1. George A. Ralls M.D. Health Services Department December 1 st, 2009 Medicaid Update 2009

2. Brief History Florida Medicaid Program Medicaid & the Economy Current Situation Summary Overview

3. Brief History Florida Medicaid Program Medicaid & the Economy Current Situation Summary Overview

4. In 1965, the Federal Social Security Act was amended to establish two major national health care programs: –Title XVIII (Medicare) –Title XIX (Medicaid) Medicaid is an open-ended, means-tested entitlement program financed jointly by the Federal Government and States Medicaid

6. Federal Medicaid laws mandate certain benefits for certain populations To qualify for Federal funds states administer their programs under federally approved state plans: –A waiver is required is state plans deviated from certain provisions of the Social Security Act Medicaid

7. Medicaid programs vary considerably from state to state, and within states over time –Optional services covered differ –Limits on mandatory and optional services differ –Level provider reimbursement Medicaid

8. Omnibus Budget Reconciliation Act 1989: –Mandates states to extend Medicaid coverage to children & pregnant women Medicaid

9. Federal Medicaid Spending: –expected to be about $216 billion in FY 2009 (7% of federal spending), rising to $287 billion in 2013 (8.4% of the federal budget) 44 million people in low-income families 14 million elderly and disabled people Medicaid

10. Brief History Florida Medicaid Program Medicaid & the Economy Current Situation Summary Overview

11. Florida implemented the Medicaid program in 1970 to provide medical services to indigent people SOBRA greatly expanded services to include pregnant women and children Medicaid program administered by AHCA Florida Medicaid

12. 2009

13. Florida Medicaid Primary Care Screening & Preventative care Laboratory, X-ray & other diagnostics Specialist referrals Inpatient care/Hospitalization Dental, Vision, Orthotics, Ambulance Transports Nursing home and long term care

14. Florida Medicaid

15. Medicaid Eligibility Levels by Annual Income and FPL (2009) Florida Medicaid

16. Federal Other State $ 14.4 Billion Florida Medicaid FY07

17. Other Florida Medicaid FY07 Local County funds Cigarette Taxes

18. F.S. 409.915: County contributions to Medicaid Inpatient hospitalization in excess of 10 days, but not in excess of 45 days Nursing home care in excess of $170 per month May not exceed $55 per month per person Florida Medicaid

19. F.S. 409.915 –The Department of Financial Services shall withhold from the cigarette tax receipts or any other funds to be distributed to the counties the individual county share that has not been remitted within 60 days after billing Florida Medicaid

20. Brief History Florida Medicaid Program Medicaid & the Economy Current Situation Summary Overview

21. Revenues Decrease Needs Increase Medicaid & the Economy

22. Kaiser Commission on the Uninsured & Medicaid 2008 1%  in National Unemployment

23. 3-4% Decrease in State Revenues 1Million more on Medicaid 1Million more Uninsured Medicaid & the Economy Kaiser Commission on the Uninsured & Medicaid 2008

24. Unemployment GDP Decline Medicaid & the Economy

25. 7% 9% 10% 16% 21% 28% 32% 97% Increase in Medicaid enrollment in 4 years *Monthly case load in thousands Medicaid & the Economy

26. Increase in unemployment since beginning of current recession expected to result in: –4.8 million more Medicaid/CHIP enrollees –5 million more uninsured Improvement in unemployment rates & Medicaid will lag behind other economic indicators

27. Brief History Florida Medicaid Program Medicaid & the Economy Current Situation Summary Overview

28. Orange County Medicaid Eligible FY08 = $9M FY09 = ? FY09 = 12.4M Current Situation

29. Shortfall covered by: $ 1.9 million from PCAN $ 700K from DJJ $ 500K from Health Services

30. Current Situation 38% increase from 2008 to 2009 Orange County Medicaid Expenditure

31. Current Situation

32. 13% in 1 year 10% in 5 months *In thousands; AHCA Current Situation

36. Proposed an increase in county contribution for Medicaid nursing home care –From $ 55 to $ 202 per month per person –$ 66 Million from counties –Has not changed in 39 years AHCA Current Situation Additional $ 3M to Orange County Medicaid expenditure

37. Medicaid Expansion  Federal Match  Cost to State  Cost to Counties Healthcare Reform

38. Brief History Florida Medicaid Program Medicaid & the Economy Current Situation Summary Overview

39. Summary Medicaid enrollment is increasing significantly Mandated expenditure for Medicaid was $3.1 Million over budgeted amount for FY2008-09 Projected Medicaid expenditure for FY2009-10 is $15.8 Million –Adopted budget for Medicaid $9.3M

40. Summary Economic recovery may be on horizon but Medicaid improvements will lag behind Changes in State law may further exacerbate budget shortfall House and Senate Healthcare reform proposals advocate extending Medicaid to more individuals

41. George A. Ralls M.D. Health Services Department December 1 st, 2009 Medicaid Update 2009