New Mexico Human Services Department

Presentation to Legislative Finance CommitteePreview of FY19 Appropriation Request

Brent Earnest, SecretaryOctober 25, 2017

HSD FY19 Appropriation Request Overview Medicaid Budget and Performance◦ Enrollment and Cost trends

Behavioral Health Budget and Performance Child Support Enforcement Income Support Division◦ Temporary Assistance for Needy Families

HHS 2020 and the Medicaid Management Information System (MMIS) replacement project

Centennial Care 2.0 Update

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Today’s Presentation

HSD FY 19 Appropriation Request

FY 19 Budget Request of $7.085 billion 2.34% increase overall $1.116 billion from the

general fund (increase of $83.8 million or 8.12%)

$5.694 billion in federal funds (increase of $82.2 million or 1.46%)

$274.1 million in other state funds and other revenue

Federal Funds80.37%

Other State

Funds and Revenue3.87%

State General Fund

15.76%

3

HSD General Fund Budget Change

15.92%

10.22%

18.48%

12.18%

-21.87%

-1.02%

36.45%

4.54%2.90%

-2.37%

0.68% 1.52% 0.152%

8.12%

-30.00%

-20.00%

-10.00%

0.00%

10.00%

20.00%

30.00%

40.00%FY

06 O

P BU

D

FY07

OP

BUD

FY08

OP

BUD

FY09

OP

BUD

FY10

OP

BUD

FY11

OP

BUD

FY12

OP

BUD

FY13

OP

BUD

FY14

OP

BUD

FY15

OP

BUD

FY16

OP

BUD

FY17

OP

BUD

FY18

OP

BUD

FY19

REQ

UEST

Percent Change in HSD General Fund Budget

*GF adjustment due to ARRA

4

Enrollment growth trends have slowed◦ By June 2018, enrollment projected to be 917,000,

essentially flat from June 2017.◦ FY19 growth of 0.8% projected, reaching more than

922,000 Cost trends in Centennial Care are significantly

lower than regional and national health care inflation

Uncertainty at the federal level◦ FMAP changes◦ Reauthorization of CHIP program◦ ACA “repeal and replace” legislation◦ Enrollment trends

5

FY19 Medicaid Budget Request Highlights

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000Ja

n-13

May

-13

Sep-

13

Jan-

14

May

-14

Sep-

14

Jan-

15

May

-15

Sep-

15

Jan-

16

May

-16

Sep-

16

Jan-

17

May

-17

Sep-

17

Jan-

18

May

-18

Sep-

18

Jan-

19

May

-19

Med

icai

d En

rollm

ent

Expansion/Other Adult Group

Sate Coverage Insurance

Medicaid Adults

Medicaid Children

June 2019Projected Enrollment

OAG: 275,685*

Medicaid Adults:271,512

Medicaid Children:379,107*

*children 19-21 y.o. counted in OAG

Medicaid EnrollmentAugust 2017 911,803

Projected

6

January 2014 also launched adult expansion of Medicaid—Alternative Benefit Package Significant enrollment growth in 4 years:

7

58%42%

2017

43%57%

2013

Children (<21 Years)

Adults (>=21 Years)

Medicaid Category Enrollment June 2013

EnrollmentAugust 2017

Percentage Increase

Parents/Caretaker Adults (0-47% FPL)

40,776 77,734 91%

Other Adults (48% - 138% FPL)

36,812 (SCI)

268,723(Adult Expansion)

629%

All Medicaid 575,908 911,803 58%

Medicaid Enrollment Transformation

8

Enrollment up 5%; Per capita costs down 2%

Centennial Care: Managing Cost Growth

Medicaid: FY 19 Appropriation Request (as of Sept. 1)

Total Medicaid Program spending in FY 19 is projected to be $5.892 billion.

o $997.2 million from the general fund, an $81.5 million increase. Major changes from FY18 include:

FY19 base - additional general fund above FY18 appropriation $15.82Expansion FMAP (drops to 94% in 2018 and 93% in 2019) $14.70Enrollment $11.73Utilization and Price increases (less than 1% change) $11.66Medicare Part B $2.62CHIP FMAP Reduction (100% to 72.13%) $31.23FMAP Change (71.90 to 72.13) ($7.18)County Support Medicaid and Tobacco Settlement Revenue (reduction) $5.34Other Revenue changes ($4.38)Total $81.54

($ in millions)

9

The total FY 19 budget request for administration of the Medicaid program is $84.4 milliono $4.864 million increase from FY18o $888.8 thousand increase in general

fund need to support contractual services.

