We promote and protect the

health and safety of Idahoans.

1
Joint Finance-Appropriations Committee
Division of Medicaid
Medicaid Administration

Leslie Clement
Administrator

January 19, 2010
We promote and protect the
health and safety of Idahoans.
2
Division as Component of DHW

Medicaid
$1,656 Million
79.1%
Family and Community
Services
$99.8 Million
4.8%
Behavioral Health
$95.2 Million
4.5%
Public Health
$84 Million
4.0%
Support Services
$34 Million
1.6%
Welfare
$125.4 Million
6.0%
Medically Indigent
$0.1 Million
0.01%
We promote and protect the
health and safety of Idahoans.
Coordinated Plan
$479.7 Million
29.0%
Enhanced Plan
$663.5 Million
40.0%
Basic Plan
$449.5 Million
27.2%
Medicaid Administration
$62.8 Million
3.8%
3
Administrative Overhead at 3.8%
We promote and protect the
health and safety of Idahoans.
4
Administrative Cost Components
Personnel
$17.7 Million
28.1%
Operating and Capital
$42.2 Million
67.2%
Trustee and Benefits
$2.9 Million
4.7%
We promote and protect the
health and safety of Idahoans.
5
Funding Sources
$6.6 M
$11.1 M
$9.8 M
$26.3 M
$6.1 M
$1.3 M
$1.1 M

Personnel Operating Trustee and Benefits
Receipts
Dedicated Funds
Federal Funds
General Funds
Total Funds
$17.7 Million
28.1%
Total Funds
$42.2 Million
67.2%
Total Funds
$2.9 Million
4.7%
Federal Funds -
$1.6 Million
We promote and protect the
health and safety of Idahoans.
6
Holdback Impacts
Federal Funds
$712,800
General Funds
$711,800
We promote and protect the
health and safety of Idahoans.
7
Funding Source History
$13.9 M
$25.3 M
$3.4 M
$16.7 M
$38.5 M
$6.0 M
$17.0 M
$45.6 M
$6.0 M
$17.8 M
$38.8 M
$6.0 M
SFY 2008 Expenses SFY 2009 Expenses SFY 2010 Estimated
Expenses
SFY 2011
Recommendation
Receipts
Dedicated Funds
Federal Funds - ARRA
Federal Funds
General Funds
Total Funds
$42.8 Million
Total Funds
$61.4 Million
Total Funds
$68.8 Million
Total Funds
$62.8 Million
Dedicated Funds for all
years - $0.2 Million
We promote and protect the
health and safety of Idahoans.
8
Focus on cost containment measures.

Medicaid personnel and contractors
role is to effectively and efficiently
manage benefits while preserving
quality and access.
Legislative Intent Status
We promote and protect the
health and safety of Idahoans.
9
Chart of Initiatives
Strategy Status
Cost sharing Pending rules approval
Managed Care contracts New rates; new RFP posted
Transportation Brokerage Reviewing RFP responses
Utilization Management RFP posted
Institutional cost drivers Negotiating pricing changes
Premium Assistance Waiver amendment initiated
National Accreditation Implemented for DDAs
Assessment Provider Streamlined; reduced
contract
We promote and protect the
health and safety of Idahoans.
10
Reduce waste, fraud, and abuse
DHW Medicaid Program Integrity Unit
AGs Medicaid Fraud Control Unit
Licensing, certification, & complaint
follow-up activities
Quality Assurance reviews
State and federal audits
New MMIS System: Enhanced editing &
auditing capabilities
Management Strategies to Control Costs
We promote and protect the
health and safety of Idahoans.
11
MMIS Operations LBB page 2-56
Decision Unit 12.01
Planned implementation of June 2010
Full year of new system operations


Description Total Funds General Funds Federal Funds
Contracted
Mailing
expenses (50%)
$220,000 $110,000 $110,000
Claims System
contracts (75%)
$5,428,800 $1,357,200 $4,071,600
Total on-going
Request
$5,648,800 $1,467,200 $4,181,600
We promote and protect the
health and safety of Idahoans.
12
MMIS certification LBB page 2-56
Decision Unit 12.02
One-time funding
Contractual payment made to vendors for
successful completion of required certification

Description Total Funds General Funds Federal Funds
MMIS
Certification
$3,847,600 $961,900 $2,885,700
Total One-
time Request
$3,847,600 $961,900 $2,885,700
We promote and protect the
health and safety of Idahoans.
3
rd
Party Recovery Funding LBB page 2-56
Loss of AG position to holdbacks
Governor restored funding to operating to
obtain these legal services in 2011
Results in cost avoidance of >$700,000 in
trustee & benefits payments.

