•

•

•

–

–

–

–

–

–

–

•

–

–

–

–

•

•

•

Sunshine 38%

United 24% American

Eldercare 16%

Molina 6%

Amerigroup 6% Coventry

5%

Humana 5%

September 2014 LTC Plan Enrollment

Staywell 24%

Sunshine 15%

Amerigroup 12%

Prestige 11% Humana

10%

United 9%

Molina 3%

Better Health 3%

Integral 3%

Simply 3%

First Coast Advantage

2%

Coventry 2%

SFCCN 2%

Preferred 1%

September 2014 MMA

Standard Plan Enrollment

Children's Medical Services

45%

Magellan 32%

Sunshine 16%

Clear Health

6%

Positive Healthcare

1%

September 2014 MMA

Specialty Plan Enrollment

Source: Florida Medicaid Management Information

System (FLMMIS) Eligibility Information, Enrollment and

demographic information, August 2013 - September

2014.

•

•

•

0

500

1,000

1,500

2,000

2,500

3,000

3,500

18 28 38 48 58 68 78 88 98 108

Age 85 and Older

Age 65 - 84

Age Under 65

LTC Enrollees by Age, September 2014

0

20

40

60

80

100

120

140

0 10 20 30 40 50 60 70 80 90 100 110

Tho

usa

nd

s

Age

Ages Under 14

Ages 14 - 20

Ages 21 and Older

MMA Enrollees by Age, September 2014

0

1,000

2,000

3,000

4,000

5,000

6,000

0 10 20 30 40 50 60 70 80 90Age

Age 21 and Older

Age 6-20

Age Under 6 Years

Specialty Plan Enrollees by Age, September 2014

Source: Florida Medicaid

Management Information System

(FLMMIS) Eligibility Information,

Enrollment and demographic

information, September 2014.

•

SMMC Capitation Payments

LTC Plans

MMA Standard

Plans

MMA Specialty

Plans

Payment Date Range 8/2013 – 6/2014 5/2014 – 6/2014 5/2014 – 6/2014

Total Capitation Payments $1,578,380,771 $482,392,603 $15,070,533

Average Payment Per Member Per Month $3,284.92* $267.90 $796.33*

Source: Florida Medicaid Management Information System (FLMMIS), Information about capitation payments to plans, August 2013

- June 2014.

•

•

0

2

4

6

8

10

12

14

16

Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14

Nu

mb

er o

f C

om

pla

ints

Per

1,0

00

Enro

llees

Source: Complaint Issues Reporting and Tracking System (CIRTS), Information about complaints registered with the

Agency, August 2013 - August 2014.

•

•

•

•

•

•

•

•

2,666,845 2,722,161 2,756,632 2,776,111 2,814,327 2,864,544 2,911,516 2,954,920 2,967,917

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2014 – April 2015

•

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15

Staywell

Sunshine

Amerigroup

Prestige

Humana

United

Molina

Better Health

Integral

Simply

CMS Network

Coventry

SFCCN

Magellan

First Coast

Preferred

Sunshine Specialty

Clear Health

Positive Healthcare

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2014 – April 2015

•

Received No Services

Received at Least One Service

Source: Florida Medicaid Managed Information System (FLMMIS) Encounter Claims Data,

August 2014 – December 2014

•

•

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15

Number MMA Standard Plan Issues Per 1,000 Enrollees

Number MMA Specialty Plan Issues Per 1,000 Enrollees

Source: Complaints Issues Reporting and Tracking System (CIRTS), August 2014 – April 2015

•

83,509 83,626 83,639 83,276 83,597 83,605 83,802 84,497 85,154 85,516 85,733 85,651 86,310 86,705

0

20,000

40,000

60,000

80,000

100,000

Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, March 2014 – April 2015

•

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Sunshine

United

American ElderCare

Molina

Amerigroup

Coventry

Humana

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, March 2014 – April 2015

•

Received No Services

Received at least One Service

Source: Florida Medicaid Managed Information System (FLMMIS) Encounter Claims Data, March 2014 – December 2014

•

•

•

•

•

•

•

Source: Plan Submitted Enrollee Residence Report, March 2014 – July 2015, and Florida Medicaid Managed

Information System (FLMMIS) Eligibility Information, March 2014 – July 2015.

•

0%

25%

50%

75%

100%

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

47.2%

47.6%

47.2%

47.7%

48.4%

49.2%

55.6%

50.6%

50.1%

50.1%

49.9%

50.7%

50.3%

52.8%

52.4%

52.8%

52.3%

51.6%

50.8%

44.4%

49.4%

49.9%

49.9%

50.1%

49.3%

49.7%

Community Setting Institutional Setting

Source: Plan Submitted Enrollee Residence Report, March 2014 – July 2015, and Florida Medicaid Managed

Information System (FLMMIS) Eligibility Information, March 2014 – July 2015.

•

75.4%

58.5% 57.7% 57.6% 53.6% 49.2% 42.6% 42.5%

24.6%

41.5% 42.3% 42.4% 46.4% 50.8% 57.4% 57.5%

0%

25%

50%

75%

100%

Amerigroup Molina AmericanEldercare

Humana Coventry All Plans United Sunshine

Community Setting Institutional Setting

Source: Plan Submitted Enrollee Residence Report, March 2014 – July 2015, and Florida Medicaid Managed Information System

(FLMMIS) Eligibility Information, March 2014 – July 2015.

*Humana enrollees are included with American ElderCare from July 2015 forward. Beginning July 2015, Humana began

operating its LTC plan as Humana American Eldercare.

•

•

61.9%

34.4% 25.9% 19.6% 19.3% 13.5%

0%

25%

50%

75%

100%

Sunshine United Amerigroup HumanaAmericanEldercare

Molina Coventry

Comprehensive Not Comprehensive

*Humana enrollees are included with American ElderCare from July 2015 forward. Beginning July 2015, Humana began

operating its LTC plan as Humana American Eldercare.

