:NotApplicableBackground:EffectiveJanuary1,1997,familyplanningserviceswereexpandedundertheFamilyPACTprogramtoprovidecontraceptiveservicestomorepersonsinneedofsuchserviceswhohaveincomesunder200%ofFederalPovertyLevel.ASection1115demonstrationprojectwaiverwasapprovedbyCentersforMedicare&MedicaidServices(CMS)effectiveDecember1,1999.AStatePlanAmendment(SPA)wasapprovedonMarch24,2011,inaccordancewiththeAffordableCareAct,totransitionthecurrentFamilyPACTWaiverintotheStatePlan.UndertheSPA,eligiblefamilyplanningservicesandsuppliesformerlyreimbursedexclusivelywith100%StateGeneralFundreceivea90%federalfinancialparticipation(FFP),andfamilyplanningrelatedservicesreceivereimbursementatTitleXIX50/50FFP.DrugrebatesforFamilyPACTdrugsareincludedintheFamilyPACTDrugRebateProgrampolicychange.ReasonforChangefromPriorEstimate:Revisedbasedonadditionaldata.Methodology:1.Familyplanningservicesandtestingforsexuallytransmittedinfections(STIs)areeligiblefor90%
FFP.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
FAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAM
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Randolph AlarcioRandolph AlarcioRandolph AlarcioRandolph Alarcio1/19971/19971/19971/1997
1111
1111
California Department of Health Care Services November 2012 Medi-Cal Estimate
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2.ThetreatmentofSTIsandotherfamilyplanningcompanionservicesareeligibleforTitleXIX50/50
FFP.
3.ThetreatmentofothermedicalconditionsincludinginpatientcareforcomplicationsfromfamilyplanningservicesarenoteligibleforFFP.
4.Itisassumedthat13.95%oftheFamilyPACTpopulationareundocumentedpersonsandarebudgetedat100%GF.
Funding:TitleXIX50/50FFP(42601010001/0890)GF(42601010001)TitleXIX10/90FFP(42601010001/0890)
FY201213 FY201314 ServiceCategory TF GF TF GFPhysicians $87,188,000 $21,816,000 $91,071,000 $22,788,000OtherMedical $348,299,000 $87,152,000 $354,503,000 $88,704,000CountyOutpatient $4,111,000 $1,029,000 $4,275,000 $1,070,000CommunityOutpatient $4,496,000 $1,125,000 $4,666,000 $1,168,000Pharmacy $153,997,000 $38,533,000 $162,606,000 $40,687,000Total $598,091,000 $149,655,000 $617,121,000 $154,417,000
FAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAMREGULAR POLICY CHANGE NUMBER: 1REGULAR POLICY CHANGE NUMBER: 1REGULAR POLICY CHANGE NUMBER: 1REGULAR POLICY CHANGE NUMBER: 1
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$1,088,132,000$1,088,132,000$1,088,132,000$1,088,132,000
0.00 %0.00 %0.00 %0.00 %
$707,285,800$707,285,800$707,285,800$707,285,800$380,846,200$380,846,200$380,846,200$380,846,200
$380,846,200$380,846,200$380,846,200$380,846,200$1,088,132,000$1,088,132,000$1,088,132,000$1,088,132,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$244,519,000$244,519,000$244,519,000$244,519,000
0.00 %0.00 %0.00 %0.00 %
$158,937,350$158,937,350$158,937,350$158,937,350$85,581,650$85,581,650$85,581,650$85,581,650
$85,581,650$85,581,650$85,581,650$85,581,650$244,519,000$244,519,000$244,519,000$244,519,000
Purpose:ThispolicychangeestimatesthebenefitscostassociatedwithtransitioningtheHealthyFamiliesProgram(HFP)subscribersintotheMediCalprogram.Authority:AB1494(Chapter28,Statutesof2012)InterdependentPolicyChanges:CA7TransitionofHealthyFamiliesChildrentoMediCalOA13TransitionofHFPtoMediCalPC64TransitionofHFPSMHServicesPC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:AB1494shiftsallHFPsubscribersintotheMediCalprogram.BeginningJanuary2013,aninemonthtransitionofsubscriberswilltakeplace.Childrenover150%ofthefederalpovertylevel(FPL)willcontinuetoberequiredtopayapremiumforcoverage.TheadministrativecostsassociatedwiththischangearebudgetedseparatelyintheTransitionofHFPtoMediCalpolicychangesunderCountyAdministrationandOtherAdministrationsectionoftheMediCalEstimate.Inaddition,postageandprintingcostsrelatedtothetransitionarebudgetedseparatelyintheHealthCareOption(HCO)section.AllsavingsrelatedtotheTransitionofHFPtoMediCalwillbereflectedintheManagedRiskMedicalInsuranceBoard(MRMIB)budget.ReasonforChangefromPriorEstimate:TheHFPcaseloadandphaseinstructurewereupdated.Additionally,thescheduledtransitionofHFPchildrentoMediCalwasdelayedfromOctober1,2012toJanuary1,2013.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
TRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CAL
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz1/20131/20131/20131/2013
1511151115111511
2222
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Methodology:1.BeginningJanuary1,2013,871,027subscriberswillbetransferredtoMediCal.Thisdoesnot
include3,997AIMinfantswithincomesbetween250300%FPL,whichwillnottransitiontoMediCal.ItisassumedtheHFPcaseloadwillexperience0.30%ofannualgrowthinFY201314.
2.TheseeligibleswillbeenrolledintomanagedcareplansinthosecountiesthathaveCounty
OrganizedHealthSystems,GeographicManagedCare,ortheTwoPlanModel.3.TheshiftofHFPsubscribersintotheMediCalprogramwilloccurinfourseparatephases.Thefirst
phasewillbesplitintothreephasestransitioningJanuary1,2013,March1,2013andApril1,2013,forallHFPsubscriberscurrentlyenrolledinamanagedcareplanthatalsocontractsdirectlywiththeDepartment.ThesecondphasewilltransitiononApril1,2013,forallHFPsubscriberscurrentlyenrolledinamanagedcareplanthatsubcontractswithaMediCalmanagedcareplan.Thethirdphasewilltransitionover3months(August1,2013toOctober31,2013)forallHFPsubscribersinamanagedcarecountythatwerenottransitionedinPhase1orPhase2.ThefourthphasewilltransitiononSeptember1,2013,forallremainingHFPsubscribers.
4.TheweightedaveragemonthlycostofbenefitsforthesesubscribersundertheMediCalprogramis
estimatedtobe$87.08.Thisincludesmanagedcarecapitationpayments,FFScosts,managedcarecarveouts,FederallyQualifiedHealthCenter(FQHC)wraparoundpaymentsanddentalpayments(excludingCaliforniaChildrenServices(CCS).
5.Premiumsonlywillbeassessedforsubscribersover150%ofFederalPovertyLevel(FPL)atthe
HFPCommunityProviderPlan(CPP)premiumlevel.Premiumsareestimatedtototal$17,926,000inFY201213and$66,191,000inFY201314.
6.Ofthe871,027subscribers,thereareanestimated6,406CCSHFPeligiblesthatwillshifttoCCS
MediCalinFY201213,and23,585inFY201314.ThecostfortheseeligiblesiscurrentlybudgetedintheFamilyHealthEstimate.CCSHFPisfundedwith65%FFP,17.5%GF,and17.5%countyfunds.ItisassumedthatthecountysharewillcontinueunderMediCal.TheGFreimbursementfromthecountiesforCCSMediCalisestimatedtobe$1,395,000inFY201213and$27,100,000inFY201314.
7.EnhancedfederalfundingunderTitleXXIisavailableforthesesubscribersenrolledinMediCal.8.Thispolicychangeincludes$7,222,000TF($2,528,000GF)inFY201213and$14,795,000TF
($5,178,000GF)inFY201314forbenefitcoststhatwerepartoftheBridgetoHFPpolicychange.