Operating Total
General
Funds
Federal Funds
Legal recovery
costs
$150,000 $75,000 $75,000
We promote and protect the
health and safety of Idahoans.
14
Administration Budget Recommendation
Medicaid
Administration
2010
Appropriation
2011 Governors
Recommendation
FTP 283 284
Personnel $18,462,500
GF: $6,817,500
$17,666,800
GF: $6,648,600
Operating $47,455,100
GF: $9,022,900
$42,222,200
GF: $9,827,400
Capitol $0 $0
Trustee & Benefits $2,949,600
GF: $1,311,000
$2,949,600
GF: $1,311,000
Total $68,867,200
GF: $17,151,400
$62,838,600
GF: $17,787,000
We promote and protect the
health and safety of Idahoans.
15
We promote and protect the
health and safety of Idahoans.
16
Joint Finance-Appropriations Committee
Division of Medicaid
Medicaid Trustee & Benefits Payments

Leslie Clement
Administrator

January 19, 2010

We promote and protect the
health and safety of Idahoans.
17
Division as Component of DHW Spending
Medicaid
$1,656 Million
79.1%
Family and Community
Services
$99.8 Million
4.8%
Behavioral Health
$95.2 Million
4.5%
Public Health
$84 Million
4.0%
Support Services
$34 Million
1.6%
Welfare
$125.4 Million
6.0%
Medically Indigent
$0.1 Million
0.01%
We promote and protect the
health and safety of Idahoans.
18
Provider Payments 96.2 % of Total
Coordinated Plan
$479.7 Million
29.0%
Enhanced Plan
$663.5 Million
40.0%
Basic Plan
$449.5 Million
27.2%
Medicaid Administration
$62.8 Million
3.8%
We promote and protect the
health and safety of Idahoans.
19
Provider Payments by Plan
Basic Plan
Trustee and Benefits
$449.5 Million
28.2%
Enhanced Plan
Trustee and Benefits
$663.5 Million
41.7%
Coordinated Plan
Trustee and Benefits
$479.7 Million
30.1%
We promote and protect the
health and safety of Idahoans.
2011 Per Enrollee Per Month
Basic Enhanced Coordinated
Cost of Adults
$680 $1,900 $1,500
Number of
Adults
17,000 25,000 15,000
Costs of
Children
$178 $1,300 n/a
Number of
Children
137,000 22,000 0
Average $
per Plan
$232 $1,600 $1,500
Total
Enrollees
$154,000 47,000 15,000
We promote and protect the
health and safety of Idahoans.
Current Enrollment by Location
Region Enrollment
1 25,268
2 11,479
3 44,217
4 40,982
5 27,526
6 24,471
7 28,210
Total 202,153
We promote and protect the
health and safety of Idahoans.
22
Funding Sources

$319.0 M
$1,107.7 M
$86.0 M
$80.0 M
Trustee and Benefits
Receipts
Dedicated Funds
Federal Funds
General Funds
Total Funds
$1,592.7 Million
We promote and protect the
health and safety of Idahoans.
23
Federal Funds
$62.3 Million
General Funds
$35.2 Million
Holdback Impacts
We promote and protect the
health and safety of Idahoans.
Permanent Holdback & Adjustments
Plans
Total
Funds
General
Fund
Dedicated
Fund
Federal
Fund
Coordinated
Page 2-59
<$6.9>

<$1.4> <$5.5>
Enhanced
Page 2-62
<$39.5>

<$10.3> $2.6 <$31.8>
Basic
Page 2-65
<$2.0>

< $ .4> <$1.6>
Totals
<$48.3>

<$12.1> $2.6 <$38.9>
We promote and protect the
health and safety of Idahoans.
Impact of Holdbacks on Providers
Provider Type Holdback % of total
Hospitals $16.2 29%
Long-term Care $ 8.4 15%
Pharmacy $ 2.2 4%
Mental Health $ 7.0 12.5%
Medical/Dental $ 7.0 13%
Developmental Disability
Services
$ 7.0 12.5%
Other $ 7.0 12.5%
All Providers $54.8 M Total $11.4 General Funds
We promote and protect the
health and safety of Idahoans.
26
History of Funding
$354.4 M
$822.2 M
$79.1 M
$310.8 M
$891.8 M
$82.4 M
$84.4 M
$293.2 M
$958.8 M
$117.6 M
$76.4 M
$319.0 M
$1,036.4 M
$71.3 M
$86.0 M
$80.0 M
SFY 2008 Expenses SFY 2009 Expenses SFY 2010 Estimated
Expenses
SFY 2011
Recommendation
Receipts
Dedicated Funds
Federal Funds - ARRA
Federal Funds
General Funds
Total Funds
$1,258.6 Million
Total Funds
$1,375.6 Million
Total Funds
$1,461.1 Million
Total Funds
$1,592.7 Million
Dedicated Funds
2008 - $2.9 Million
2009 - $6.2 Million
2010 - $15.1 Million
We promote and protect the
health and safety of Idahoans.
27
Focus on cost containment measures.

