1. health and fitness

New Hampshire
Department of Health and Human Services
Preparing for SFY 16/17
January 21, 2015
House Finance Committee
Nick Toumpas, Commissioner
1/21/2015
DHHS Finance Committee Update
1
Agenda
• Objective
– Set context for development of SFY 16/17 budget and policy
•
•
•
•
Brief Overview of DHHS and Current State
Setting the Context for Budget Development
Review of SFY 16/17 Budget Request
Review of Key Strategic Themes and Innovation
Initiatives
• Questions and answers
• Next Steps
1/21/2015
DHHS Finance Committee Update
2
Executive Summary
•
•
•
•
•
•
•
The Department has and continues to faces unprecedented challenges to fulfilling
our core mission.
These challenges and the demands on DHHS along with the realities of the
external environment require a rethinking of how we do things.
DHHS is responding with a dual agenda: focus on achieving greater efficiency and
effectiveness in core operations while driving a set of transformative initiatives
that define how we deal with the new realities.
Central to our future is to focus on the whole person and improving the health of
the population.
Projections on budgets are challenging every year, but this year with the level of
changes to our Medicaid business model will make the effort more challenging
Alignment between State Health Improvement Program and the Medicaid Care
Management program that will drive improved health for all citizens
We will present and discuss our budget along two dimensions, the “agency” view
and by a population segmentation to bring greater transparency to our choices
and their implications on those served by the Department.
1/21/2015
DHHS Finance Committee Update
3
Overview of DHHS
The Mission
Roles and Responsibilities
Services, Programs and Populations
Caseloads
Staffing
SFY 15 Budget Status
1/21/2015
DHHS Finance Committee Update
4
DHHS Mission
& Responsibilities
“To join communities and families in providing
opportunities for citizens to achieve health and
independence”
• To meet the health needs of New Hampshire citizens
• To meet the basic human needs of New Hampshire citizens
• To provide treatment and support services to those who have unique
needs including disabilities, mental illness, special health care needs
or substance abuse problems
• To protect and care for New Hampshire’s most vulnerable citizens
1/21/2015
DHHS Finance Committee Update
5
Key Roles of DHHS
• Educate the public and providers on navigating complex systems of care
• Deliver services to clients
–
–
–
–
Directly via our 11 District Offices
Client Services Call Center
Directly via 3 Institutions
Purchased via contracts with providers
• Protect the health and safety of the population
– Protect children and adults from abuse and exploitation
– Public health disease prevention, surveillance and response
• Provide regulatory oversight
– Health facilities
– Child care facilities
– Food service businesses
• Insure program and operational integrity
1/21/2015
DHHS Finance Committee Update
6
Services and Populations
To join communities and families in providing opportunities for citizens to achieve health and independence
Children & Families
Elderly
Child Abuse Protection &
Prevention
Elder Abuse
Protection &
Prevention
Juvenile Justice
Child Support
Foster Care & Adoption
Employment Services
Food Stamps
Child Development
Transitional Cash
Assistance
Mental Health &
Substance Abuse
Developmentally
Disabled
Community Mental
Health
Support Services
Employment Supports
Caregivers
Housing
Nutrition
New Hampshire
Hospital
Family Supports
Glencliff Home
Residential Services
Long-term Care
Community-Based
Nursing Homes
Home Care
Housing
Substance Abuse
Prevention,
Intervention &
Treatment
Population Health
Public Health
Laboratory Services
Disease Prevention
Food Safety
Childhood Vaccines
Emergency Response
Homelessness
Rural Health
WIC
-------Medicaid Medical Primary Care, Specialty Care, Rx Services-----
Enabling Organization Support
Service Eligibility, Fraud Investigations, Appeals, Quality Assurance, Licensing, Recoveries
Lean, Data Analytics, Inspections, Ombudsman, Finance, Business Operations, Systems, HR
1/21/2015
DHHS Finance Committee Update
7
Caseloads
6 Year View
•
•
•
•
•
Date
Unduplicated
Medicaid
LTC
FANF
APTD
SNAP
Jan-2009
131,088
106,833
7,243
12,347
7,299
73,617
Jan-2010
146,491
117,326
7,312
14,392
8,337
101,013
Jan-2011
153,338
119,554
7,217
13,796
8,740
113,127
