AHCCCS Update Ohio Medicaid Expansion data - PowerPoint Presentation

1. AHCCCS Update

2. Ohio Medicaid Expansion dataUninsured rate for adults below 138% went from 32.4% to 14%88% of 700,000 were uninsured51% age 45 and older27% diagnosed with chronic condition after eligibility38.8% had a chronic condition and 59.1% reported easier to manage 32% screened positive for depression or anxiety – 32.3% had substance use disorder2Reaching across Arizona to provide comprehensive quality health care for those in need

3. Ohio SummaryReduced uninsured rate to lowest ever – Improved access to care - innappropriate use shifted – new diagnosis of chronic issuesNearly half reported improved health and only 3.5% reported worseningOne third met screening criterial for depression or anxiety and they reported higher level of improvementCoverage has allowed participants to better pay for other necessitiesSupported employment and job seeking3Reaching across Arizona to provide comprehensive quality health care for those in need

4. Speaker Ryan – A Better WayFederal/State balance has shifted strongly to fedsFederal spending is unsustainable:Growth from $350 billion in 2015 to an est. $624 billion in 2026Better Way:Choice of per capita allotment or block grantPhases down enhanced FMAP to regular FMAP – significant state fiscal impactCHIP back to original matchLimits CNOM authority to just Medicaid populationGrandfathers successful waiversDoes not cut DSH in 18 or 19 - Creates single uncomp care pool at fed level 4Reaching across Arizona to provide comprehensive quality health care for those in need

5. A Better Way – Per CapitaAverage expense for individual populations:Aged, Blind and Disabled ChildrenAdults2016 base trended to 2019 by inflationDSH and GME separateStates would be given authority to better manage for non-disabled adultsCan require job searchEnforceable reasonable premiumsCan offer limited benefit package for optional populationCan do premium assistance without wrap-around of other servicesStates can use freezes and caps for non-mandatory populations; expansion states can reduce eligibility thresholds5Reaching across Arizona to provide comprehensive quality health care for those in need

6. A Better Way – Block GrantMore flexibility in state management of programRequired to serve elderly and disabledBase assumes “expansion” population transitions to other sources of coverage (Prop 204 implications unclear)States can keep savingsStill require stringent eligibilityCan require job search for “able bodied”Can exclude undocumented individuals6Reaching across Arizona to provide comprehensive quality health care for those in need

7. Risk Transfer ChallengesTransfer of risk to States is particularly challenging for ArizonaPreviously expanded – loss of federal funds (See A Better Way)Voter-Protected coverage requirements (will not be able to avoid “available funding” in perpetuity)Overall lower per capita income to support programs and riskLarge American Indian population – fed $Particularly vulnerable in recessions (see Great Rec.)Ongoing instability due to funding pressure will undermine managed care delivery system7Reaching across Arizona to provide comprehensive quality health care for those in need

8. Risk Transfer Challenges (ctd.)Lower-cost more efficient stateFewer optional benefits (e.g., no dental)High rates of HCBSAligned DualsLow pharmacy spendMature managed care – for almost all populationsDelivery system performs wellFew special payments funded with non-state $8Reaching across Arizona to provide comprehensive quality health care for those in need

9. How Will AZ Manage Risk?Changes will be states’ responsibility and many will be very politically challenging:Reducing BenefitsReducing EligibilityReducing PaymentsIncreasing Cost SharingProgram AdministrationWill likely be annual discussion as part of state budget negotiations 9Reaching across Arizona to provide comprehensive quality health care for those in need

10. Examples of Flexibility – McCarthy LetterFreeze or cap certain eligibility group–ability to eliminate TMAStates should not have to cover all FDA approved drugsChange FQHC reimbursements and statutes Eliminate NEMT for certain populationsIncreased cost sharing flexibilityEliminate comparability and state-wideness Eliminate Essential Health Benefits requirementAllow more frequent eligibility redeterminationsEliminate and reduce CMS regulatory burden1115 path to permanency 10Reaching across Arizona to provide comprehensive quality health care for those in need

