CHC Population Review CHC SubMAAC December 4 2015

CHC Population Review CHC Sub-MAAC December 4, 2015 10/16/2021 1

Population Breakdown MA Eligible 21+ NFCE: NF or OLTL HCBS Waiver Dual Eligible 10/16/2021 Non-NFCE Dual Eligible NFI Non-Dual 2 Non-Dual (Not CHC Eligible)

Population Summary Five Groups 1. 2. 3. 4. 5. 10/16/2021 Nursing Facility Duals Nursing Facility Non-Duals Waiver Non-Duals not in a Waiver, Nursing Facility or excluded Facility Code 3

Steps for Inclusion / Exclusion in CHC Population 1. Age 21+ (as of 1 st day of the month) with no Date of Death 2. Dual Eligible a) Have Medicare A, B or D b) Have Medicaid c) Remove Partial Duals (Use Program & Category Codes) 3. Open Facility or Waiver Code in CIS a) Remove excluded Facility Codes b) NFCE Facility Codes c) Non-NFCE Facility Code Duals NOTE: Populations are based on codes which currently exist in CIS as of October 2015 for SFY 2013 -14 10/16/2021 4

Results from OLTL SFY 13 -14 State Fiscal Year 2013/2014 State Fiscal Year Distinct Number of Recipients 393, 693 NFCE Dual Waiver Eligible 2013/2014 45, 853 NFCE Non NFCE NFI Duals Dual NF Dual Waiver Non Dual Eligible NF Eligible 77, 247 13, 962 Duplication may exist if participants crossed categories in FY 10/16/2021 5 7, 524 267, 046

Results from OLTL SFY 13 -14 Health Choice Age Group Zone Lehigh/Capital Northeast Northwest Southeast Southwest NFCE Dual Waiver Eligible NFCE Dual NF Eligible NFCE Non Dual Waiver Eligible NFCE Non Dual NF Eligible NFI Duals Age < 60 1, 701 1, 009 1, 027 647 28, 559 Age >= 60 3, 190 16, 488 346 544 23, 670 Age < 60 1, 404 743 842 580 21, 171 Age >= 60 3, 578 13, 310 225 413 19, 475 Age < 60 1, 178 419 756 425 13, 454 Age >= 60 3, 001 6, 791 257 220 9, 026 Age < 60 4, 992 1, 394 5, 728 1, 590 36, 677 Age >= 60 18, 035 19, 058 2, 253 1, 259 47, 716 Age < 60 2, 742 1, 084 1, 813 1, 099 35, 676 Age >= 60 6, 032 16, 951 715 747 31, 622 45, 853 77, 247 13, 962 7, 524 267, 046 Duplication may exist if participants crossed categories in FY 10/16/2021 6

MAPS 10/16/2021 7

MAPS 10/16/2021 8

MAPS 10/16/2021 *Under 10 not shown for consumer protection reasons

MAPS 10/16/2021 *Under 10 not shown for consumer protection reasons 10

MAPS 10/16/2021 11

Utilization Estimates FY 13/14 Statewide Medicaid Costs for CHC Eligibles 1 Federal 2 State 2 Total Acute Medical $ 308, 901, 843 $ 266, 227, 263 $ 575, 129, 107 Nursing Facility 3 $ 1, 660, 303, 099 $ 1, 430, 933, 355 $ 3, 091, 236, 454 HCBS Waiver $ 714, 908, 500 $ 616, 144, 377 $ 1, 331, 052, 877 Total $ 2, 684, 113, 443 $ 2, 313, 304, 995 $ 4, 997, 418, 438 1 Reflects raw data that was restricted to the CHC eligible population outlined in the November 16, 2015 draft RFP. Does not include behavioral health costs. 2 Federal and State shares estimated based on effective FMAP during the FY 13/14 time period. 3 Supplemental payments made by DHS to Nursing Facilities were not included in the data summaries. Information on these payments is available on the DHS website. 10/16/2021 12

Utilization Estimates FY 13/14 Medicaid Costs for CHC Eligibles by Zone 1 CHC Zone Lehigh/Capital Northeast Northwest Southeast Southwest Total 10/16/2021 Acute Medical $76, 517, 819 $60, 327, 246 $41, 713, 235 $275, 745, 693 $120, 825, 114 $575, 129, 107 Nursing Facility 3 HCBS Waiver Total $703, 399, 481 $164, 761, 055 $944, 678, 354 $498, 092, 396 $144, 235, 141 $702, 654, 782 $239, 385, 467 $116, 142, 314 $397, 241, 016 $975, 149, 078 $660, 271, 119 $1, 911, 165, 891 $675, 210, 032 $245, 643, 249 $1, 041, 678, 394 $3, 091, 236, 454 $1, 331, 052, 877 $4, 997, 418, 438 13

Utilization Estimates FY 13/14 Statewide Medicaid Costs for Top 5 Service Categories for CHC Eligibles 1 HCBS Waiver Acute Medical Inpatient Pharmacy DME/Supplies Physician Other Medical Acute Medical Subtotal Personal Assistance Service Coordination Home Health - Nursing & Therapies Vendor Services 4 Day Habilitation & Adult Daily Living HCBS Waiver Subtotal $196, 199, 788 $140, 804, 347 $64, 534, 689 $49, 505, 646 $24, 666, 593 $475, 711, 063 $1, 075, 689, 520 $71, 198, 096 $56, 543, 358 $33, 277, 075 $29, 846, 660 $1, 266, 554, 709 4 Vendor services includes: Accessibility Adaptations, Community Transition, Homemaker, Home Delivered Meals, Personal Emergency Response System and Telecare services. 10/16/2021 14

Utilization - Medicare Paid Claims - CY 2013 County Southeast Southwest Northwest Capitol-Lehigh Northeast Statewide 10/16/2021 Total Medicare Paid Medicare Acute Participants Claims Care Paid Claims 137, 030 $1, 980, 012, 139 $1, 836, 412, 348 114, 037 $1, 150, 504, 502 $1, 088, 793, 690 39, 170 $497, 082, 116 $460, 187, 018 87, 610 $1, 061, 347, 504 $981, 016, 516 73, 227 $1, 023, 812, 470 $936, 147, 820 451, 074 $5, 712, 758, 731 15 $5, 302, 557, 391

Questions 10/16/2021 16