Jan-2012
154,765
119,338
7,189
11,781
8,834
117,047
Jan-2013
157,348
130,239
7,194
8,559
8,115
120,153
Jan-2014
154,862
132,034
7,265
7,330
7,834
113,326
Nov-2014
180,798
162,848
7,160
6,705
7,607
107,214
Caseloads in the traditional Medicaid program have stabilized and have actually declined
We had a significant increase in low income children to the Medicaid program in the first half of CY 14
The NH Health Protection Program has added over 31,000 newly eligible—100% FFP through 12/31/16
Declines in FANF and APTD driven by policy decisions
SNAP decreases driven by improved economy
1/21/2015
DHHS Finance Committee Update
8
Staffing
•
Positions in calendar year 2014
– 1/1/14:
2,897 authorized, 309 vacant, 10.6% vacant
– 1/1/15:
2,981 authorized, 356 vacant, 11.9% vacant
• 68 positions were added to address NH Health Protection Program eligibility
• 93 of 2,981 authorized positions are Unclassified and of those, 18 are vacant
• Since July 2011, DHHS has abolished 468 positions
Authorized
%
Organization
296
9.9%
Public Health, Drug and Alcohol
799
26.8%
Institutions: New Hampshire Hospital and Glencliff Home
504
16.9%
Client Services and Family Assistance
841
28.3%
Human Services (DCYF, DCSS, HHS, OMHRA, BEAS/APS)
382
12.8%
Program Integrity, operations support, information and administrative services
159
5.3%
Medicaid enterprise
1/21/2015
DHHS Finance Committee Update
9
NH DEPARTMENT OF HEALTH AND HUMAN SERVICES
DEPARTMENT VACANCY PERCENT
July 1, 2008 Through December 31, 2014
20.0%
July 2011
Abolished 369
18.0%
16.0%
14.0%
12.0%
Dec 2011
Abolished 99
10.0%
8.0%
6.0%
December 31, 2014 - 11.9%
4.0%
2.0%
0.0%
1/21/2015
DHHS Finance Committee Update
10
SFY 14 Actual Spending ($000’s)
Total Spending of $1,877,984
Direct Service: Institutions
$ 86,987
Division Administration
$ 34,957
Enrolled Providers
Service Delivery Management
$ 1,151,977
$18,926
Medicaid Enhancement
Contracted Services
IT Systems
$ 101,509
$ 301,561
$ 47,015
Field Operations
Human Resources
$ 67,266
$ 1,620
Cash Assistance
Legal, Regulatory, Audits
$ 42,463
87.9%
12.1%
$ Direct Services
1/21/2015
$ 23,703
$ Administration
DHHS Finance Committee Update
11
Medicaid Spending
by Eligibility Category
Percentage
Of Clients
Percentage
Of Costs
Low Income Child
58.6%
22.0%
Low Income Adult
12.0%
7.8%
Severely Disabled Child
1.2%
3.6%
Adults Disabled Physical
6.3%
20.1%
Adults Mental Illness
8.6%
22.5%
Elderly
6.6%
23.4%
QMB/SLMB
6.6%
0.7%
~72% of
members/
~33% of
costs
~22% of
members/
~66% of
costs
QMB: Qualified Medicare Beneficiary/SLMB: Special Low Income Beneficiary
Based on average for SFY 10 through SFY 14
1/21/2015
DHHS Finance Committee Update
12
SFY 15 Budget Update
•
DHHS produces a monthly Dashboard for the Governor and the Legislature (see Attached)
– 4 sections
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•
•
•
•
•
•
Narrative
Budget summary and projection for the Fiscal Year
Key program client counts
Select initiative updates
November 2014 Dashboard projects a $58.33M general fund shortfall
5 factors drive almost 90% of the total General Fund shortfall
– $9.3M for mandated back of the budget reductions plus DHHS share of Statewide reduction
– $9.6M due to delay in implementation of Medicaid Care Management and decision to defer second
step of program to July 1, 2015
– $5.7M for startup and operational costs to implement the NH Health Protection Program (SB 413)
– $5.4M for costs to fund US DOJ litigation on State’s mental health system (HB 1635)
– $21.4M in additional costs to fund Medicaid caseload increases due to change in Federally prescribed
eligibility calculation—Modified Adjusted Gross Income or MAGI
DHHS has addressed ~$17M of the general fund shortfalls
– A plan to address the balance will be presented to the Fiscal Committee on January 23rd of this month
– DHHS will also seek authority for transfers to balance accounts and enable sufficient funds to make
payments to the Managed Care Organizations
– The plan will impact the Department’s lapse obligation
1/21/2015
DHHS Finance Committee Update
13
Key Accomplishments
DHHS has had a number of significant successes in a challenging time
• Implemented the Medicaid Care Management program
• Implemented the NH Health Protection Program
• Worked with LRGH to establish a new Designated Receiving Facility in Franklin
• Systems
– 9 months after go-live with a new MMIS, adapted system to address care management
