General Assistance Unemployable General Assistance-Unemployable by hmh17149

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									         Assistance-Unemployable
 General Assistance Unemployable
     (GA-U) and related programs
Prepared by Senate Ways and Means Committee Staff

                                February 11th, 2009
Agenda
    Overview
     GA‐U, GA‐X, and ADATSA program descriptions 
     GA‐U GA‐X and ADATSA program descriptions
     Client demographics, incapacities, & county comparisons

    Medical Assistance Caseloads and Expenditures
     Comparison of per person medical costs
     Caseload trends and policy changes
     Length of stay on various programs

    GA‐U programs across the states

    The Governor’s budget proposal and alternatives
2
Program Descriptions

General Assistance – Unemployable (GA-U)
   State‐funded program providing cash and medical benefits for 
   adults who are physically or mentally incapacitated and 
   expected to be unemployable for more than 90 days

   Primary incapacity cannot be chemical dependency


General Assistance – Expedited SSI (GA-X)
           y         p g               p        p    y g
   Federally matched program for those presumptively eligible for 
   federal Supplemental Security Income (SSI) cash and medical 
   benefits
Program Descriptions

Alcohol and Drug Addiction Treatment and Support Act
  (ADATSA)

     Established in 1987, a state‐funded program providing cash and 
        di l b     fi f    d l     h      i    i       i i h i l
     medical benefits for adults whose primary incapacity is chemical 
     dependency

     Must be unemployable and willing and capable of benefiting 
     M tb           l bl    d illi      d     bl f b     fiti
     from chemical dependency treatment




 4
  The GA-U clients are primarily white males,
  with an average age of 42 years old
             Age Distribution                      Race | Ethnicity
               June 2008                             June 2008      Hispanic
                                                                       6%         Asian/
Under 20       515                                                                Pacific
   21-29                                                                         Islander
                              2,683
                                                                                    3%
   30-39                         3,079                               Black
                                                                     11%          Native
   40-49                                   5,642                                 American
                                                                                   4%
   50-59                                 4,088
    60+         619
                                                                         Unknown
            The average age is 42.3 years old
                                                                           8%
                                                      White
                    Gender                            67%
                   June 2008
           59.9%
                                  40.1%
           Male
           9,957                 Female
                                  6,669
                                  6 669

   5                                                           Source: 2008 ESA-ACES Data
Counties with urban areas have more clients
but rural counties have higher use
     Top Ten Counties By Caseload         Top Ten Counties By Use Rate
                             Percent of                                  Percent of
      County     Clients                     County       Population
                              Caseload                                   Population
          King     10,288           29%    Pend Oreille         12,600             1.0%

        Pierce       4,054          11%     Okanogan            39,800             1.0%

     Snohomish       3,576          10%         Mason           54,600             0.9%

      Spokane
       p              ,
                     3,102           9%   Grays Harbor
                                             y                    ,
                                                                70,800             0.9%

        Yakima       1,446           4%        Clallam          68,500             0.8%

        Kitsap       1,219           3%          Ferry           7,550             0.8%

         Cl k
         Clark       1,195
                     1 195           3%          Lewis
                                                 L i            74,100
                                                                74 100             0.8%
                                                                                   0 8%

      Thurston       1,170           3%         Pacific         21,600             0.8%

      Whatcom        1,164           3%         Chelan          71,200             0.8%

        Benton        905            3%        Stevens          43,000             0.7%

 6                                                                   Source: DSHS-RDA
                                                          2007 GA-U Unduplicated Counts
GA-U and GA-X primary incapacities reflect
different primary conditions
              GA-U                                  GA-X



      43.8%                     Mental Illness                        72.5%




    53.1%                   Physical C
                                     Condition          26.1%




                     3.1%     Other/ Unknown     1.3%




7                                                       Source: 2008 ESA-ACES Data
A 2006 report shows GA-U clients have
co occurring
co-occurring diagnoses




8                                               Source: DSHS RDA
                            GA-U Challenges and Opportunities 2006
 GA-U makes up the bulk of the state and
 federal support
                      Average monthly assistance amounts
                                 (does not include local support)
1400
                                                                    $112      $1,129 - $1,241
1200                                                 $151

1000                             $660

800

600

400          $318

200

  0
         GA-U Cash          GA-Medical          Basic Food Housing ESAP             Total
  9    *Cash and Basic Food monthly amounts are for on-going                    Source: DSHS ESA
       payments. Medical represents FY09 average per person cost.   ACES Data Warehouse and CTED
Agenda
     Overview
      GA‐U, GA‐X, and ADATSA program descriptions 
      GA‐U GA‐X and ADATSA program descriptions
      Client demographics, incapacities, & county comparisons