(InThousands) CountyFY201213 TF GF Reimbursement*OtherServices $245,257 $85,840 CCS $9,966 $2,093 $1,395BridgetoHFP $7,222 $2,528 BenefitsTotal $262,445 $90,461 $1,395Premiums $17,926 $6,274 Net $244,519 $84,187 $1,395
TRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALREGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2
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Funding:TitleXXI65/35FFP(42601130001/0890)ReimbursementGF(42606100995)*
(InThousands) CountyFY201314 TF GF Reimbursement*OtherServices $945,958 $331,085 CCS $193,570 $40,650 $27,100BridgetoHFP $14,795 $5,178 BenefitsTotal $1,154,323 $376,913 $27,100Premiums $66,191 $23,167 Net $1,088,132 $353,746 $27,100
TRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALREGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$143,082,000$143,082,000$143,082,000$143,082,000
0.00 %0.00 %0.00 %0.00 %
$81,034,200$81,034,200$81,034,200$81,034,200$62,047,800$62,047,800$62,047,800$62,047,800
$62,047,800$62,047,800$62,047,800$62,047,800$143,082,000$143,082,000$143,082,000$143,082,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$140,364,000$140,364,000$140,364,000$140,364,000
0.00 %0.00 %0.00 %0.00 %
$79,571,050$79,571,050$79,571,050$79,571,050$60,792,950$60,792,950$60,792,950$60,792,950
$60,792,950$60,792,950$60,792,950$60,792,950$140,364,000$140,364,000$140,364,000$140,364,000
Purpose:Thispolicychangeestimatesthefeeforservice(FFS)costsoftheBreastandCervicalCancerTreatmentProgram(BCCTP).Authority:AB430(Chapter171,Statutesof2001)InterdependentPolicyChanges:NotApplicableBackground:AB430authorizedtheBCCTPeffectiveJanuary1,2002,forwomenunder200%ofthefederalpovertylevel(FPL).EnhancedTitleXIXMedicaidfunds(35%GF/65%FFP)maybeclaimedunderthefederalMedicaidBreastandCervicalCancerTreatmentActof2000(P.L.106354)forcancertreatmentandfullscopeMediCalbenefitsforwomenunderage65whoarecitizensorlegalimmigrantswithnootherhealthcoverage.AStateOnlyprogramcoverswomenaged65orolderregardlessofimmigrationstatus,individualswhoareunderinsured,undocumentedwomen,andmalesforcancertreatmentonly.Thecoveragetermis18monthsforbreastcancerand24monthsforcervicalcancer.EstimatedStateOnlycostsincludeundocumentedpersonsnonemergencyservicesduringcancertreatment.BeneficiariesarescreenedthroughCentersforDiseaseControl(CDC)andFamilyPACTproviders.ReasonforChangefromPriorEstimate:ProjectedexpendituresincreasedduetoasmallgrowthinFY201112caseloaddata.Methodology:1.Therewere10,550FFSand2,594managedcareeligiblesasofAugust2012(totalof13,144).
2,649oftheFFSeligibleswereeligibleforStateOnlyservices.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
BREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENT
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz1/20021/20021/20021/2002
3333
3333
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 12
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2.610oftheFFSeligibleswereinAcceleratedEnrollmentasofAugust2012.3.AssumetheStatewillpayMedicareandotherhealthcoveragepremiumsforanaverageof361
beneficiariesmonthlyinFY201213andFY201314.Assumeanaveragemonthlypremiumcostperbeneficiaryof$250.59.
FY201213:361x$250.59x12months=$1,086,000*TF($1,086,000GF)*RoundedFY201314:361x$250.59x12months=$1,086,000*TF($1,086,000GF)*Rounded
4.FFScostsareestimatedasfollows:
5.ManagedCarecostsassociatedwiththeBCCTParebudgetedintheTwoPlan,CountyOrganized
HealthSystems(COHS),andGeographicManagedCare(GMC)policychanges.6.FederalreimbursementforaportionofStateOnlyBCCTPcostsbasedonthecertificationofpublic
expendituresisbudgetedinthepolicychangeMH/UCDBCCTP.Funding:
(Rounded) FY201213 FY201314 TF GF TF GFFullScopeCosts $122,417,000 $42,846,000 $124,668,000 $43,634,000StateOnlyCosts Services $16,861,000 $16,861,000 $17,328,000 $17,328,000Premiums $1,086,000 $1,086,000 $1,086,000 $1,086,000Total $140,364,000 $60,793,000 $143,082,000 $62,048,000
FY201213: GF FF TFGeneralFund 4260101001 $17,947,000 $0 $17,947,000TitleXIX35/65FFP 42601010001/0890 $42,846,000 $79,571,000 $122,417,000Total $60,793,000 $79,571,000 $140,364,000 FY201314: GF FF TFGeneralFund 4260101001 $18,414,000 $0 $18,414,000TitleXIX35/65FFP 42601010001/0890 $43,634,000 $81,034,000 $124,668,000Total $62,048,000 $81,034,000 $143,082,000
BREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTREGULAR POLICY CHANGE NUMBER: 3REGULAR POLICY CHANGE NUMBER: 3REGULAR POLICY CHANGE NUMBER: 3REGULAR POLICY CHANGE NUMBER: 3
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 01/04/2013 PC Page 13
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$14,178,000$14,178,000$14,178,000$14,178,000
0.00 %0.00 %0.00 %0.00 %
$9,215,700$9,215,700$9,215,700$9,215,700$4,962,300$4,962,300$4,962,300$4,962,300
$4,962,300$4,962,300$4,962,300$4,962,300$14,178,000$14,178,000$14,178,000$14,178,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$13,886,000$13,886,000$13,886,000$13,886,000
0.00 %0.00 %0.00 %0.00 %
$9,025,900$9,025,900$9,025,900$9,025,900$4,860,100$4,860,100$4,860,100$4,860,100
$4,860,100$4,860,100$4,860,100$4,860,100$13,886,000$13,886,000$13,886,000$13,886,000
Purpose:Thispolicychangeestimatesthecostofprovidingpreenrollment(PE)intotheHealthyFamiliesProgram(HFP)forchildrenwhoreceiveaChildrensHealthandDisabilityProgram(CHDP)screening.Authority:Welfare&InstitutionsCode,section14011.7AB442(Chapter1161,Statutesof2002)InterdependentPolicyChanges:NotApplicableBackground:TheCHDPGatewayprogramwasimplementedJuly1,2003.ChildrenwhoreceiveaCHDPscreenreceivePEintoMediCalortheHFP.PEprovidesaminimumof2monthsoffullscopecoverage,duringwhichthefamilymayapplyforongoingMediCalorHFPcoverage.ThestatefundedCHDPprogramcontinuestoprovidescreenstochildreneligibleforlimitedscopeMediCal.TheMediCalPEiscapturedintheMedicallyIndigentChildrenaidcode,whichisincorporatedinthebaseestimate.EffectiveJanuary2013,theHFPwillceasetoenrollnewapplicantsandwillbephasedoutoveraninemonthperiod.ChildrenenrolledintheHFPwillbetransitionedtotheMediCalprogram,andchildrenreceivingascreenthroughtheCHDPGatewayprogramwillbepreenrolledintoMediCal.ReasonforChangefromPriorEstimate:UpdatedJune2009throughAugust2012dataoneligiblesforaidcode8X,andchangeinthephaseinfortheHFPtransitiontoMediCal.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
CHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENT
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Davonna McClendonDavonna McClendonDavonna McClendonDavonna McClendon7/20087/20087/20087/2008
8888
4444
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 14
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Methodology:1.BasedonJune2009throughAugust2012eligibledatatherewillbe588,445children(35,529HFP,
33,873ShiftofHFPtoMediCal,478,283MediCaland40,760CHDPStateOnly)inFY201213and586,158children(70,864HFP,475,921MediCaland39,373CHDPStateOnly)inFY201314whowillbescreenedthroughtheGateway.
2.BasedonAugust2011throughJuly2012costdataandMay2011throughApril2012eligibledata,
thepermemberpermonth(PMPM)costforHFPPEis$200.10.3.BasedonAugust2011throughJuly2012costdataandMay2011throughApril2012eligibledata,
thePMPMcostforMediCalPEis$200.07.4.TheestimatedFY201112andFY201213HFPandMediCalPEcostsareasfollows:
*DuetotheShiftofHFPintoMediCal,HFPPEisbasedonsixmonthsofimpactinFY201213.TheothersixmonthsiscapturedintheShiftHFPtoMediCalPE.Funding:TitleXXI35/65FFP(42601130001/0890)TitleXIX50/50FFP(42601010001/0890)
Avg.Mo.