– Continued to update the New Heights and NH EASY systems to accommodate NH HPP
– Implemented a new Child Support Enforcement information system
• Received approval for rule on the Therapeutic Use of Cannabis program
– Expect to make decisions on the Alternative Treatment Centers in early February
• Created a State Health Improvement Plan that targets 10 key health areas
• Continued partnership with the National Guard on serving the State’s citizen warriors
• Creating a “no wrong door” for long-term care assessment
• Centralized the medical and financial eligibility functions for long-term care
• Achieve Prison Rape Elimination Act (PREA) standard at the Sununu Youth Services
Center
• Awarded 2 bonuses for excellent performance on the SNAP program
• Led health, medical and shelter operations for multiple natural weather events
1/21/2015
DHHS Finance Committee Update
14
Setting the Context
Challenges
SFY 15 Update
1/21/2015
DHHS Finance Committee Update
15
External Factors Impact DHHS
Increasing Client Complexity and Diversity
Economic and Fiscal
Delivery Systems
Technology
Demographics
1/21/2015
Cybersecurity
DHHS
Litigation
Uninsured
Federal government
DHHS Finance Committee Update
16
Key Challenges
• Continue full implementation of Medicaid Care Management program to achieve our goals
• Increasingly complex populations that challenge where care can be best provided
–
Demographics and impacts on long-term care system financing
• A mental health system that is strained and driving additional costs at all levels of government
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Daily waiting list for admission into the New Hampshire Hospital
• An epidemic of drug and opioid use is challenging every level of government and communities
• Cybersecurity threatens all of State government and DHHS is no exception
• Accelerating need for changes to key information systems
–
–
Federal requirements
Changes to State programs
• Payment structures are not aligned with desired client and provider behaviors
–
Many provider networks are financially fragile and fragmented
• Department’s workforce is aging and risk loss of significant program and operational knowledge
DHHS has a number of strategic initiatives to respond to each of these challenges
1/21/2015
DHHS Finance Committee Update
17
Strategic Themes
•
Strategy
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•
Customer Service
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•
–
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Care management , service coordination through integrated service delivery systems
Performance based contracting—focused on outcomes vs. services and payment system that is aligned with desired
outcomes
Strengthen and integrate provider networks
Community based services when more effective and efficient than institutional services
Enabling Management Infrastructure
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–
–
1/21/2015
Assure that what we are doing in service delivery and operations is measurable and effective
Service Delivery
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–
•
No wrong door, efficient and effective interactions with clients
Centralize services with greater use of technology
Quality Management
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•
Focus on first on population segment and then based on primary need
Whole person and client centered over the life span
High quality services that contribute to the improvement in the health of the population
Strengthen data and information systems
Integrity and efficiency in all operations
Optimize State and Federal resources
DHHS Finance Committee Update
18
SFY 16/17 Budget Overview
Budget Summary
Budget Drivers
Strategies to Reduce Budget Request
1/21/2015
DHHS Finance Committee Update
19
Overview
• DHHS currently working Governor’s phase
• Summary of Maintenance request in $000’s
Total Funds General Funds
– SFY 14 $1,878
$534
– SFY 15 $2,118
$614
– SFY 16 $2,440
$746
– SFY 17 $2,511
$778
1/21/2015
DHHS Finance Committee Update
20
SFY 16/17 Budget Overview
Agency Perspective
General Funds Only
Agency Description
42
45
47
48
49
90
91
92
93
94
95
FY 2014
FY 2015
Actual
Adj Auth
FY 2016
Maint
80,233 81,503
48,651 50,275
89,422 281,339
76,191 49,101
Change
FY 2017
Total
Human Services (SYSC, DCYF)
Div Family Asst. & Div Client Services
OMBP
Elderly and Adult Services
DCBCS (Military Support, Drug & Alch.