     Medical Assistance Caseloads and Expenditures
      Comparison of per person medical costs
      Caseload trends and policy changes
      Length of stay on various programs

     GA‐U programs across the states

     The Governor’s budget proposal and alternatives
10
GA-U medical program expenditures are among the fastest
growing of DSHS medical programs

          Average caseload and expenditures for 2007-09 biennium
                and projected growth for 2009-11 biennium
               07-09      09-11     07-09       09-11    07-09 Total      09-11
              Caseload   Growth   Per Capita   Growth   Expenditures
                                                                         Growth
                          Rate                  Rate
                                                                          Rate
ADATSA           4,600      3%         $210       5%      $23 million         8%


GA X /
GA-X          138 000
              138,000       6%         $672      10%      $2 2 billion
                                                          $2.2 billi         17%
SSI

GA-U            13,800     16%         $624      11%     $207 million        28%

Medical       790,000       9%         $278       4%      $5.3 billion       13%
Assistance
– All Other

   11
The GA-U caseload is impacted directly and
indirectly by policy changes and other programs
18,000

16,000
          2001-03
14,000
          Budget
12,000    Reductions

10,000

 8,000

 6,000

 4,000

 2,000
 2 000

    0




   12
The GA-U caseload is impacted directly and
indirectly by policy changes and other programs
18,000

16,000
          2001-03
14,000
          Budget
12,000    Reductions

10,000

 8,000

 6,000                 J l 2003
                       July 2003:
                       Elimination of
 4,000                 Medically
 2,000
 2 000
                       Indigent (MI)
                       program
    0




   13
The GA-U caseload is impacted directly and
indirectly by policy changes and other programs
18,000

16,000
          2001-03
14,000
          Budget       GA-X
12,000    Reductions
                                          J l 2008
                                          July 2008:
10,000                                    Citizenship
                                   GA-U
 8,000                                    verification
                                          p     y
                                          policy changeg
 6,000                  July 2003:
                        J l 2003
                        Elimination of
 4,000                  Medically
 2,000
 2 000
                        Indigent (MI)
                        program
    0




   14
 . . . Rather than the economy
18,000                                                  9%

16,000                                                  8%
                                 GA U
                                 GA-U
14,000                                                  7%

12,000                                                  6%

10,000                                                  5%

 8,000                                                  4%
                                    Unemployment rate
 6,000                                                  3%

 4,000                                                  2%

 2,000                                                  1%

    0                                                   0%




   15
 Where are ADATSA clients two years after entering the
 program?
100%
                                               71% left DSHS
90%                                            medical coverage
80%

70%                                            7% are GA-X or
                                               SSI Disabled
60%

50%                                            7% are GA-U
40%

30%
                                               8% have other
20%                                            DSHS medical
                                               coverage
10%
                                               7% remain on or
 0%                                            return to
                                               ADATSA
                                           Source: OFM Eligibility File
   16
 Where are GA-U medical clients two years after entering
 the program?
100%                                           48% left DSHS
90%
                                               medical coverage

80%                                            6% have other
                                               DSHS medical
70%                                            coverage
60%                                            1% are ADATSA

50%
                                               9% are SSI
40%
                                               Disabled
30%
                                               17% are GA-X
20%

10%
                                               18% remain on or
 0%                                                      GA U
                                               return to GA-U

       17                                  Source: OFM Eligibility File
 Where are GA-X clients two years after entering
 the program?
100%
                                        33% left DSHS
90%
                                        medical coverage
80%
70%                                     5% are GA-U

60%
50%                                     11% have other
                                        DSHS medical
40%                                     coverage

30%                                     30% are SSI
                                        Disabled
  %
20%
10%                                     22% remain or
                                        return to GA-X
 0%

                                      Source: OFM Eligibility File
   18
Agenda
     Overview
      GA‐U, GA‐X, and ADATSA program descriptions 
      GA‐U GA‐X and ADATSA program descriptions
      Client demographics, incapacities, & county comparisons

     Medical Assistance Caseloads and Expenditures
      Comparison of per person medical costs
      Caseload trends and policy changes
      Length of stay on various programs

     GA‐U programs across the states

     The Governor’s budget proposal and alternatives
19
GA U
GA-U programs across the U.S.