Eligibles
FY201213: TF GFHFPPE* 5,922 $7,109,000 $2,488,000ShiftHFPtoMediCalPE 5,645 $6,777,000 $3,389,000 $13,886,000 $5,877,000MediCalPE 39,857 $95,692,000 $47,846,000Total $109,578,000 $53,723,000 Avg.Mo.
Eligibles
FY201314 TF GFMediCalPE 39,660 $95,220,000 $47,610,000HFPPE 5,905 $14,178,000 $4,962,000Total $109,398,000 $52,572,000
CHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTREGULAR POLICY CHANGE NUMBER: 4REGULAR POLICY CHANGE NUMBER: 4REGULAR POLICY CHANGE NUMBER: 4REGULAR POLICY CHANGE NUMBER: 4
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 15
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$14,024,000$14,024,000$14,024,000$14,024,000
0.00 %0.00 %0.00 %0.00 %
$14,024,000$14,024,000$14,024,000$14,024,000$0$0$0$0
$0$0$0$0$14,024,000$14,024,000$14,024,000$14,024,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$9,149,000$9,149,000$9,149,000$9,149,000
0.00 %0.00 %0.00 %0.00 %
$9,149,000$9,149,000$9,149,000$9,149,000$0$0$0$0
$0$0$0$0$9,149,000$9,149,000$9,149,000$9,149,000
Purpose:ThispolicychangeestimatestheFederalFinancialParticipation(FFP)providedtotheCaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)andcountiesforthecostofinpatientservicesforinmateswhoaredeemedeligibleforMediCal.Authority:AB1628(Chapter729,Statutesof2010)SB1399(Chapter405,Statutesof2010)InterdependentPolicyChanges:NotapplicableBackground:AB1628authorizestheDepartment,counties,andtheCDCRtoclaimFFPforinpatienthospitalservicestoMediCalorLowIncomeHealthProgram(LIHP)eligibleadultinmatesinStateandcountycorrectionalfacilitieswhentheseservicesareprovidedoffthegroundsofthefacility.PreviouslytheseserviceswerepaidbyCDCRorthecounty.SB1399authorizestheBoardofParoleHearingstograntmedicalparoleormedicalprobationtopermanentlymedicallyincapacitatedStateorcountyinmates.Stateinmatesgrantedmedicalparoleandcountyinmatesgrantedmedicalprobation,arepotentiallyeligibleforMediCal.Whenastateinmateisgrantedmedicalparole,CDCRsubmitsaMediCalapplicationtotheDepartmenttodetermineeligibility.Whenacountyinmateisgrantedmedicalprobation,thecountyprocessesaMediCalapplicationandnotifiestheDepartment.PreviouslytheseserviceswerefundedthroughCDCRorthecountieswith100%GeneralFundorcountyfunds.CDCRwillutilizetheMediCalapplicationscurrentlyusedbycounties,andtheDepartmentmakesaneligibilitydeterminationaccordingtocurrentstandardeligibilityrules.FederalMedicaidregulationsandfederalguidanceprovidedtostatesallowforcoverageofinpatientservicestoeligibleinmateswhenprovidedinoffsitefacilities.TheDepartmentcurrentlyhasaninteragencyagreementwithCDCRinordertoclaimTitleXIXFFP.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATES
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz4/20124/20124/20124/2012
1569156915691569
5555
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 16
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ReasonforChangefromPriorEstimate:Previously,thispolicychangeonlyestimatedinpatientcostsrelatedtoadultStateinmatesandmedicalparolees.Thispolicychangenowcoversinpatientcostsassociatedwithcountyadultinmatesandindividualsgrantedmedicalprobation.Inaddition,theestimatedmonthlynumberofMediCalapplicationsisnow72ratherthan125.Methodology:1.ImplementationofcoveragefortheStateinmatesbeganApril2012.Implementationofcoveragefor
countyinmateswillbeginJanuary1,2013.2.ApplicationsforMediCalareprocessedbytheDepartmentiftheapplicantreceivedoffsite
inpatientrelatedservices.CostsforStateinmateseligibleforLIHParebudgetedintheLIHPInpatientHosp.CostsforCDCRInmatespolicychange.
3.ItisassumedtheDepartmentwillprocess375applicationspermonthforStateinmateswith
verifiedcitizenship.4.Assume96percentofthemonthlyapplicantswillbecomeeligibleforMediCalorLIHP.
375monthlyapplicationsx96%=360eligibleStateinmates5.Ofthe360eligibleStateinmates,itisassumed20%areforMediCaland80%areforLIHP.Ofthe
MediCalapplications,itisassumed75%areage65orolder,15%aredisabled,5%areforpregnancyevents,and5%areunder21yearsofage.
6.ItisassumedtheDepartmentwillprocess170MediCalapplicationspermonthforcountyinmates
withverifiedcitizenship.7.Ofthe170eligiblecountyinmates,itisassumed75%areage65orolder,10%aredisabled,10%
areforpregnancyevents,and5%areunder21yearsofage
8.Basedonbirtheventsdata30%oftheannualbirtheventswillbeforcesareandeliveriesand70%
willbeforvaginaldeliveries.
MonthlyApplications FY201213 FY201314
Aged 360 x 20% x 75% = 54 360 x 20% x 75% = 54Disabled 360 x 20% x 15% = 11 360 x 20% x 15% = 11PregnancyEvent
360 x 20% x 5% = 4 360 x 20% x 5% = 4
Under21 360 x 20% x 5% = 4 360 x 20% x 5% = 4
MonthlyApplications FY201213 FY201314Aged 170 x 75% = 127 170 x 75% = 127Disabled 170 x 10% = 17 170 x 10% = 17PregnancyEvent 170 x 10% = 17 170 x 10% = 17Under21 170 x 5% = 9 170 x 5% = 9
MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESREGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5
California Department of Health Care Services November 2012 Medi-Cal Estimate
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9.Basedonfeeforservice(FFS)costdatatheaveragepermemberpermonth(PMPM)costforan
inpatientadmissionis$9,506foraged,$11,751fordisabled,and$9,401forunder21.10.BasedonFFSdeliverycostdatatheaveragePMPMcostpereventis$5,931forcesareandelivery
and$3,759foravaginaldelivery.11.Stateinmateinpatientcostsareestimatedtobe$8,280,000($4,140,000GF)inFY201213andFY
201314.Countyinmateinpatientcostsareestimatedtobe$9,373,000($4,686,500GF)inFY201213and$18,745,000($9,373,000GF)inFY201314.
12.InFY201213andFY201314,itisassumedtheDepartmentwillprocess35applicationsannually
forStateMedicalParoleeswithverifiedcitizenship.Itisassumedtheseeligibleswillreceivelongtermcare(LTC)services.
13.BasedonFFScostdatatheaveragePMPMcostforaLTCeligibleis$7,576.
14.ImplementationofcoverageforinmatesgrantedMedicalProbationwillbeginJanuary1,2013.15.InFY201213andFY201314,itisassumedtherewillbe100applicationsannuallyforcounty
inmatesgrantedMedicalProbation.ItisassumedtheseeligibleswillreceiveLTCservices.16.BasedonFFScostdatatheaveragePMPMcostforaLTCeligibleis$7,576.
