The National Medicaid Congress Medicaid Managed Care Opportunities

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The National Medicaid Congress “Medicaid Managed Care: Opportunities and Implications of State Expansions” Brian

The National Medicaid Congress “Medicaid Managed Care: Opportunities and Implications of State Expansions” Brian Coyne Senior Vice President Federal Government Relations AMERIGROUP Corporation June 6, 2006

AMERIGROUP Overview • • Multi-State Medicaid Managed Care 9 states and District of Columbia

AMERIGROUP Overview • • Multi-State Medicaid Managed Care 9 states and District of Columbia Approximately 1. 1 million lives covered Multi-Products – Families & Kids (TANF & CHIP) – Elderly and Disabled (SSI) – Dual Eligibles (Special Needs Plan/Medicare Advantage Plan)

AMERIGROUP Overview

AMERIGROUP Overview

Personal Experience 1992 Small State, Big Ideas: RIte Care • Coverage of Children 0

Personal Experience 1992 Small State, Big Ideas: RIte Care • Coverage of Children 0 to 6 (“All kids enter school healthy and ready to learn”) • Linked to Managed Care • Foundation for Continued Coverage Expansion

States Adopt Managed Care Medicaid Managed Care Enrollment (In millions) Source: Kaiser Family Foundation

States Adopt Managed Care Medicaid Managed Care Enrollment (In millions) Source: Kaiser Family Foundation

Medicaid Spending FY 2003: $283 B 42. 5 % 16% 36% Sources: CMS, Kaiser

Medicaid Spending FY 2003: $283 B 42. 5 % 16% 36% Sources: CMS, Kaiser Family Foundation and Lewin Group 5. 5 %

Medicaid Managed Care • Medicaid Managed Care Spending as percent of Medicaid Source: Lewin

Medicaid Managed Care • Medicaid Managed Care Spending as percent of Medicaid Source: Lewin Group

Managed Care Expansion Opportunities: Non-Duals • $75 Billion Expenditures available for Capitation (excluding duals):

Managed Care Expansion Opportunities: Non-Duals • $75 Billion Expenditures available for Capitation (excluding duals): – Nearly 1/3 of all Medicaid spending not currently in capitation arrangements • $46 Billion from SSI (non-duals) – 60% of potential expenditures available for capitation from SSI-only program Source: Lewin Group

Managed Care Expansion Opportunities: Dual Eligibles • Over 40% Medicaid Spending for Dual Eligibles

Managed Care Expansion Opportunities: Dual Eligibles • Over 40% Medicaid Spending for Dual Eligibles • 2/3 Expenditures for LTC Services • Special Needs Plus (SNP) potential for acute care coordination with Medicaid

Barriers/Challenges • Upper Payment Limit (UPL) • Integrating Medicare/Medicaid through SNP • Recognizing savings

Barriers/Challenges • Upper Payment Limit (UPL) • Integrating Medicare/Medicaid through SNP • Recognizing savings associated with Managed Care • Long-Term Care • Actuarial Soundness • Medicaid Reform (Expand or Contract)

Large and Growing Program Medicaid Expenditures $335 B $724 B $161 B 1996 2006

Large and Growing Program Medicaid Expenditures $335 B $724 B $161 B 1996 2006 Source: The Congressional Budget Office 2016 E

Fastest Growing State Expenditure id a ic n ed io at M 8. 0%

Fastest Growing State Expenditure id a ic n ed io at M 8. 0% S E& uc d E n tio ta r o p s an Tr gh i H er n io t a c u Ed l Al e O er h t is ss c an t b Pu A il c s c n tio e rr Co Source: 2003 State Expenditures Report, National Association of State Budget Officers