HFSInfo CenterFacts & Figures

Presentation to House Human Services Appropriations Committee April 10, 2014

Julie Hamos, HFS Director April 10, 2014

HFS Mission

  • To empower Illinoisans to lead healthier and more independent lives through the "Triple Aim" by improving the quality of healthcare, improving the health of populations and reducing the growth in healthcare costs; and
  • To enhance children's well-being and families' self-sufficiency by establishing and enforcing child-support obligations.

Agenda

Managing the Medicaid Budget

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

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

Medicaid FY 2015 Introduced Budget

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)

Medicaid Without Current Tax Rates

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 entities organize networks of providers
  • Networks include primary care, specialists, hospitals, behavioral healthcare
  • Clients select a managed care entity, then stay within network for 1 year
  • Patient-centered health homes coordinate care of clients with complex needs
  • Multidisciplinary teams focus on clients' holistic needs
  • Care coordinators help navigate the system, arrange care transitions and follow-up care
  • Electronic health records make care coordination possible with sharing of clinical information
  • Payments reward for quality and health outcomes ("value-based purchasing"); transition from fee-for-service to full risk
  • Renewed focus on social determinants of health and wellness

Managed Care Roll-Out Plan

Rebalancing Long-Term Care System

  • Assisting sister agencies with 3 Consent Decrees
  • Applied for and received Balancing Incentive Program (BIP) award, with enhanced federal match, to increase community capacity
  1. $19.5 million included in HFS' FY 2015 budget request
  2. $90.3 million expected for State by September 2015
  • Nursing home reimbursement system has been modernized (RUGs)

Continuing Program Integrity Efforts

  • Quinn Administration has made it a priority to root out Medicaid waste, fraud and abuse
  • State verifies eligibility through data matching
  1. Secretary of State driver's license and state identification data
  2. Social Security Administration data
  3. Automated Wage Verification System data
  4. DHS' SNAP and cash assistance data
  5. HFS' child support data
  6. IL Department of Revenue tax records
  7. The Work Number – Income verification service vendor
  • State enhanced the annual redetermination process with assistance from Maximus

IL Medicaid Redetermination Project: Phase I

  • 234,000 clients (148,000 cases) removed from Medicaid – mainly between March and December 2013
  • Maximus reviews focused on clients receiving Medicaid, but not other types of assistance
  • Cases reviewed by priority order – based on likelihood client would be found ineligible
  • Resulting cancellation rate was 41%
  1. Most cases were cancelled due to lack of response to the initial redetermination letter
  2. 33% of clients cancelled returned to Medicaid within 3 months of cancellation – when they presented required information for eligibility

IL Medicaid Redetermination Project: Phase II

  • HFS and DHS have worked to reorganize the redetermination project to be compliant with AFSCME arbitration resolution and SMART Act
  • DHS has hired and trained additional caseworkers and support personnel to staff two main redetermination hubs
  • Maximus continues to staff call center, mail room and provides needed software
  • In February and March 2014, 35,994 cases were reviewed – 50.6% were cancelled
  1. 83% were cancelled due to lack of response

Office of Inspector General

  • OIG's mission is to prevent, detect and eliminate fraud, waste, abuse, mismanagement and misconduct
  • Fraud Prevention Investigation (FPI) program ensures only those eligible for Medicaid receive benefits
  • Long-Term Care Asset Discovery Investigations (LTC-ADI) uncover undisclosed assets and improper asset transfers
  • OIG collects overpayments and seeks sanctions of providers through audits, peer reviews, civil/criminal investigations and advanced data mining
  • Preliminary results in CY2013 are $121m in cost avoidance, cost savings and recoupments – up from $90m in CY 2012

Facts & Figures

 

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