Medical Assistance Division administrative spending is only 1.43% of the total program budget.

Priorities for MAD staff in 2019 include:o Implementation of 1115 Waiver

Renewalo Continued procurement and

implementation of replacement MMIS

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Federal Funds, $66.85 M, 79%

State General Fund, $15.14 M,

18%

Other State

Funds, $2.42 M,

3%

Medicaid: Administration

Medicaid: MCO HEDIS Performance Measures

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64% 66% 68%

0%10%20%30%40%50%60%70%

HEDIS 14 HEDIS 15 HEDIS 16

Annual Dental Visits

47%52%

57%

0%10%20%30%40%50%60%70%

HEDIS 14 HEDIS 15 HEDIS 16

Well Child Visits within 1st 15 mos.

47%52% 54%

0%10%20%30%40%50%60%70%

HEDIS 14 HEDIS 15 HEDIS 16

Asthma Medication Management

48 49 48 45

0102030405060

HEDIS 14 HEDIS 15 HEDIS 16 SFY17Preliminary

ER Visits per 1,000

12

73% 71% 77%

0%

20%

40%

60%

80%

HEDIS 14 HEDIS 15 HEDIS 16

Prenatal Care Visits in the 1stTrimester

Medicaid: MCO HEDIS Performance Measures

52%46%

56%

0%10%20%30%40%50%60%

HEDIS 14 HEDIS 15 HEDIS 16

Received greater than 81% of expected prenatal visits

7% 7% 7%6%

0%

2%

4%

6%

8%

CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3

Reduction in hospital readmissions for children within 30 days of discharge

13% 12%10% 10%

0%

5%

10%

15%

CY16 Avg. CY17 Q1 CY17 Q2 CY17 Q3

Reduction in hospital readmissions for adults within 30 days of discharge

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Behavioral Health Spending

FY19 request for BHSD is $59.6 million, $37.0 million from the General Fund.◦ Increased federal funding for combating opioid addiction and overdose

crisis

Total HSD Behavioral Health Spending (excl. administration)

FY17 Actuals FY18 Op Bud* FY19 Request

($ in millions) GF FF Total GF FF Total GF FF Total

Medicaid Behavioral Health $107.49 $393.62 $501.11 $115.58 $424.3 $539.87 $107.48 $394.36 $501.83

Behavioral Health Services Division $37.4 $21.05 $58.45 $37.04 $20.6 $57.64 $37.04 $22.57 $59.61

Total $144.89 $414.67 $559.56 $152.62 $444.9 $597.52 $144.52 $416.93 $561.44

Percent change from prior year -1.24% 3.40% 2.15% 5.33% 7.29% 6.78% -5.31% -6.29% -6.04%

Note: *FY18 Operating Budget for MAD BH is overstated. Adjustments to the Medicaid appropriation were not included in the MAD BH program appropriation.

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2,699

3,682

4,890

SFY 15

SFY 16

SFY17

3.5%

5.7%

1.7%

3.8% 3.7%

10.2%

4.4%

5.7%

1.4% 2.2%0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

SFY12 SFY13 SFY14 SFY15 SFY16

5th Grade Reading 8th Grade Math

Number of persons served through Telehealth in rural and frontier counties

Individuals served by BH Collaborative programs

145,534160,843 173,781

0

50,000

100,000

150,000

200,000

CY14 CY15 CY16

Reduction in Proficiency Gaps

Behavioral Health Performance

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29.84%

39.11%

33.28%

42.24%

48.50%

61.92%

52.40%

61.65%

20%

30%

40%

50%

60%

70%

SFY14 SFY15 SFY16 SFY17

Improving Follow-Up Services after Discharge

7 Day 30 Day

87.70% 88.00% 86.40% 86.44%

86.40% 87.10% 83.50% 84.02%

0%

20%

40%

60%

80%

100%

0%20%40%60%80%

100%

2014 2015 2016 2017

Adult Family/Caregiver

Satisfaction with Behavioral Health Services

Behavioral Health Performance

Child Support Enforcement Division

$30.97 million total budgetrequest

o $7.64 million from the general fundo Reduce the vacancy rateo Replace other revenue

o $20.31 million from federal fundingo $3 million from other revenue

69,127 child support cases in FY17

Key priorities◦ Implement Business process model

to ensure more efficient and effective service

◦ Replacement of the old Child Support Enforcement IT system

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$132

.1 M

$137

.1 M $1

40.1

M

$140

.8 M

$139

.6 M

$126. M

$128. M

$130. M

$132. M

$134. M

$136. M

$138. M

$140. M

$142. M

FY13 FY14 FY15 FY16 FY17

Child Support Collections(in millions)

Income Support Division

$965.0 million overall budget Increase of $398.5 thousand in

General Fund needed to maintain Senior SNAP Supplement ($25 per month).

