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  3. Presentation to Senate Appropriations Committee April 8, 2014

Presentation to Senate Appropriations Committee April 8, 2014 

 

Julie Hamos, HFS Director

HFS Mission

Medical Programs FY 2015 Goals

Providing Healthcare Coverage

* Excludes enrollees in partial benefit programs

Enrollment Under ACA

Medical Programs Average Enrollment

Group FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 Estimated FY2015 Projected
Children 1,127,843 1,185,757 1,303,495 1,416,033 1,504,057 1,596,975 1,657,273 1,693,839 1,671,910 1,626,200 1,626,200
Adults with Disabilities 225,738 246,277 23,1209 235,965 241,288 249,517 258,354 265,221 266,374 266,400 266,400
Other Adults 405,383 448,439 473,558 505,979 537,765 588,451 624,085 643,616 656,643 670,000 683,400
Seniors 137,270 140,842 142,257 146,314 150,515 156,001 166,138 174,673 180,541 186,000 191,500
ACA New Eligibles - - - - - - - - - 172,200 371,100
Existing Eligibles Enrolling Post ACA - - - - - - - - - 31,200 80,600
Totals 1,896,234 2,021,314 2,150,519 2,304,291 2,433,625 2,590,945 2,705,850 2,777,349 2,775,468 2,952,000 3,219,200

Reflects average annual enrollees. Excludes enrollees in partial benefit programs.

Small % of Medicaid Clients Incur Majority of Medicaid Costs

17% of recipients who are Seniors and Persons with Disabilities (SPD) result in 57% of Medicaid costs  (all agencies) – they have most complex health/behavioral health needs.

Group Number of Enrollees Share of Cost
SPDs 17% 57%
Other Adults 26% 17%
Children 57% 26%

Medicaid costs are driven by the number and type of recipients (eligibility rules), their service utilization patterns and the established reimbursement methodologies for those services.

Illinois State Mandate

Our Unique Structure: Models of  “Managed Care Entities”

What Is Changing With Managed Care?

Managed Care Roll-Out Plan

Rebalancing Long-Term Care System

Continuing Program Integrity Efforts

IL Medicaid Redetermination Project: Phase I

IL Medicaid Redetermination Project: Phase II

Office of Inspector General

Managing the Medicaid Budget

Historical Medical Programs Liability GRF and Related Funds

Total Liability in Billions

Fiscal Year Total Liability
FY2007 $8.2
FY2008 $8.7
FY2009 $9.1
FY2010 $9.7
FY2011 $10.4
FY2012 $10.5
FY2013 $9.8 SMART Act
FY2014 est. $10.9 ACA Eligibility
FY2015 proj. $12.7 ACA Eligibility

SMART Act Reconciliation

(Dollars in Millions)

Original FY13 SMART Act savings target $1,600.0
Plus: budgeted new revenues $1,100.0
Equals: FY13 budget plan to close projected $2.7 billion shortfall $2,700.0
   
FY13 actual SMART Act savings $1,037.6

Actual new revenue item receipts (values double with federal match)

$151 million GRF transfer to Healthcare Prov. Relief $302.0
$50 million from new hospital assessment (rec'd retro in FY14) $100.0
Cigarette/Tobacco tax increase ($283.5 million actual to HFS) $567.0
Sub-total-new revenues $969.0
   
Lower than budgeted FY12 liability (out of FY12 and FY13 base) $702.2
   
Total lower costs and new revenue $2,708.8

Child Support Services

Department of Healthcare and Family Services Program Area Appropriations Comparison (Dollars in Millions)

All Funds*

Total by Program FY2014 FY2015 $ Change
Medical Assistance $18,981.0 $19,138.1 $157.1
Child Support Services 212.7 259.6 46.9
Program Operations 297.6 268.7 (29.0)
Cost Recoveries 42.8 43.5 0.7
Inspector General 23.3 32.6 9.2
Total $19,557.5 $19,742.5 $185.0

General Revenue Fund*

Total by Program FY2014 FY2015 $ Change
Medical Assistance $6,965.8 $7,039.0 $73.2
Child Support Services 0.0 32.2 32.2
Program Operations 72.8 57.1 (15.6)
Inspector General 0.0 6.7 6.7
Total $7,038.6 $7,135.1 $96.5

* In FY2014, the General Assembly appropriated GRF Operations, including the Inspector General and the Child Support fund deposit, from a lump sum appropriation which is reflected in Program Operations. The FY2015 budget assumes operations costs are budgeted in the legacy appropriation lines.

Historical On-Board Headcount: Serving More Clients With Fewer Employees

FY End of Fiscal Year Headcount Other Administration Finance Inspector General Information Services Medical Programs Child Support Enforcement
FY2001 2,925 294 290 278 277 758 1,028
FY2002 2,803 290 279 272 275 704 983
FY2003 (Ryan ERI) 2,362 236 239 218 247 591 831
FY2004 2,361 226 273 221 247 553 841
FY2005 2,182 235 257 203 172 519 796
FY2006 2,317 265 249 194 214 597 798
FY2007 2,407 252 243 192 240 670 810
FY2008 2,462 255 240 196 253 675 843
FY2009 2,406 220 251 184 243 677 831
FY2010 2,313 206 244 173 230 646 814
FY2011 2,243 201 233 163 230 635 781
FY2012 2,100 197 218 150 215 562 758
FY2013 2,105 191 193 178 202 617 724
January 2014 2,104 191 186 179 204 620 724

HFS on-board headcount has decreased by 28%, or 821 staff since FY 2001, while enrollment in medical programs has increased 90% (1.3 million clients) and cases for which the Division of Child Support Services receives collections has grown by 54% (75,800 cases).