Transcript Indigent Care Redesign

Larry E. Tisdale
Vice-President of Finance
Medicaid Redesign
Better for Idaho’s taxpayers, businesses, and patients
Required

\=
Medicaid
Expansion
in PPACA
Optional –
at State’s
Discretion
Where we stand
Charitable
Orgs.
Community
Health
Centers
County
Indigent
Program
Health care
options for
Idaho’s low
income
workers
Medicaid
State
Catastrophic
Fund
Emergency
Departments
Who are the “medically indigent”?

Working Idahoans

Self-employed & Small Business Employees
Idaho’s minimum wage = $15,080/year
Idaho average salary = $38,000/year
Annual Cost of Living *
$7,164
Groceries
$10,820
Rent
$3,476
Utilities
$2,748
Gasoline
$24,208
* U.S. Bureau of Labor Statistics - averages are based on 2.6 person households
Idaho has a choice
High cost
County Medically Indigent Funding
$60,000,000
Forecast
$50,000,000
$40,000,000
$30,000,000
$20,000,000
$10,000,000
Spent
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
$0
County Indigent Fund – supported entirely by property taxes
High cost
Catastrophic Health Care Fund
$70,000,000
$60,000,000
Forecast
$50,000,000
$40,000,000
$30,000,000
$20,000,000
$10,000,000
Appropriated
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
$0
State Catastrophic Fund – supported entirely by income taxes
<6k
served
Staffing
>$60
million
Ineffective
Expensive
Low Value
100
employees
Financial Risk
$120,000,000
$100,000,000
$80,000,000
$60,000,000
$40,000,000
$20,000,000
$0
County Indigent
State CAT
Financial Risk
Enrollee
Growth
Budget
• 45,000 qualified
but not enrolled
• $394 million
over 10 years
Low
Value
High
Cost
Financial
Risk
$60+ million budget =
expensive, episodic
treatment for
<6k
$60 mil/yr budget
from county and state
taxes
45k qualified Idahoans
joining Medicaid =
$394 million over 10
years
Idaho has a choice
Eliminate Waste
Projected County and State Indigent
Care Savings
$140,000,000
$120,000,000
$100,000,000
$80,000,000
$60,000,000
$40,000,000
Over $1 billion
in tax dollars from
2014 - 2024
$20,000,000
$0
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Half fiscal year
Coverage for Working Idahoans
68% of those who qualify have at least one full-time worker in the household;
16% have one or more part-time workers
Provide Coverage for Working Idahoans



Provides coverage to adults earning <138% of FPL or a
family of four must have income less than $32,500
Adults age 19-64
Must be legal Idaho residents
Idaho minimum wage =
$7.25/hr or $15,080/yr
2013 Federal
Poverty Limits
<100% FPL
100% to 125% FPL
125% to 138% FPL
Annual Income Individual
$0 - $11,490
$11,491 - $14,362
$14,363 -$15,856
Annual Income Family of 4
$0 - $23,550
$23,551 - $29,437
$29,438 - $32,499
Redesign the System
Personal responsibility and
accountability
 Coordinated Care
 Managed Care for chronic conditions
 Reduce waste through technology and
electronic health records

Eliminate
Waste
Cover Working
Idahoans
System
Redesign
Save Idaho taxpayers
$1 billion by
eliminating two
government programs
Provide health care to
149,000 low income
Idahoans
Construct a system
focused on personal
responsibility.
for Idaho’s Economy
$12.3-18.5 million in federal
penalties for businesses
Healthier Workforce
Rising taxes or budget cuts to
critical programs
16,000 new jobs
Not attractive to new
businesses
Bringing Idaho taxes back to
Idaho
Costs / Savings
2014-2024
State Medicaid Increases
+ $394 Million
+ $1,043 Million
State CAT Program
costs/savings
+ $540 Million
- $540 Million
County Indigent Program
costs/savings
+ $478 Million
- $478 Million
DHW mental health
costs/savings
+ $110 Million
- $110 Million
Total costs/savings
$1.5 Billion
$85 Million
Only one choice
Status Quo
• Spend $394 million +
keep $1B in inefficient
gov’t programs
Medicaid Redesign
• Save $85 million & cover
149,000 Idahoans
www.TheRightMedicineForIdaho.org
Potential Legislative Activity
 Medicaid Expansion ?
 Insurance Exchange
 Time Sensitive Emergencies
 Hospital Tax Exemptions
 Managed Care for Dual Eligibles HB351
 Battery of Health Care Workers
 Medically Indigent Statute changes
 Idaho Physician Shield Act (IMA)
 Transparency
 State Health Innovation Plan (SHIP)
Medicaid Expansion

Not a current initiative for the 2014
Legislative Session

Governor Otter “current Medicaid
system is broken”

Currently exploring 1115 waiver
possibilities
Insurance Exchange

Passed by last year’s Legislature

Current exchange is federally supported

This is mostly a political fight
Time Sensitive Emergencies

TSE is a statewide system for the coordinating and
delivering evidence based care

Includes trauma, strokes and heart attacks (STEMI)

Hospital designation and participation is voluntary

Allows billing for trauma team activation
◦ Certified by American College of Surgeons
◦ Designated by the State
Hospital Tax Exemptions

Largely a political misinformation
campaign
◦ CEO Compensation
◦ Physician Employment
◦ Profit Margins

Increasing taxes on community hospitals
will not lower the cost of health care
Managed Care for Medicaid/Medicare

HB351 Manditory or Voluntary
enrollment?

In response to HB260 from 2011

Largest issue may be with nursing facility
payments
◦ UPL
◦ Quality Incentives
Battery of Health Care Workers
Carryover from last year
 Makes it a felony to assault hospital
workers
 New version includes non-licensed
workers
 Lesser punishment than first responder
assault
 Tough sell with the Legislature

Medically Indigent Statute Changes
Two potential Proposals:

Eliminate funding over 100% of federal
poverty level

Remove money to fund “community
clinics”
Idaho Physician Shield Act

Ensures that no guideline or metrics
established by the PPACA shall be used as
a basis for establishing community
standards of care

IHA has no formal position at this time
Transparency

Again?

IHA opposes transparency based solely
on pricing data

States’ websites that have pricing
information go largely unused

IHA would support transparency of
quality data
State Health Innovation Plan (SHIP)

There is potential for a resolution
supporting the design model

The design grant ended in December
2013

The Department of Health and Welfare is
in the process of applying for a testing
grant
Questions