Funding:TitleXIXFFP(42601010890)
35 LTCeligiblemonths x $7,576 = $265,000 ($132,500FF)
FY201213 50 LTCeligiblemonths x $7,576 = $379,000 ($189,500FF) FY201314 100 LTCeligiblemonths x $7,576 = $758,000 ($379,000FF)
FY201213 FY201314(Rounded) TF FF TF FFMedicalParole $265,000 $132,500 $265,000 $132,500MedicalProbation $379,000 $189,500 $758,000 $379,000CDCRInmates $8,280,000 $4,140,000 $8,280,000 $4,140,000CountyInmates $9,373,000 $4,686,500 $18,745,000 $9,372,500Total $18,297,000 $9,148,500 $28,048,000 $14,024,000
MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESREGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$7,212,000$7,212,000$7,212,000$7,212,000
0.00 %0.00 %0.00 %0.00 %
$4,687,800$4,687,800$4,687,800$4,687,800$2,524,200$2,524,200$2,524,200$2,524,200
$2,524,200$2,524,200$2,524,200$2,524,200$7,212,000$7,212,000$7,212,000$7,212,000
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
$0$0$0$0$0$0$0$0
$0$0$0$0$0$0$0$0
Purpose:ThispolicychangeestimatestheexpendituresforchildrenplacedintheBridgetoHealthyFamiliesProgram(HFP).Authority:AB2780(Chapter310,Statutesof1998)InterdependentPolicyChanges:PC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:InordertoallowtimeforfamiliestoapplyfortheHFPfortheirchildren,AB2780providesonemonthadditionalMediCaleligibilityasabridgeforchildrenwhobecomeineligibleforMediCalwithoutashareofcostorareeligibleforMediCalwithashareofcostandhaveincomelessthan250%ofpoverty(aidcode7X).ThecostsforthisprogramarenotincludedintheMediCalbaseestimate.Theyareaddedthroughthispolicychange.EffectiveJanuary1,2013,theHFPwillceasetoenrollnewapplicantsandwillbephasedoutoveraninemonthperiod,whichwilleliminatetheneedforthebridgefromMediCaltotheHFP.ReasonforChangefromPriorEstimate:TheassumedtransitionofHFPintoMediCalwasdelayedfromOctober1,2012toJanuary1,2013.Methodology:1.BeginningJanuary1,2013,thebridgefromMediCaltoHFPwillbeeliminated.EstimatedFY2012
13costsarebasedonJuly1,2012throughDecember31,2012.2.BasedoncurrentMediCaldata,itisestimated64,283childrenwillreceivetheonemonthbridge
(aidcode7X)inFY201213.Theaveragemonthlynumberofbeneficiarieswillbe10,714.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
BRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFP
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz11/199811/199811/199811/1998
5555
6666
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 19
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3.InFY201213,theFFSeligiblemonthsforaidcode7Xareestimatedtobe14,624,andthe
managedcareeligiblemonthsareestimatedtobe49,659.4.BasedonFY201112costdataandeligibledatafromApril2011throughMarch2012,theFFS
PMPMcostforaidcode7Xis$49.25.ThetotalFFSexpendituresforaidcode7Xwillbe$720,000inFY201213.
FY201213:$49.25PMPMx14,624=$720,000
5.BasedonFY201112costdataandeligibledatafromApril2011throughMarch2012,thetotal
averagemonthlymanagedcarecarveoutcostforaidcode7Xis$22.51.Thetotalmanagedcarecarveoutexpendituresforaidcode7Xwillbe$1,118,000inFY201213.
FY201213:$22.51CarveOutx49,659=$1,118,000
6.Themanagedcarecapitationcostforaidcode7Xwillbe$5,374,000inFY201213.
FY201213:$108.22managedcarecapitatedratex49,659=$5,374,0007.Thetotalmanagedcarecostforaidcode7Xwillbe$6,492,000inFY201213.FY201213:$1,118,000CarveOut+$5,374,000Capitation=$6,492,0008.Totalexpendituresforaidcode7Xareestimatedtobe$7,212,000TFinFY201213.
FY201213:$720,000+$6,492,000=$7,212,000TF($2,524,000GF)Funding:TitleXXI35/65FFP(42601130001/0890)
BRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFPREGULAR POLICY CHANGE NUMBER: 6REGULAR POLICY CHANGE NUMBER: 6REGULAR POLICY CHANGE NUMBER: 6REGULAR POLICY CHANGE NUMBER: 6
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$5,540,000$5,540,000$5,540,000$5,540,000
0.00 %0.00 %0.00 %0.00 %
$0$0$0$0$5,540,000$5,540,000$5,540,000$5,540,000
$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$4,615,000$4,615,000$4,615,000$4,615,000
0.00 %0.00 %0.00 %0.00 %
$0$0$0$0$4,615,000$4,615,000$4,615,000$4,615,000
$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000
Purpose:ThispolicychangeestimatestherefugeesmedicalexpenditurestobereimbursedbytheCaliforniaDepartmentofPublicHealth(CDPH).Authority:InteragencyAgreement#1210028InterdependentPolicyChanges:NotApplicableBackground:FullfederalfundingisavailablethroughtheRefugeeResettlementProgram(RRP)formedicalservicestorefugeesreceivingRefugeeCashAssistance(AidCodes01,08,and0A)andforRefugeeMedicalAssistancerefugees(AidCode02)duringtheirfirst8monthsintheUnitedStates.TheRRPfederalgrantisadministeredbyCDPH,whichhasprogramresponsibilitythroughtheRefugeeHealthAssessmentProgram.ThefederalOfficeofRefugeeResettlementallowsonlyonegrantawardforrefugeehealthservicesinthestate.TheDepartmentofHealthCareServicesinvoicestheCDPHforthereimbursementofrefugeeexpenditures,whichareoriginallyfundedwithGeneralFund.ReasonforChangefromPriorEstimate:Updatedrefugeeeligiblesfrompreviousestimate.Methodology:TotalrefugeeexpenditurestobereimbursedbyCDPHareestimatedtobe$4,615,000inFY201213and$5,540,000inFY201314.Funding:Reimbursements(42606100995)
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
REFUGEESREFUGEESREFUGEESREFUGEES
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Luna WooLuna WooLuna WooLuna Woo7/19807/19807/19807/1980
14141414
7777
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 21
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$4,901,000$4,901,000$4,901,000$4,901,000
0.00 %0.00 %0.00 %0.00 %
$4,901,000$4,901,000$4,901,000$4,901,000$0$0$0$0
$0$0$0$0$4,901,000$4,901,000$4,901,000$4,901,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$2,451,000$2,451,000$2,451,000$2,451,000
0.00 %0.00 %0.00 %0.00 %
$2,451,000$2,451,000$2,451,000$2,451,000$0$0$0$0
$0$0$0$0$2,451,000$2,451,000$2,451,000$2,451,000
Purpose:ThispolicychangeestimatesthefederalmatchprovidedtotheCaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)andthecountiesforthecostofinpatientservicesforjuvenileinmateswhoaredeemedeligibleforMediCal.Authority:AB396(Chapter394,Statutesof2011)InterdependentPolicyChanges:NotapplicableBackground:AB396authorizestheDepartment,counties,andtheCDCRtoclaimFederalFinancialParticipation(FFP)forinpatienthospitalservicestoMediCaleligiblejuvenileinmatesinStateandcountycorrectionalfacilitieswhentheseservicesareprovidedoffthegroundsofthefacility.PreviouslytheseserviceswerepaidbyCDCRorthecounty.CDCRwillutilizetheMediCalapplicationscurrentlyusedbycounties,andtheDepartmentwillreviewtheseapplicationstomakeaneligibilitydeterminationaccordingtocurrentstandardeligibilityrules.HealthcarecostsofstateinmatesarecurrentlypaidbytheStateGeneralFund.FederalMedicaidregulationsandfederalguidanceprovidedtostatesallowforcoverageofinpatientservicestoeligibleinmateswhenprovidedinoffsitefacilities.TheDepartmentcurrentlyhasaninteragencyagreementwithCDCRinordertoclaimTitleXIXFFP.ReasonforChangefromPriorEstimate:Thisisanewpolicychange.Methodology:1.ImplementationofcoveragewillbeginJanuary1,2013.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
MEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATES
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz1/20131/20131/20131/2013
1755175517551755
8888
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 22
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2.ApplicationsforMediCalwillbeprocessedbytheDepartmentiftheapplicantreceivedoffsite
inpatientorpsychiatricrelatedservices.
3.ItisassumedtheDepartmentwillprocess30applicationspermonthforStateinmatesand88applicationspermonthforcountyinmateswithverifiedcitizenship.
4.Oftheestimated118monthlyapplications,itisassumed80%areforpsychiatricservicesand20%areforinpatientservices.
5.Basedonfeeforservice(FFS)costdatatheaveragepermemberpermonth(PMPM)costforan
generalacutecareinpatientadmissionis$9,401and$6,297foraninpatientpsychiatricadmissionforthoseunder21yearsold.
