MEDI-CAL NOVEMBER 2012 LOCAL ASSISTANCE ESTIMATE … · · 2017-08-22medi-cal november 2012 local assistance estimate for fiscal years 2012-13 and 2013-14 ... 34 hearing aid cap

MEDI-CAL NOVEMBER 2012

LOCAL ASSISTANCE ESTIMATE for

FISCAL YEARS 2012-13 and 2013-14

REGULAR POLICY CHANGES

Fiscal Forecasting and Data Management Branch State Department of Health Care Services

1501 Capitol Avenue, Suite 6069 Sacramento, CA 95814

(916) 552-8550

EDMUND G. BROWN JR.

Governor State of California

Diana Dooley Toby Douglas Secretary Director California Health and Human Services Agency Department of Health Care Services

November 2012 Medi-Cal EstimateCalifornia Department of Health Care Services

MEDI-CAL PROGRAM REGULARPOLICY CHANGE INDEX

POLICY CHANGENUMBER POLICY CHANGE TITLE

ELIGIBILITY

1 FAMILY PACT PROGRAM2 TRANSITION OF HFP TO MEDI-CAL3 BREAST AND CERVICAL CANCER TREATMENT4 CHDP GATEWAY - PREENROLLMENT5 MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATES6 BRIDGE TO HFP7 REFUGEES8 MEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATES9 MCHA VS. DHCS AND MRMIB10 LANTERMAN DEVELOPMENTAL CENTER CLOSURE11 250% WORKING DISABLED PROGRAM CHANGES12 LOMELI V. SHEWRY13 CHIPRA - M/C FOR CHILDREN & PREGNANT WOMEN14 NEW QUALIFIED ALIENS15 RESOURCE DISREGARD - % PROGRAM CHILDREN16 PARIS-FEDERAL17 PARIS - VETERANS MATCH18 PARIS-INTERSTATE

AFFORDABLE CARE ACT

19 PRIVATE DSH REPLACEMENT PAYMENT REDUCTION20 DISPROPORTIONATE SHARE HOSPITAL REDUCTION21 RECOVERY AUDIT CONTRACTOR SAVINGS41 FEDERAL DRUG REBATE CHANGE51 MANAGED CARE DRUG REBATES136 PAYMENTS TO PRIMARY CARE PHYSICIANS138 NF-B RATE CHANGES173 COMMUNITY FIRST CHOICE OPTION

BENEFITS

22 ADDITIONAL SERVICES FOR HCBS CLIENTS23 LOCAL EDUCATION AGENCY (LEA) PROVIDERS24 MULTIPURPOSE SENIOR SERVICES PROGRAM-CDA25 CALIFORNIA COMMUNITY TRANSITIONS COSTS

PC Page 1Last Refresh Date: 12/31/2012




BENEFITS

26 MFP FUNDING TO CDDS AND CDSS FOR CCT27 DENSE BREAST NOTIFICATION SUPPLEMENTAL SCREENING28 SF COMMUNITY-LIVING SUPPORT BENEFIT WAIVER29 QUALITY OF LIFE SURVEYS FOR MFP30 FAMILY PACT RETROACTIVE ELIGIBILITY31 INCREASED FEDERAL MATCHING FUNDS FOR FPACT32 ADHC TRANSITION-BENEFITS33 SCHIP FUNDING FOR PRENATAL CARE34 HEARING AID CAP35 ELIMINATION OF OTC COUGH AND COLD PRODUCTS36 CERVICAL CANCER SCREENING37 PHYSICIAN AND CLINIC SEVEN VISIT SOFT CAP38 CALIFORNIA COMMUNITY TRANSITIONS SAVINGS39 COPAYMENT FOR NON-EMERGENCY ER VISITS

PHARMACY

42 KALYDECO FOR TREATMENT OF CYSTIC FIBROSIS43 NON FFP DRUGS44 BCCTP DRUG REBATES45 MEDICAL SUPPLY REBATES46 PHYSICIAN-ADMINISTERED DRUG REIMBURSEMENT47 FAMILY PACT DRUG REBATES48 AGED AND DISPUTED DRUG REBATES49 STATE SUPPLEMENTAL DRUG REBATES50 LITIGATION SETTLEMENTS52 FEDERAL DRUG REBATE PROGRAM

DRUG MEDI-CAL

58 ANNUAL RATE ADJUSTMENT59 DRUG MEDI-CAL PROGRAM COST SETTLEMENT

MENTAL HEALTH

61 SPECIALTY MENTAL HEALTH SVCS SUPP REIMBURSEMENT62 HEALTHY FAMILIES - SED





MENTAL HEALTH

63 KATIE A. V. DIANA BONTA64 TRANSITION OF HFP - SMH SERVICES65 SOLANO COUNTY66 OVER ONE-YEAR CLAIMS67 SPECIALTY MENTAL HEALTH LAWSUIT68 SISKIYOU COUNTY MENTAL HEALTH PLAN OVERPAYMENT69 IMD ANCILLARY SERVICES70 REIMBURSEMENT IN IMD ANCILLARY SERVICES COSTS71 CHART REVIEW72 INTERIM AND FINAL COST SETTLEMENTS - SMHS204 ELIMINATION OF STATE MAXIMUM RATES

WAIVER--MH/UCD & BTR

73 BTR - LIHP - MCE74 MH/UCD & BTRDSH PAYMENT75 BTR DPH DELIVERY SYSTEM REFORM INCENTIVE POOL76 MH/UCD & BTRPRIVATE HOSPITAL DSH REPLACEMENT77 BTRSAFETY NET CARE POOL 78 BTRLOW INCOME HEALTH PROGRAM - HCCI79 MH/UCD & BTRPRIVATE HOSPITAL SUPPLEMENTAL PAYMENT80 LIHP MCE OUT-OF-NETWORK EMERGENCY CARE SVS FUND81 BTRINCREASE SAFETY NET CARE POOL82 MH/UCD & BTRDPH & NDPH PHYSICIAN & NON-PHYS. COST83 MH/UCDSTABILIZATION FUNDING84 MH/UCDDPH INTERIM & FINAL RECONS85 NDPH DELIVERY SYSTEM REFORM INCENTIVE POOL 86 BTR LIHP INPATIENT HOSP. COSTS FOR CDCR INMATES87 MH/UCD & BTRCCS AND GHPP88 BTR - LIHP - DSRIP HIV TRANSITION PROJECTS89 MH/UCD & BTRDPH INTERIM RATE GROWTH90 MH/UCDSAFETY NET CARE POOL91 NDPH SAFETY NET CARE POOL 92 MH/UCDHEALTH CARE COVERAGE INITIATIVE93 BTRDESIGNATED STATE HEALTH PROGRAMS94 MH/UCD & BTRNDPH SUPPLEMENTAL PAYMENT95 MH/UCDDISTRESSED HOSPITAL FUND





WAIVER--MH/UCD & BTR

96 MH/UCD & BTRMIA-LTC97 MH/UCD & BTRBCCTP98 MH/UCD & BTRDPH INTERIM RATE99 MH/UCDFEDERAL FLEX. & STABILIZATION - SNCP ARRA100 BTRINCREASE DESIGNATED STATE HEALTH PROGRAMS101 DRG - INPATIENT HOSPITAL PAYMENT METHODOLOGY102 ELIMINATE NDPH SUPPLEMENTAL PAYMENT103 MH/UCDFEDERAL FLEX. & STABILIZATION-SNCP104 ELIMINATE NDPH IGT SUPPLEMENTAL PAYMENTS105 NDPH IP FFS PAYMENT METHODOLOGY CHANGE106 HOSPITAL STABILIZATION 107 BTRHEALTH CARE COVERAGE INITIATIVE ROLLOVER FUNDS

MANAGED CARE

111 MANAGED CARE PUBLIC HOSPITAL IGTS112 MANAGED CARE RATE RANGE IGTS113 TRANSFER OF IHSS COSTS TO CDSS114 RETRO MC RATE ADJUSTMENTS FOR FY 2011-12116 MANAGED CARE COST BASED REIMBURSEMENT CLINICS120 INCREASE IN CAPITATION RATES FOR GROSS PREMIUM TAX121 NOTICES OF DISPUTE/ADMINISTRATIVE APPEALS123 CAPITATED RATE ADJUSTMENT FOR FY 2013-14125 MANAGED CARE IGT ADMIN. & PROCESSING FEE126 GENERAL FUND REIMBURSEMENTS FROM DPHS127 FUNDING ADJUSTMENT OF GROSS PREMIUM TAX TO GF128 FFS COSTS FOR MANAGED CARE ENROLLEES129 SCAN TRANSITION TO MANAGED CARE130 DISCONTINUE UNDOCUMENTED BENEFICIARIES FROM PHC131 MANAGED CARE DEFAULT ASSIGNMENT132 MANAGED CARE EXPANSION TO RURAL COUNTIES133 POTENTIALLY PREVENTABLE ADMISSIONS134 ALIGN MANAGED CARE BENEFIT POLICIES135 TRANSITION OF DUAL ELIGIBLES-LONG TERM CARE207 EXTEND GROSS PREMIUM TAX - INCR. CAPITATION RATES208 EXTEND GROSS PREMIUM TAX-FUNDING ADJUSTMENT209 EXTEND GROSS PREMIUM TAX





MANAGED CARE

212 STABLE ENROLLMENT PROGRAM213 MANAGED CARE EFFICIENCIES214 TRANSITION OF DUAL ELIGIBLES-MANAGED CARE PAYMENTS215 CCI-IHSS FUNDING ADJUSTMENT

PROVIDER RATES

137 FQHC/RHC/CBRC RECONCILIATION PROCESS139 10% PYMT REDUCTION RESTORATION FOR AB 1629 FAC.140 LTC RATE ADJUSTMENT141 AB 1629 RATE ADJUSTMENTS DUE TO QA FEE INCREASE142 AIR AMBULANCE MEDICAL TRANSPORTATION143 ANNUAL MEI INCREASE FOR FQHCS/RHCS144 HOSPICE RATE INCREASES145 QUALITY AND ACCOUNTABILITY PAYMENTS PROGRAM146 SB 90 PRESERVING CONTRACT HOSPITALS147 DENTAL RETROACTIVE RATE CHANGES148 LABORATORY RATE METHDOLOGY CHANGE149 REDUCTION TO RADIOLOGY RATES 150 NON-AB 1629 LTC RATE FREEZE151 ELIMINATE 2012-13 RATE INCREASE & SUPP. PAYMENT 152 10% PAYMENT REDUCTION FOR LTC FACILITIES153 10% PROVIDER PAYMENT REDUCTION

SUPPLEMENTAL PMNTS.

