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Medicaid Reporting and Trend Review

Department of Social ServicesDivision of Financial Services

October 10, 2014

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Medicaid Reporting and Trend Review

Expenditure Reporting Update New Legislative Report

Review of Major Medicaid Enrollment and Expenditure Trends Enrollment Trends Expenditure Trends Per Member Per Month Costs

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Medicaid - New Legislative Expenditure Report

New Report Initiated at End of SFY 2014

Joint Effort with the Office of Fiscal Analysis and the Office of Policy and Management

Currently Shared with Committee Leadership (Appropriations & Human Services)

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Medicaid - New Legislative Expenditure Report

Prior Medicaid Expenditure Report

Category of Service Focus

Did not Separate Expenditures by HUSKY Component (A,C, D)

Prior to Net Funding of Medicaid

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Medicaid - New Legislative Expenditure Report

Prior FormatProvider Code Jan-2012 Feb-2012 Mar-2012 Apr-2012 May-2012 Jun-2012 TOTAL

Hospital Inpatient 35,402,679 54,547,841 69,468,740 54,323,620 55,309,457 70,901,733 561,684,319 Hospital Outpatient 25,942,873 40,320,812 53,383,246 45,962,498 50,203,397 58,818,837 406,519,055 Physician Services 9,733,802 20,296,957 27,211,900 21,193,359 23,026,240 28,608,081 181,106,442 Pharmacy 48,957,909 52,596,242 59,609,566 52,998,124 54,567,351 66,035,169 650,620,831 Clinic Services 18,809,818 23,758,186 27,529,427 22,225,196 22,750,878 28,455,113 273,391,643 Home Health Services 18,751,218 20,486,710 23,294,813 19,667,586 20,037,897 23,860,506 243,149,038 Transportation 1,980,431 2,703,233 3,278,014 2,635,260 2,612,842 3,424,343 29,839,043 Non - Emergency Transportation 4,083,060 1,520,103 7,429,605 3,074,492 3,393,415 3,531,874 40,034,897 Dental Services 12,561,531 14,666,901 19,298,486 15,260,591 16,209,785 17,518,995 185,204,053 Vision Care Services 1,001,083 1,900,299 2,312,886 1,810,731 2,095,799 2,180,532 14,755,689 Lab & X-Ray 1,425,909 2,300,729 2,845,070 1,385,822 1,582,370 4,314,420 20,638,611 Durable Medical Equipment 4,872,767 6,243,447 7,928,637 5,844,880 6,194,203 7,557,411 64,490,344 MH Waiver 204,799 188,518 203,593 224,679 239,342 (631,644) 757,953 Managed Care Capitation 71,160,667 25,873,663 16,629,090 (299,218) (521,408) (260,400) 558,515,915 Alcohol & Drug Services 897,414 1,360,460 1,270,075 1,201,227 1,114,571 1,469,597 14,238,102 Other Practitioner 2,630,587 3,290,207 4,071,155 2,096,057 3,721,568 2,551,307 32,926,469 CHC Admin. Services (Assessment) 33,601 39,129 63,186 81,609 43,124 62,132 695,398 CHC Waiver Services 12,947,942 12,924,930 15,455,366 12,920,235 11,411,319 16,098,516 158,058,702 PCA Waiver Services 1,902,891 2,015,855 2,718,032 2,119,288 2,158,446 2,458,155 25,981,444 Model Waiver Services 1,909 3,959 4,112 2,934 1,978 3,393 30,240 ABI Waiver Services 2,483,768 3,154,294 4,182,668 3,313,727 3,434,674 3,861,564 42,299,580 Hospital Supplemental Payment - 32,750,006 - - 32,749,982 - 131,000,000 Psych Reinsurance Claims - - - - - - - Hospice Services 130,311 230,943 269,502 189,040 224,457 241,226 2,381,947

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Medicaid - New Legislative Expenditure Report

Enhancements in the New Report

Format changes to traditional category of service section

HUSKY A, C and D expenditures with monthly detail

Quarterly enrollment, expenditures, and per member per month (PMPM) by HUSKY A,C,D

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Medicaid - New Legislative Expenditure Report

Other Considerations

Why quarterly versus monthly? Trends more apparent and monthly

variations are “normalized”

Reporting is based upon date of payment consistent with general State expenditure reporting practices

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Medicaid - New Legislative Expenditure Report

New Format – Category of Service Expenditures by Component (A, C, D)

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Medicaid - New Legislative Expenditure Report

Added Quarterly Enrollment by Program

Significant increase in HUSKY A and D coincides with Exchangeimplementation

HUSKY A + 8.6%HUSKY D +52.5%

HUSKY C enrollment remains steady

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Medicaid - New Legislative Expenditure Report

Added Quarterly ExpendituresExpenditures are generally consistent with enrollment increases

Steady for HUSKY A since December

Steady for HUSKY C Large increase for HUSKY D

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Medicaid - New Legislative Expenditure Report

Added Quarterly PMPMRemarkably steady per member per month (PMPM) costs across the board with a sizable decrease in the PMPM for the HUSKY D population

HUSKY C PMPM is clearly the highest at $2,398 PMPM with HUSKY A the lowest at $328 PMPM

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Medicaid – Latest Trends in Enrollment

Overall Medicaid enrollment has surpassed 753,000

This is an increase of 20% in the nine months since December 2013

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Medicaid – Latest Trends in Expenditures

As a result, Connecticut has experienced an increase in overall Medicaid spending

The overall increase in CT Medicaid spending between SFY 2013 and SFY 2014 was 9.4%

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Medicaid – Latest Trends in Per Member Per Month Costs

The overall Medicaid per member per month trendline has been relatively stable

PMPM decreased from SFY 2012 to 2013 by -0.7%

PMPM increased from SFY 2013 to 2014 by 1.8%

Average two year growth rate of approximately 0.5%

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Medicaid – Latest TrendsExpenditures & Enrollment

In this side-by-side review, enrollment growth can be clearly seen as exceeding overall expenditure growth trends

For this period, the enrollment growth trend was 20%, compared to the trend in overall expenditure growth which was 13.6%

Medicaid – Composition of Enrollment

HUSKY C

HUSKY D

HUSKY A

Medicaid – Composition of Expenditures

HUSKY D

HUSKY C

HUSKY A

Enrollment: HUSKY A 65.6%; HUSKY C 13.6%; HUSKY D 20.7%

Closing

National Medicaid trend information - latest CMS Actuarial report cites national PMPM in the range of 5% for FFY 2013

Favorable cost trends - combination of efforts and factors

Costs carefully managed while access and improved outcomes have also been achieved