AHCCCS Update Reaching across Arizona to provide comprehensive

AHCCCS Update

Reaching across Arizona to provide comprehensive quality health care for those in need 2

Current Status of Medicaid Expansion Decisions VT WA MT* ND NH* MN OR WI* SD ID WY UT CO CA AZ NM NY MI* PA IA* NE NV ME IL KS OK MO IN* KY WV VA AR* AL NJ DE MD DC NC TN MS TX OH MA CT RI SC GA Adopted (32 States including DC) LA AK Not Adopting At This Time (19 States) FL HI NOTES: Current status for each state is based on KCMU tracking and analysis of state executive activity. *AR, IA, IN, MI, MT, and NH have approved Section 1115 waivers. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion. SOURCE: “Status of State Action on the Medicaid Expansion Decision, ” KFF State Health Facts, updated July 7, 2016. http: //kff. org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ Reaching across Arizona to provide comprehensive quality health care for those in need

Restoration and Expansion by the numbers • 400, 000 • Expansion Adults • 82, 000 • MH Service • 47, 000 • Substance Use Disorder • 26, 700 • Cancer Treatment • 31% each • 20 -29 years old - >50 • 11, 563 • Individuals with SMI • 17. 3% to 11. 1% • Uninsured rate 2013 to 2015 Reaching across Arizona to provide comprehensive quality health care for those in need 4

Age Distribution of ACA members 140, 000 120, 000 100, 000 80, 000 100 -138% 0 -100% 60, 000 40, 000 20, 000 Under 20 20 -29 30 -39 40 -49 Reaching across Arizona to provide comprehensive quality health care for those in need 50+ 5

AHCA Impact Snapshot FY 18 FY 19 FY 20 FY 21 FY 22 FY 23 Freeze coverage losses (June) 134, 000 274, 000 319, 000 383, 000 Decrease in Healthcare spending with Freeze $118 m $1. 5 B $2. 0 B $2. 5 B $148 m $319 m $408 m $478 m $9. 8 m $29. 4 m $49 m $68. 6 m New State Costs +Restore Freeze at 100% State Costs Patient State Stability Fund $30 m $92 m Reaching across Arizona to provide comprehensive quality health care for those in need 6

Marketplace Enrollment: Arizona 250, 000 200, 000 150, 000 100, 000 50, 000 0 2014 2015 Reaching across Arizona to provide comprehensive quality health care for those in need 2016 7

Marketplace Insurers 2014 -2017 2016 2015 2014 Counties Apache Cochise Coconino Gila Graham Greenlee La Paz Maricopa Mohave Navajo Pima Pinal Santa Cruz Yavapai Yuma 2014 6 6 6 6 9 6 6 8 7 2015 7 7 7 7 10 7 7 9 8 2016 3 2 3 3 2 2 2 8 3 3 5 2 2017 1 1 1 1 1 2 1 7 7 2 1 7 6 7 7 2 2 1 1 Reaching across Arizona to provide comprehensive quality health care for those in need 8

Secretary Tom Price & Administrator Seema Verma’s Letter to Governors “We commit to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population. ” https: //www. hhs. gov/sites/default/files/secprice-admin-verma-ltr. pdf a. Reaching across Arizona to provide comprehensive quality health care for those in need 9

Examples of Flexibility – Mc. Carthy Letter 1. Freeze or cap certain eligibility group–ability to eliminate TMA 2. States should not have to cover all FDA approved drugs 3. Change FQHC reimbursements and statutes 4. Eliminate NEMT for certain populations 5. Increased cost sharing flexibility 6. Eliminate comparability and state-wideness 7. Eliminate Essential Health Benefits requirement 8. Allow more frequent eligibility redeterminations 9. Eliminate and reduce CMS regulatory burden 10. 1115 path to permanency Reaching across Arizona to provide comprehensive quality health care for those in need 10

Medicaid Portion of General Fund 21. 1% 22. 6% $7, 517. 8 $7, 389. 0 $1, 926. 2 $2, 016. 3 $2, 155. 5 FY 2010 FY 2016 FY 2017 24. 9% 10. 8% $5, 798. 4 12. 2% $5, 306. 8 $2, 651. 8 $367. 9 $639. 7 FY 1990 FY 2000 Reaching across Arizona to provide comprehensive quality health care for those in need 11

Hospital Assessment Rebase • Hospital Assessment developed in 2013 to fund costs associated with Proposition 204 population and expansion. o Guiding principle to limit negative impacts on systems. o Used 2011 data • Rebase for SFY 2019 (July 1, 2018–June 30, 2019) o Hospital workgroup created o Rule update will include public comment Reaching across Arizona to provide comprehensive quality health care for those in need 12

Uncompensated Care Trends Arizona Hospital Uncompensated Care Trends Before and After Medicaid Expansion 450, 000 8. 00% 400, 000 7. 00% 350, 000 6. 00% 300, 000 5. 00% 250, 000 4. 00% 200, 000 3. 00% 150, 000 2. 00% 100, 000 1. 00% 50, 000 0. 00% - 20 11 20 13 42 77 9 42 83 8 42 89 9 42 96 0 43 02 1 43 08 2 42 78 0 42 83 9 42 90 0 42 96 1 43 02 2 43 08 3 42 78 1 42 84 0 42 90 1 42 96 2 43 02 3 43 08 4 42 78 2 42 84 1 42 90 2 42 96 3 43 02 4 43 08 5 42 78 3 9. 00% Uncompensated Care % Total Childless Adults Covered by AHCCCS Source: Arizona Hospital and Healthcare Association) Reaching across Arizona to provide comprehensive quality health care for those in need 13

Budget Update Adult Emergency Dental • $1, 000 limit • Target October 1, 2017 Occupational Therapy • Target October 1, 2017 Opioid Initiative • 3 OIG Staff • 2 Clinical Staff Proposition 206 • -Ongoing 1 -1 -17 -Flagstaff 7 -1 -17 • -Sick Leave 7 -1 -17 -Increase in Min. Wage 1 -1 -18 • -Network Adequacy Study Reaching across Arizona to provide comprehensive quality health care for those in need 14

Other Legislative Items HB 2493 SB 1434 SB 1440 • Drug Overdose Review Team • Naloxone standing order • Limits the art therapists AHCCCS and its Contractors may use to nationallycertified art therapists or master’s level graduates under supervision of nationally-certified art therapist • Does not require contracting for art therapy • AHCCCS to establish internal clinical oversight review committee to review clinical data and analyze performance • Solicit external feedback • Submit an annual report to Legislature in February of each year Reaching across Arizona to provide comprehensive quality health care for those in need 15

Arizona Management System Governor’s Roadmap and Goal Council Employee Development & Engagement Visual Management Arizona Management System Business Reviews & Strategic Plan Leader Standard Work Reaching across Arizona to provide comprehensive quality health care for those in need

AMS Success Stories • OALS streamlined the processing of provider claims disputes, resulting in 90% processed in under 60 days (up from 26% in March 2016). • Collaborative efforts with DES resulted in 95% of Community Assistor requests addressed within 3 days, 75% same day. • Increased TPL workers’ compensation recovery by 140% in Q 1 2017 (compared to 2016 avg). • Reduced DFSM provider claim backlog from 50, 000 claims to <1, 000. Instituted a same day processing policy. Reaching across Arizona to provide comprehensive quality health care for those in need 17