Funding:TitleXIXFFP(42601010890)
(Rounded) FY201213 FY201314ServiceType TotalMemberMonths TotalMemberMonthsPsychiatricServices 118 x 80% x 6 = 566 118 x 80% x 12 = 1,133InpatientServices 118 x 20% x 6 = 142 118 x 20% x 12 = 283
FY201213 FY201314(Rounded) TF FF TF FFCDCR Psych.Services $907,000 $453,500 $1,814,000 $907,000Inpt.Services $338,000 $169,000 $677,000 $338,500Subtotal $1,245,000 $622,500 $2,491,000 $1,245,500 Counties Psych.Services $2,662,000 $1,331,000 $5,324,000 $2,662,000Inpt.Services $994,000 $497,000 $1,987,000 $993,500Subtotal $3,656,000 $1,828,000 $7,311,000 $3,655,500 Total $4,901,000 $2,450,500 $9,802,000 $4,901,000
MEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESREGULAR POLICY CHANGE NUMBER: 8REGULAR POLICY CHANGE NUMBER: 8REGULAR POLICY CHANGE NUMBER: 8REGULAR POLICY CHANGE NUMBER: 8
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$511,000$511,000$511,000$511,000
0.00 %0.00 %0.00 %0.00 %
$255,500$255,500$255,500$255,500$255,500$255,500$255,500$255,500
$255,500$255,500$255,500$255,500$511,000$511,000$511,000$511,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$661,000$661,000$661,000$661,000
0.00 %0.00 %0.00 %0.00 %
$330,500$330,500$330,500$330,500$330,500$330,500$330,500$330,500
$330,500$330,500$330,500$330,500$661,000$661,000$661,000$661,000
Purpose:ThispolicychangeestimatesthebenefitscostofenrollingchildrenintoMediCalthatwerenotpreviouslyidentifiedaseligiblewhentheywerescreenedthroughtheSinglePointofEntry(SPE).Authority:NotApplicableInterdependentPolicyChanges:CA8MCHAvs.DHCSandMRMIBPC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:TheDepartmentusestheSPEtoprocessjointapplicationsthatserveasanapplicationfortheHealthyFamiliesProgram(HFP)andascreeningdevicefortheFederalPovertyLevel(FPL)MediCalprogram.MaternalandChildHealthAccess(MCHA)contendedinalawsuitthattheDepartmentandtheManagedRiskMedicalInsuranceBoard(MRMIB)arelegallyrequiredtousethejointapplicationasanapplicationforallMediCalprograms,notjusttheFPLprogram.OnDecember6,2010,thecourtissueditsdecisionrulinginfavoroftheDepartmentonallissuesexceptthattheStatemustscreenforsection1931(b)MediCaleligibilitybeforeenrollingchildrenages6to18intheHFP.OnJuly10,2012,theSanFranciscoSuperiorCourtissuedanorderenforcingwritconcerningthe1931(b)screening.TheDepartmenthadpreviouslyagreedtoimplementascreenatSPEtoidentifydeemedeligibleinfants.BeginningJanuary1,2013,theHFPwillceasetoenrollnewapplicantsandallapplicationssubmittedtotheSPEwillbesenttocountyeligibilityworkersforaMediCaldetermination.Therefore,theimpactofthecourtdecisiononlywillimpactapplicantswhowerescreenedbySPEpriortoJanuary1,2013.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
MCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIB
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz2/20132/20132/20132/2013
1735173517351735
9999
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 24
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Methodology:1.AssumethatMRMIBwillnotifyapproximately275,000priorSPEapplicantsthattheymaybeeligible
for1931(b)MediCalcoverage.2.AssumethattheresponsestotheMRMIBnotificationswillbereceivedandprocessedduring
January,February,andMarch2013.3.Assumea7.3%responseratewillresultin20,000responses.4.Assumethat33%oftherespondentswillqualifyfor2monthsofacceleratedenrollmentata
monthlycostof$66.45.
20,000responses*33%qualifyforAE*2months*$66.45=$877,000(unlagged)5.Assumethatoftherespondents,30%willprovidethenecessarydocumentationtomakea
determinationofMediCal1931(b)eligibility.6.Assumethatofthosethatreceiveadeterminationofeligibility,only2%willbefoundeligible.7.Assumethattheaveragebenefitscostpermonthforthosefoundeligibleis$159.45.
20,000responses*30%providedocumentation*2%foundeligible*$159.45permonth*12months=$230,000(fullyearcost,unlagged)
8.Applyingpartialyearphaseinadjustmentsandappropriatepaymentlags,thecostsare:
Funding:TitleXIX50/50GF(42601010001/0890)
FY201213TF
FY201314TF
AcceleratedEnrollment $595,000 $282,000OngoingBenefits $66,000 $229,000Total $661,000 $511,000
MCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBREGULAR POLICY CHANGE NUMBER: 9REGULAR POLICY CHANGE NUMBER: 9REGULAR POLICY CHANGE NUMBER: 9REGULAR POLICY CHANGE NUMBER: 9
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$7,372,000$7,372,000$7,372,000$7,372,000
0.00 %0.00 %0.00 %0.00 %
$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000
$3,686,000$3,686,000$3,686,000$3,686,000$7,372,000$7,372,000$7,372,000$7,372,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$607,000$607,000$607,000$607,000
0.00 %0.00 %0.00 %0.00 %
$303,500$303,500$303,500$303,500$303,500$303,500$303,500$303,500
$303,500$303,500$303,500$303,500$607,000$607,000$607,000$607,000
Purpose:ThispolicychangeestimatesthecostsfortheclosureoftheLantermanDevelopmentCenter.Authority:AB97(Chapter3,Statutesof2011)InterdependentPolicyChanges:NotApplicableBackground:OnApril1,2010,theCaliforniaDepartmentofDevelopmentalServices(CDDS)submittedaplantotheLegislaturefortheclosureofLantermanDevelopmentalCenter.SinceFY201112,CDDShasbeenworkingwithconsumers,familiesandtheregionalcenterstotransitionresidentstocommunitylivingarrangements.ResidentsmovingintothecommunitywillbeenrolledinaMediCalmanagedcarehealthplanorreceiveservicesthroughtheMediCalfeeforservicesystem.ReasonforChangefromPriorEstimate:UpdatedcaseloaddataMethodology:1.UnderCDDSPlanforClosureofLantermanDevelopmentalCenter,theindividualplanning
processwillbethebasisforensuringthateachresidentsneedsandchoicesareidentifiedandappropriatelyaddressedinthecommunity.Therefore,thecostsoftheservicestobeprovidedthroughtheMediCalprogramoncetheresidentstransitiontothecommunityareunknownatthistime.
2.Placeholdercostsof$607,000($303,500GF)forFY201213and$7,372,000($3,686,000GF)for
FY201314areincludedintheNovember2012MediCalEstimate.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
LANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURE
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Candace EpsteinCandace EpsteinCandace EpsteinCandace Epstein3/20123/20123/20123/2012
1560156015601560
10101010
California Department of Health Care Services November 2012 Medi-Cal Estimate
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3.Assume135residentswilltransitionfromLantermanDevelopmentalCenterintothecommunityin201213and123residentswilltransitionin201314.AsofJuly1,2012,122residentshavemovedintothecommunity.
