Ohio Medicaid - search-prod.lis.state.oh.us

Ohio Medicaid - search-prod.lis.state.oh.us

Ohio Medicaid March 13, 2019 Why We Care Ohios Medicaid Program is the: Largest health insurer in the state Largest payer of long-term care in the state Largest state program in Ohio Sixth largest Medicaid program in the nation Historic Medicaid Spending FY 2008: $13.7 billion FY 2018: $26.3 billion $30

$25 Federal Share Billions $20 $15 $10 $5 $- 2008

2009 2010 2011 2012 2013 2014 2015 2016

2017 2018 General Accounting Offices Report on the Ohio Medicaid Program, 1978 FY 2018 GRF Expenditures by Category (State and Federal Funds) General Government 6% Corrections 6% Human Services 4% K-12 Education 30%

Higher Education 8% Medicaid 46% FY 2018 GRF Expenditures by Category (State Funds Only) General Government 9% Corrections 9% K-12 Education 43% Human Services

6% Medicaid 22% Higher Education 11% Agenda Overview Eligibility Benefits Delivery Systems Budget Overview Medicaid Program Description

Administration Medicaid vs. Medicare Medicaid Program Description Congress established Medicaid in 1965 Provides: Health care services to the poor Health care and long-term care services to the elderly and disabled Eligible individuals entitled to receive services Federal government sets guidelines; states administer their own Medicaid programs Administration Ohio Department of Medicaid (ODM) is the single state agency administering Ohio Medicaid. ODM contracts with other state agencies

Developmental Disabilities provides institutional and communitybased services to individuals with intellectual disabilities Aging administers programs for older Ohioans Education administers the Medicaid Schools Program Health surveys and certifies Medicaid facilities (e.g. nursing homes) Job and Family Services reimburses local administration and transportation Mental Health and Addiction Services administers programs related to behavioral health State Board of Pharmacy integration of its Rx reporting system into electronic medical records Administration Local Administration County departments of job and family services County boards of developmental disabilities Area agencies on aging County behavioral health boards

Schools Medicaid vs. Medicare: Whats the Difference? Administration Funding source(s) Population served Income limits Coverage Care Medicaid Medicare State

Federal State, federal, local Federal Kids, parents, adults, disabled and elderly Elderly (65+) and some disabled Low-income No limits

Varies by state Standard across nation Primary, acute and long-term Primary and acute Eligibility Eligibility Requirements Eligible Populations Eligibility Requirements Be a US citizen (or meet Medicaid citizenship

requirements) and an Ohio resident Meet income requirements - different income limitations for different populations Asset Limitation Applies only to aged, blind, and disabled population $2,000 for an individual and $3,000 for a couple Federal Poverty Level (FPL), 2019 Family Size 100% FPL 200% FPL 1 $12,490

$24,980 2 $16,910 $33,820 3 $21,330 $42,660 4

$25,750 $51,500 5 $30,170 $60,340 Eligibility Groups in Ohio Children, parents, pregnant women, and adults, as well as disabled and elderly individuals at different income levels are eligible for Ohios Medicaid program Three major groups receiving full benefits: Covered Families and Children (CFC)

Aged, Blind, and Disabled (ABD) Affordable Care Act expansion adults (Group VIII) Families, Children, and Adults 2019 Monthly Financial Eligibility Monthly Income Eligible Populations Income Limits (FPL) Family of 1 Family of 3 Parents/Caretaker Relatives

90% $937 $1,600 Adults (age 19-64) 133% $1,384 $2,364 Children with Insurance

156% $1,624 $2,773 Pregnant Women 200% $2,082 $3,555 Children without Insurance 206%

$2,144 $3,662 Aged, Blind, or Disabled Individuals 2019 Monthly Financial Eligibility Monthly Income Eligible Populations Income Limits Aged, Blind, or Disabled Individuals

SSI Benefit Rate $771 Individual, $1,157 Couple Medicaid Buy-In for Workers with Disabilities (MBIWD) 250% FPL $2,602 Individual Qualified Medicare Beneficiary (QMB) 100% FPL

$1,041 $1,409 Specified Low-Income Medicare Beneficiary (SLMB) 120% FPL $1,249 $1,691 Qualified Individuals (QI-1) 135% FPL

$1,405 $1,902 Family of 1 Family of 2 Medicaid Caseloads FY 2008: 1.8 million FY 2018: 3.0 million 3,500 3,000

Group VIII ABD CFC Thousand 2,500 2,000 1,500 1,000

500 0 2008 2009 2010 2011 2012 2013 2014

2015 2016 2017 2018 Benefits Mandatory Benefits Optional Benefits Mandatory Benefits Certified pediatric and family nurse practitioners EPSDT (Healthchek)

Family planning services Federally qualified health center Freestanding birth center Home health Inpatient hospital Lab & x-ray Nursing facility care Nurse midwife Outpatient hospital Physician Rural health clinic Transportation to medical care Tobacco cessation counseling for pregnant women

Optional Benefits Ambulance & ambulette Chiropractic Community alcohol and drug addiction treatment Community behavioral mental health Dental Durable medical equipment and supplies Home & community-based service Hospice care Intermediate care facility Occupational therapy Physical therapy

Podiatry Prescription drugs Private duty nursing Speech therapy Targeted case management Vision care Delivery Systems Fee for Service Managed Care Delivery Systems Fee For Service (FFS) The state contracts directly with providers Enrollees can receive services from any provider that contracts with Ohio Medicaid State pays providers directly for services

Delivery Systems Managed Care Managed Care Organizations (MCOs) contract with providers Eligible enrollees must receive services from providers within their MCOs provider network State pays a monthly capitated rate for each enrolled individual MCOs assume risk for each enrollees health care Most of Ohios Medicaid population is enrolled in a managed care plan effective July 1, 2018 behavioral health services were integrated into managed care Budget Spending Funding

Medicaid Spending & Enrollment Aged, Blind, & Disabled (ABD), Group VIII, and Covered Families & Children (CFC), FY 2018 Enroll... Spen... 24% 20% Medicaid Spending by Payment Category (FY 2018) Behavioral Health 5% All Other

6% Nursing Facilities 6% DDD 10% Managed Care 60% Hospitals, Physicians, and Drugs 13% Hospital care and other services provided to Medicaid recipients enrolled onto a Managed Care plan are accounted for in the Managed Care category.

Federal Funding Federal Medical Assistance Percentages (FMAP) Percentage of Medicaid expenditures that the federal government reimburses FMAP varies by state and type of expenditure (services vs. administration) FMAP is based on the relative per capita income of each state Ohios federal fiscal year 2019 rate is 63.09% State Sources of Funding General Revenue Fund Provider fees and assessments Hospitals Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID)

Managed Care Organizations Nursing Facilities Rebates from prescription drug purchases Legislative Budget Office Health and Human Services Division Vern Riffe Center 77 South High Street, 15th Floor Columbus, Ohio 43215 Ivy Chen Principal Economist 644-7764 [email protected]

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