154 HOSPITAL QAF - HOSPITAL PAYMENTS155 HOSPITAL OUTPATIENT SUPPLEMENTAL PAYMENT156 FFP FOR LOCAL TRAUMA CENTERS157 FREESTANDING CLINICS SUPPLEMENTAL PAYMENTS158 CAPITAL PROJECT DEBT REIMBURSEMENT159 NDPH IGT SUPPLEMENTAL PAYMENTS160 CERTIFICATION PAYMENTS FOR DP-NFS161 IGT FOR NON-SB 1100 HOSPITALS162 MEDI-CAL REIMBURSEMENTS FOR OUTPATIENT DSH163 MEDI-CAL REIMBURSEMENTS FOR OUTPATIENT SRH164 STATE VETERANS' HOMES SUPPLEMENTAL PAYMENTS





SUPPLEMENTAL PMNTS.

165 GEMT SUPPLEMENTAL PAYMENT PROGRAM203 HOSPITAL QAF PROGRAM CHANGES206 EXTEND HOSPITAL QAF - HOSPITAL PAYMENTS

OTHER

170 ARRA HITECH - PROVIDER PAYMENTS171 AB 97 INJUNCTIONS174 ICF-DD TRANSPORTATION AND DAY CARE COSTS- CDDS180 AUDIT SETTLEMENTS181 CDDS DENTAL SERVICES182 ICF-DD ADMIN. AND QA FEE REIMBURSEMENT - CDDS183 NONCONTRACT HOSP INPATIENT COST SETTLEMENTS186 INDIAN HEALTH SERVICES188 CIGARETTE AND TOBACCO SURTAX FUNDS189 CLPP FUNDS190 HOSPITAL QAF - CHILDREN'S HEALTH CARE191 FIRST 5 CALIFORNIA FUNDING 192 TRANSFER OF IHSS COSTS TO DHCS193 OPERATIONAL FLEXIBILITIES194 FI COST CONTAINMENT PROJECTS195 OVERPAYMENTS - INTEREST RATE CHANGE196 MEDICARE BUY-IN QUALITY REVIEW PROJECT197 ANTI-FRAUD ACTIVITIES FOR PHARMACY AND PHYSICIANS198 TRANSITION OF DUAL ELIGIBLES - MEDICARE SAVINGS199 FQHC/RHC AUDIT STAFFING200 REDUCTION IN IHSS AUTHORIZED HOURS201 3.6% IHSS REDUCTION205 EXTEND HOSPITAL QAF - CHILDREN'S HEALTH CARE


FULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDSFULL YEAR COST - TOTAL FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS- STATE FUNDS

PAYMENT LAGPAYMENT LAGPAYMENT LAGPAYMENT LAG% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE% REFLECTED IN BASE

APPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASEAPPLIED TO BASE TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS TOTAL FUNDS

STATE FUNDSSTATE FUNDSSTATE FUNDSSTATE FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDSFEDERAL FUNDS

FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$617,121,000$617,121,000$617,121,000$617,121,000

0.00 %0.00 %0.00 %0.00 %

$462,704,100$462,704,100$462,704,100$462,704,100$154,416,900$154,416,900$154,416,900$154,416,900

$154,416,900$154,416,900$154,416,900$154,416,900$617,121,000$617,121,000$617,121,000$617,121,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$598,091,000$598,091,000$598,091,000$598,091,000

0.00 %0.00 %0.00 %0.00 %

$448,435,700$448,435,700$448,435,700$448,435,700$149,655,300$149,655,300$149,655,300$149,655,300

$149,655,300$149,655,300$149,655,300$149,655,300$598,091,000$598,091,000$598,091,000$598,091,000

Purpose:ThispolicychangeestimatesthecostsoffamilyplanningservicesprovidedbytheFamilyPlanning,Access,Care,andTreatment(PACT)program.Authority:Welfare&InstitutionsCode14132(aa)InterdependentPolicyChanges:NotApplicableBackground:EffectiveJanuary1,1997,familyplanningserviceswereexpandedundertheFamilyPACTprogramtoprovidecontraceptiveservicestomorepersonsinneedofsuchserviceswhohaveincomesunder200%ofFederalPovertyLevel.ASection1115demonstrationprojectwaiverwasapprovedbyCentersforMedicare&MedicaidServices(CMS)effectiveDecember1,1999.AStatePlanAmendment(SPA)wasapprovedonMarch24,2011,inaccordancewiththeAffordableCareAct,totransitionthecurrentFamilyPACTWaiverintotheStatePlan.UndertheSPA,eligiblefamilyplanningservicesandsuppliesformerlyreimbursedexclusivelywith100%StateGeneralFundreceivea90%federalfinancialparticipation(FFP),andfamilyplanningrelatedservicesreceivereimbursementatTitleXIX50/50FFP.DrugrebatesforFamilyPACTdrugsareincludedintheFamilyPACTDrugRebateProgrampolicychange.ReasonforChangefromPriorEstimate:Revisedbasedonadditionaldata.Methodology:1.Familyplanningservicesandtestingforsexuallytransmittedinfections(STIs)areeligiblefor90%

FFP.

DESCRIPTIONDESCRIPTIONDESCRIPTIONDESCRIPTION

FAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAM

REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:REGULAR POLICY CHANGE NUMBER:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:IMPLEMENTATION DATE:ANALYST:ANALYST:ANALYST:ANALYST:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:FISCAL REFERENCE NUMBER:

Randolph AlarcioRandolph AlarcioRandolph AlarcioRandolph Alarcio1/19971/19971/19971/1997

1111

1111

California Department of Health Care Services November 2012 Medi-Cal Estimate

Last Refresh Date: 12/31/2012 PC Page 7

2.ThetreatmentofSTIsandotherfamilyplanningcompanionservicesareeligibleforTitleXIX50/50

FFP.

3.ThetreatmentofothermedicalconditionsincludinginpatientcareforcomplicationsfromfamilyplanningservicesarenoteligibleforFFP.

4.Itisassumedthat13.95%oftheFamilyPACTpopulationareundocumentedpersonsandarebudgetedat100%GF.

Funding:TitleXIX50/50FFP(42601010001/0890)GF(42601010001)TitleXIX10/90FFP(42601010001/0890)

FY201213 FY201314 ServiceCategory TF GF TF GFPhysicians $87,188,000 $21,816,000 $91,071,000 $22,788,000OtherMedical $348,299,000 $87,152,000 $354,503,000 $88,704,000CountyOutpatient $4,111,000 $1,029,000 $4,275,000 $1,070,000CommunityOutpatient $4,496,000 $1,125,000 $4,666,000 $1,168,000Pharmacy $153,997,000 $38,533,000 $162,606,000 $40,687,000Total $598,091,000 $149,655,000 $617,121,000 $154,417,000

FAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAMFAMILY PACT PROGRAMREGULAR POLICY CHANGE NUMBER: 1REGULAR POLICY CHANGE NUMBER: 1REGULAR POLICY CHANGE NUMBER: 1REGULAR POLICY CHANGE NUMBER: 1







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$1,088,132,000$1,088,132,000$1,088,132,000$1,088,132,000

0.00 %0.00 %0.00 %0.00 %

$707,285,800$707,285,800$707,285,800$707,285,800$380,846,200$380,846,200$380,846,200$380,846,200

$380,846,200$380,846,200$380,846,200$380,846,200$1,088,132,000$1,088,132,000$1,088,132,000$1,088,132,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$244,519,000$244,519,000$244,519,000$244,519,000

0.00 %0.00 %0.00 %0.00 %

$158,937,350$158,937,350$158,937,350$158,937,350$85,581,650$85,581,650$85,581,650$85,581,650

$85,581,650$85,581,650$85,581,650$85,581,650$244,519,000$244,519,000$244,519,000$244,519,000

Purpose:ThispolicychangeestimatesthebenefitscostassociatedwithtransitioningtheHealthyFamiliesProgram(HFP)subscribersintotheMediCalprogram.Authority:AB1494(Chapter28,Statutesof2012)InterdependentPolicyChanges:CA7TransitionofHealthyFamiliesChildrentoMediCalOA13TransitionofHFPtoMediCalPC64TransitionofHFPSMHServicesPC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:AB1494shiftsallHFPsubscribersintotheMediCalprogram.BeginningJanuary2013,aninemonthtransitionofsubscriberswilltakeplace.Childrenover150%ofthefederalpovertylevel(FPL)willcontinuetoberequiredtopayapremiumforcoverage.TheadministrativecostsassociatedwiththischangearebudgetedseparatelyintheTransitionofHFPtoMediCalpolicychangesunderCountyAdministrationandOtherAdministrationsectionoftheMediCalEstimate.Inaddition,postageandprintingcostsrelatedtothetransitionarebudgetedseparatelyintheHealthCareOption(HCO)section.AllsavingsrelatedtotheTransitionofHFPtoMediCalwillbereflectedintheManagedRiskMedicalInsuranceBoard(MRMIB)budget.ReasonforChangefromPriorEstimate:TheHFPcaseloadandphaseinstructurewereupdated.Additionally,thescheduledtransitionofHFPchildrentoMediCalwasdelayedfromOctober1,2012toJanuary1,2013.


TRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CAL


Ryan WitzRyan WitzRyan WitzRyan Witz1/20131/20131/20131/2013

1511151115111511

2222



Methodology:1.BeginningJanuary1,2013,871,027subscriberswillbetransferredtoMediCal.Thisdoesnot

include3,997AIMinfantswithincomesbetween250300%FPL,whichwillnottransitiontoMediCal.ItisassumedtheHFPcaseloadwillexperience0.30%ofannualgrowthinFY201314.

