1. Preview of FY20 Appropriation Request Brent Earnest, Secretary
October 24,2018

2. Appropriation Request
HSD Fiscal Year 2020
Appropriation Request
FY 20 Budget Request of $7.143 billion
3.85% increase overall
$1.128 billion from the general fund (increase of $74.7 million or 7.09%)
$5.729 billion in federal funds (increase of $166.9 million or 3.00%)
$285.5 million in other state funds and other revenue

3. HSD General Fund Budget Change
*GF adjustment due to ARRA

4. Medicaid Budget Update
For FY18, the Legislature appropriated $915.6 million. We are projecting to spend $ million, resulting in a general fund surplus of $7.8 million in FY 18.
The FY19 general fund need for Medicaid is projected to be $944.6 million. The Legislature appropriated $933.6 million, resulting in a projected shortfall of $11.0 million in FY 19.
($ in millions)
FY14 Actual
FY15 Actual
FY16 Projection
FY17 Projection*
FY18
Projection*
FY19
Total Budget
$4,200.6
$5,162.3
$5,413.9
$5,607.1
$5,680.0
$5,709.8
General Fund Need
$901.9
$894.1
$912.9
$909.5
$907.8
$944.6
*Projection data as of June The projections include all push forward amounts between SFYs. These figures exclude Medicaid administration.

5. *children 19-21 y.o. counted in OAG
New Mexico Medicaid Enrollment and PMPM
June 2019
Projected Enrollment
Total=865,280
(+2.1% from June 2018)
Expansion/OAG:
260,024
Medicaid Adults:
251,005
Medicaid Children:
354,330*
*children y.o. counted in OAG
Projected
June 2018: 847,794 5

6. Enrollment Impacts New Mexico’s Improving economy
Source: Bureau of Labor Statistics (2018 Data is Preliminary)

7. Enrollment Impacts
National Trend of Slowing enrollment

9. Enrollment Impacts New Mexico’s Uninsured Rate
2016
New Mexico – 8.9%
U.S. – 8.5%

10. Enrollment Impacts: New Mexico Uninsured and Medicaid-Insured by FPL 2016: 138% FPL, $16,394 (single), $33,534 (4-person)
This is an optional chart if you want the level and percentage charts combined.
Source: SHADAC State Health Compare, University of Minnesota

11. Federal Outlook (FY20 Budget Issues)
Expansion FMAP steps down again on January 1, 2019, to 93% and on January 1, 2020 to 90%.
Regular FMAP rates improved slightly for NM
CHIP Reauthorization
100% expires in September 30, 2019.
Phase-out increased to states’ E-FMAP by 11.5% through September 30, 2020.
E-FMAP reverts back on October 1, 2020.
Re-imposition of the Federal Health Insurance Provider Fee
FFY 2018
FFY 2019
FFY 2020
72.16%
72.26%
72.71%

12. Medicaid: FY 20 Appropriation Request (as of Sept. 1)
Total Medicaid Program spending in FY 20 is projected to be $ billion.
$1,004.7 million from the general fund, a $71.1 million increase. Major changes from FY19 include:
($ in millions)
FY20 base - additional general fund above FY19 appropriation
$9.23
Expansion FMAP (drops to 93% in 2019 and 90% in 2020)
$33.0
CHIP FMAP Reduction (100% to 92.37%)
$6.87
FMAP Change (71.9% to 72.13%)
($12.12)
Centennial Care Enrollment and utilization
$34.45
Centennial Care 2.0 Initiatives
$6.99
Medicare Part A, B & D
$8.13
Fee for Service lines, HIT, UR Contracts
$.74
Other Revenue changes – Drug Rebates, County Supported , Other
($16.14)
Total
$71.1

13. Medicaid: Administration
The total FY 20 budget request for administration of the Medicaid program is $88.4 million
$3.836 million increase from FY19
$492.2 thousand increase in general fund need
1.49% of the total program budget.
Priorities for MAD staff in 2019 include:
Implementation of 1115 Waiver Renewal
Continued procurement and implementation of replacement MMIS
Implementation of JUST health program with correctional facilities ($400 thousand from 2018 HB2 appropriation)