11. Age Distribution of ACA members11Reaching across Arizona to provide comprehensive quality health care for those in need

12. 12Reaching across Arizona to provide comprehensive quality health care for those in need

13. Annual Waiver SubmittalAHCCCS statutorily required to submit annual waiver requesting:Work requirement for all able-bodied adultsEstablish one-year “ban” for knowingly failing to report change in income or making false statements re: workLifetime limit of 5 years for able-bodied adultsPublic Hearings in January/Submit in March13Reaching across Arizona to provide comprehensive quality health care for those in need

14. Targeted Investment$300 million over 5 years9 to 1 matchPaid out through MCOs3 Targeted Initiatives – Integration (Adult and Child) – Justice Transitions – Need to re-scope proposal based on reduced funding – stay tuned14Reaching across Arizona to provide comprehensive quality health care for those in need

15. Arizona Management SystemReaching across Arizona to provide comprehensive quality health care for those in need

16. AMS ResultsDBF project to increase providers paid electronically by 5%. Division hit 9% and increased target to 15%. DFSM project to improve timeliness of authorizations for members needing level one facility admissions. The team reduced turnaround times by 75% The DHCAA project to reduce the number of members that are awaiting advocacy support. August 2015 162 members on a waitlist (up to 24 months) today there are 37 members (longest wait time 2.5 months).DMS and OALS project improve the Trust Review process. Time needed decreased from 44 days in January of 2016 to average of 10 days. Trusts taking 15 days or more has gone from 45% to 14%. OIG created a collections office project to collect 10% of the outstanding payments greater than 60 days. Today number is 18%. HRD projects to reduce agency turnover. December 2015 turnover was 21%. In November 2016 15%. 16Reaching across Arizona to provide comprehensive quality health care for those in need

17. OtherIMD Waiver submittal – IndianaFY 18 BudgetJLBC and OSPB relatively closeAssume 3% cap rate increaseExecutive has funding for Emergency dental with $1,000 capIncludes recommendation expansion of newborn screening to include Severe Combined Immuno Deficiency (SCID) – rare genetic disorder that if not detected and treated early can be deadly 17Reaching across Arizona to provide comprehensive quality health care for those in need

18. Justice Involved and Recidivism  Ind./No recidivism0-6 mo6-12 Mo12-18 MoJul 1 2014 thru Dec 31 2014 16,240 6,726 3,590 2,317 Percent 41%22%14%Jan 1 2015 thru June 30 2015 20,661 8,711 3,872 1,833 Percent 42%19%9%July 1 2015 thru Dec 31 2015 20,347 7,953 2,541 2 Percent 39%  18Reaching across Arizona to provide comprehensive quality health care for those in need

19. The Heroism of Incremental Care (Gawande)Cites study that those who have primary care physician as their usual source of care had lower subsequent 5-year mortality rateIn UK a 10% increase in primary care supply was shown to improve health so much that you could add 10 years to everyones life and still not match benefitIn California that provided all Medicaid recipients with primary care physician saw reduced hospital rates – Medicare plans that increased copays for primary care visits saw increased hospital“Governments everywhere tend to drastically undervalue incrementalism and overvalue heroism”19Reaching across Arizona to provide comprehensive quality health care for those in need

20. Incrementalism continuedAbility to use and understand information is acceleratingInternal systems – imaging & labsLiving conditions – housing State of care – what treatments and medsYour behaviors – sleep – exerciseTop Doc $ - Orthopedics – Cardiology – Dermatology –Bottom Doc $ – Pediatrics – Endroconology – Family Med30% of Americans have high blood pressure – 50% get treatment25% those who die before 75 do not need to with appropriate treatment27% of adults are not insurable due to pre-existing conditionsResources made to surgeon and what’s available to pediatrician ..is immoral20Reaching across Arizona to provide comprehensive quality health care for those in need