Svs)
Public Health
Glencliff
Behavioral Health
Developmental Svs
NH Hopital
Commissioner Office
72,493
39,713
113,051
63,727
3,410
4,147
6,142
5,677
13,457 17,786 18,284
6,174
7,139
8,052
41,755 73,024 13,920
117,951 148,853 156,913
21,234 23,314 26,808
39,810 43,148 54,423
10,673
891
Totals
533,512 613,903 746,295
75,197 821,492
Maint
84,913 83,217
50,275 51,454
29,007 310,346 295,513
12,875 61,976 51,888
17,584
19
458
280
Change
3,436
SFY 16-17 Biennium Total
Total
Maint
Change
Total
SFY 16-17 Biennium
Maint Incr Change Inc
9,531
7,350
86,653
51,454
305,044
59,238
164,720
101,729
576,852
100,989
6,846
38,538
20,225
171,566
101,729
615,390
121,214
11,994
13,365
374,379
(38,929)
6,846
38,538
20,225
16,350
5,767 7,054
19,175 18,452
892
8,052
8,165
31,504 13,840 19,631
156,932 167,455
27,266 27,769
437
54,703 54,597
320
12,821
19,344
8,165
33,471
167,455
28,206
54,917
11,444
36,736
16,217
27,760
324,368
54,577
109,020
17,727
1,783
37,215
19
895
600
29,171
38,519
16,217
64,975
324,387
55,472
109,620
17,727
1,783
37,215
19
895
600
1,524,412 123,848
1,648,260
1,155
5,493
2,904
(87,019)
57,564
10,029
26,062
376,997
778,117 48,651
826,768
123,848
• DHHS budget comprised of 11 agencies
• SFY 14 to SFY 15 increase of ~$80M in General Funds
• Driven largely be increases in Developmental Disabilities, Mental Health and NH HPP start-up costs
• Key issues for consideration
• Maintenance of Effort
• No change items are included yet, there are two that will need to be considered
1/21/2015
DHHS Finance Committee Update
21
Segmented by Population
A whole person focus requires looking at the full range of activities for the segment
Funds in 85 accounting units drive 98% of budget—this view shows what population served
Supporting narratives provide details on who, what, how much, etc.