Funding:TitleXIX50/50FFP(42601010890)
LANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSUREREGULAR POLICY CHANGE NUMBER: 10REGULAR POLICY CHANGE NUMBER: 10REGULAR POLICY CHANGE NUMBER: 10REGULAR POLICY CHANGE NUMBER: 10
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$249,700$249,700$249,700$249,700
83.40 %83.40 %83.40 %83.40 %
$81,760$81,760$81,760$81,760$167,910$167,910$167,910$167,910
$1,011,500$1,011,500$1,011,500$1,011,500$1,504,000$1,504,000$1,504,000$1,504,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$493,500$493,500$493,500$493,500
67.10 %67.10 %67.10 %67.10 %
$161,870$161,870$161,870$161,870$331,630$331,630$331,630$331,630
$1,008,000$1,008,000$1,008,000$1,008,000$1,500,000$1,500,000$1,500,000$1,500,000
Purpose:Thispolicychangeestimatesthecostsofchangesmadetothe250%WorkingDisabledProgram(WDP).Authority:AB1269(Chapter282,Statutesof2009)InterdependentPolicyChanges:NotApplicableBackground:TheWDPallowsforemployedindividualswithdisabilitiestoearnupto250%ofthefederalpovertylevel(FPL)andreceivefullscopeMediCalbenefits.Alleligiblesinthisprogramarerequiredtopayamonthlypremiumbasedontheircountableincome.AB1269requirestheDepartmenttoimplementchangestotheWDP30daysaftertheAmericanRecoveryandReinvestmentActof2009(ARRA)endsonJune30,2011.ThechangesmadebyAB1269are:1.Exemptionofdisabilityincomethatconvertstoretirementincome.2.Exemptionofretainedincomefromtheresourcecalculationwhenheldinaseparatelyidentifiable
accountandnotcomingledwithotherresources.3.AllowsbeneficiariestoremaineligibleforMediCalupto26weekswhileunemployed,provided
premiumscontinuetobepaid.4.Allowsthemonthlypremiumcalculationtobebasedonfivepercentofanindividualscountable
income.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Davonna McClendonDavonna McClendonDavonna McClendonDavonna McClendon8/20118/20118/20118/2011
1558155815581558
11111111
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 28
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However,underthePatientProtectionandAffordableCareAct(PPACA)of2010,MaintenanceofEffort(MOE)requirementsareimposeduponstatesuntilJanuary1,2014.TheserequirementspreventstatesfromimplementingmorerestrictiveMedicaideligibilitypolicies,proceduresormethodologieswithoutjeopardizingfederalfunding,thereforechange#4concerningmonthlypremiumswillnotbeimplementedduetotheMOEprovisionsofPPACA.ReasonforChangefromPriorEstimate:Thechangeisduetomorerecentaidcode6Geligibledatawhichshowedagreaternumberofeligiblesaswellasahigherrateofincrease(211versus70annualgrowth).Methodology:1.ThechangestotheWDPwereimplementedAugust1,2011.2.Theprovisionsofthebillconcerningretainedincomeexemptionand26weeksofeligibilitywhile
unemployedhaveanindeterminateimpact.3.Theexemptionofdisabilityincomethatconvertstoretirementincomewillcreateanincreaseinthe
numberofWDPparticipantsresultinginadditionalcoststoMediCal.4.Thoseaffectedbytheexemptionofdisabilityincomethatconvertstoretirementincomeareage65
andolder.5.BasedonJune2011throughMay2012eligibledata,thereare618averagemonthlyeligiblesinAid
Code6Gwhoareover65yearsofage.6.Thecurrentgrowthrateofover65yearoldsinAidCode6Gis2.8%monthlyor18beneficiariesper
month(rounded).Itisassumedtherewillbeanadditionalincreaseof211eligiblesperyeartotheWDP.
7.Thefullincreaseineligibleswillbephasedinover12months.8.Thefeeforservice(FFS)permemberpermonth(PMPM)costpereligibleforaidcode6Gis
$271.12andtheaveragemonthlymanagedcarecostis$600.28($507.35caprateand$86.90forcarveoutPMPMcost).Themonthlydentalcapitationrateis$6.03.
9.ThemonthlypremiumfortheMedicarePartBpremiumis$99.90in2012and2013.Themonthly
premiumfortheMedicarePartDpremiumis$102.76in2012,andisestimatedtobe$104.46in2013and$105.60in2014.
250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGESREGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11
California Department of Health Care Services November 2012 Medi-Cal Estimate
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Funding:
FY201213 TF GFFFS $432,000 $216,000ManagedCare $537,000 $268,500MedicarePartB $263,000 $263,000MedicarePartD $253,000 $253,000Dental $15,000 $7,500Total $1,500,000 $1,008,000
FY201314 TF GFFFS $433,000 $216,500ManagedCare $537,000 $268,500MedicarePartB $266,000 $266,000MedicarePartD $253,000 $253,000Dental $15,000 $7,500Total $1,504,000 $1,011,500
FY201213: GF FF TFTitleXIX50/50FFP 42601010001/0890 $492,000 $492,000 $984,000GF 42601010001 $516,000 $0 $516,000 FY201314: GF FF TFTitleXIX50/50FFP 42601010001/0890 $492,500 $492,500 $985,000GF 42601010001 $519,000 $0 $519,000
250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGESREGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$0$0$0$0
100.00 %100.00 %100.00 %100.00 %
$0$0$0$0$0$0$0$0
$252,000$252,000$252,000$252,000$504,000$504,000$504,000$504,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$85,900$85,900$85,900$85,900
82.95 %82.95 %82.95 %82.95 %
$42,970$42,970$42,970$42,970$42,960$42,960$42,960$42,960
$252,000$252,000$252,000$252,000$504,000$504,000$504,000$504,000
Purpose:ThispolicychangeestimatesthecostofreimbursementsmadetoSupplementalSecurityIncome(SSI)beneficiariesforoutofpocketmedicalanddentalcostsrelatedtotheLomeli,etal.,v.Shewrylawsuit.Authority:NotApplicableInterdependentPolicyChanges:NotApplicableBackground:TheDepartmentfinalizedasettlementoftheLomelilawsuit,whichallegedthattheDepartmentdidnotproperlyinformSSIapplicantsoftheavailabilityofretroactiveMediCalcoverage.InAugust2011,theDepartmentbegansendingnoticestoSSIapplicantswhodidnothaveMediCaleligibilityforallthreemonthsbeforeapplyingforSSIandanupdatednoticetonewSSIrecipients,informingthemoftheavailabilityofretroactivecoverage.Benefitcostsforeligiblemedicalservicesduringtheretroactivecoverageperiodmayqualifyindividualsforreimbursement.ReasonforChangefromPriorEstimate:Thereisnochange.Methodology:1.TheDepartmenthasestablishedthefollowingassumptionsbasedonpreviouslawsuitsettlements.2.TheDepartmentbeganreceivingclaimsinOctober2011,andcostsbeganinDecember2011.3.Assumethereare1,000MediCalclaimspermonth,ofwhich60%areeligibleforretroactive
coverage.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
LOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRY
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Yao-Hui YuYao-Hui YuYao-Hui YuYao-Hui Yu12/201112/201112/201112/2011
1583158315831583
12121212
California Department of Health Care Services November 2012 Medi-Cal Estimate
Last Refresh Date: 12/31/2012 PC Page 31
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4.Ofthose,assume33%oftheclaimsarefordentalservicesand67%oftheclaimsareformedical
services.5.Itisestimatedthat18%ofdentalclaimswillbeapproved.6.Itisestimatedthat28%ofmedicalclaimswillbeapproved.7.Assumetheaveragecostis$533.74fordentalclaimsand$202.98formedicalclaims.
FY201213 TF GFDentalCosts $228,000 $114,000MedicalCosts $276,000 $138,000TotalCost $504,000 $252,000
FY201314 TF GFDentalCosts $228,000 $114,000MedicalCosts $276,000 $138,000TotalCost $504,000 $252,000
LOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRYREGULAR POLICY CHANGE NUMBER: 12REGULAR POLICY CHANGE NUMBER: 12REGULAR POLICY CHANGE NUMBER: 12REGULAR POLICY CHANGE NUMBER: 12
California Department of Health Care Services November 2012 Medi-Cal Estimate
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
$9,127,400$9,127,400$9,127,400$9,127,400-$9,127,400-$9,127,400-$9,127,400-$9,127,400
-$9,127,400-$9,127,400-$9,127,400-$9,127,400$0$0$0$0
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
$9,127,400$9,127,400$9,127,400$9,127,400-$9,127,400-$9,127,400-$9,127,400-$9,127,400
-$9,127,400-$9,127,400-$9,127,400-$9,127,400$0$0$0$0
Purpose:Thispolicychangeestimatesthetechnicaladjustmentsinfundingfrom100%StateGFtoclaimTitleXIXorTitleXXIfederalmatchforthehealthcareexpendituresofqualifiedchildrenandpregnantalienswhohavenotyetmetthefederal5yearbar.Authority:Children'sHealthInsuranceProgramReauthorizationAct(CHIPRA)InterdependentPolicyChanges:NotApplicableBackground:ThePersonalResponsibilityandWorkOpportunityReconciliationActof1996(PRWORA)providesthatfederalfinancialparticipation(FFP)isavailableforimmigrantswhoaredesignatedasQualifiedAliensiftheyhavebeenintheUnitedStatesforatleastfiveyears.CaliforniacurrentlyprovidesfullscopeMediCaltootherwiseeligibleQualifiedAlienswhohavebeenintheUSforlessthanfiveyearsandpaysfornonemergencyserviceswith100%StatefundsifFFPisnotavailable.(FFPisavailableregardlessofimmigrationstatusforemergencyandpregnancyrelatedservices.)CHIPRAincludesaprovisionwhichgivesstatestheoptiontoprovidefullscopeMediCalwithFFPtoeligibleQualifiedAlienswhoarechildrenorpregnantwomeneveniftheyhavebeenintheU.S.forlessthanfiveyears,effectiveApril1,2009.EnhancedTitleXXIfundingisavailableforchildreneighteenyearsofageandyounger.ReasonforChangefromPriorEstimate:Thechangesareduetoupdatedexpendituresforqualifiedchildrenandpregnantaliensunderthe5yearbar.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
CHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMEN
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Davonna McClendonDavonna McClendonDavonna McClendonDavonna McClendon1/20111/20111/20111/2011
1371137113711371
13131313
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Methodology:1.TitleXXIfundingof65/35FFPisavailablefor0to18yearoldsandTitleXIXfundingof50/50FFPis
availablefor19and20yearoldsandpregnantwomen.2.AssumeFY201213andFY201314willbeunchangedfromcalendaryear2011.3.Children
BaseduponquarterlyclaimingreportsforFY201112,37.57%ofexpendituresforNQAservicesarefornonemergencyservices.