14. Behavioral Health Services Division
Total budget request of $60.3 million
$37.8 million request from the general fund ($763.7 thousand increase from FY19)
$238 thousand to fill vacant positions for utilization management, program and financial audit functions
$300 thousand for evidence based substance use disorder treatment
$100 thousand for housing for the homeless due to behavioral health disabilities
$100 thousand for JUST Health program
$22.5 million in federal grants

15. BH Utilization Trend

16. Behavioral Health Spending
Total HSD Behavioral Health Spending (excl. administration)-
FY18 Actuals
FY19 Op Bud
FY20 Request
($ in millions) GF FF
Total
Medicaid Behavioral Health
$97.93
$390.11
$488.04
$101.21
$401.07
$502.28
$110.15
$421.07
$531.22
Behavioral Health Services Division
$34.72
$24.63
$59.35
$34.38
$22.24
$56.61
$34.44
$22.60
$57.04
$132.65
$414.73
$547.39
$135.59
$423.31
$558.88
$144.60
$443.67
$588.26
Percent change from prior year
-8.4%
-0.015%
-2.2%
2.21%
2.07%
2.10%
6.64%
4.81%
5.25%

17. Child Support Enforcement Division
$31.25 million total budget
Request – Request is flat from FY19
$7.74 million from the general fund
$20.5 million from federal funding
$3 million from other revenue
71,965 child support cases in FY18
78.5% of cases have obligated support order  

18. Income Support Division
$957.1 million overall budget
$2.1 million increase from the general fund :
$502 thousand to maintain Senior SNAP Supplement; projected caseload of 18,400
$1.2 million for eligibility system and processing services (mailing, call center services, training, income verification services)
$375 thousand increase for food banks
SNAP Caseload
Slight growth projected, from 224,027 thousand cases to 225,282.
$660 million of SNAP benefits

19. Temporary Assistance for Needy Families – (TANF)
FY20 TANF appropriation request of $139.5 million:
TANF block grant of $109.9 million and $29.5 million of current carry over balances. 
Cash assistance, flat with FY19 OpBud.
Includes restoring (increasing) monthly cash assistance grant by 7.5% 
Maintains support of programs at other agencies
Continues support services programs, such as attaining high school equivalency and employment programs.

20. Temporary Assistance for Needy Families – (TANF)
Admin Includes: Income Support Administration and Program Support Administration
Cash Assistance Includes: Cash Assistance, Clothing Allowance, Diversion Payments, Wage Subsidy and State Funded Legal Aliens
Support Services Include: NM Works Program, Transportation, Career Links, High School Equivalency program, Vocational Training Program and Employment Related Costs
Other Agencies Include: CYFD Pre K, CYFD Child Care, CYFD Home Visiting, CYFD Supportive Housing and PED Pre K

21. Program Support and Information Technology
Program Support provides administrative support to the program divisions of HSD
The FY20 budget request for Program Support is $55.6 million, with $16.1 million requested from the General Fund
Key projects and results
ASD: Unqualified opinion from independent auditors in FY16 and FY17; FY18 in progress and on track
ITD: Maintain and support critical and large-scale, statewide IT systems
ITD: MMIS and CSIS replacement projects in progress

22. Medicaid Management Information System Replacement (MMISR)
Part of the HHS2020 initiative
Creates a client-centric business solution and is the foundation for additional development within New Mexico’s Health & Human Services (HHS) enterprise.
Undertaking multiple procurements to implement MMISR
System Integrator (SI) – contract awarded
Data Services (DS) – contract in review and signature process
Quality Assurance (QA) -- in contract negotiation
Benefit Management Services (BMS) -- release RFP in November 2018
Financial Services (FS) -- release RFP in December 2018
Unified Public Interface (UPI)
Consolidated Customer Services Center – November 2018
Unified Portal -- TBD

23. Questions?