Figures Rounded to $000
Total Funds
SFY14
Genl Fund
SFY14
MEDICAL SERVICES
MENTAL HEALTH SERVICES
HUMAN SERVICES
LONG TERM SUPPORT SERVICES
TOTALS
$254,298
$8,646
$165,489
$13,902
$442,335
$43,447
$3,185
$72,321
$5,981
$124,934
MEDICAL SERVICES
MENTAL HEALTH SERVICES
HUMAN SERVICES
LONG TERM SUPPORT SERVICES
TOTALS
$277,081
$68,667
$44,809
$227,143
$617,699
$52,805
$26,326
$25,765
$109,525
$214,421
MEDICAL SERVICES
MENTAL HEALTH SERVICES
HUMAN SERVICES
LONG TERM SUPPORT SERVICES
TOTALS
$94,221
0
$28,807
$383,514
$506,542
$56,212
0
$16,393
$24,226
$96,831
PREVENTION SERVICES
PROTECTION SERVICES
MEDICAL SERVICES
TOTAL
$8,765
$15,027
$119,452
$143,244
$3,822
$6,520
$21,875
$32,217
TOTAL ADMINISTRATIVE
$142,742
$59,722
$745,052
$77,313
$239,105
$624,558
$8,765
$15,027
$142,742
$1,852,562
98.6%
$174,338
$29,511
$114,479
$139,732
$3,822
$6,520
$59,722
$528,124
99.0%
MEDICAL SERVICES
MENTAL HEALTH SERVICES
HUMAN SERVICES
LONG TERM SUPPORT SERVICES
PREVENTION SERVICES
PROTECTION SERVICES
ADMINISTRATIVE COSTS
TOTALS
PERCENTAGE LISTED
1/21/2015
Total Funds
SFY15
Genl Fund
SFY15
CHILDREN
$301,554
$48,149
$9,263
$3,497
$198,351
$83,704
$19,666
$8,854
$528,834
$144,203
ADULT
$332,768
$58,376
$86,079
$36,256
$48,559
$27,231
$269,669
$135,662
$737,075
$257,525
SENIORS
$117,961
$69,132
0
0
$33,491
$18,429
$394,183
$27,067
$545,635
$114,628
GENERAL POPULATION
$12,563
$4,798
$27,384
$7,705
$79,687
$2,528
$119,634
$15,031
ADMINISTRATION
$151,217
$75,378
$831,970
$95,342
$280,401
$683,518
$12,563
$27,384
$151,217
$2,082,395
98.3%
$178,184
$39,753
$129,364
$171,583
$4,798
$7,705
$75,378
$606,765
98.8%
Total
SFY16
General
SFY16
Total
SFY17
General
SFY17
Biennium to Biennium Increase
in GF
$376,834
$10,229
$193,463
$18,635
$599,161
$102,091
$4,021
$85,906
$9,377
$201,395
$391,666
$10,472
$196,246
$19,044
$617,427
$107,424
$4,165
$87,410
$9,607
$208,606
$117,919
$1,504
$17,291
$4,149
$140,864
$416,579
$93,244
$47,681
$289,394
$846,898
$127,772
$43,028
$27,316
$142,988
$341,104
$435,629
$98,731
$48,514
$309,775
$892,649
$134,613
$47,260
$27,870
$153,246
$362,988
$151,204
$27,706
$2,189
$51,047
$232,146
$84,791
0
$33,488
$415,356
$533,635
$54,807
0
$20,149
$28,815
$103,771
$88,629
0
$33,634
$428,953
$551,216
$57,281
0
$20,687
$30,887
$108,855
($13,256)
$0
$6,014
$8,409
$1,167
$12,084
$27,837
$214,772
$254,693
$4,579
$8,548
$2,663
$15,790
$12,055
$28,540
$219,671
$260,266
$4,602
$8,659
$2,726
$15,987
$562
$2,982
($19,014)
($15,470)
$191,525
TOTALS
$88,776
$189,723
$89,718
$43,394
$1,092,975
$103,473
$274,632
$723,385
$12,084
$27,837
$191,525
$2,425,911
98.7%
$287,333
$47,049
$133,371
$181,180
$4,579
$8,548
$88,776
$750,836
99.1%
$1,135,595
$109,203
$278,394
$757,772
$12,055
$28,540
$189,723
$2,511,282
98.8%
$302,043
$51,425
$135,967
$193,740
$4,602
$8,659
$89,718
$786,154
99.1%
$236,853
$29,210
$25,495
$63,605
$562
$2,982
$43,394
$402,101
DHHS Finance Committee Update
22
Agency Request Increase
SFY 14/15 to SFY 16/17
TOTAL Maintenance Request
Medicaid
376,997
193,480
% of Increase
51%
•
LTSS Disabilities
46,162
3,322
2,630
52,114
12%
1%
1%
14%
•
5,505
3,669
1%
1%
•
16,692
4%
2,485
1,946
1%
1%
MMIS
(enhanced
FFP)
3,500
1%
Transfers to DoIT
(direct & shared)
8,500
2%
•
•
•
•
•
•
Public Health
3,339
1%
Est Dept Wide Sal & Ben
Items not accounted for
33,823
51,944
9%
14%
Total Maintenance
376,997
DD medicaid waiver & wl
ABD medicaid waiver & wl
I HS medicaid waiver & wl
Seniors
Nursing Home /CFI Services
Non Medicaid social svc
Human Services
NHH
Glencliff
OIS
Areas of change _ Maintenance Only
Caseload growth assumptions vary by
population and program
Significant growth in Medicaid driven by
MAGI
Rates increase requests vary by population
