Department of Health and Social Services Division of
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Department of Health and Social Services Division of Medicaid & Medical Assistance Joint Finance Committee Hearing Fiscal Year 2013 Rosanne Mahaney Division Director Wednesday, February 22, 2012
Overview • Medicaid • Delaware Healthy Children Program (CHIP) • Delaware Prescription Assistance Program (DPAP) • Chronic Renal Disease Program (CRDP) Delaware Health and Social Services
Medicaid Enrollment Delaware Health and Social Services
Medicaid Enrollment & Unemployment Rate 10, 0% 240 000 9, 0% 220 000 8, 0% 200 000 7, 0% 6, 0% 180 000 5, 0% 160 000 4, 0% 3, 0% 140 000 2, 0% 120 000 1, 0% 0, 0% мар-06 100 000 мар-07 мар-08 мар-09 мар-10 мар-11 Delaware Health and Social Services Unemployment Rate Average Quarterly Medicaid Eligibles
Medicaid Service Expenditures Delaware Health and Social Services
Medicaid Average Monthly Cost Per Participant Delaware Health and Social Services
Evolution of Medicaid 1995 2012 Fragmented Fee-for-Service and 65, 500 Medicaid eligibles Managed Care and over 207, 000 Medicaid eligibles Inadequate Provider Network Expanded Provider Network Reliance on Institutional Care Emphasis on Community-Based Care • Lack of Quality Performance Measures Robust Quality Performance Measures Delaware Health and Social Services
Opportunities & Accomplishments Rebalancing Long-Term Care: • Diamond State Health Plan Plus • Program for All-Inclusive Care for the Elderly (PACE) • Money Follows the Person Program Delaware Health and Social Services
Opportunities & Accomplishments Enhance Health Information Technology: • EHR Incentive Payments • Coordination with DHIN • Continued Increase in E-Prescribing Delaware Health and Social Services
Opportunities & Accomplishments Increased Program Integrity Strategies: • TPL, Estate, Subrogation and SUR Recoveries • Recovery Audit Contractor (RAC) • National Correct Coding Initiative (NCCI) • New Provider Screening & Enrollment Requirements Delaware Health and Social Services
Opportunities & Accomplishments Improve Health Outcomes: • Identify High Risk Participants • Care & Disease Management programs • Performance Improvement Projects (PIPs) • Access Standards & Performance Measures • Partnership with UD & Health. Core, Inc. Delaware Health and Social Services
FY 13 Governor’s Recommended Budget • $20. 9 million Projected growth in Medicaid Eligibles • ($4. 3 million) Reduction • $4 million Disproportionate Share Hospitals (DSH) • $1 million DHIN Transaction Fees • $693. 2 1% HCBS Provider Rate Increase Delaware Health and Social Services
FY 13 Governor’s Recommended Budget Tobacco Funds • $350. 0 Medicaid (Pregnant Women & Infants) • $256. 4 Delaware Healthy Children Program Delaware Health and Social Services
Thank You Delaware Health and Social Services