Medicaid Redesign Team: Progress Update by HC120328041944

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									                 February 1, 2012
Jason Helgerson, Medicaid Director
       John Ulberg, Medicaid CFO
   Includes 25 MRT Phase II recommendations.
    ◦ Remaining workgroup recommendations will be
      included in MRT waiver process.
   No traditional cost containment items.
   Budget is “cap neutral”
   Provides two year appropriation and extends
    super powers.
   Preserves 4% annual spending growth.
   Proposes State takeover of local administration
    and county fiscal relief.

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  All Other    Medicaid
    26%         18%




                   School Aid
Debt                  23%
 7%


   State         Annual % Growth
 Operations/     -Medicaid (4.0%)
   Fringe        -School Aid (4.0% - school year basis)
  Benefits       -State Ops/Fringe Benefits (-0.4%)
    26%          -Debt (4.7%)
                 -All Other Local Assistance (2.7%)


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                                            (dollars in billions)
                                  2011-12        2012-13            2013-14
State Funds                         $21.1           $21.8             $22.8
-- DOH (Global Cap / 4% growth)      15.3              15.9            16.6
-- Other State Agencies               5.8               5.9             6.2


Federal Funds                       $24.5           $24.2             $26.1


Local Funds                          $8.6             $8.0             $8.5


All Funds                           $54.2           $54.0             $57.4



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Key Reforms
   Program Streamlining &            Basic Benefit Review
    State/Local Responsibilities      Workforce Flexibility and
   Managed Long Term Care             Change of Scope of
    Implementation and Waiver          Practice
    Redesign                          Payment Reform and
   Behavioral Health Reform           Quality Measurement
   Health Disparities                Affordable Housing
   Health Systems Redesign:          Medical Malpractice
    Brooklyn                           Reform


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                                                          (“-” denotes savings; dollars in millions)
                                                2012-13         2012-13            2013-14             2013-14
Workgroup
                                                 Gross           State              Gross               State
Basic Benefit Review                               $-30.3             $-15.2            $-35.7            $-17.9

Health Disparities                                  $32.4               $6.1             $20.7             $0.3

Payment Reform                                     $100.0              $50.0           $100.0             $50.0

Program Streamlining                                $25.0               $4.5             $40.0             $8.0
Workforce Flexibility/Managed LTC                    $1.5               $1.0              $1.5             $1.0

Spousal Refusal                                    $-68.6             $-34.3          $-137.0             $-68.5

Redirect Transition II Funds                       $-25.0             $-12.5            $-25.0            $-12.5

Net MRT Phase II Recommendations                    $35.0              $-0.4            $-35.5            $-39.6

Affordable Housing ($75 million in base) and Health Systems Redesign/Brooklyn (fiscal impact
 reflected in Payment Reform).
Net savings from phasing out growth in local Medicaid spending over three years is not included
 above.



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   Expanding coverage of podiatry services for adult
    diabetics.
   Providing breastfeeding support and tobacco
    cessation counseling.
   Reducing payments for elective cesarean sections
    without medical indication.
   Eliminating coverage for knee arthroscopy, back
    pain treatments, angioplasty, and growth
    hormones where there is no evidence of benefit.

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   Expanding services to promote maternal and child
    health, hepatitis C care and treatment, harm
    reduction counseling and services, and language
    accessible prescriptions.
   Providing reimbursement for interpretation
    services for patients with limited English and
    communication services for patients who are deaf
    and hard of hearing.
   Implementing and expanding data collection to
    measure disparities.
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   Essential Community Provider Network
    ◦ Provides short term funding to address facility closure,
      merger, integration or reconfiguration of services.
   Vital Access Providers (VAP)
    ◦ Provides ongoing rate enhancements or other support
      during significant restructuring.
   HEAL reserves of up to $450 million to ensure
    smooth transition of services within communities
    and to provide reinvestment capital.


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   Establishes Exchange as public benefits
    corporation.
   Nine member governing board.
   Five regional advisory committees.
   Thirteen policy studies.




