Florida Dual Eligibles Data Overview

ACAP Dual Eligibles Toolkit: Summary Data for Florida Compiled by: Special Needs Consulting Services (SNCS)

Key Information, Florida Florida has roughly 300,000 full duals 52% of these persons are age 65+ The full duals annual costs (across Medicaid and Medicare) now total approximately $300 billion roughly $50,000 per person per year 53% of these expenditures are paid for by Medicaid SNCS estimates that 18% of the Florida s duals costs are currently paid via capitation; 82% via FFS Florida plans to participate in CMS Capitation Alignment Demonstration, with initial enrollment effective January 2013 MCOs interested in serving duals under this demonstration need to engage in significant preparations during CY2012 (and CY2013) Average lifetime revenue for each dual eligible enrolled is likely to approach or exceed $500,000, since most duals will remain eligible and enrolled for remainder of their lives (which should average > 10 years) The high needs and high costs, coupled with the rest of life enrollment dynamic, creates profound and exciting care coordination opportunities Moving Florida s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup

Estimated PMPM Cost, Florida Full Duals, 2008 Florida Age <65 Age 65+ All Full Duals Average Eligibles 90,670 200,418 291,088 Total Medicaid Cost $1,255 $1,037 $1,104 Nursing Home $320 $703 $584 Capitated Care $37 $108 $86 HCBS Waiver & Prosthetics $387 $67 $167 Personal Support $21 $66 $52 ICF/MR $245 $9 $82 All Other Medicaid $245 $83 $134 Estimated Medicare Costs $1,496 $1,531 $1,520 Part A $367 $488 $450 Part B $486 $671 $613 Part D $642 $372 $456 Total Costs, Medicaid & Medicare $2,750 $2,567 $2,624

Estimated Total Dollar Cost, Florida Full Duals, 2008 Florida Age <65 Age 65+ All Full Duals Average Eligibles 90,670 200,418 291,088 Total Medicaid Cost $1,365,131,114 $2,492,805,665 $3,857,936,779 Nursing Home $348,051,580 $1,691,564,534 $2,039,616,114 Capitated Care $40,545,087 $258,803,681 $299,348,768 HCBS Waiver & Prosthetics $421,271,105 $160,736,226 $582,007,331 Personal Support $22,625,012 $159,781,922 $182,406,934 ICF/MR $266,429,796 $21,228,007 $287,657,803 All Other Medicaid $266,208,534 $200,691,295 $466,899,829 Estimated Medicare Costs $1,627,464,611 $3,681,699,275 $5,309,163,886 Part A $399,534,934 $1,173,191,310 $1,572,726,243 Part B $529,174,375 $1,612,838,788 $2,142,013,164 Part D $698,755,302 $895,669,177 $1,594,424,479 Total Costs, Medicaid & Medicare $2,992,595,725 $6,174,504,940 $9,167,100,665

Publicly Available Resources Containing Data and/or Other Information About Florida s Dual Eligibles Medicare-Medicaid Enrollee State Profile, Florida, Centers for Medicare & Medicaid Services http://www.integratedcareresourcecenter.com/PDFs/Stat eProfileFL.pdf Achieving Optimal Care Coordination for Medicaid/Medicare Dual Eligibles, August 2011, Special Needs Consulting Services (Joel Menges, Jeremy Batt, Kaleigh Beronja, Jessica Wiecezak) http://www.sncservices.com/Achieving%20Optimal%20Care %20Coordination%20for%20Dual%20Eligibles-%20FINAL.pdf