medicaid expenditure trends and projections; smiles for...

Medicaid Expenditure Trends and Projections; Smiles for

Children Dental Program

Presentation to the:

Senate Finance Committee

Patrick W. Finnerty, DirectorDepartment of Medical Assistance Services

May 23, 2007Richmond, Virginia

2

Presentation Outline

Medicaid Program Overview

FY 2007 Projections

FY 2007 Year-to-Date Trends

Smiles for Children Dental Program

3

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Medicaid Enrollment Trends

Notes: Average monthly enrollment in the Virginia Medicaid Program

731,137

4

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Fee ForService

CapitatedManagedCareTotalEnrollment

Medicaid Enrollment Trendsby Service Delivery Type

Notes: Average monthly enrollment in the Virginia Medicaid ProgramCapitated Care consists of the Options and Medallion II programs

58%

42%

5

$4.8 billion

$.0 billion

$1.0 billion

$2.0 billion

$3.0 billion

$4.0 billion

$5.0 billion

$6.0 billion

1992 1994 1996 1998 2000 2002 2004 2006

State Fiscal Year

Medical Expenditure Trends

6

$4.8 billion

$.0 billion

$1.0 billion

$2.0 billion

$3.0 billion

$4.0 billion

$5.0 billion

$6.0 billion

1992 1994 1996 1998 2000 2002 2004 2006

Fee ForService

ManagedCare

TotalExpenditures

Medical Expenditure Trendsby Service Delivery Type

State Fiscal Year

77%

23%

7

Medicaid Enrollment & ExpendituresFY 2006

Children

Children

Adults

Adults

Blind & Disabled

Blind & Disabled

AgedAged

Recipients Expenditures

10%

20%

14%

56%

23%

46%

9%

22%

8



FY 2007 Projections



9

2006 Consensus Medicaid Forecast

Historical and Projected Expenditures for General Medicaid, Long-Term Care and Mental Health Services($billions)

$0.0$1.0$2.0$3.0$4.0$5.0$6.0

$ B

illio

ns

Historical 1.96 2.07 2.14 2.24 2.5 2.76 2.85 3.29 3.57 4.06 4.432006 Forecast 4.83 5.2 5.542005 Forecast 4.47 4.82 5.18% Growth 6% 6% 3% 5% 12% 11% 3% 15% 9% 14% 9% 9% 8% 7%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

% Growth reflects annual growth of historical expenditures and the 2006 forecast.

10$2,489,932,917 ($4,026,675)$2,493,959,592 State Appropriation$2,332,804,518 ($5,571,675)$2,338,376,193 Federal Funding$4,822,737,435 ($9,598,350)$4,832,335,785 Total Medicaid Expenditures

303,873,4610303,873,461Total Mental Health1,421,375,107(8,689,696)1,430,064,803Total Long-Term Care

689,948,989(190,000)690,138,989All Other Acute Services180,508,202(718,654)181,226,856Pharmacy153,169,5280153,169,528Physician Services109,437,2250109,437,225Outpatient Hospital 763,086,0740763,086,074Inpatient Hospital

$1,201,338,848$0$1,201,338,848Managed CareAppropriationAmendmentsForecast

CurrentChapter 847Official

FY 2007 Funding Amendments

11



FY 2007 Projections



12

-50,000

100,000150,000200,000250,000300,000350,000400,000450,000

FY19

92

FY19

93

FY19

94

FY19

95

FY19

96

FY19

97

FY19

98

FY19

99

FY20

00

FY20

01

FY20

02

FY20

03

FY20

04

FY20

05

FY20

06


Non-Disabled Adults & Children

Aged, Blind &

Disabled

Area enlarged

below

13

200,000

225,000

250,000

275,000

300,000

Sep-

05

Oct

-05

Nov

-05

Dec

-05

Jan-

06

Feb-

06

Mar

-06

Apr

-06

May

-06

Jun-

06

Jul-0

6

Aug

-06

Sep-

06

Oct

-06

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

Apr

-07

May

-07

350,000

375,000

400,000

425,000

450,000


Non-Disabled Adults & Children

Aged, Blind & Disabled

Implementation of federal DRA citizenship and identity requirements

Age

d, B

lind

& D

isab

led

Enro

llmen

t Non-D

isabled Adults &

Children

Enrollment

Creation of Consensus Medicaid Forecast

14

FY 2007 Year-to-Date Expenditures

YTDYTD

11.5%10.1%1,810,538,9591,992,678,130$2,489,932,917 State Appropriation6.1%3.4%1,810,398,7971,872,845,884$2,332,804,518 Federal Funding8.8%6.8%$3,620,937,757 $3,865,524,014 $4,822,737,435