•

0%

2%

4%

Percentage ofCommunity Enrolleeswho Transferred to a

Nursing Facility

Percentage of NursingFacility Enrollees who

Transferred to theCommunity

1.6%

2.9%

0

2

4

6

8

Amerigroup AmericanEldercare

Coventry Humana Molina United Sunshine

6.2

4.9 4.4

3.7 3.3

2.6

2.0

Source: Plan Submitted Enrollee Residence Report, June 2014

– July 2015, Plan Submitted Nursing Home Transfer Report,

March 2014 – May 2014, and Florida Medicaid Managed

Information System (FLMMIS) Eligibility Information, March

2014 – July 2015.

Percentage of Nursing Facility Enrollees Who Transferred to the Community

•

•

•

617 701

799 884

950 992

1,117 1,223

1,331 1,410

1,472 1,552

1,629 1,689

1,791 1,897

1,956

0

500

1,000

1,500

2,000

Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

PDO Enrollees

Source: Plan Submitted PDO Report, March 2014 – July 2015, and Florida Medicaid Managed Information

System (FLMMIS) Eligibility Information, March 2014 – July 2015.

•

•

56.8%

62.4%

54.4%

45.6%

44.2%

47.0%

45.4%

27.9%

39.9%

44.2%

48.7%

51.3%

52.5%

57.1%

58.4%

74.9%

-80% -60% -40% -20% 0% 20% 40% 60% 80%

United

Sunshine

Across All Plans

Coventry

Humana

American Eldercare

Molina

Amerigroup

% Enrollees Receiving Institutional Services

% Enrollees Receiving Community Services

*Some services can be received in either an institutional or community setting and are not included in this graph. Therefore, institutional and community

percentages will not total to 100 percent of enrollees.

Source: Florida Medicaid Managed Information System (FLMMIS) Encounter Data, March 2014 – February 2015, and FLMMIS FFS Claims Data for

American ElderCare, March 2014 – August 2014.

•

•

•

•

•

•

•

•

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

Mill

ion

s

Continued in FFS

Entered or LeftMedicaid

Changed within theMedicaid Program

Continued in MMA

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, May 2014 – October 2015.

•

•

•

•

0

100,000

200,000

300,000

400,000

500,000

600,000

Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15

Died Left Medicaid Entered Medicaid

Moved between FFS and MMA Changed MMA Plans Plan Mergers and Acquisitions

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, May 2014 – October 2015.

•

•

-30,000

-20,000

-10,000

0

10,000

20,000

30,000

Net Gain to Standard Plan Net Gain to Specialty Plan

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, May 2014 – October 2015.

•

0

25,000

50,000

75,000

100,000

Continued in PACE

Continued in FFS

Plan Acquistion, Changed LTC Plan, or Moved between LTC and FFS or PACE

New to or No Longer Receiving LTC Services

Continued in LTC

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2013 – October 2015.

•

•

•

•

0

2,500

5,000

7,500

10,000

Died No Longer Receiving LTC Services

New to LTC Services Moved between LTC and FFS or PACE

Changed LTC Plan Plan Mergers and Acquisitions

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2013 – October 2015.

•

•

-1,000

-500

0

500

1,000

1,500

2,000

Sunshine Coventry Amerigroup Humana Molina United AmericanElderCare

Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2013 – October 2015.

•

•

•

•

•

•

$0

$200,000,000

$400,000,000

$600,000,000

$800,000,000

$1,000,000,000

$1,200,000,000

Total Revenue

Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014

•

0%

20%

40%

60%

80%

100%

120%

140%

Amount Paid for MMA Services as a Percentage of Revenue

Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014

•

•

-50%

-40%

-30%

-20%

-10%

0%

10%

Cle

ar H

ealt

h A

llian

ce

Sim

ply

SFC

CN

Bet

ter

Hea

lth

Stay

wel

l

Inte

gral

Am

erig

rou

p

Po

siti

ve

Tota

l

Pre

stig

e

Ma

gella

n

Firs

t C

oas

t A

dva

nta

ge

Co

ven

try

Sun

shin

e

Mo

lina

Hu

man

a

Un

ited

Pre

ferr

ed

Operating Margin

Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014

•

0%10%20%30%40%50%60%70%80%90%

100%

Percentage of Plan Revenue Spent on Hospital Services

Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014

•

0%

20%

40%

60%

80%

100%

120%

140%Other State Plan

Transplant

Transportation

Dental

Mental Health & SubstanceAbuse

Pharmacy

Professional

Hospital

Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014

•

-

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

1,400,000,000

Sunshine United AmericanEldercare

Molina Coventry Humana Amerigroup

Total Revenue

Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014

•

0%

20%

40%

60%

80%

100%

Sunshine Coventry United Total Humana Molina AmericanEldercare

Amerigroup

Percentage of Revenue Spent on LTC Services

Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014

•

-14.00%

-12.00%

-10.00%

-8.00%

-6.00%

-4.00%

-2.00%

0.00%

2.00%

4.00%

6.00%

Am

eri

gro

up

Mo

lina

Hu

man

a

Tota

l

Sun

shin

e

Un

ited

Am

eric

an E

lder

care

Co

ven

try

Operating Margin

Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014

•

0%

20%

40%

60%

80%

100%

120%

Sun

shin

e

Un

ited

Co

ven

try

Hu

man

a

Mo

lina

Am

eric

an E

lder

care

Am

erig

rou

p

LTC Services Settlements

Ending IBNP

Subcapitated

Other HCBS

Transportation

Therapy Services

Medical Supplies

Home Health

Assisted Living

Hospice

Nursing Facility

Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014