FFS:SpecialreportsofexpendituresforNQAchildrenfor2011servicesshowfeeforservice(FFS)costs(includingmanagedcarecarveouts)of$9,787,000for0to18yearoldsand$1,055,000for19and20yearolds.
NonemergencyFFSexpendituresforNQAchildrenare:$9,787,000x37.57%nonemergency=$3,677,000(0to18yearolds)$1,055,000x37.57%nonemergency=$396,000(19and20yearolds)
ManagedCare:SpecialreportsofNQAchildrenmanagedcareeligiblesforcalendar2011show171,628eligiblemonthsfor0to18yearoldsand14,593for19and20yearolds.
TheaveragecapitationfortheNQAchildrenandpregnantwomenisassumedtobe$113.20PMPM.
ThenonemergencymanagedcareexpendituresforNQAchildrenare:171,628eligiblemonthsx$113.20PMPMx37.57%nonemergency=$7,299,000(0to18yearolds)14,593eligiblemonthsx$113.20PMPMx37.57%nonemergency=$621,000(19and20yearolds)
4.PregnantWomenBasedonspecialreportsofexpendituresforpregnantwomen,6.64%ofexpendituresforpregnantwomenarefornonpregnancyrelatedservices.
FFS:TotalFFScostsincludingcarveoutsforpregnantwomenare$34,926,000.
ThenonpregnancyrelatedFFSexpendituresforpregnantwomenare:$34,926,000x6.64%=$2,319,000
ManagedCare:SpecialreportsofNQApregnanteligiblesforcalendaryear2011show86,471eligiblemonths.
Theaveragecapitationforpregnantwomenisassumedtobe$113.20PMPM.
Nonpregnancyservices=86,471eligiblemonthsx$113.20PMPMx6.64%=$650,000
CHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENREGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13
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5.TotalFFPof$9,127,000offsetstheGeneralFundcostofprovidingservicestotheseeligibles.Funding:TitleXIX50/50FFP(42601010001/0890)TitleXXIEnhancedHealthyFamiliesFFP(42601130890)
TitleXIX TitleXXIChildren(018) FFS $3,677,000ManagedCare $7,299,000Children(1920)
FFS $396,000 ManagedCare $621,000 PregnantWomen
FFS $2,319,000 ManagedCare $650,000
Total(rounded) $3,986,000 $10,976,000GF $1,993,000 $3,841,600FFP $1,993,000 $7,134,400
CHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENREGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
-$64,317,000-$64,317,000-$64,317,000-$64,317,000$64,317,000$64,317,000$64,317,000$64,317,000
$64,317,000$64,317,000$64,317,000$64,317,000$0$0$0$0
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
-$64,317,000-$64,317,000-$64,317,000-$64,317,000$64,317,000$64,317,000$64,317,000$64,317,000
$64,317,000$64,317,000$64,317,000$64,317,000$0$0$0$0
Purpose:ThispolicychangeisatechnicaladjustmenttoshiftfundsfromTitleXIX50%federalfinancialparticipation(FFP)to100%GFbecausetheDepartmentcannotclaimFFPfornonemergencyhealthcareexpendituresforNewQualifiedAliens(NQA).Authority:H.R.3734(1996),PersonalResponsibilityandWorkOpportunityAct(PRWORA)Welfare&InstitutionsCode,section14007.5InterdependentPolicyChanges:NotapplicableBackground:PRWORAspecifiedthatFFPisnotavailableforfullscopeMediCalservicesformostqualifiednonexemptalienswhoenterthecountryafterAugust1996,forthefirst5yearstheyareinthecountry.TheyareeligibleforFFPforemergencyservicesonly.AsCalifornialawrequiresthatlegalimmigrantsreceivethesameservicesascitizens,thenonemergencyservicesare100%Statefunded.ReasonforChangefromPriorEstimate:ThechangesareduetoupdatedexpendituresfornonemergencyservicesforNQAs.Methodology:1.Basedonactualexpenditurereportsforthefeeforservice(FFS)nonemergencyservicescostsof
NQAsfromJanuary2006throughJune2012,currentyearandbudgetyearcostswereprojected.
2.BasedonthehistoricalpatternofFFSversusmanagedcarenonemergencyserviceexpendituresfortheperiodofJune2010throughJuly2011(19.27%),themanagedcaretotalsforcurrentyearandbudgetyearwereprojected.
3.TheimpactoftheStateChildrensHealthInsuranceProgram(SCHIP)fundingforprenatalcarefor
newqualifiedaliensisincludedintheSCHIPFundingforPrenatalCarepolicychange.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
NEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENS
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz12/199712/199712/199712/1997
15151515
14141414
California Department of Health Care Services November 2012 Medi-Cal Estimate
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4.TheimpactofChildren'sHealthInsuranceProgramReauthorizationAct(CHIPRA)fundingforfull
scopeMediCalwithFFPtoeligibleQualifiedAlienswhoarechildrenorpregnantwomen,eveniftheyhavebeenintheU.S.forlessthanfiveyears,isbudgetedintheCHIPRAMediCalforChildrenandPregnantWomenpolicychange.
Funding:TitleXIXGeneralFund(42601010001)
(rounded) FY201213 FY201314FFS $107,848,000 $107,848,000ManagedCare $20,786,000 $20,786,000Total $128,634,000 $128,634,000FFPRepayment $64,317,000 $64,317,000
NEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENSREGULAR POLICY CHANGE NUMBER: 14REGULAR POLICY CHANGE NUMBER: 14REGULAR POLICY CHANGE NUMBER: 14REGULAR POLICY CHANGE NUMBER: 14
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
$46,071,000$46,071,000$46,071,000$46,071,000-$46,071,000-$46,071,000-$46,071,000-$46,071,000
-$46,071,000-$46,071,000-$46,071,000-$46,071,000$0$0$0$0
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
$0$0$0$0
0.00 %0.00 %0.00 %0.00 %
$44,850,150$44,850,150$44,850,150$44,850,150-$44,850,150-$44,850,150-$44,850,150-$44,850,150
-$44,850,150-$44,850,150-$44,850,150-$44,850,150$0$0$0$0
Purpose:Thispolicychangeestimatesthetechnicaladjustmentinfundingforthe100%and133%ProgramsexpenditurestobeadjustedfromTitleXIX50%FederalFinancialParticipation(FFP)toenhancedTitleXXI65%FFP.Authority:SB903(Chapter624,Statutesof1997)InterdependentPolicyChanges:PC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:BasedontheprovisionsofSB903andSection1902(l)(3)ofthefederalSocialSecurityAct(42U.S.C.Sec1396a(l)(3)),resourceswillnotbecountedindeterminingtheMediCaleligibilityforchildrenagesoneto19inthe100%and133%programs.ThischangewasimplementedtohelpstreamlinetheapplicationprocessandtoalignMediCaleligibilitymorecloselywiththeHealthyFamiliesProgram.EffectiveJanuary1,2013,theHealthyFamiliesProgramwillceasetoenrollnewapplicantsandwillbephasedoutoveraninemonthperiod.ChildrenenrolledintheHealthyFamiliesProgramwillbetransitionedtotheMediCalProgramastargetedlowincomechildrenandresourceswillnotbecountedforchildrenwithincomesupto250%oftheFederalPovertyLevel(FPL).ReasonforChangefromPriorEstimate:Thechangesareduetoadditionalcaseloadandexpenditures.Methodology:1.Aidcodes(8N,8P,8R,and8T)thatidentifychildreneligibleforMediCalduetodisregardingassets
wereimplementedinDecember1998.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
RESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDREN
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Yao-Hui YuYao-Hui YuYao-Hui YuYao-Hui Yu12/199812/199812/199812/1998
13131313
15151515
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2.Averagemonthlyfeeforservice(FFS)eligibles,whichareincludedinthebase,areestimatedtobe44,953inFY201213and46,272inFY201314.ItisassumedtotalFFSexpenditureswillbe$25,320,000inFY201213and$26,063,000inFY201314.