The increase in Federal funds is primarily due to an increase in SNAP caseload and higher projected spending in the LIHEAP Program- 100% Federal funding.

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Federal Funds95.38%

State General Fund4.55%Other State

Funds0.07%

SNAP Participation

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130,000

150,000

170,000

190,000

210,000

230,000

250,000

17,000,000

18,000,000

19,000,000

20,000,000

21,000,000

22,000,000

23,000,000

24,000,000

Oct 2009

Dec 2009

Feb 2010

Apr 2

010

Jun 2010

Aug 2010

Oct 2010

Dec 2010

Feb 2011

Apr 2

011

Jun 2011

Aug 2011

Oct 2011

Dec 2011

Feb 2012

Apr 2

012

Jun 2012

Aug 2012

Oct 2012

Dec 2012

Feb 2013

Apr 2

013

Jun 2013

Aug 2013

Oct 2013

Dec 2013

Feb 2014

Apr 2

014

Jun 2014

Aug 2014

Oct 2014

Dec 2014

Feb 2015

Apr 2

015

Jun 2015

Aug 2015

Oct 2015

Dec 2015

Feb 2016

Apr 2

016

Jun 2016

Aug 2016

Oct 2016

Dec 2016

Feb 2017

Apr 2

017

Jun 2017

Total SNAP

 Hou

seho

lds in New

 Mexico

Total SNAP

 Hou

seho

lds in th

e US

SNAP: Monthly Number of Households

National Households New Mexico Households

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Supplemental Nutrition Assistance Program

87.1

%

93.3

%

95.6

%

92.5

%

96.9

%

82.5

%

90.0

%

97.4

%

92.4

%

97.1

%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

2014 2015 2016 2017 2018(1st Qtr.)

Regular - 30 Day Expedited - 7 Day

82.1%

88.8%92.4% 92.2%

80.0%

85.0%

90.0%

95.0%

100.0%

Timeliness of application processing

Percent of eligible children participating in SNAP

TANF Participation

20

5,000

7,000

9,000

11,000

13,000

15,000

17,000

19,000

21,000

23,000

950,000

1,050,000

1,150,000

1,250,000

1,350,000

1,450,000

1,550,000

1,650,000

1,750,000

1,850,000

1,950,000

Oct‐05

Feb‐06

Jun‐06

Oct‐06

Feb‐07

Jun‐07

Oct‐07

Feb‐08

Jun‐08

Oct‐08

Feb‐09

Jun‐09

Oct‐09

Feb‐10

Jun‐10

Oct‐10

Feb‐11

Jun‐11

Oct‐11

Feb‐12

Jun‐12

Oct‐12

Feb‐13

Jun‐13

Oct‐13

Feb‐14

Jun‐14

Oct‐14

Feb‐15

Jun‐15

Oct‐15

Feb‐16

Jun‐16

Oct‐16

Feb‐17

Total TAN

F Ca

ses in New

 Mexico 

Total TAN

F Ca

ses in th

e US

TANF: Monthly Number of Families

US: Number of TANF Families New Mexico: Number of TANF Families

Temporary Assistance for Needy Families – (TANF)

FY19 TANF appropriation request of $136.3 million:◦ TANF block grant of $109.9

million and $25.5 million of current carry over balances.

◦ Cash assistance, flat with FY18 OpBud. Includes restoring (increasing)

monthly cash assistance grant by 7.5%

◦ Maintains support of programs at other agencies

◦ Continues support services programs, such as attaining high school equivalency and employment programs.

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Cash Assistance, $51.1 M, 38%

Administration, $11.5 M, 8%Support Services,

$19.7 M, 14%

Other Agencies, $54. M, 40%

TANF Work Participation Rate Caseload has decreased

o In 2012, HSD had an average caseload of 18,201

o In 2017, the average was 11,055

Increase of child only caseso In 2012, the average child only cases 

was 37.1% of the caseload.o In 2017, the average child only cases 

was 45.3% of the caseload.

1 parent household has decreasedo In 2012, the average number of one 

parent households was 56.2% of the caseload.

o In 2017, the average number of one parent households had dropped to 47.2% of the caseload.