                                                                                   p g
                                                                        GA-X or no program
                                                                        State administered

                                                                        Locally administered




20   •Any program that requires SSI application     Source: Compiled from written and
     were considered GA-X for comparison purposes   telephone interviews in 2005 and 2009
Summary of GA-U program options from
other states and programs
Governor Proposal: Eliminate GA-U cash and medical

Keep as state administered cash and medical

Eliminate either cash or medical

Time limit participation

Employ other eligibility changes and/or participation
requirements

Block grant program to local governments

21
The Governor’s 2009-11 budget proposal eliminates
GA U                       medical
GA-U and ADATSA cash and medical*

Program             2009-11 Estimated Savings, in Millions                    TOTAL

                                       Medical -          Medical -
                 Cash - State
                                        State             Federal
GA-U                 ($156)             ($232)               ($36)            ($424)

ADATSA                 ($4)              ($22)                ($3)            ($29)


                    2009-11 Program Additions, in Millions                    TOTAL

Community              $40                                                     $40
Clinic Grants
Housing                $20                                                     $20

                      Total Savings net of program additions                  ($393)

 22    *The Governor’s budget proposal does not eliminate the GA-X program.
Back-up
Back up slides
GA-U monthly per person medical costs by service
$700                                  service,
       Average annual growth rates by service FY2007 – FY2009:
       • Inpatient:   13%                                          $660
       • Outpatient: 14%
       • Physicians, drugs, & managed care premiums combined: 7%
$600                                                               $134
                                                                          I   ti t
                                                                          Inpatient

$500
                                                                   $151   Outpatient
$400
                                                                          managed
$300                                                               $133
                                                                   $      care
                                                                          premiums
                                                                          drugs
$200
                                                                   $109
                                                                          physicians
$100
                                                                   $93

                                                                   $40    other
 $0
        2004        2005         2006        2007        2008      2009
  24
Service Utilization Comparison, per person per
month FY2009
100%                4%                   Other
         8%
                               15%
 90%     0%
                    20%                  Transportation
 80%     17%                    2%

 70%                                     Managed Care
                    16%        24%       Pil t
                                         Pilot
 60%     19%
                                         Drugs
 50%                14%        11%
 40%                                     Physicians
         34%                   12%
 30%                23%
                                         Outpatient
 20%
                               32%
 10%     19%        20%                  Inpatient

  0%
       ADATSA      GA-U     GA-X & SSI
 25
Percent of GA-U caseload moving to GA-X or SSI
on a monthly basis
60.0%


50.0%


40.0%


30.0%


20.0%
20 0%


10.0%


0.0%
               Governor s
Extend through Governor’s budget proposal

16,000                                      9%
                          GA-U     l d
                          GA U caseload
14,000                                      8%
12,000                                      7%
                                            6%
10,000
10 000
                                            5%
 8,000
                       Unemployment rate    4%
  ,
 6,000
                                            3%
 4,000                                      2%
 2,000                                      1%
    0                                       0%
         Jan-98
         Sep-98
         May-99
         Jan-00
         Sep-00
         May-01
         Jan-02
         Sep-02
         May-03
         Jan-04
         Sep-04
         May-05
         Jan-06
         Sep-06
         May-07
         Jan-08
         Sep-08
         May-09
         Jan-10
         Sep-10
         May-11
         M
         M



         M



         M



         M



         M



         M
         J
         S

         J
         S

         J
         S

         J
         S

         J
         S

         J
         S

         J
         S
With flat per caps, caseloads drive GA-U cash
expenditures
     $325                                                                  $7,000,000



     $320
                   2007                 2008                       2009
                                                                           $6,000,000
                   $320                                             $319
                                        $319

     $315
                                                                           $5,000,000


     $310
                                                                           $4,000,000

     $305

                                                                           $3,000,000
     $300
            $300                                         $300
                                 $299
                                                                           $2,000,000
     $295


                                                                           $1,000,000
     $290



     $285                                                                  $0
                    GA-U PP   GA-X PP   GA-U Total Exp   GA-X Total Exp
28
 GA-U and GA-X caseload changes from prior biennia

60%

                                     GA-U     GA-X
50%
                         50%
40%
                   46%

30%

                                            26%
20%
                                                       21%
10%
                               12%
                                                  6%         8%
 0%

-10%

-20%        -24%

 30%
-30%
              2001-03     2003-05            2005-07    2007-09
       29

								
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