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                                    Establishment Establishment Establishment
                 Early Innovator     Level One    Level One (Dec) Level Two
Planning Grant        Grant            (June)
  Awarded to       NY selected       Awarded to          Applied        TBD
      NYS          as one of 7         the NYS       December 30,
   Insurance      states to build   Department of        2011 to       Requires
 Department to     information         Health to      continue the      State
    begin the       systems to       continue the       planning      Legislation
    planning       operate the         planning         process,
 process ($1M)        Health         process and       consumer       Application
                    Insurance       conduct policy     assistance
                    Exchange            studies         activities,    deadline:
                     ($27.4M)         ($10.7M)       conduct policy    June 29,
                                                      studies and        2012
                                                         support
                                                      Exchange IT
                                                        ($48.5M)




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   With Planning and Establishment Grant Funding
    and Technical Assistance from the Robert Wood
    Johnson Foundation, New York has a series of
    Exchange activities underway:
    ◦   Simulation Modeling
    ◦   Business Operations Work Plan
    ◦   Five-Year Exchange Budget and Self-Sustainability Analysis
    ◦   Exchange Policy Studies




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     Why is it the right time for the State to take
     over responsibility for county Medicaid
     program growth and administration?
1.   Current 3% local Medicaid growth cap exceeds
     2% Property Tax Cap.
2.   MRT and Federal health care reforms require
     greater administrative centralization to achieve
     efficiency and effectiveness goals.


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15
           Phase Down Growth Starting in 2013, Effective April 1, 2013
                                              (in millions)

 Fiscal Year              Rest of State               New York City                        Total
   2012-13                       $0.0                         $0.0                         $0.0
   2013-14                      $18.1                        $43.1                        $61.1
   2014-15                      $55.3                       $131.8                       $187.0
   2015-16                     $109.2                       $260.4                       $369.6
   2016-17                     $163.2                       $389.0                       $552.2
   2017-18                     $217.1                       $517.7                       $734.8
   2018-19                     $271.1                       $646.3                       $917.4
   2019-20                     $325.0                       $774.9                      $1,100.0
   2020-21                     $379.0                       $903.6                      $1,282.5
   2021-22                     $432.9                      $1,032.2                     $1,465.1
*Monroe County provides tax intercepts in lieu of Medicaid Cap payments. Monroe historical cap payments are
included for comparative purposes as a proxy for estimating local relief under this proposal.




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   Federal Health Care Reform requires single point of
    entry.

   Enables fundamental rethinking/retooling of how
    Medicaid program is managed.

   Results: Services delivered more uniformly, efficiently,
    and cost effectively.

   State savings from capping administrative
    reimbursement at FY 2012 levels partially offsets State
    costs of takeover.



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                                  ($ in millions)
State Share                               2012-13    2013-14   2014-15   2015-16

Cap Medicaid Admin at 2011-12 levels       ($23.0)   ($46.9)   ($71.7)   ($97.5)

Expansion of Enrollment Center              $14.5     $29.0     $36.0     $36.0

State Staff                                 $5.0      $9.0      $11.0     $11.0

FTEs                                         120       370       600      1,200

Subtotal – Medicaid Admin Takeover          ($3.5)    ($8.9)   ($24.7)   ($50.5)


Limiting MA Cap Growth (Phase Down)           --      $61.1    $187.0    $369.6


Total – Financial Plan Impact               ($3.5)    $52.2    $162.3    $319.1



Additional Admin Savings (Efficiency)       ($5.0)   ($21.5)   ($71.0)   ($130.5)




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Work Ahead
   New York is poised to fundamentally transform its Medicaid program
    into a national model for cost-effective health care delivery.
   New York is also well positioned to ensure that Medicaid reform also
    means more comprehensive health system reform.
   The Medicaid Redesign Team has developed a multi-year action
    plan that if fully implemented will not only bend the state’s Medicaid
    cost curve but also improve health outcomes for more than 5 million
    New Yorkers.
   To fully implement the MRT action plan, a ground-breaking new
    Medicaid 1115 waiver will probably be necessary.
   Still a lot of work to be done: It is up to the state, stakeholders and
    the broader New York community to continue to work together to
    successfully implement this multi-year action plan.

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   MRT Website:
    http://www.health.ny.gov/health_care/medicaid/redesign/

   Sign up for email updates:
    http://www.health.ny.gov/health_care/medicaid/redesign/l
    istserv.htm

   ‘Like’ the MRT on Facebook:
    http://www.facebook.com/NewYorkMRT

   Follow the MRT on Twitter: @NewYorkMRT


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   If you have questions from today’s presentation, please join us on
    Twitter, Friday, February 3, 8:30 – 9:30 AM for an opportunity to ask
    questions and have them answered in real time.

   How to participate in the live Twitter chat:
    ◦   If you’re not already on Twitter, join at www.twitter.com
    ◦   Follow the MRT on Twitter: @NewYorkMRT
    ◦   Login to Twitter between 8:30 and 9:30 AM on Friday
    ◦   Ask questions by including #NYMRT in your tweets, or
    ◦   Directly tweet us by including @NewYorkMRT in your tweet
    ◦   You don’t have to tweet – you can watch the conversation just by
        following @NewYorkMRT on Twitter – updates will show up in your news
        feed.




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