2.TheseeligibleswillbeenrolledintomanagedcareplansinthosecountiesthathaveCounty

OrganizedHealthSystems,GeographicManagedCare,ortheTwoPlanModel.3.TheshiftofHFPsubscribersintotheMediCalprogramwilloccurinfourseparatephases.Thefirst

phasewillbesplitintothreephasestransitioningJanuary1,2013,March1,2013andApril1,2013,forallHFPsubscriberscurrentlyenrolledinamanagedcareplanthatalsocontractsdirectlywiththeDepartment.ThesecondphasewilltransitiononApril1,2013,forallHFPsubscriberscurrentlyenrolledinamanagedcareplanthatsubcontractswithaMediCalmanagedcareplan.Thethirdphasewilltransitionover3months(August1,2013toOctober31,2013)forallHFPsubscribersinamanagedcarecountythatwerenottransitionedinPhase1orPhase2.ThefourthphasewilltransitiononSeptember1,2013,forallremainingHFPsubscribers.

4.TheweightedaveragemonthlycostofbenefitsforthesesubscribersundertheMediCalprogramis

estimatedtobe$87.08.Thisincludesmanagedcarecapitationpayments,FFScosts,managedcarecarveouts,FederallyQualifiedHealthCenter(FQHC)wraparoundpaymentsanddentalpayments(excludingCaliforniaChildrenServices(CCS).

5.Premiumsonlywillbeassessedforsubscribersover150%ofFederalPovertyLevel(FPL)atthe

HFPCommunityProviderPlan(CPP)premiumlevel.Premiumsareestimatedtototal$17,926,000inFY201213and$66,191,000inFY201314.

6.Ofthe871,027subscribers,thereareanestimated6,406CCSHFPeligiblesthatwillshifttoCCS

MediCalinFY201213,and23,585inFY201314.ThecostfortheseeligiblesiscurrentlybudgetedintheFamilyHealthEstimate.CCSHFPisfundedwith65%FFP,17.5%GF,and17.5%countyfunds.ItisassumedthatthecountysharewillcontinueunderMediCal.TheGFreimbursementfromthecountiesforCCSMediCalisestimatedtobe$1,395,000inFY201213and$27,100,000inFY201314.

7.EnhancedfederalfundingunderTitleXXIisavailableforthesesubscribersenrolledinMediCal.8.Thispolicychangeincludes$7,222,000TF($2,528,000GF)inFY201213and$14,795,000TF

($5,178,000GF)inFY201314forbenefitcoststhatwerepartoftheBridgetoHFPpolicychange.

(InThousands) CountyFY201213 TF GF Reimbursement*OtherServices $245,257 $85,840 CCS $9,966 $2,093 $1,395BridgetoHFP $7,222 $2,528 BenefitsTotal $262,445 $90,461 $1,395Premiums $17,926 $6,274 Net $244,519 $84,187 $1,395

TRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALREGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2



Funding:TitleXXI65/35FFP(42601130001/0890)ReimbursementGF(42606100995)*

(InThousands) CountyFY201314 TF GF Reimbursement*OtherServices $945,958 $331,085 CCS $193,570 $40,650 $27,100BridgetoHFP $14,795 $5,178 BenefitsTotal $1,154,323 $376,913 $27,100Premiums $66,191 $23,167 Net $1,088,132 $353,746 $27,100

TRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALTRANSITION OF HFP TO MEDI-CALREGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2REGULAR POLICY CHANGE NUMBER: 2







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$143,082,000$143,082,000$143,082,000$143,082,000

0.00 %0.00 %0.00 %0.00 %

$81,034,200$81,034,200$81,034,200$81,034,200$62,047,800$62,047,800$62,047,800$62,047,800

$62,047,800$62,047,800$62,047,800$62,047,800$143,082,000$143,082,000$143,082,000$143,082,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$140,364,000$140,364,000$140,364,000$140,364,000

0.00 %0.00 %0.00 %0.00 %

$79,571,050$79,571,050$79,571,050$79,571,050$60,792,950$60,792,950$60,792,950$60,792,950

$60,792,950$60,792,950$60,792,950$60,792,950$140,364,000$140,364,000$140,364,000$140,364,000

Purpose:Thispolicychangeestimatesthefeeforservice(FFS)costsoftheBreastandCervicalCancerTreatmentProgram(BCCTP).Authority:AB430(Chapter171,Statutesof2001)InterdependentPolicyChanges:NotApplicableBackground:AB430authorizedtheBCCTPeffectiveJanuary1,2002,forwomenunder200%ofthefederalpovertylevel(FPL).EnhancedTitleXIXMedicaidfunds(35%GF/65%FFP)maybeclaimedunderthefederalMedicaidBreastandCervicalCancerTreatmentActof2000(P.L.106354)forcancertreatmentandfullscopeMediCalbenefitsforwomenunderage65whoarecitizensorlegalimmigrantswithnootherhealthcoverage.AStateOnlyprogramcoverswomenaged65orolderregardlessofimmigrationstatus,individualswhoareunderinsured,undocumentedwomen,andmalesforcancertreatmentonly.Thecoveragetermis18monthsforbreastcancerand24monthsforcervicalcancer.EstimatedStateOnlycostsincludeundocumentedpersonsnonemergencyservicesduringcancertreatment.BeneficiariesarescreenedthroughCentersforDiseaseControl(CDC)andFamilyPACTproviders.ReasonforChangefromPriorEstimate:ProjectedexpendituresincreasedduetoasmallgrowthinFY201112caseloaddata.Methodology:1.Therewere10,550FFSand2,594managedcareeligiblesasofAugust2012(totalof13,144).

2,649oftheFFSeligibleswereeligibleforStateOnlyservices.


BREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENT



3333

3333



2.610oftheFFSeligibleswereinAcceleratedEnrollmentasofAugust2012.3.AssumetheStatewillpayMedicareandotherhealthcoveragepremiumsforanaverageof361

beneficiariesmonthlyinFY201213andFY201314.Assumeanaveragemonthlypremiumcostperbeneficiaryof$250.59.

FY201213:361x$250.59x12months=$1,086,000*TF($1,086,000GF)*RoundedFY201314:361x$250.59x12months=$1,086,000*TF($1,086,000GF)*Rounded

4.FFScostsareestimatedasfollows:

5.ManagedCarecostsassociatedwiththeBCCTParebudgetedintheTwoPlan,CountyOrganized

HealthSystems(COHS),andGeographicManagedCare(GMC)policychanges.6.FederalreimbursementforaportionofStateOnlyBCCTPcostsbasedonthecertificationofpublic

expendituresisbudgetedinthepolicychangeMH/UCDBCCTP.Funding:

(Rounded) FY201213 FY201314 TF GF TF GFFullScopeCosts $122,417,000 $42,846,000 $124,668,000 $43,634,000StateOnlyCosts Services $16,861,000 $16,861,000 $17,328,000 $17,328,000Premiums $1,086,000 $1,086,000 $1,086,000 $1,086,000Total $140,364,000 $60,793,000 $143,082,000 $62,048,000

FY201213: GF FF TFGeneralFund 4260101001 $17,947,000 $0 $17,947,000TitleXIX35/65FFP 42601010001/0890 $42,846,000 $79,571,000 $122,417,000Total $60,793,000 $79,571,000 $140,364,000 FY201314: GF FF TFGeneralFund 4260101001 $18,414,000 $0 $18,414,000TitleXIX35/65FFP 42601010001/0890 $43,634,000 $81,034,000 $124,668,000Total $62,048,000 $81,034,000 $143,082,000

BREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTBREAST AND CERVICAL CANCER TREATMENTREGULAR POLICY CHANGE NUMBER: 3REGULAR POLICY CHANGE NUMBER: 3REGULAR POLICY CHANGE NUMBER: 3REGULAR POLICY CHANGE NUMBER: 3







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$14,178,000$14,178,000$14,178,000$14,178,000

0.00 %0.00 %0.00 %0.00 %

$9,215,700$9,215,700$9,215,700$9,215,700$4,962,300$4,962,300$4,962,300$4,962,300

$4,962,300$4,962,300$4,962,300$4,962,300$14,178,000$14,178,000$14,178,000$14,178,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$13,886,000$13,886,000$13,886,000$13,886,000

0.00 %0.00 %0.00 %0.00 %

$9,025,900$9,025,900$9,025,900$9,025,900$4,860,100$4,860,100$4,860,100$4,860,100

$4,860,100$4,860,100$4,860,100$4,860,100$13,886,000$13,886,000$13,886,000$13,886,000

Purpose:Thispolicychangeestimatesthecostofprovidingpreenrollment(PE)intotheHealthyFamiliesProgram(HFP)forchildrenwhoreceiveaChildrensHealthandDisabilityProgram(CHDP)screening.Authority:Welfare&InstitutionsCode,section14011.7AB442(Chapter1161,Statutesof2002)InterdependentPolicyChanges:NotApplicableBackground:TheCHDPGatewayprogramwasimplementedJuly1,2003.ChildrenwhoreceiveaCHDPscreenreceivePEintoMediCalortheHFP.PEprovidesaminimumof2monthsoffullscopecoverage,duringwhichthefamilymayapplyforongoingMediCalorHFPcoverage.ThestatefundedCHDPprogramcontinuestoprovidescreenstochildreneligibleforlimitedscopeMediCal.TheMediCalPEiscapturedintheMedicallyIndigentChildrenaidcode,whichisincorporatedinthebaseestimate.EffectiveJanuary2013,theHFPwillceasetoenrollnewapplicantsandwillbephasedoutoveraninemonthperiod.ChildrenenrolledintheHFPwillbetransitionedtotheMediCalprogram,andchildrenreceivingascreenthroughtheCHDPGatewayprogramwillbepreenrolledintoMediCal.ReasonforChangefromPriorEstimate:UpdatedJune2009throughAugust2012dataoneligiblesforaidcode8X,andchangeinthephaseinfortheHFPtransitiontoMediCal.


CHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENT


Davonna McClendonDavonna McClendonDavonna McClendonDavonna McClendon7/20087/20087/20087/2008

8888

4444



Methodology:1.BasedonJune2009throughAugust2012eligibledatatherewillbe588,445children(35,529HFP,

33,873ShiftofHFPtoMediCal,478,283MediCaland40,760CHDPStateOnly)inFY201213and586,158children(70,864HFP,475,921MediCaland39,373CHDPStateOnly)inFY201314whowillbescreenedthroughtheGateway.

2.BasedonAugust2011throughJuly2012costdataandMay2011throughApril2012eligibledata,

thepermemberpermonth(PMPM)costforHFPPEis$200.10.3.BasedonAugust2011throughJuly2012costdataandMay2011throughApril2012eligibledata,

thePMPMcostforMediCalPEis$200.07.4.TheestimatedFY201112andFY201213HFPandMediCalPEcostsareasfollows:

*DuetotheShiftofHFPintoMediCal,HFPPEisbasedonsixmonthsofimpactinFY201213.TheothersixmonthsiscapturedintheShiftHFPtoMediCalPE.Funding:TitleXXI35/65FFP(42601130001/0890)TitleXIX50/50FFP(42601010001/0890)

Avg.Mo.

Eligibles

FY201213: TF GFHFPPE* 5,922 $7,109,000 $2,488,000ShiftHFPtoMediCalPE 5,645 $6,777,000 $3,389,000 $13,886,000 $5,877,000MediCalPE 39,857 $95,692,000 $47,846,000Total $109,578,000 $53,723,000 Avg.Mo.

Eligibles

FY201314 TF GFMediCalPE 39,660 $95,220,000 $47,610,000HFPPE 5,905 $14,178,000 $4,962,000Total $109,398,000 $52,572,000

CHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTCHDP GATEWAY - PREENROLLMENTREGULAR POLICY CHANGE NUMBER: 4REGULAR POLICY CHANGE NUMBER: 4REGULAR POLICY CHANGE NUMBER: 4REGULAR POLICY CHANGE NUMBER: 4







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$14,024,000$14,024,000$14,024,000$14,024,000

0.00 %0.00 %0.00 %0.00 %

$14,024,000$14,024,000$14,024,000$14,024,000$0$0$0$0

$0$0$0$0$14,024,000$14,024,000$14,024,000$14,024,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$9,149,000$9,149,000$9,149,000$9,149,000

0.00 %0.00 %0.00 %0.00 %

$9,149,000$9,149,000$9,149,000$9,149,000$0$0$0$0

$0$0$0$0$9,149,000$9,149,000$9,149,000$9,149,000

Purpose:ThispolicychangeestimatestheFederalFinancialParticipation(FFP)providedtotheCaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)andcountiesforthecostofinpatientservicesforinmateswhoaredeemedeligibleforMediCal.Authority:AB1628(Chapter729,Statutesof2010)SB1399(Chapter405,Statutesof2010)InterdependentPolicyChanges:NotapplicableBackground:AB1628authorizestheDepartment,counties,andtheCDCRtoclaimFFPforinpatienthospitalservicestoMediCalorLowIncomeHealthProgram(LIHP)eligibleadultinmatesinStateandcountycorrectionalfacilitieswhentheseservicesareprovidedoffthegroundsofthefacility.PreviouslytheseserviceswerepaidbyCDCRorthecounty.SB1399authorizestheBoardofParoleHearingstograntmedicalparoleormedicalprobationtopermanentlymedicallyincapacitatedStateorcountyinmates.Stateinmatesgrantedmedicalparoleandcountyinmatesgrantedmedicalprobation,arepotentiallyeligibleforMediCal.Whenastateinmateisgrantedmedicalparole,CDCRsubmitsaMediCalapplicationtotheDepartmenttodetermineeligibility.Whenacountyinmateisgrantedmedicalprobation,thecountyprocessesaMediCalapplicationandnotifiestheDepartment.PreviouslytheseserviceswerefundedthroughCDCRorthecountieswith100%GeneralFundorcountyfunds.CDCRwillutilizetheMediCalapplicationscurrentlyusedbycounties,andtheDepartmentmakesaneligibilitydeterminationaccordingtocurrentstandardeligibilityrules.FederalMedicaidregulationsandfederalguidanceprovidedtostatesallowforcoverageofinpatientservicestoeligibleinmateswhenprovidedinoffsitefacilities.TheDepartmentcurrentlyhasaninteragencyagreementwithCDCRinordertoclaimTitleXIXFFP.


MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATES



1569156915691569

5555



ReasonforChangefromPriorEstimate:Previously,thispolicychangeonlyestimatedinpatientcostsrelatedtoadultStateinmatesandmedicalparolees.Thispolicychangenowcoversinpatientcostsassociatedwithcountyadultinmatesandindividualsgrantedmedicalprobation.Inaddition,theestimatedmonthlynumberofMediCalapplicationsisnow72ratherthan125.Methodology:1.ImplementationofcoveragefortheStateinmatesbeganApril2012.Implementationofcoveragefor

countyinmateswillbeginJanuary1,2013.2.ApplicationsforMediCalareprocessedbytheDepartmentiftheapplicantreceivedoffsite

inpatientrelatedservices.CostsforStateinmateseligibleforLIHParebudgetedintheLIHPInpatientHosp.CostsforCDCRInmatespolicychange.

3.ItisassumedtheDepartmentwillprocess375applicationspermonthforStateinmateswith

verifiedcitizenship.4.Assume96percentofthemonthlyapplicantswillbecomeeligibleforMediCalorLIHP.

375monthlyapplicationsx96%=360eligibleStateinmates5.Ofthe360eligibleStateinmates,itisassumed20%areforMediCaland80%areforLIHP.Ofthe

MediCalapplications,itisassumed75%areage65orolder,15%aredisabled,5%areforpregnancyevents,and5%areunder21yearsofage.

6.ItisassumedtheDepartmentwillprocess170MediCalapplicationspermonthforcountyinmates

withverifiedcitizenship.7.Ofthe170eligiblecountyinmates,itisassumed75%areage65orolder,10%aredisabled,10%

areforpregnancyevents,and5%areunder21yearsofage

8.Basedonbirtheventsdata30%oftheannualbirtheventswillbeforcesareandeliveriesand70%

willbeforvaginaldeliveries.

MonthlyApplications FY201213 FY201314

Aged 360 x 20% x 75% = 54 360 x 20% x 75% = 54Disabled 360 x 20% x 15% = 11 360 x 20% x 15% = 11PregnancyEvent

360 x 20% x 5% = 4 360 x 20% x 5% = 4

Under21 360 x 20% x 5% = 4 360 x 20% x 5% = 4

MonthlyApplications FY201213 FY201314Aged 170 x 75% = 127 170 x 75% = 127Disabled 170 x 10% = 17 170 x 10% = 17PregnancyEvent 170 x 10% = 17 170 x 10% = 17Under21 170 x 5% = 9 170 x 5% = 9

MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESREGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5



9.Basedonfeeforservice(FFS)costdatatheaveragepermemberpermonth(PMPM)costforan

inpatientadmissionis$9,506foraged,$11,751fordisabled,and$9,401forunder21.10.BasedonFFSdeliverycostdatatheaveragePMPMcostpereventis$5,931forcesareandelivery

and$3,759foravaginaldelivery.11.Stateinmateinpatientcostsareestimatedtobe$8,280,000($4,140,000GF)inFY201213andFY

201314.Countyinmateinpatientcostsareestimatedtobe$9,373,000($4,686,500GF)inFY201213and$18,745,000($9,373,000GF)inFY201314.

12.InFY201213andFY201314,itisassumedtheDepartmentwillprocess35applicationsannually

forStateMedicalParoleeswithverifiedcitizenship.Itisassumedtheseeligibleswillreceivelongtermcare(LTC)services.

13.BasedonFFScostdatatheaveragePMPMcostforaLTCeligibleis$7,576.

14.ImplementationofcoverageforinmatesgrantedMedicalProbationwillbeginJanuary1,2013.15.InFY201213andFY201314,itisassumedtherewillbe100applicationsannuallyforcounty

inmatesgrantedMedicalProbation.ItisassumedtheseeligibleswillreceiveLTCservices.16.BasedonFFScostdatatheaveragePMPMcostforaLTCeligibleis$7,576.

Funding:TitleXIXFFP(42601010890)

35 LTCeligiblemonths x $7,576 = $265,000 ($132,500FF)

FY201213 50 LTCeligiblemonths x $7,576 = $379,000 ($189,500FF) FY201314 100 LTCeligiblemonths x $7,576 = $758,000 ($379,000FF)

FY201213 FY201314(Rounded) TF FF TF FFMedicalParole $265,000 $132,500 $265,000 $132,500MedicalProbation $379,000 $189,500 $758,000 $379,000CDCRInmates $8,280,000 $4,140,000 $8,280,000 $4,140,000CountyInmates $9,373,000 $4,686,500 $18,745,000 $9,372,500Total $18,297,000 $9,148,500 $28,048,000 $14,024,000

MEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESMEDI-CAL INPATIENT HOSP. COSTS - ADULT INMATESREGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5REGULAR POLICY CHANGE NUMBER: 5







FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$7,212,000$7,212,000$7,212,000$7,212,000

0.00 %0.00 %0.00 %0.00 %

$4,687,800$4,687,800$4,687,800$4,687,800$2,524,200$2,524,200$2,524,200$2,524,200

$2,524,200$2,524,200$2,524,200$2,524,200$7,212,000$7,212,000$7,212,000$7,212,000

FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

$0$0$0$0$0$0$0$0

$0$0$0$0$0$0$0$0

Purpose:ThispolicychangeestimatestheexpendituresforchildrenplacedintheBridgetoHealthyFamiliesProgram(HFP).Authority:AB2780(Chapter310,Statutesof1998)InterdependentPolicyChanges:PC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:InordertoallowtimeforfamiliestoapplyfortheHFPfortheirchildren,AB2780providesonemonthadditionalMediCaleligibilityasabridgeforchildrenwhobecomeineligibleforMediCalwithoutashareofcostorareeligibleforMediCalwithashareofcostandhaveincomelessthan250%ofpoverty(aidcode7X).ThecostsforthisprogramarenotincludedintheMediCalbaseestimate.Theyareaddedthroughthispolicychange.EffectiveJanuary1,2013,theHFPwillceasetoenrollnewapplicantsandwillbephasedoutoveraninemonthperiod,whichwilleliminatetheneedforthebridgefromMediCaltotheHFP.ReasonforChangefromPriorEstimate:TheassumedtransitionofHFPintoMediCalwasdelayedfromOctober1,2012toJanuary1,2013.Methodology:1.BeginningJanuary1,2013,thebridgefromMediCaltoHFPwillbeeliminated.EstimatedFY2012

13costsarebasedonJuly1,2012throughDecember31,2012.2.BasedoncurrentMediCaldata,itisestimated64,283childrenwillreceivetheonemonthbridge

(aidcode7X)inFY201213.Theaveragemonthlynumberofbeneficiarieswillbe10,714.


BRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFP



5555

6666



3.InFY201213,theFFSeligiblemonthsforaidcode7Xareestimatedtobe14,624,andthe

managedcareeligiblemonthsareestimatedtobe49,659.4.BasedonFY201112costdataandeligibledatafromApril2011throughMarch2012,theFFS

PMPMcostforaidcode7Xis$49.25.ThetotalFFSexpendituresforaidcode7Xwillbe$720,000inFY201213.

FY201213:$49.25PMPMx14,624=$720,000

5.BasedonFY201112costdataandeligibledatafromApril2011throughMarch2012,thetotal

averagemonthlymanagedcarecarveoutcostforaidcode7Xis$22.51.Thetotalmanagedcarecarveoutexpendituresforaidcode7Xwillbe$1,118,000inFY201213.

FY201213:$22.51CarveOutx49,659=$1,118,000

6.Themanagedcarecapitationcostforaidcode7Xwillbe$5,374,000inFY201213.

FY201213:$108.22managedcarecapitatedratex49,659=$5,374,0007.Thetotalmanagedcarecostforaidcode7Xwillbe$6,492,000inFY201213.FY201213:$1,118,000CarveOut+$5,374,000Capitation=$6,492,0008.Totalexpendituresforaidcode7Xareestimatedtobe$7,212,000TFinFY201213.

FY201213:$720,000+$6,492,000=$7,212,000TF($2,524,000GF)Funding:TitleXXI35/65FFP(42601130001/0890)

BRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFPBRIDGE TO HFPREGULAR POLICY CHANGE NUMBER: 6REGULAR POLICY CHANGE NUMBER: 6REGULAR POLICY CHANGE NUMBER: 6REGULAR POLICY CHANGE NUMBER: 6







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$5,540,000$5,540,000$5,540,000$5,540,000

0.00 %0.00 %0.00 %0.00 %

$0$0$0$0$5,540,000$5,540,000$5,540,000$5,540,000

$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000$5,540,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$4,615,000$4,615,000$4,615,000$4,615,000

0.00 %0.00 %0.00 %0.00 %

$0$0$0$0$4,615,000$4,615,000$4,615,000$4,615,000

$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000$4,615,000

Purpose:ThispolicychangeestimatestherefugeesmedicalexpenditurestobereimbursedbytheCaliforniaDepartmentofPublicHealth(CDPH).Authority:InteragencyAgreement#1210028InterdependentPolicyChanges:NotApplicableBackground:FullfederalfundingisavailablethroughtheRefugeeResettlementProgram(RRP)formedicalservicestorefugeesreceivingRefugeeCashAssistance(AidCodes01,08,and0A)andforRefugeeMedicalAssistancerefugees(AidCode02)duringtheirfirst8monthsintheUnitedStates.TheRRPfederalgrantisadministeredbyCDPH,whichhasprogramresponsibilitythroughtheRefugeeHealthAssessmentProgram.ThefederalOfficeofRefugeeResettlementallowsonlyonegrantawardforrefugeehealthservicesinthestate.TheDepartmentofHealthCareServicesinvoicestheCDPHforthereimbursementofrefugeeexpenditures,whichareoriginallyfundedwithGeneralFund.ReasonforChangefromPriorEstimate:Updatedrefugeeeligiblesfrompreviousestimate.Methodology:TotalrefugeeexpenditurestobereimbursedbyCDPHareestimatedtobe$4,615,000inFY201213and$5,540,000inFY201314.Funding:Reimbursements(42606100995)


REFUGEESREFUGEESREFUGEESREFUGEES


Luna WooLuna WooLuna WooLuna Woo7/19807/19807/19807/1980

14141414

7777







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$4,901,000$4,901,000$4,901,000$4,901,000

0.00 %0.00 %0.00 %0.00 %

$4,901,000$4,901,000$4,901,000$4,901,000$0$0$0$0

$0$0$0$0$4,901,000$4,901,000$4,901,000$4,901,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$2,451,000$2,451,000$2,451,000$2,451,000

0.00 %0.00 %0.00 %0.00 %

$2,451,000$2,451,000$2,451,000$2,451,000$0$0$0$0

$0$0$0$0$2,451,000$2,451,000$2,451,000$2,451,000

Purpose:ThispolicychangeestimatesthefederalmatchprovidedtotheCaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)andthecountiesforthecostofinpatientservicesforjuvenileinmateswhoaredeemedeligibleforMediCal.Authority:AB396(Chapter394,Statutesof2011)InterdependentPolicyChanges:NotapplicableBackground:AB396authorizestheDepartment,counties,andtheCDCRtoclaimFederalFinancialParticipation(FFP)forinpatienthospitalservicestoMediCaleligiblejuvenileinmatesinStateandcountycorrectionalfacilitieswhentheseservicesareprovidedoffthegroundsofthefacility.PreviouslytheseserviceswerepaidbyCDCRorthecounty.CDCRwillutilizetheMediCalapplicationscurrentlyusedbycounties,andtheDepartmentwillreviewtheseapplicationstomakeaneligibilitydeterminationaccordingtocurrentstandardeligibilityrules.HealthcarecostsofstateinmatesarecurrentlypaidbytheStateGeneralFund.FederalMedicaidregulationsandfederalguidanceprovidedtostatesallowforcoverageofinpatientservicestoeligibleinmateswhenprovidedinoffsitefacilities.TheDepartmentcurrentlyhasaninteragencyagreementwithCDCRinordertoclaimTitleXIXFFP.ReasonforChangefromPriorEstimate:Thisisanewpolicychange.Methodology:1.ImplementationofcoveragewillbeginJanuary1,2013.


MEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATES



1755175517551755

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2.ApplicationsforMediCalwillbeprocessedbytheDepartmentiftheapplicantreceivedoffsite

inpatientorpsychiatricrelatedservices.

3.ItisassumedtheDepartmentwillprocess30applicationspermonthforStateinmatesand88applicationspermonthforcountyinmateswithverifiedcitizenship.

4.Oftheestimated118monthlyapplications,itisassumed80%areforpsychiatricservicesand20%areforinpatientservices.

5.Basedonfeeforservice(FFS)costdatatheaveragepermemberpermonth(PMPM)costforan

generalacutecareinpatientadmissionis$9,401and$6,297foraninpatientpsychiatricadmissionforthoseunder21yearsold.

Funding:TitleXIXFFP(42601010890)

(Rounded) FY201213 FY201314ServiceType TotalMemberMonths TotalMemberMonthsPsychiatricServices 118 x 80% x 6 = 566 118 x 80% x 12 = 1,133InpatientServices 118 x 20% x 6 = 142 118 x 20% x 12 = 283

FY201213 FY201314(Rounded) TF FF TF FFCDCR Psych.Services $907,000 $453,500 $1,814,000 $907,000Inpt.Services $338,000 $169,000 $677,000 $338,500Subtotal $1,245,000 $622,500 $2,491,000 $1,245,500 Counties Psych.Services $2,662,000 $1,331,000 $5,324,000 $2,662,000Inpt.Services $994,000 $497,000 $1,987,000 $993,500Subtotal $3,656,000 $1,828,000 $7,311,000 $3,655,500 Total $4,901,000 $2,450,500 $9,802,000 $4,901,000

MEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESMEDI-CAL INPATIENT HOSP. COSTS - JUVENILE INMATESREGULAR POLICY CHANGE NUMBER: 8REGULAR POLICY CHANGE NUMBER: 8REGULAR POLICY CHANGE NUMBER: 8REGULAR POLICY CHANGE NUMBER: 8







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$511,000$511,000$511,000$511,000

0.00 %0.00 %0.00 %0.00 %

$255,500$255,500$255,500$255,500$255,500$255,500$255,500$255,500

$255,500$255,500$255,500$255,500$511,000$511,000$511,000$511,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$661,000$661,000$661,000$661,000

0.00 %0.00 %0.00 %0.00 %

$330,500$330,500$330,500$330,500$330,500$330,500$330,500$330,500

$330,500$330,500$330,500$330,500$661,000$661,000$661,000$661,000

Purpose:ThispolicychangeestimatesthebenefitscostofenrollingchildrenintoMediCalthatwerenotpreviouslyidentifiedaseligiblewhentheywerescreenedthroughtheSinglePointofEntry(SPE).Authority:NotApplicableInterdependentPolicyChanges:CA8MCHAvs.DHCSandMRMIBPC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:TheDepartmentusestheSPEtoprocessjointapplicationsthatserveasanapplicationfortheHealthyFamiliesProgram(HFP)andascreeningdevicefortheFederalPovertyLevel(FPL)MediCalprogram.MaternalandChildHealthAccess(MCHA)contendedinalawsuitthattheDepartmentandtheManagedRiskMedicalInsuranceBoard(MRMIB)arelegallyrequiredtousethejointapplicationasanapplicationforallMediCalprograms,notjusttheFPLprogram.OnDecember6,2010,thecourtissueditsdecisionrulinginfavoroftheDepartmentonallissuesexceptthattheStatemustscreenforsection1931(b)MediCaleligibilitybeforeenrollingchildrenages6to18intheHFP.OnJuly10,2012,theSanFranciscoSuperiorCourtissuedanorderenforcingwritconcerningthe1931(b)screening.TheDepartmenthadpreviouslyagreedtoimplementascreenatSPEtoidentifydeemedeligibleinfants.BeginningJanuary1,2013,theHFPwillceasetoenrollnewapplicantsandallapplicationssubmittedtotheSPEwillbesenttocountyeligibilityworkersforaMediCaldetermination.Therefore,theimpactofthecourtdecisiononlywillimpactapplicantswhowerescreenedbySPEpriortoJanuary1,2013.


MCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIB



1735173517351735

9999



Methodology:1.AssumethatMRMIBwillnotifyapproximately275,000priorSPEapplicantsthattheymaybeeligible

for1931(b)MediCalcoverage.2.AssumethattheresponsestotheMRMIBnotificationswillbereceivedandprocessedduring

January,February,andMarch2013.3.Assumea7.3%responseratewillresultin20,000responses.4.Assumethat33%oftherespondentswillqualifyfor2monthsofacceleratedenrollmentata

monthlycostof$66.45.

20,000responses*33%qualifyforAE*2months*$66.45=$877,000(unlagged)5.Assumethatoftherespondents,30%willprovidethenecessarydocumentationtomakea

determinationofMediCal1931(b)eligibility.6.Assumethatofthosethatreceiveadeterminationofeligibility,only2%willbefoundeligible.7.Assumethattheaveragebenefitscostpermonthforthosefoundeligibleis$159.45.

20,000responses*30%providedocumentation*2%foundeligible*$159.45permonth*12months=$230,000(fullyearcost,unlagged)

8.Applyingpartialyearphaseinadjustmentsandappropriatepaymentlags,thecostsare:

Funding:TitleXIX50/50GF(42601010001/0890)

FY201213TF

FY201314TF

AcceleratedEnrollment $595,000 $282,000OngoingBenefits $66,000 $229,000Total $661,000 $511,000

MCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBMCHA VS. DHCS AND MRMIBREGULAR POLICY CHANGE NUMBER: 9REGULAR POLICY CHANGE NUMBER: 9REGULAR POLICY CHANGE NUMBER: 9REGULAR POLICY CHANGE NUMBER: 9







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$7,372,000$7,372,000$7,372,000$7,372,000

0.00 %0.00 %0.00 %0.00 %

$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000$3,686,000

$3,686,000$3,686,000$3,686,000$3,686,000$7,372,000$7,372,000$7,372,000$7,372,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$607,000$607,000$607,000$607,000

0.00 %0.00 %0.00 %0.00 %

$303,500$303,500$303,500$303,500$303,500$303,500$303,500$303,500

$303,500$303,500$303,500$303,500$607,000$607,000$607,000$607,000

Purpose:ThispolicychangeestimatesthecostsfortheclosureoftheLantermanDevelopmentCenter.Authority:AB97(Chapter3,Statutesof2011)InterdependentPolicyChanges:NotApplicableBackground:OnApril1,2010,theCaliforniaDepartmentofDevelopmentalServices(CDDS)submittedaplantotheLegislaturefortheclosureofLantermanDevelopmentalCenter.SinceFY201112,CDDShasbeenworkingwithconsumers,familiesandtheregionalcenterstotransitionresidentstocommunitylivingarrangements.ResidentsmovingintothecommunitywillbeenrolledinaMediCalmanagedcarehealthplanorreceiveservicesthroughtheMediCalfeeforservicesystem.ReasonforChangefromPriorEstimate:UpdatedcaseloaddataMethodology:1.UnderCDDSPlanforClosureofLantermanDevelopmentalCenter,theindividualplanning

processwillbethebasisforensuringthateachresidentsneedsandchoicesareidentifiedandappropriatelyaddressedinthecommunity.Therefore,thecostsoftheservicestobeprovidedthroughtheMediCalprogramoncetheresidentstransitiontothecommunityareunknownatthistime.

2.Placeholdercostsof$607,000($303,500GF)forFY201213and$7,372,000($3,686,000GF)for

FY201314areincludedintheNovember2012MediCalEstimate.


LANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURE


Candace EpsteinCandace EpsteinCandace EpsteinCandace Epstein3/20123/20123/20123/2012

1560156015601560

10101010



3.Assume135residentswilltransitionfromLantermanDevelopmentalCenterintothecommunityin201213and123residentswilltransitionin201314.AsofJuly1,2012,122residentshavemovedintothecommunity.

Funding:TitleXIX50/50FFP(42601010890)

LANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSURELANTERMAN DEVELOPMENTAL CENTER CLOSUREREGULAR POLICY CHANGE NUMBER: 10REGULAR POLICY CHANGE NUMBER: 10REGULAR POLICY CHANGE NUMBER: 10REGULAR POLICY CHANGE NUMBER: 10







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$249,700$249,700$249,700$249,700

83.40 %83.40 %83.40 %83.40 %

$81,760$81,760$81,760$81,760$167,910$167,910$167,910$167,910

$1,011,500$1,011,500$1,011,500$1,011,500$1,504,000$1,504,000$1,504,000$1,504,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$493,500$493,500$493,500$493,500

67.10 %67.10 %67.10 %67.10 %

$161,870$161,870$161,870$161,870$331,630$331,630$331,630$331,630

$1,008,000$1,008,000$1,008,000$1,008,000$1,500,000$1,500,000$1,500,000$1,500,000

Purpose:Thispolicychangeestimatesthecostsofchangesmadetothe250%WorkingDisabledProgram(WDP).Authority:AB1269(Chapter282,Statutesof2009)InterdependentPolicyChanges:NotApplicableBackground:TheWDPallowsforemployedindividualswithdisabilitiestoearnupto250%ofthefederalpovertylevel(FPL)andreceivefullscopeMediCalbenefits.Alleligiblesinthisprogramarerequiredtopayamonthlypremiumbasedontheircountableincome.AB1269requirestheDepartmenttoimplementchangestotheWDP30daysaftertheAmericanRecoveryandReinvestmentActof2009(ARRA)endsonJune30,2011.ThechangesmadebyAB1269are:1.Exemptionofdisabilityincomethatconvertstoretirementincome.2.Exemptionofretainedincomefromtheresourcecalculationwhenheldinaseparatelyidentifiable

accountandnotcomingledwithotherresources.3.AllowsbeneficiariestoremaineligibleforMediCalupto26weekswhileunemployed,provided

premiumscontinuetobepaid.4.Allowsthemonthlypremiumcalculationtobebasedonfivepercentofanindividualscountable

income.


250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES



1558155815581558

11111111



However,underthePatientProtectionandAffordableCareAct(PPACA)of2010,MaintenanceofEffort(MOE)requirementsareimposeduponstatesuntilJanuary1,2014.TheserequirementspreventstatesfromimplementingmorerestrictiveMedicaideligibilitypolicies,proceduresormethodologieswithoutjeopardizingfederalfunding,thereforechange#4concerningmonthlypremiumswillnotbeimplementedduetotheMOEprovisionsofPPACA.ReasonforChangefromPriorEstimate:Thechangeisduetomorerecentaidcode6Geligibledatawhichshowedagreaternumberofeligiblesaswellasahigherrateofincrease(211versus70annualgrowth).Methodology:1.ThechangestotheWDPwereimplementedAugust1,2011.2.Theprovisionsofthebillconcerningretainedincomeexemptionand26weeksofeligibilitywhile

unemployedhaveanindeterminateimpact.3.Theexemptionofdisabilityincomethatconvertstoretirementincomewillcreateanincreaseinthe

numberofWDPparticipantsresultinginadditionalcoststoMediCal.4.Thoseaffectedbytheexemptionofdisabilityincomethatconvertstoretirementincomeareage65

andolder.5.BasedonJune2011throughMay2012eligibledata,thereare618averagemonthlyeligiblesinAid

Code6Gwhoareover65yearsofage.6.Thecurrentgrowthrateofover65yearoldsinAidCode6Gis2.8%monthlyor18beneficiariesper

month(rounded).Itisassumedtherewillbeanadditionalincreaseof211eligiblesperyeartotheWDP.

7.Thefullincreaseineligibleswillbephasedinover12months.8.Thefeeforservice(FFS)permemberpermonth(PMPM)costpereligibleforaidcode6Gis

$271.12andtheaveragemonthlymanagedcarecostis$600.28($507.35caprateand$86.90forcarveoutPMPMcost).Themonthlydentalcapitationrateis$6.03.

9.ThemonthlypremiumfortheMedicarePartBpremiumis$99.90in2012and2013.Themonthly

premiumfortheMedicarePartDpremiumis$102.76in2012,andisestimatedtobe$104.46in2013and$105.60in2014.

250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGESREGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11



Funding:

FY201213 TF GFFFS $432,000 $216,000ManagedCare $537,000 $268,500MedicarePartB $263,000 $263,000MedicarePartD $253,000 $253,000Dental $15,000 $7,500Total $1,500,000 $1,008,000

FY201314 TF GFFFS $433,000 $216,500ManagedCare $537,000 $268,500MedicarePartB $266,000 $266,000MedicarePartD $253,000 $253,000Dental $15,000 $7,500Total $1,504,000 $1,011,500

FY201213: GF FF TFTitleXIX50/50FFP 42601010001/0890 $492,000 $492,000 $984,000GF 42601010001 $516,000 $0 $516,000 FY201314: GF FF TFTitleXIX50/50FFP 42601010001/0890 $492,500 $492,500 $985,000GF 42601010001 $519,000 $0 $519,000

250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGES250% WORKING DISABLED PROGRAM CHANGESREGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11REGULAR POLICY CHANGE NUMBER: 11







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$0$0$0$0

100.00 %100.00 %100.00 %100.00 %

$0$0$0$0$0$0$0$0

$252,000$252,000$252,000$252,000$504,000$504,000$504,000$504,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$85,900$85,900$85,900$85,900

82.95 %82.95 %82.95 %82.95 %

$42,970$42,970$42,970$42,970$42,960$42,960$42,960$42,960

$252,000$252,000$252,000$252,000$504,000$504,000$504,000$504,000

Purpose:ThispolicychangeestimatesthecostofreimbursementsmadetoSupplementalSecurityIncome(SSI)beneficiariesforoutofpocketmedicalanddentalcostsrelatedtotheLomeli,etal.,v.Shewrylawsuit.Authority:NotApplicableInterdependentPolicyChanges:NotApplicableBackground:TheDepartmentfinalizedasettlementoftheLomelilawsuit,whichallegedthattheDepartmentdidnotproperlyinformSSIapplicantsoftheavailabilityofretroactiveMediCalcoverage.InAugust2011,theDepartmentbegansendingnoticestoSSIapplicantswhodidnothaveMediCaleligibilityforallthreemonthsbeforeapplyingforSSIandanupdatednoticetonewSSIrecipients,informingthemoftheavailabilityofretroactivecoverage.Benefitcostsforeligiblemedicalservicesduringtheretroactivecoverageperiodmayqualifyindividualsforreimbursement.ReasonforChangefromPriorEstimate:Thereisnochange.Methodology:1.TheDepartmenthasestablishedthefollowingassumptionsbasedonpreviouslawsuitsettlements.2.TheDepartmentbeganreceivingclaimsinOctober2011,andcostsbeganinDecember2011.3.Assumethereare1,000MediCalclaimspermonth,ofwhich60%areeligibleforretroactive

coverage.


LOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRY


Yao-Hui YuYao-Hui YuYao-Hui YuYao-Hui Yu12/201112/201112/201112/2011

1583158315831583

12121212



4.Ofthose,assume33%oftheclaimsarefordentalservicesand67%oftheclaimsareformedical

services.5.Itisestimatedthat18%ofdentalclaimswillbeapproved.6.Itisestimatedthat28%ofmedicalclaimswillbeapproved.7.Assumetheaveragecostis$533.74fordentalclaimsand$202.98formedicalclaims.

FY201213 TF GFDentalCosts $228,000 $114,000MedicalCosts $276,000 $138,000TotalCost $504,000 $252,000

FY201314 TF GFDentalCosts $228,000 $114,000MedicalCosts $276,000 $138,000TotalCost $504,000 $252,000

LOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRYLOMELI V. SHEWRYREGULAR POLICY CHANGE NUMBER: 12REGULAR POLICY CHANGE NUMBER: 12REGULAR POLICY CHANGE NUMBER: 12REGULAR POLICY CHANGE NUMBER: 12







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

$9,127,400$9,127,400$9,127,400$9,127,400-$9,127,400-$9,127,400-$9,127,400-$9,127,400

-$9,127,400-$9,127,400-$9,127,400-$9,127,400$0$0$0$0

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

$9,127,400$9,127,400$9,127,400$9,127,400-$9,127,400-$9,127,400-$9,127,400-$9,127,400

-$9,127,400-$9,127,400-$9,127,400-$9,127,400$0$0$0$0

Purpose:Thispolicychangeestimatesthetechnicaladjustmentsinfundingfrom100%StateGFtoclaimTitleXIXorTitleXXIfederalmatchforthehealthcareexpendituresofqualifiedchildrenandpregnantalienswhohavenotyetmetthefederal5yearbar.Authority:Children'sHealthInsuranceProgramReauthorizationAct(CHIPRA)InterdependentPolicyChanges:NotApplicableBackground:ThePersonalResponsibilityandWorkOpportunityReconciliationActof1996(PRWORA)providesthatfederalfinancialparticipation(FFP)isavailableforimmigrantswhoaredesignatedasQualifiedAliensiftheyhavebeenintheUnitedStatesforatleastfiveyears.CaliforniacurrentlyprovidesfullscopeMediCaltootherwiseeligibleQualifiedAlienswhohavebeenintheUSforlessthanfiveyearsandpaysfornonemergencyserviceswith100%StatefundsifFFPisnotavailable.(FFPisavailableregardlessofimmigrationstatusforemergencyandpregnancyrelatedservices.)CHIPRAincludesaprovisionwhichgivesstatestheoptiontoprovidefullscopeMediCalwithFFPtoeligibleQualifiedAlienswhoarechildrenorpregnantwomeneveniftheyhavebeenintheU.S.forlessthanfiveyears,effectiveApril1,2009.EnhancedTitleXXIfundingisavailableforchildreneighteenyearsofageandyounger.ReasonforChangefromPriorEstimate:Thechangesareduetoupdatedexpendituresforqualifiedchildrenandpregnantaliensunderthe5yearbar.


CHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMEN



1371137113711371

13131313



Methodology:1.TitleXXIfundingof65/35FFPisavailablefor0to18yearoldsandTitleXIXfundingof50/50FFPis

availablefor19and20yearoldsandpregnantwomen.2.AssumeFY201213andFY201314willbeunchangedfromcalendaryear2011.3.Children

BaseduponquarterlyclaimingreportsforFY201112,37.57%ofexpendituresforNQAservicesarefornonemergencyservices.

FFS:SpecialreportsofexpendituresforNQAchildrenfor2011servicesshowfeeforservice(FFS)costs(includingmanagedcarecarveouts)of$9,787,000for0to18yearoldsand$1,055,000for19and20yearolds.

NonemergencyFFSexpendituresforNQAchildrenare:$9,787,000x37.57%nonemergency=$3,677,000(0to18yearolds)$1,055,000x37.57%nonemergency=$396,000(19and20yearolds)

ManagedCare:SpecialreportsofNQAchildrenmanagedcareeligiblesforcalendar2011show171,628eligiblemonthsfor0to18yearoldsand14,593for19and20yearolds.

TheaveragecapitationfortheNQAchildrenandpregnantwomenisassumedtobe$113.20PMPM.

ThenonemergencymanagedcareexpendituresforNQAchildrenare:171,628eligiblemonthsx$113.20PMPMx37.57%nonemergency=$7,299,000(0to18yearolds)14,593eligiblemonthsx$113.20PMPMx37.57%nonemergency=$621,000(19and20yearolds)

4.PregnantWomenBasedonspecialreportsofexpendituresforpregnantwomen,6.64%ofexpendituresforpregnantwomenarefornonpregnancyrelatedservices.

FFS:TotalFFScostsincludingcarveoutsforpregnantwomenare$34,926,000.

ThenonpregnancyrelatedFFSexpendituresforpregnantwomenare:$34,926,000x6.64%=$2,319,000

ManagedCare:SpecialreportsofNQApregnanteligiblesforcalendaryear2011show86,471eligiblemonths.

Theaveragecapitationforpregnantwomenisassumedtobe$113.20PMPM.

Nonpregnancyservices=86,471eligiblemonthsx$113.20PMPMx6.64%=$650,000

CHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENREGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13



5.TotalFFPof$9,127,000offsetstheGeneralFundcostofprovidingservicestotheseeligibles.Funding:TitleXIX50/50FFP(42601010001/0890)TitleXXIEnhancedHealthyFamiliesFFP(42601130890)

TitleXIX TitleXXIChildren(018) FFS $3,677,000ManagedCare $7,299,000Children(1920)

FFS $396,000 ManagedCare $621,000 PregnantWomen

FFS $2,319,000 ManagedCare $650,000

Total(rounded) $3,986,000 $10,976,000GF $1,993,000 $3,841,600FFP $1,993,000 $7,134,400

CHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENCHIPRA - M/C FOR CHILDREN & PREGNANT WOMENREGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13REGULAR POLICY CHANGE NUMBER: 13







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

-$64,317,000-$64,317,000-$64,317,000-$64,317,000$64,317,000$64,317,000$64,317,000$64,317,000

$64,317,000$64,317,000$64,317,000$64,317,000$0$0$0$0

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

-$64,317,000-$64,317,000-$64,317,000-$64,317,000$64,317,000$64,317,000$64,317,000$64,317,000

$64,317,000$64,317,000$64,317,000$64,317,000$0$0$0$0

Purpose:ThispolicychangeisatechnicaladjustmenttoshiftfundsfromTitleXIX50%federalfinancialparticipation(FFP)to100%GFbecausetheDepartmentcannotclaimFFPfornonemergencyhealthcareexpendituresforNewQualifiedAliens(NQA).Authority:H.R.3734(1996),PersonalResponsibilityandWorkOpportunityAct(PRWORA)Welfare&InstitutionsCode,section14007.5InterdependentPolicyChanges:NotapplicableBackground:PRWORAspecifiedthatFFPisnotavailableforfullscopeMediCalservicesformostqualifiednonexemptalienswhoenterthecountryafterAugust1996,forthefirst5yearstheyareinthecountry.TheyareeligibleforFFPforemergencyservicesonly.AsCalifornialawrequiresthatlegalimmigrantsreceivethesameservicesascitizens,thenonemergencyservicesare100%Statefunded.ReasonforChangefromPriorEstimate:ThechangesareduetoupdatedexpendituresfornonemergencyservicesforNQAs.Methodology:1.Basedonactualexpenditurereportsforthefeeforservice(FFS)nonemergencyservicescostsof

NQAsfromJanuary2006throughJune2012,currentyearandbudgetyearcostswereprojected.

2.BasedonthehistoricalpatternofFFSversusmanagedcarenonemergencyserviceexpendituresfortheperiodofJune2010throughJuly2011(19.27%),themanagedcaretotalsforcurrentyearandbudgetyearwereprojected.

3.TheimpactoftheStateChildrensHealthInsuranceProgram(SCHIP)fundingforprenatalcarefor

newqualifiedaliensisincludedintheSCHIPFundingforPrenatalCarepolicychange.


NEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENS



15151515

14141414



4.TheimpactofChildren'sHealthInsuranceProgramReauthorizationAct(CHIPRA)fundingforfull

scopeMediCalwithFFPtoeligibleQualifiedAlienswhoarechildrenorpregnantwomen,eveniftheyhavebeenintheU.S.forlessthanfiveyears,isbudgetedintheCHIPRAMediCalforChildrenandPregnantWomenpolicychange.