Total Medicaid Expenditures

17.3%16.9%210,411,541245,905,434303,873,461Mental Health Services12.4%9.6%1,043,063,5861,142,916,5781,421,375,107Long-Term Care Services33.3%46.5%379,478,940555,987,342689,948,989All Other Acute Services

-47.0%-53.4%327,216,991152,490,536180,508,202Pharmacy-0.5%-5.4%127,515,030120,663,728153,169,528Physician Services-4.9%-7.6%93,878,82786,757,360109,437,225Outpatient Hospital 10.7%5.6%538,373,409568,703,933763,086,074Inpatient Hospital 10.1%10.1%$900,999,433$992,099,102$1,201,338,848Managed Care

GrowthGrowthFY 2006FY 2007AppropriationExpenseFundedYTDCurrent

15



FY 2007 Projections



16

Access to/Utilization of Dental Services Needed to Improve

87%

13%

Not ParticipatingParticipating

Low participation of dentists (620 of 4,786) in the Medicaid/FAMIS program was a major problem– Low reimbursement– Administrative “hassles”– Patient no-shows

Dentist Participation in Medicaid/SCHIP*

* FY 2003

In FY 2003, only 23.4% of all eligible children actuallyreceived any dental services

17

Key Stakeholders Worked Together for Change

Advocacy Groups

MCOs

OrganizedDentistry

Medicaid/SCHIP Agency

Governor

Legislature

New Medicaid/ FAMIS Dental

Program

18

New Program Structure and a 30% Increase In Fees

General Assembly/Governor authorized DMAS to develop an entirely new program structure

Also approved a 30% increase in dental fees– 28% on July 1, 2005; additional 2% in May, 2006

19

A New Day for Dental! Smiles for Children

Effective date: July 1, 2005

All children (Medicaid & FAMIS) are enrolled in a single program administered by Doral Dental USA

Limited medically necessary diagnostic/oral surgery services for adults

DMAS retains policymaking authority and closely monitors contractor activities along with Dental Advisory Committee

20

Key Program Enhancements

Old Program Smiles for Children

Different credentialing processes

Complicated Administration

Limited local representation on program decisions

Enrollee transfer betweenplans can disrupt care

Single Vendor (Doral)

Streamlined Credentialing

Easy, Industry-Standard Administration

Va. Based Peer ReviewCommittee & DentalAdvisory Committee

Multiple Vendors

All enrollees in Smiles forChildren program

21

Value-Added Benefits for Providers

Toll-free phone number for providers

Call center specialists– Member Placement– Eligibility, benefits, authorizations– Claims issues– Addressing patient “no-shows”

Multiple claim submission options……free, electronic filing

Timely and accurate payments

Automated, web-integrated or live eligibility verification (24/7)

22

Program Changes = Increased Provider Network

326 new dentists are participating (53% increase)– Network continues to

expand– 6 localities that previously

had no participating dentists now have access

– Percentage of contracted providers who are billing for services has increased from 50% to 80%

Very high level of provider satisfaction

620

946

0100200300400500600700800900

1000

Jul-05 Apr-07

Participating Providers

23

…..And Increased Access to Care

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%

Ages 0-20 Ages 3-20

FFY 2005 FFY 2006

Percentage of Children Receiving Necessary Dental Care

30% Increase

33% Increase

24% 32% 30% 39%

Source: CMS 416 Report for Virginia

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Smiles for Children Has Received National Attention

14th Annual Medicaid Managed Care Congress

2006 & 2007

THANK YOU!!

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