3.AveragemonthlyManagedCareeligibles,whicharebudgetedinthemanagedcaremodelpolicychanges,areestimatedtobe180,003inFY201213and182,861inFY201314.ItisassumedtotalManagedCareexpenditureswillbe$273,681,000inFY201213and$281,077,000inFY201314.
4.EnhancedfederalfundingunderTitleXXIMedicaidChildrensHealthInsuranceProgram(MCHIP)maybeclaimedforchildreneligibleundertheseaidcodes.Itis65.00%inFY201213andFY201314.
Funding:
FY201213: GF FF TF
TitleXIX50/50FFP 42601010001/0890 ($149,500,000) ($149,501,000) ($299,001,000)TitleXXI65/35FFP 42601130001/0890 $104,650,000 $194,351,000 $299,001,000NetImpact ($44,850,000) $44,850,000 $0 FY201314: GF FF TFTitleXIX50/50FFP 42601010001/0890 ($153,570,000) ($153,570,000) ($307,140,000)TitleXXI65/35FFP 42601130001/0890 $107,499,000 $199,641,000 $307,140,000NetImpact ($46,071,000) $46,071,000 $0
RESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENREGULAR POLICY CHANGE NUMBER: 15REGULAR POLICY CHANGE NUMBER: 15REGULAR POLICY CHANGE NUMBER: 15REGULAR POLICY CHANGE NUMBER: 15
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
1.00001.00001.00001.0000
-$665,000-$665,000-$665,000-$665,000
0.00 %0.00 %0.00 %0.00 %
-$332,500-$332,500-$332,500-$332,500-$332,500-$332,500-$332,500-$332,500
-$332,500-$332,500-$332,500-$332,500-$665,000-$665,000-$665,000-$665,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
1.00001.00001.00001.0000
-$388,000-$388,000-$388,000-$388,000
0.00 %0.00 %0.00 %0.00 %
-$194,000-$194,000-$194,000-$194,000-$194,000-$194,000-$194,000-$194,000
-$194,000-$194,000-$194,000-$194,000-$388,000-$388,000-$388,000-$388,000
Purpose:ThispolicychangeestimatesthesavingsfromthePublicAssistanceReportingInformationSystem(PARIS)Federal.Authority:NotApplicableInterdependentPolicyChanges:PC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:PARISisaninformationsharingsystem,operatedbytheU.S.DepartmentofHealthandHumanServicesAdministrationforChildrenandFamilies,whichallowsstatesandfederalagenciestoverifypublicassistanceclientcircumstances.ThePARISsystemincludesthreedifferentdatamatches.ThePARISVeteransmatchallowsstatestocomparetheirbeneficiaryinformationwiththeU.S.DepartmentofVeteransAffairs.ThePARISFederalmatchallowsstatestocomparetheirbeneficiaryinformationwiththeU.S.DepartmentofDefenseandtheU.S.OfficeofPersonnelManagementtoidentifyfederalpensionincomeorhealthbenefits.ThePARISInterstatematchallowsstatestocomparetheirbeneficiaryinformationwithotherstatestoidentifybeneficiarychangesinresidenceandpublicassistancebenefitsinotherstates.
TheDepartmentimplementedaPARISFederalmatchpilotprograminFY200910.ThepilotprogramallowedtheDepartmenttoidentifylongtermsavingspriortoincurringcoststhatwouldbeassociatedwithstatewideimplementation.Sincethelaunchofthepilotprogram,MediCalsavingshavebeenachievedthroughimprovedverificationandidentificationcapabilities.Currently,PARISFederalisimplementedin30counties.TheDepartmentplanstoexpandto40countiesinFY201314.
DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION
PARIS-FEDERALPARIS-FEDERALPARIS-FEDERALPARIS-FEDERAL
REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:
Ryan WitzRyan WitzRyan WitzRyan Witz5/20115/20115/20115/2011
1738173817381738
16161616
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ReasonforChangefromPriorEstimate:ThenumberofbeneficiariesthatwillbediscontinuedasaresultofPARISFederalmatcheshasincreasedbasedonrecentmatches.Additionally,thesavingsrelatedtoPARISInterstatematchesarenowcapturedinaseparatepolicychange.Methodology:1.SavingsforPARISFederalisassumedforbothManagedCareandfeeforservice(FFS).2.BasedonquarterlyreportsforAugust2012throughMay2013,itisestimated344managedcare
and84FFSbeneficiarieswillbediscontinuedfromMediCalinFY201213.3.BasedonquarterlyreportsforAugust2013throughMay2014,itisestimated424managedcare
and104FFSbeneficiarieswillbediscontinuedfromMediCalinFY201314.4.Totalmanagedcaresavingsisestimatedtobe$680,000TFinFY201213,and$1,032,000TFin
FY201314.TotalFFSsavingsisestimatedtobe$2,235,000TFinFY201213and$3,392,000TFinFY201314.
5.InFY201213,itisestimatedthat86.69%ofthemanagedcareandFFSsavingsiscapturedinthe
basetrends.InFY201314,itisestimatedthat84.96%ofthemanagedcareandFFSsavingsiscapturedinthebasetrends.
6.Totalestimatedsavingsnotinthebasetrends:
Funding:TitleXIXFFP(42601010001/0890)
FY201213 TotalSavings %inBase SavingsinBaseManagedCareSavings ($680,000) 86.69% ($589,000)FFSSavings ($2,235,000) 86.69% ($1,937,000)Total ($2,915,000) ($2,526,000) FY201314 TotalSavings %inBase SavingsinBaseManagedCareSavings ($1,032,000) 84.96% ($877,000)FFSSavings ($3,392,000) 84.96% ($2,882,000)Total ($4,424,000) ($3,759,000)
FY201213 TF GFManagedCareSavings ($91,000) ($45,500)FFSSavings ($297,000) ($148,500)Total ($388,000) ($194,000) FY201314 TF GFManagedCareSavings ($155,000) ($77,500)FFSSavings ($510,000) ($255,000)Total ($665,000) ($332,500)
PARIS-FEDERALPARIS-FEDERALPARIS-FEDERALPARIS-FEDERALREGULAR POLICY CHANGE NUMBER: 16REGULAR POLICY CHANGE NUMBER: 16REGULAR POLICY CHANGE NUMBER: 16REGULAR POLICY CHANGE NUMBER: 16
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FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS
PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE
APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS
STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS
FY 2013-14FY 2013-14FY 2013-14FY 2013-14
0.94760.94760.94760.9476
-$1,038,700-$1,038,700-$1,038,700-$1,038,700
35.14 %35.14 %35.14 %35.14 %
-$519,350-$519,350-$519,350-$519,350-$519,350-$519,350-$519,350-$519,350
-$845,000-$845,000-$845,000-$845,000-$1,690,000-$1,690,000-$1,690,000-$1,690,000
FY 2012-13FY 2012-13FY 2012-13FY 2012-13
0.93600.93600.93600.9360
-$866,500-$866,500-$866,500-$866,500
29.76 %29.76 %29.76 %29.76 %
-$433,260-$433,260-$433,260-$433,260-$433,260-$433,260-$433,260-$433,260
-$659,000-$659,000-$659,000-$659,000-$1,318,000-$1,318,000-$1,318,000-$1,318,000
Purpose:ThispolicychangeestimatesthesavingsfromthePublicAssistanceReportingInformationSystem(PARIS)VeteransMatch.Authority:Welfar