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34.4% 33.5%36.6%

48.4%

51.9%

46.0%

51.7%

39.3%36.1%

54.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

2012 2013 2014 2015 2016

FFY Work Participation Rates

US Average New Mexico

Job Readiness Activities ISD remains focused on helping TANF

recipients prepare for and find employmento CareerLinkso Wage Subsidyo High School Equivalency Credential Programo Vocational Training Program

Partnership with the Department of Workforce Solutions

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Temporary Assistance for Needy Families – (TANF)

Temporary Assistance for Needy Families – (TANF)

Admin Includes: Income Support Administration and Program Support Administration Cash Assistance Includes: Cash Assistance, Clothing Allowance, Diversion Payments, Wage

Subsidy and State Funded Legal Aliens Support Services Include: NM Works Program, Transportation, Career Links, High School

Equivalency program, Vocational Training Program and Employment Related Costs Other Agencies Include: CYFD Pre K, CYFD Child Care, CYFD Home Visiting, CYFD

Supportive Housing and PED Pre K

PROGRAM($ in millions) GF FF TOTAL GF FF TOTAL

General Funds in HSD for TANF 0.09 - 0.09 0.09 - 0.09Unspent balances from prior periods - 69.7 69.7 - 48.3 48.3TANF Block Grant - 109.9 109.9 - 109.9 109.9TANF Contingency - - - - - - TOTAL REVENUE 0.09 179.6 179.7 0.09 158.2 158.3ADMIN TOTAL - 11.5 11.5 - 11.5 11.5Cash Assistance 0.09 51.2 51.3 0.09 51.0 51.1Support Services - 20.7 20.7 - 19.7 19.7Other Agencies - 54.0 54.0 - 54.0 54.0TOTAL 0.09 137.4 137.5 0.09 136.2 136.3Calculated Carryover Balance 42.3 21.9

FY18 OP BUD FY19 REQUEST

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Program Support provides administrative support to the program divisions of HSD

The FY19 budget request for Program Support is $53.3 million, with $15.8 million requested from the General Fund

Key projects and results◦ ASD: Unqualified opinion from independent auditors

(FY16); FY17 in progress and on track◦ ITD: Maintain and support critical and large-scale,

statewide IT systems◦ ITD: MMIS and CSES replacement projects in progress

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Program Support and Information Technology

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System processes 10 million transactions, totaling $6 billion in medical care for 900,000 New Mexicans through 27,675 providers and 4 MCOs. 

Aligns with federal requirements◦ Risk of reduced federal funding for non‐compliant system

90% Federal ‐ 10% State funding Creates a client‐centric business solution and is the foundation for additional development within New Mexico’s Health & Human Services (HHS) enterprise.◦ Connecting existing services in HSD with DOH, CYFD, and ALTSD to deliver a customer‐centric focus through shared technology Unified Portal and Consolidated Customer Service Center and Data Services

Medicaid Management Information System Replacement (MMISR)

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Undertaking five procurements to implement MMISRo System Integrator (SI) -- in contract negotiationo Data Services (DS) -- finalizing vendor selectiono Quality Assurance (QA) -- release RFP in November 2017o Benefit Management Services (BMS) -- release RFP in February 2018o Financial Services (FS) -- release RFP in May 2018

HSD requests $6.8 million in State General Fund to support the continuation of the $175.6 million MMISR project.o The legislature has appropriated $87.09 million (Federal and State

share) in project funds to date.o The project received approval of an Advanced Planning Document

Update Budget from CMS in June 2017.

Category or Account Description

FY17 & Prev

ActualFY18

BudgetedFY19

Request FY20 EstimateFY21

Estimate TotalGeneral Fund $1,699.0 $7,010.0 $6,801.9 $2,033.4 $3.6 $17,845.9

Federal Funds $15,636.2 $62,744.7 $64,445.3 $14,838.3 $33.1 $157,758.3

Total $17,335.2 $69,754.7 $71,605.9 $16,871.7 $36.7 $175,604.2

MMISR Costs and Budget

Next Public Meeting: Albuquerque – Monday, October 30, 2017, 5:30 to 7:30 pm◦ National Hispanic Cultural Center◦ By phone: 1-888-757-2790, participant code 991379#

Additional info: ◦ http://www.hsd.state.nm.us/centennial-care-2-0.aspx

To submit comments:◦ Email to HSD-PublicComment@state.nm.us◦ Mail to Human Services Department, ATTN: HSD Public

Comments, PO Box 2348, Santa Fe, NM 87504-2348

Comments will be accepted until 5:00pm MST on Monday, November 6, 2017

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Centennial Care 2.0 Information

Questions?

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