and program
NH HPP operations including eligibility staff
Waiver services and DD waitlist requests
Crisis beds as the NHH
Essential system changes
Increase in salary and benefits
Greater details in House phase of budget
Misc
1/21/2015
DHHS Finance Committee Update
23
Change Budget
• Total Change Budget of $123.8M General funds over biennium
• Significant items
– Governor’s Commission Full Funding
– Substance Use Disorder benefit for current Medicaid population
– Elimination of Budget Neutrality Factor for Nursing Home services
• Two items are non-discretionary
– Community Mental Health Agreement Funding
• $9.7M in SFY 16
• $13.3M in SFY 17
– Possible funding from the 1115 Transformation waiver could offset a portion of
this request
– DCYF Age of Majority (HB 525)
• $1.75M in SFY 16
• $1.75M in SFY 17
1/21/2015
DHHS Finance Committee Update
24
Budget Considerations
• Traditional budget development focused on
– Rates---Utilization---Caseloads
• What considerations or options impact budget request?
–
–
Caseload growth assumptions
Rate increases in both Fee for Service and Care Management
•
–
–
Rates for care management must be actuarially sound and approved by CMS
Cost of living increases
Utilization of service projections in both Fee for Service and in the Care Management program
•
Projecting change in trend for Step 2 services and populations
– Medicaid Enhancement Tax and payments for Uncompensated Care
– Maintenance of Effort on key Federal programs
– Program requirements at both State and Federal level
•
–
–
–
–
–
Includes information systems
Disease burden or need of target populations
Functions performed by the Department
Level of County Cap—this did not change
Pending Federal action on certain programs, CHIP
Impact of the changes to how eligibility is calculated for certain populations
•
The Modified Adjusted Gross Income or MAGI impacts for children and parents
– Cost shifting to local and county
– State impacts of the NH HPP
1/21/2015
DHHS Finance Committee Update
25
Innovation Initiatives
High Level Review
Medicaid Care Management
Mental Health System
Improving the Health of the Population
Organization
Additional detailed Sessions Planned with Finance and Division III
1/21/2015
DHHS Finance Committee Update
26
Key Initiatives
• Develop the SFY 16/17 budget
• Fully implement a managed care model for Medicaid
–
–
–
Implementation of Premium Assistance Program
Implementation of next phases of Substance Use Disorder benefit
Implementation of Step 2 Care Management for the long-term supports and services focused on those with
intellectual and developmental disabilities and the elderly
• Strengthen the Mental Health System
–
–
–
–
Continue to strengthen the mental health system infrastructure
Implementation of the Community Mental Health Agreement
1115 Transformation Waiver
Re-engineering the New Hampshire Hospital admissions area and creating 10 crisis beds
• Redesign of the Organization
–
–
Centralize Client Services
Centralize long-term care eligibility-clinical and financial
• Systems
–
–
–
–
Certification of the Medicaid Management Information System
Implementation of ICD-10
Continued improvements to New Heights system
Increased focus on information security
• Improving the health of the population
–
–
1/21/2015
Integration of the State Health Improvement Plan with Care Management and across all populations
Awarded grant to plan for regional health cooperatives to assess and improve health at the local level
DHHS Finance Committee Update
27
Additional Updates
• The Department has 3 additional updates for the
House Finance Committee and Division III to provide
greater detail on several critical initiatives.
