Chapter Nine State and Local Government Local Government ~~~~~ Units of Local Government.
Health and Human Services in State and Local Government
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Transcript of Health and Human Services in State and Local Government
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•Where are we now and what are we watching?•Affordable Care Act•Medicaid•Long-Term and Managed Care•CHIPS
• What does it mean?
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March 23, 2010
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Affordable Care Act Status
More Americans have Health Insurance• 15M Americans now covered• Percentage of uninsured adults in US down from 18% to
13.4%• Estimate +9.9M enrollees added during 2nd enrollment
period ending Feb 15 • 9.5M enrollees in second open enrollment as of Jan 17
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Affordable Care Act Status
Enrollment Occurred Online, by States and at Work•6.4M: HealthCare.gov federal marketplace•850,000: 14 states with own marketplace•1.9M: auto-renewal, renewal and new signups
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Federal Marketplace Snapshot Week 6Dec 20 – Dec 26
Cumulative Nov 15 – Dec 26
Plan Selections 99,446 6,490,492
Applications Submitted 197,402 8,189,587
Call Center Volume 452,276 6,731,353
Average Call Center Wait Time 2 seconds 8 minutes 49 seconds
Calls with Spanish SpeakingRepresentative
28,131* 525,505
Average Wait for Spanish Speaking Rep 2 seconds 30 seconds
HealthCare.gov Users 1,381,879 15,032,614
CuidadoDeSalud.gov Users 43,835 527,217
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**
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** FFM
SBM
FFM Partnership Model
Affordable Care Act: What We’re Watching
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• Judiciary • Supreme Court decision on legality of federal subsidies
• State Specific Exchanges
• King v. Burwell – March 2015
• Legislative• Republican-controlled Congress repeal or limit provisions such as:
• Various taxes on health care industry
• Cadillac tax on high-cost health plans
Affordable Care Act: What We’re Watching
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July 30, 1965
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Medicaid (avg. monthly projected estimates - millions)
FY 2013 FY 2014 FY 2015
Total 58.1 63.0 66.7
Aged 5.2 5.4 5.5
Blind/Disabled 9.7 9.8 9.8
Children 28.3 28.8 29.3
Adults 14.8 14.8 15.1
Expansion Children 0.0 0.5 0.7
Expansion Adult 0.0 3.7 6.4
CHIP (avg monthly) 5.8 6.0 6.2
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Medicaid: What We’re Watching
• Medical Doctor’s Pay
• 47% pay cut in 23 states after ACA reimbursement expires
• 15 states subsidize; 12 states undecided; many states refuse to extend
• Doctors cite low payment as reason to not participate in Medicaid; need more research
• Medical Expansion Waivers
• 28 states expanded Medicaid; election results limit additional expansion
• Movement from states: privatization, patient pay more and employer insurance coverage
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Medicaid: State Expansion Status
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Managed Care Regulations
• By 2016, 3 of 4 Medicaid patients enrolled in managed care plans
• Regulation• Private health insurers
• Centers for Medicare & Medicaid Services to strengthen oversight of states and set more uniform access standards this year
• Rate setting rules - how rates determined by states
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Medicaid: What We’re WatchingHigh-Cost Specialty Drugs• States follow FDA Drug Approvals
• 2013: Hepatitis C drug Sovaldi: cures disease; costs $84K for treatment
• 2015: CA budget includes $300M for drug payments, mostly Hepatitis C drug for Medi-Cal and California’s infected prisoners
• Medicaid directors advocate for federal intervention• Price controls• Better federal matching rates for “curative” specialty drugs• Greater waiver flexibility to allow states to push for better deals
with drug manufacturers
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Super-utilizers: 5% of Medicaid’s beneficiaries account for 60% of the overall spending on the program
By 2020, an estimated 55 million people in the United States will be over the age of 65 = 16.1% of the population
Medicaid: What We’re WatchingDemographics: Super-utilizers and Aging Population
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Managed Care & Long-Term Care: What We’re Watching
• Medicaid • 75% of all Medicaid enrollees will be in some form of managed care, including older,
sicker, and more challenged populations than were included in traditional Medicaid
• Significant market opportunities for Medicaid plans
• New challenges in contract management and oversight for state governments
• Long-Term Care • States must file plans with CMS about how they’re creating home-like atmospheres
through community-based and not institutionalized care – giving seniors real options
• Growing use of managed care
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CHIP Reauthorization Status • CHIP funding expires September 2015
• CHIP jointly funded by state and federal governments
• Unlike Medicaid, insures children from families with higher income levels
• 70% of funding comes is federal
• Financial and Coverage Impact varies by State based on:• State program design
• Federal matching rate
• Number of children supported with CHIP funds
• If not reauthorized, states will been to fill budget holes and find ways to maintain coverage for about 4 million children for billions of dollars
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What Does It All Mean for Companies Doing Business with States and Advocacy Groups Trying to Influence Policy?
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Top 10 States’ HHS Spend
1. California-$85.5 billion
2. New York-$49.1 billion
3. Pennsylvania-$31.7 billion
4. Texas-$24.5 billion
5. Florida-$23.2 billion
6. Ohio-$22.5 billion
7. Illinois-$19.7 billion
8. North Carolina-$19.1 billion
9. Michigan-$17.4 billion
10. New Jersey- $15.8 billion
At a total of $308.5 billion, the top 10 states represent about 50 percent of all spending in this vertical
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Transformative Change to Watch• Payment Reform: Demonstrations aimed at ending wasteful fee-for-
service system• Oregon: unique ACO model
• Tennessee and Arkansas: bundled payments.
• Bold cost-containment strategies• Maryland and Massachusetts: Cap spending
• Comprehensive health delivery system waivers (DSRIP)• New York (most recently), Texas and California
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Summary• Affordable Care Act Enrolls Millions while New Congress
Deliberates Amendments
• Medicaid Expansion and Subsidies Debated State by State
• Drug Costs Dictate Hard Choices
• Changing Demographics Affect Medicaid and Managed Care
• CHIP Reauthorization Critical Path through Congress
• States Innovate based on Champions in Government and Philosophy of Leaders