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Georgia Medicaid Budget and Funding Options

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  1. Georgia Medicaid Budget and Funding Options Presented to: HomeTown Health November 12, 2009 By: Josh Belinfante RobbinsLaw LLC www.robbinslawllc.com RobbinsLaw LLC Litigation & Regulatory Law

  2. Overview • FY 2009 • FY 2010 • FY 2011 • DCH Budget • Politics of the 2011 Session • Provider Fee • CMO Premium Tax RobbinsLaw LLC Litigation & Regulatory Law

  3. Georgia Budgets RobbinsLaw LLC Litigation & Regulatory Law

  4. Budgets:Overview • Terms • Breakdown RobbinsLaw LLC Litigation & Regulatory Law

  5. Budgets:Overview RobbinsLaw LLC Litigation & Regulatory Law

  6. Budgets:October 2009 RobbinsLaw LLC Litigation & Regulatory Law

  7. FY 2009 RobbinsLaw LLC Litigation & Regulatory Law

  8. FY 2009 • As passed in 2008: • Provider rate increases: $70,219,164 • Hospitals: $29,419,916 (41% of new funds) • Physicians: $17,243,389 • Nursing Homes: $17,650,154 • Ambulance: $1,986,043 • Other Providers (waivers, home health, etc.): $3,919,662 • Executive Withhold RobbinsLaw LLC Litigation & Regulatory Law

  9. FY 2009 Amended • Stimulus funds: • FMAP: 64.5% match to 73.4% match • January 2009 - January 2011 • No provider rate increases RobbinsLaw LLC Litigation & Regulatory Law

  10. FY 2010 RobbinsLaw LLC Litigation & Regulatory Law

  11. FY 2010 • Lost Revenue ($208,088,881) • 5% Budget Cut ($111,486,829) • Federal regulation on CMOs: ($96,602,052) • Required Cuts: ($130,467,938) • After all discretionary spending cuts: ($77,620,943) RobbinsLaw LLC Litigation & Regulatory Law

  12. FY 2010 • Revenue: • Governor’s Provider Fee • Tobacco Tax • Cuts: • 10% Medicaid Expense Cut for Hospitals. • 15% rate cut totaling $85,307,375. • 6% Expense Cut for Others. • 10% rate cut totaling: $93,924,186. RobbinsLaw LLC Litigation & Regulatory Law

  13. FY 2010 • Rates spared. • Fair Rental Value System for SNF’s Funded. • $23M for trauma (super speeder). • High reliance on Stimulus funds. RobbinsLaw LLC Litigation & Regulatory Law

  14. FY 2010 Amended • Off-Budget by approximately $912M • 3% Medicaid Withhold • SHBP Redesign • 3 Day Furlough • 5% Agency Withholds RobbinsLaw LLC Litigation & Regulatory Law

  15. FY 2010 Amended: DCH Budget • Medicaid Revenue: $114.37M • Surplus funds: $52.7M • Medicaid enrollment adjustments: $15.8M • PeachCare enrollment adjustments: $21.5M • Miscellaneous: $24.3M RobbinsLaw LLC Litigation & Regulatory Law

  16. FY 2010 Amended: DCH Budget • Medicaid Expenditures: ($ 52.9M) • DSH Matching: ($8.6M) • 3% Cut: ($44.3M) • Surplus to 2011: $61.4M RobbinsLaw LLC Litigation & Regulatory Law

  17. FY 2011 RobbinsLaw LLC Litigation & Regulatory Law

  18. FY 2011: Overview • Compare: • Loss of Stimulus Medicaid Funds: ($347,977,910) • FY 2010: ($208,088,881) RobbinsLaw LLC Litigation & Regulatory Law

  19. FY 2011: DCH Budget • Medicaid Expenditures ($86.2M) • Projected Medicaid growth: $83.2M • New ICWP slots: $1.2M • ICWP waiting list: $1.8M RobbinsLaw LLC Litigation & Regulatory Law

  20. FY 2011: DCH Budget • Medicaid Revenue: $92.88M • Surplus from FY 2010: $61.4M • Lower PeachCare enrollment: $16.7M • Nursing home fees: $8.7M • Foster care children to CMOs: $2.9 • Drug renegotiation: $0.64M • Capping CMO rates: $2.54M RobbinsLaw LLC Litigation & Regulatory Law

  21. FY 2011: DCH Budget • Medicaid Cuts: ($37.1M) • Reduce CMO reimbursement rates 1.86%: $15.7M • Reduce FFS reimbursement rates by 1.86%: $21.4M • Totals: • New Revenue: $92.88M • Reimbursement Cuts: $37.1M • New Expenses: ($86.2M) • 3% Reduction: ($44.3M) RobbinsLaw LLC Litigation & Regulatory Law

  22. FY 2011: Problems with DCH Budget • Presumes only 3% cut ($44M). • Revenues continue to fall? • Competing priorities? • Surplus carryover. RobbinsLaw LLC Litigation & Regulatory Law

  23. FY 2011: Political Realities • Gubernatorial Race: 1 Senator, 2 Representatives • Congress: 1 Senator, 3 Representatives • Insurance Commissioner: 2 Senators, 1 Representative • Attorney General: 1 Representative • Labor Commissioner: 1 Representative • Court of Appeals: 2 Judgeships RobbinsLaw LLC Litigation & Regulatory Law

  24. FY 2011: Political Realities • Educators • Healthcare • Corrections • Judicial Branch RobbinsLaw LLC Litigation & Regulatory Law

  25. FY 2011: Provider Fee • New Revenue: $389,576,496 (Net: $372,840,569) • CMO and private insurance fee of 1.6%: $90,778,848 • CMOs: $49,518,535 (Net: $32,782,608) • Commercial: $57,333,746 • Hospital fee of 1.6% of gross revenue: $259,724,215 • Super Speeder: $23,000,000 • Program cuts: none to services.   • Additional Expenditures: $171,992,802 • Trauma: $60,000,000 • Provider Rate Increases: $98,279,417 • Hospitals: $52,213,936 (53% of new funds) • Physicians: $17,243,389 • Nursing Homes: $15,000,000 • Other Providers: $5,256,845 (home health, CCSP, MRWP and ICWP) • Ambulance: $1,988,999 • DSH Funds: $13,713,384 (solves private hospitals). RobbinsLaw LLC Litigation & Regulatory Law

  26. FY 2011: CMO Tax Exemption Repeal • CMO’s exempt from premium tax (2.25%) • Repeal: $43.2M RobbinsLaw LLC Litigation & Regulatory Law

  27. Questions? Josh Belinfante RobbinsLawLLC 999 Peachtree Street, NE Suite 1120 Atlanta, GA 30309 404-856-3262 josh.belinfante@robbinslawllc.com RobbinsLaw LLC Litigation & Regulatory Law