– January 22: Medicaid and New Hampshire Health
Protection Program
– January 26: DSH/MET and the Community Mental
Health Agreement
– January 27: Overview of the yet to be delivered 1115
Transformation Waiver focused on Mental Health and
Substance Use Disorders infrastructure and innovation
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DHHS Finance Committee Update
28
Care Management Timeline
• DHHS used a phased approach to implement SB 147 where all populations and
services be in a managed care model
– Step 1: all Medicaid State Plan Services plus mental health and Rx services for
certain populations
• Implemented on December 1, 2013
– Step 2: implement in two phases
• Phase 1: mandate most of Medicaid population into the program, expand services to include
nursing facility and those within the Choices for Independence waiver
– Targeted for July 1, 2015
– Requires CMS approval
• Phase 2: integrates services provided for those with Intellectual and Developmental
disabilities, those with Acquired Brain Disorders and In-Home Supports
– Target date is not determined
– Will require CMS approval
– Step 3: was planned to be Medicaid Expansion but SB 413 ushered in the NH
Health Protection Program
• The Health Insurance Premium Program or HIPP went live on August 15, 2014
• The Bridge to Premium Assistance Program went live thru the MCOs on September 1, 2014
• The Premium Assistance Program is targeted to go-live on January 1, 2016
– The Fiscal Committee approved the 1115 Waiver and it has been submitted to CMS
– CMS must approve the waiver before March 31, 2015
» Should CMS not approve the waiver by this time, the Bridge program ends on June 30, 2015
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DHHS Finance Committee Update
29
NH Medicaid Care Management
Enrollment, 12/1/13 – 1/1/15
160,000
133,716
140,000
120,000
104,284
Members
100,000
108,206
111,151
114,366 116,143
119,152 119,790 120,966 121,444
137,030
140,225
145,763
126,938
MAGI Impact
NHHPP
80,000
Total MCM
60,000
Non-MCM
40,000
26,147
25,186
22,772
18,775
17,708
17,450
16,306
15,824
16,125
3/1/14
4/1/14
5/1/14
6/1/14
7/1/14
8/1/14
20,000
21,418
22,090
21,127
22,067
9/1/14
10/1/14 11/1/14 12/1/14
1/1/15
21,102
0
12/1/13
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1/1/14
2/1/14
DHHS Finance Committee Update
Note: Non-MCM Includes retroactive enrollment and excludes members who only have Medicare savings plans (e.g., QMB)
30
NH Medicaid Care Management by
Eligibility Group, 1/1/15
Low-Income Children (Age 0-18)
47,936
50,000
40,000
Children With Severe Disabilities (Age 0-18)
Foster Care & Adoption Subsidy (Age 0-25)
39,612
Low-Income Adults & BCCP (Age 19-64)
NHHPP (Age 19-64)
Adults With Disabilities (Age 19-64)
30,000
5,226
4,128
7,025
1,128
486
1,000
3,074
1,535
7,583
12,568
8,200
825
305
1,694
767
10,000
6,778
6,494
20,000
11,150
Elderly & Elderly With Disabilities (Age 65+)
316
Percent of Total Eligibility Group Population
60,000
0
NH Healthy Families
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Well Sense
DHHS Finance Committee Update
Non-MCM
31
Improving the Mental Health System
• Several elements
– 10-Year Olmstead Plan
– Community Mental Health Agreement
– Leverage the NH Health Protection Program mental
health and substance use disorder service funding
– 1115 Transformation Waiver
– Re-engineering of the admissions unit at NHH
– Medicaid Care Management drives integrated
behavioral health and primary care
• Innovative payment structure between the MCO and the
Community Mental Health Centers
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DHHS Finance Committee Update
32
Improving the
Health of the Population
• NH today is a healthy State but with high health
care costs
• Under the leadership of the Division of Public
Health Services a State Health Improvement Plan
developed
• Recently, the State has been awarded a second
State Innovation Model planning grant
– Action is required by Fiscal
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DHHS Finance Committee Update
33
State Health Improvement Plan:
Charting a Course to Improve the Health of New Hampshire
10 Key Health Areas
SHIP Aims:
•
•
“Highlight 10 key health
areas and their health
outcome indicators that
describe the most
significant health issues
currently facing our
population.”