Funding:TitleXIXGeneralFund(42601010001)

(rounded) FY201213 FY201314FFS $107,848,000 $107,848,000ManagedCare $20,786,000 $20,786,000Total $128,634,000 $128,634,000FFPRepayment $64,317,000 $64,317,000

NEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENSNEW QUALIFIED ALIENSREGULAR POLICY CHANGE NUMBER: 14REGULAR POLICY CHANGE NUMBER: 14REGULAR POLICY CHANGE NUMBER: 14REGULAR POLICY CHANGE NUMBER: 14







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

$46,071,000$46,071,000$46,071,000$46,071,000-$46,071,000-$46,071,000-$46,071,000-$46,071,000

-$46,071,000-$46,071,000-$46,071,000-$46,071,000$0$0$0$0

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

$0$0$0$0

0.00 %0.00 %0.00 %0.00 %

$44,850,150$44,850,150$44,850,150$44,850,150-$44,850,150-$44,850,150-$44,850,150-$44,850,150

-$44,850,150-$44,850,150-$44,850,150-$44,850,150$0$0$0$0

Purpose:Thispolicychangeestimatesthetechnicaladjustmentinfundingforthe100%and133%ProgramsexpenditurestobeadjustedfromTitleXIX50%FederalFinancialParticipation(FFP)toenhancedTitleXXI65%FFP.Authority:SB903(Chapter624,Statutesof1997)InterdependentPolicyChanges:PC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:BasedontheprovisionsofSB903andSection1902(l)(3)ofthefederalSocialSecurityAct(42U.S.C.Sec1396a(l)(3)),resourceswillnotbecountedindeterminingtheMediCaleligibilityforchildrenagesoneto19inthe100%and133%programs.ThischangewasimplementedtohelpstreamlinetheapplicationprocessandtoalignMediCaleligibilitymorecloselywiththeHealthyFamiliesProgram.EffectiveJanuary1,2013,theHealthyFamiliesProgramwillceasetoenrollnewapplicantsandwillbephasedoutoveraninemonthperiod.ChildrenenrolledintheHealthyFamiliesProgramwillbetransitionedtotheMediCalProgramastargetedlowincomechildrenandresourceswillnotbecountedforchildrenwithincomesupto250%oftheFederalPovertyLevel(FPL).ReasonforChangefromPriorEstimate:Thechangesareduetoadditionalcaseloadandexpenditures.Methodology:1.Aidcodes(8N,8P,8R,and8T)thatidentifychildreneligibleforMediCalduetodisregardingassets

wereimplementedinDecember1998.


RESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDREN


Yao-Hui YuYao-Hui YuYao-Hui YuYao-Hui Yu12/199812/199812/199812/1998

13131313

15151515



2.Averagemonthlyfeeforservice(FFS)eligibles,whichareincludedinthebase,areestimatedtobe44,953inFY201213and46,272inFY201314.ItisassumedtotalFFSexpenditureswillbe$25,320,000inFY201213and$26,063,000inFY201314.

3.AveragemonthlyManagedCareeligibles,whicharebudgetedinthemanagedcaremodelpolicychanges,areestimatedtobe180,003inFY201213and182,861inFY201314.ItisassumedtotalManagedCareexpenditureswillbe$273,681,000inFY201213and$281,077,000inFY201314.

4.EnhancedfederalfundingunderTitleXXIMedicaidChildrensHealthInsuranceProgram(MCHIP)maybeclaimedforchildreneligibleundertheseaidcodes.Itis65.00%inFY201213andFY201314.

Funding:

FY201213: GF FF TF

TitleXIX50/50FFP 42601010001/0890 ($149,500,000) ($149,501,000) ($299,001,000)TitleXXI65/35FFP 42601130001/0890 $104,650,000 $194,351,000 $299,001,000NetImpact ($44,850,000) $44,850,000 $0 FY201314: GF FF TFTitleXIX50/50FFP 42601010001/0890 ($153,570,000) ($153,570,000) ($307,140,000)TitleXXI65/35FFP 42601130001/0890 $107,499,000 $199,641,000 $307,140,000NetImpact ($46,071,000) $46,071,000 $0

RESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENRESOURCE DISREGARD - % PROGRAM CHILDRENREGULAR POLICY CHANGE NUMBER: 15REGULAR POLICY CHANGE NUMBER: 15REGULAR POLICY CHANGE NUMBER: 15REGULAR POLICY CHANGE NUMBER: 15







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

1.00001.00001.00001.0000

-$665,000-$665,000-$665,000-$665,000

0.00 %0.00 %0.00 %0.00 %

-$332,500-$332,500-$332,500-$332,500-$332,500-$332,500-$332,500-$332,500

-$332,500-$332,500-$332,500-$332,500-$665,000-$665,000-$665,000-$665,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

1.00001.00001.00001.0000

-$388,000-$388,000-$388,000-$388,000

0.00 %0.00 %0.00 %0.00 %

-$194,000-$194,000-$194,000-$194,000-$194,000-$194,000-$194,000-$194,000

-$194,000-$194,000-$194,000-$194,000-$388,000-$388,000-$388,000-$388,000

Purpose:ThispolicychangeestimatesthesavingsfromthePublicAssistanceReportingInformationSystem(PARIS)Federal.Authority:NotApplicableInterdependentPolicyChanges:PC209ExtendGrossPremiumTaxPC207ExtendGrossPremiumTaxIncr.CapitationRatesPC208ExtendGrossPremiumTaxFundingAdjustmentBackground:PARISisaninformationsharingsystem,operatedbytheU.S.DepartmentofHealthandHumanServicesAdministrationforChildrenandFamilies,whichallowsstatesandfederalagenciestoverifypublicassistanceclientcircumstances.ThePARISsystemincludesthreedifferentdatamatches.ThePARISVeteransmatchallowsstatestocomparetheirbeneficiaryinformationwiththeU.S.DepartmentofVeteransAffairs.ThePARISFederalmatchallowsstatestocomparetheirbeneficiaryinformationwiththeU.S.DepartmentofDefenseandtheU.S.OfficeofPersonnelManagementtoidentifyfederalpensionincomeorhealthbenefits.ThePARISInterstatematchallowsstatestocomparetheirbeneficiaryinformationwithotherstatestoidentifybeneficiarychangesinresidenceandpublicassistancebenefitsinotherstates.

TheDepartmentimplementedaPARISFederalmatchpilotprograminFY200910.ThepilotprogramallowedtheDepartmenttoidentifylongtermsavingspriortoincurringcoststhatwouldbeassociatedwithstatewideimplementation.Sincethelaunchofthepilotprogram,MediCalsavingshavebeenachievedthroughimprovedverificationandidentificationcapabilities.Currently,PARISFederalisimplementedin30counties.TheDepartmentplanstoexpandto40countiesinFY201314.


PARIS-FEDERALPARIS-FEDERALPARIS-FEDERALPARIS-FEDERAL



1738173817381738

16161616



ReasonforChangefromPriorEstimate:ThenumberofbeneficiariesthatwillbediscontinuedasaresultofPARISFederalmatcheshasincreasedbasedonrecentmatches.Additionally,thesavingsrelatedtoPARISInterstatematchesarenowcapturedinaseparatepolicychange.Methodology:1.SavingsforPARISFederalisassumedforbothManagedCareandfeeforservice(FFS).2.BasedonquarterlyreportsforAugust2012throughMay2013,itisestimated344managedcare

and84FFSbeneficiarieswillbediscontinuedfromMediCalinFY201213.3.BasedonquarterlyreportsforAugust2013throughMay2014,itisestimated424managedcare

and104FFSbeneficiarieswillbediscontinuedfromMediCalinFY201314.4.Totalmanagedcaresavingsisestimatedtobe$680,000TFinFY201213,and$1,032,000TFin

FY201314.TotalFFSsavingsisestimatedtobe$2,235,000TFinFY201213and$3,392,000TFinFY201314.

5.InFY201213,itisestimatedthat86.69%ofthemanagedcareandFFSsavingsiscapturedinthe

basetrends.InFY201314,itisestimatedthat84.96%ofthemanagedcareandFFSsavingsiscapturedinthebasetrends.

6.Totalestimatedsavingsnotinthebasetrends:

Funding:TitleXIXFFP(42601010001/0890)

FY201213 TotalSavings %inBase SavingsinBaseManagedCareSavings ($680,000) 86.69% ($589,000)FFSSavings ($2,235,000) 86.69% ($1,937,000)Total ($2,915,000) ($2,526,000) FY201314 TotalSavings %inBase SavingsinBaseManagedCareSavings ($1,032,000) 84.96% ($877,000)FFSSavings ($3,392,000) 84.96% ($2,882,000)Total ($4,424,000) ($3,759,000)

FY201213 TF GFManagedCareSavings ($91,000) ($45,500)FFSSavings ($297,000) ($148,500)Total ($388,000) ($194,000) FY201314 TF GFManagedCareSavings ($155,000) ($77,500)FFSSavings ($510,000) ($255,000)Total ($665,000) ($332,500)

PARIS-FEDERALPARIS-FEDERALPARIS-FEDERALPARIS-FEDERALREGULAR POLICY CHANGE NUMBER: 16REGULAR POLICY CHANGE NUMBER: 16REGULAR POLICY CHANGE NUMBER: 16REGULAR POLICY CHANGE NUMBER: 16







FY 2013-14FY 2013-14FY 2013-14FY 2013-14

0.94760.94760.94760.9476

-$1,038,700-$1,038,700-$1,038,700-$1,038,700

35.14 %35.14 %35.14 %35.14 %

-$519,350-$519,350-$519,350-$519,350-$519,350-$519,350-$519,350-$519,350

-$845,000-$845,000-$845,000-$845,000-$1,690,000-$1,690,000-$1,690,000-$1,690,000

FY 2012-13FY 2012-13FY 2012-13FY 2012-13

0.93600.93600.93600.9360

-$866,500-$866,500-$866,500-$866,500

29.76 %29.76 %29.76 %29.76 %

-$433,260-$433,260-$433,260-$433,260-$433,260-$433,260-$433,260-$433,260

-$659,000-$659,000-$659,000-$659,000-$1,318,000-$1,318,000-$1,318,000-$1,318,000

Purpose:ThispolicychangeestimatesthesavingsfromthePublicAssistanceReportingInformationSystem(PARIS)VeteransMatch.Authority:Welfar

MEDI-CAL NOVEMBER 2012 LOCAL ASSISTANCE ESTIMATE … · · 2017-08-22medi-cal november 2012 local assistance estimate for fiscal years 2012-13 and 2013-14 ... 34 hearing aid cap

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