Medicaid personnel and contractors
role is to effectively and efficiently
manage benefits while preserving
quality and access.
Legislative Intent Status
We promote and protect the
health and safety of Idahoans.
28
Chart of Initiatives
Strategy Status
Cost sharing Pending rules approval
Managed Care contracts New rates; new RFP posted
Transportation Brokerage Reviewing RFP responses
Utilization Management RFP posted
Institutional cost drivers Negotiating pricing changes
Premium Assistance Waiver amendment initiated
National Accreditation Implemented for DDAs
Assessment Provider Streamlined; reduced
contract
We promote and protect the
health and safety of Idahoans.
29
Four primary avenues to control costs:
1. Reduce Prices
2. Limit/Eliminate Benefits
3. Limit/Eliminate Eligibility categories
4. Management
Cost Containment Strategies
We promote and protect the
health and safety of Idahoans.
30
Pricing
Federal law:
Imposes significant requirements
Sets certain provider rates
Requires that payment is consistent with
efficiency, economy, and quality of care.
Requires that payment must attract enough
providers so that Medicaid services are available
to the same extent as non-Medicaid services
States have some flexibility subject to approval
We promote and protect the
health and safety of Idahoans.
31
Benefits
Federal law:
Requires certain benefits
Requires states cover EPSDT
Requires certain standards
States have some flexibility:
Define scope, amount and duration

We promote and protect the
health and safety of Idahoans.
32
Eligibility- MOE
No changes permissible at this time
States cannot reduce eligibility and
receive the increased FMAP
Proposed health legislation
States cannot reduce eligibility for adults
until 12/2013; certain exceptions are
allowed for non-pregnant, non-disabled
adults
States cannot reduce eligibility for children
until 09/2019
We promote and protect the
health and safety of Idahoans.
33
Management Strategies
Improve:
Technology tools: front-end edits
Payment methodology
Assessment
Benefit Design
Utilization & case management
Communications
Sharing costs

We promote and protect the
health and safety of Idahoans.
2010 Forecasted Expenditures: Shortfall

Supplemental 4.31 LBB page 2-53
Plan
Total
Fund
General
Fund
Dedicated/
Other Fund
Federal
Fund
Basic
Page 2-65
$15.0 $2.8

<$1.1> $13.3
Enhanced
Page 2-62
$36.5

$7.6

<$ .7> $29.5
Coordinated
Page 2 -59
$13.1 $3.5 <$.3> $ 10.0
Total $64.6

$13.9

<$2.1> $52.8
We promote and protect the
health and safety of Idahoans.
35
Nursing Facility Provider Assessment

Supplemental 4.36 LBB page 2-59
Plan
Total
Fund
Dedicated
Fund
Federal
Fund
Coordinated $11.5 $2.4 $9.1
Total $11.5 $2.4 $9.1
We promote and protect the
health and safety of Idahoans.
36
Benefit Plan Maintenance LBB page 2-52
Plans
Total
Funds
General
Funds
Dedicated
Funds
Federal
Funds
Basic $32.4

$20.3 $.7 $11.4
Enhanced $72.4

$52.4 $1.9 $18.1

Coordinated $21.8

$21.9 $<.2> $.07
Total $126.9

$94.6 $2.4 $29.5
We promote and protect the
health and safety of Idahoans.
Mid-Year FMAP Change LBB page 2-52
Plan
Other State
Funds
Federal Fund
Basic $13.8 <$13.8>
Enhanced $39.8 <$39.8>
Coordinated $17.6 <$17.6>
Total $71.2 <$71.2>
We promote and protect the
health and safety of Idahoans.
38


..

Basic Plan Recommendation
Basic Plan
2010
Appropriation
2011
Recommendation
Enrollment 148,000 154,000
General Fund $63,375,900 $ 72,192,500
Dedicated Fund
Other Funds
$41,110,000
$ 23,789,700
$ 30,786,000
Federal Fund $299,607,300 $322,729,400
Total $404,093,200 $449,497,600
We promote and protect the
health and safety of Idahoans.
Enhanced Plan Recommendation
Enhanced Plan
2010
Appropriation
2011
Recommendation
Enrollment 45,400 47,400
General Fund $133,430,200 $145,184,000
Dedicated Fund
Other
$39,137,000
$ 42,080,900
$ 38,975,100
Federal Fund $421,460,900 $437,253,600
Total $594,028,100 $663,493,600
We promote and protect the
health and safety of Idahoans.
Coordinated Plan Recommendation
Coordinated
Plan
2010
Appropriation
2011
Recommendation
Enrollment 15,065 15,575
General Fund $95,220,770 $101,641,600
Dedicated Fund
Other
$10,922,500
$ 20,157,800
$ 10,226,700
Federal Fund $334,097,600 $347,667,700
Total Funds $440,240,800 $479,693,800
We promote and protect the
health and safety of Idahoans.
Questions?
Leslie Clement
clementl@dhw.idaho.gov
208-364-1804