January 25 2017 Department of health care finance Health care policy and research administration ACA Repeal Context President Trump Speaker Ryan Majority Leader McConnell committed to ACA repeal this year ID: 716891
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Slide1
ACA RepeAl & Implications for District Medicaid Program
January 25, 2017
Department of health care finance
Health care policy and research administrationSlide2
ACA Repeal Context
President Trump, Speaker Ryan, Majority Leader McConnell committed to ACA repeal this yearCongress passed Budget Resolution (S. Con. Res. 3) advancing Reconciliation on 1/13/17President Trump signed ACA Executive Order on 1/20/17
ACA Repeal/Replacement bills being introduced
2Slide3
District Medicaid Expansion
DC was one of the first “early expansion” states to expand Medicaid eligibility under the ACA – 34k transitioned from Alliance to Medicaid expansion in 2010
District has the highest eligibility level for childless adults
Federal medical assistance percentage (FMAP) varies for different groups
0-133% FPL: 95% FMAP
134-210% FPL: 70% FMAP (upper eligibility limit converted 10/13
)
As a result of the ACA, more than 96% of District residents have health coverage and the District ranks in the top three states in coverage rates
3Slide4
Childless Adults Profile
Largest eligibility group (32%) – tied with children75,000 childless adult enrollees (enrollment as of 7/16):
64,000 (85%) enrollees in the lower-income group (0-133% FPL);
11,080 (15%) in the higher income group (134-210% FPL)
Demographic makeup comparable to Medicaid
Racial/ethnic makeup comparable to Medicaid, but fewer Hispanic (4%) and Other (1%) and twice as many “Unknown”
Comparable age and geographic distribution – enrollees live across the District in all Wards
Three times as likely to be incarcerated, half as likely to be homeless than Medicaid enrollees generallySubstantial health care needs:O
ne in four have at least two chronic conditions; 14% have at least three
Most common chronic conditions are hypertension, high cholesterol, diabetes, obesity, depression and asthma
Comparable rates of HIV diagnosis and substance use disorder, slightly lower rates of serious mental illness diagnosisUtilization rates comparable to Medicaid, except slightly lower for inpatient hospital admissions, emergency department, primary care and mental healthAll enrolled in MCO plans
4Slide5
District Implications of ACA Medicaid Expansion Repeal
5
75,000 beneficiaries at risk
In FY18, District will spend estimated $623 m. for this population - $60 m. of this is local funding
MCOs, hospitals, physicians, dentists, FQHCs and other providers will be substantially impacted if coverage is lost
Safety net supports could be affected by a funding reduction
GWU/Commonwealth Fund study estimates 8,000 jobs and $11.3 billion in business output lost by 2023
if ACA Medicaid expansion and tax subsidies repealedSister agencies also may be affected, including DHS, HBX, DOH, DBH, DOC, CFSA, and others
Possible shift from
health coverage
(Medicaid, subsidized private coverage) to grant-funded (e.g., DSH, high-risk pools, FQHC HRSA grants) and defined contribution private market (e.g., HSA) approachSlide6
Ancillary Medicaid Risks
6ACA Executive Order
CMS Administrative Oversight
Medicaid Block Grant
Other Funding RisksSlide7
DHCF Position and Action Steps
7
Mayor opposes ACA repeal
, Medicaid block grants
Letter to Majority Leader McCarthy January 4, 2017
DHCF formed internal task force to monitor, analyze and respond to federal initiatives
Analyzing proposals, likely impact
Considering options if funding is cutDHCF is not anticipating program changes based on current requirementsFuture changes based on federal action may warrant adjustmentsTimeframe for possible changes uncertain:
Congressional ACA repeal effort likely effective in future years, not FY17
Executive actions could take effect sooner
DHCF proposes to use MCAC to engage stakeholders on Medicaid reformSlide8
D.C. Medicaid Enrollment FY2010 thru FY2016+
Source
:
Enrollment data was obtained from the D.C. Medicaid Management Information System (MMIS) Recipient Package, January 2016
+
Reported figures depict the number of beneficiaries enrolled at the end of each fiscal year.
MAGI annual renewals deferred between
1/1/14 and 12/1/14