“To assist state and
community leaders in
focusing their work to
improve the public’s
health and to promote
coordination and
collaboration among
public health partners.”
Tobacco
Reduce adult cigarette smoking, the initiation of tobacco use in
children, tobacco use by adolescents, smoking during pregnancy,
and exposure to indoor tobacco use
Obesity/Diabetes
Reduce adult and childhood obesity; decrease emergency
department visits and hospitalizations for diabetes
Heart Disease and Stroke
Reduce high blood pressure and cholesterol in adults, and death
from coronary heart disease and/or stroke
Healthy Mothers and Babies
Reduce preterm births, unintended teen births, and children
dental caries; increase screening for Autism Spectrum Disorder
(ASD) and other developmental delays
Cancer Prevention
Increase colorectal cancer screening and mammogram screening
for breast cancer; reduce melanoma and lung cancer deaths
Asthma
Increase asthma control in adults and children
Injury Prevention
Reduce unintentional poisoning deaths, falls-related deaths in
older adults, motor vehicle crash injuries in teens, suicide deaths
for all persons, and suicide attempts by adolescents
Infectious Disease
Increase childhood vaccinations, timeliness of foodborne illness
investigations, and seasonal influenza vaccinations; reduce
health care associated infections, and enhance food safety
Emergency Preparedness
Misuse of Alcohol and Drugs
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Health Outcome Indicators
Increase community engagement in public health emergency
activities and the State’s ability to dispense emergency countermeasures to the public; strengthen the capacity to respond to
public health emergencies in a timely manner and the capacity to
maintain situational awareness of health threats
Reduce binge drinking, marijuana use in youth, the non-medical
use of pain relievers, and drug-related overdose deaths
DHHS Finance Committee Update
Operating Model for the Future
• Improve the health of the population
– Focus on prevention and wellness
– Whole person
• Separate strategy and delivery to break silos and set stage for payment
reform
• Quality and outcome measurement at a Department level
– Build on the significant commitment to Quality in MCM
• Centralize and streamline client services from front door inquiry to
determination of eligibility
• Realign and focus the enabling functions
• DHHS has outlined the overall architecture for the organization around
these major elements and will do further design and implementation in
several stages
– First area of focus has been some consolidations—see Efficiency section
– Next area of focus are the Medicaid related operations
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DHHS Finance Committee Update
35
Other Updates
Litigation
Efficiencies
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DHHS Finance Committee Update
36
Litigation
• There are a number of active cases.
• Four of the most significant are:
– Amanda D, et. al. Hassan, et. al; United States v
New Hampshire
– Residential Child Care Rate Appeal (Chase Home)
2007-2010
– Wallace et. al. v. State of New Hampshire
– Harbor Homes, Inc. v. Nicholas Toumpas
• Other litigation concerning various personnel
matters
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DHHS Finance Committee Update
37
Innovation and Efficiency
• LEAN has become part of DHHS culture
• Redesign of the organization
• Centralization of several critical functions
– Client Services
– Long-term care eligibility
– Contracting unit
– Assessment is in progress to align or consolidate
like functions across all areas
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Summary and Next Steps
• DHHS is a vital organization to the people of the State
of New Hampshire
• Our staff and those of our partners are diligent and
committed
• Resource limitations are the reality and we are
embracing innovation and change to fulfill our mission
• We will be before the Fiscal Committee on Friday to
outline SFY 15 spending adjustments
• Further sessions with House Finance and Division III are
scheduled to do more in-depth reviews of key issues
1/21/2015
DHHS Finance Committee Update
39
Thank You
NToumpas@DHHS.State.NH.US
(O) 603-271-9446, (C) 603-545-4995
1/21/2015
DHHS Finance Committee Update
40