Kentucky Medicaid Works Program for Disabled Individuals

Department for Medicaid Services Prepared for the Medicaid Oversight and Advisory Committee Lisa Lee, Commissioner, DMS Steve Bechtel, Chief Financial Officer, DMS June 16, 2021

OVERVIEW OF MEDICAID WORKS PROGRAM 2

Medicaid Works Background Individuals with severe medical or physical impairments have high medical costs Prior to ACA, difficulty finding affordable private health insurance or may be denied health insurance due to pre- existing condition May not be able to afford employer coverage Employers may not offer health insurance To be eligible for disability benefits, individuals must be unable to engage in substantial gainful activity (SGA) Disability is an eligibility category for Medicaid Individuals who earn more than the SGA are no longer considered disabled for purposes of SSI or Medicaid 3

Medicaid Works Background Ticket to Work and Work Incentives Improvement Act of 1999 option for working individuals with disabilities to buy-in to Medicaid Individuals who would be eligible for SSI benefits except for their earnings State establishes income and asset tests as well as methodology for determining May impose premiums based on a sliding scale No premiums for those below 100% of FPL 4

Kentucky Medicaid Works Implemented November 2007 Eligibility Criteria Blind or disabled individuals must meet Social Security definition of disabled Continues to be eligible for Medicaid except for employment earnings Lack of eligibility for Medicaid would inhibit ability to continue employment Between the ages of 16 and 64 Must meet Medicaid resource standards no more than $4,000 in personal assets Only income of working disabled is counted Unearned income limit (SS, Worker s Comp, Veteran s benefits, interest) of approximately $773 monthly 5

Kentucky Medicaid Works Enrollment 15 Unduplicated Members since implementation 5 currently enrolled All below 100% of FPL no premium requirement Move to Medicaid Expansion? HJR57 Bridge Plan potential for those who do not qualify for expansion 6

SFY 2021 Benefits Budget Update 7

Kentucky Medicaid at a Glance Approximately 1,664,000 members currently enrolled 605,159 children enrolled in Medicaid and KCHIP (36% of total enrollment) 129,454 of total enrolled are currently in presumptive eligibility (8% of total enrollment) Over 59,300 enrolled providers $14.7 billion budget (Administrative and Benefits combined) 8

Eligibility Experience Enrollment for the period of July 2019 through May 2021: o Since March 2020, our Total Enrollment has increased by 350,047 (26.50%). o Presumptive Eligibility currently accounts for 129,454 (37%) of the overall increase in eligible members. 9

Presumptive Eligibility Discontinued (moved to Exchange, employer sponsored health insurance, or uninsured) Qualified for Full Medicaid Total Number of Individuals Ever Enrolled Since March 2020 Currently Enrolled 129,454 227,996 29,443 69,099 10

PE Expenditures Total FFS Spend: $312,433,833 Average of $1,370.35 per enrollee 11

MEDICAID EXPENDITURES BENEFITS (INCLUDES KCHIP) Historical Expenditures and Enacted Budget SFY 2017 ACTUAL SFY 2018 ACTUAL SFY 2019 ACTUAL SFY 2020 ACTUAL SFY 2021 BUDGETED (actual) (actual) (actual) $1,880,812,400 (actual) $1,825,369,800 (budgeted) $2,018,893,700 $1,707,980,000 $1,983,649,500 General Fund Restricted Agency Funds $491,271,700 $500,620,700 $506,680,600 $478,112,300 $713,921,500 $7,928,095,500 $8,149,996,200 $8,068,252,600 $9,381,017,300 $11,745,488,200 Federal Funds $10,127,347,200 $10,531,429,300 $10,400,303,000 $11,842,779,100 $14,478,303,400 TOTAL 12

MEDICAID EXPENDITURES BENEFITS SFY 2021 Budgeted vs. Actual SFY 2021 SFY 2021 SFY 2021 Remaining Appropriations $7,425,900 $309,148,000 $1,209,542,600 $1,526,116,500 Benefits Budget (Thru May 31, 2021) (actual) Budgeted Appropriations $2,018,893,700 $713,921,500 $11,745,488,200 $14,478,303,400 (actual) Actual To-Date Expenditures $2,011,467,800 $404,773,500 $10,535,945,600 $12,952,186,900 (actual) (actual) (budgeted) General Funds Restricted Agency Funds Federal Funds TOTAL 13

Growth of Medicaid In comparing June 2019 thru March 2020 data to June 2020 thru March 2021 data, we can see the following: 18.83% increase in the monthly average eligibles 16.05% increase in total expenditures 14

Per Member Per Month (PMPM) Monthly Average ELIGIBLES TRADITIONAL EXPANSION CHIP TOTAL AVG July 2019-March 2020 July 2020-March 2021 % CHANGE 825,964 444,602 91,115 1,361,682 900,102 618,999 98,953 1,618,053 8.98% 39.23% 8.60% 18.83% PMPM TRADITIONAL EXPANSION CHIP Aggregate PMPM July 2019-March 2020 July 2020-March 2021 $795.59 $614.83 $220.98 $698.12 % CHANGE 3.67% -11.13% 5.20% -2.30% $824.83 $546.41 $232.47 $682.09 15

TEMPORARY INCREASE IN FMAP FOR HCB WAIVER SERVICES AUTHORIZED BY THE AMERICAN RESCUE PLAN 16

Temporary Increase in FMAP for HCBS One-year, 10% increase in FMAP for HCBS Must be used to supplement, not replacing existing state funds Facilitate activities that enhance, expand, or strengthen HCBS Cannot impose stricter eligibility requirements States must submit plan to CMS within 30 days of receipt of guidance Kentucky requested and was approved a 30 day extension for plan submission Conducting provider and member surveys Internal workgroup to eliminate duplication of efforts across the Cabinet States have until March 31, 2024 to fully expend funds Must receive appropriations for state match 17

Temporary Increase in FMAP for HCBS Options Conducting crosswalk from all agencies providing recommendations Oversight quarterly reporting to CMS Short term vs. Long Term Bolstering workforce: invest in training and career pathway strategies to grow a diverse LTC workforce Rate methodology aligning reimbursement across waiver types and programs serving the population across Cabinet PACE Home modifications structural improvements (Hart-Supported Living) Technology computers, tablets to assist with telehealth, remote patient monitoring devices Compliance with procurement rules 18

UPDATE ON MCO CONTRACT AND RFP PROCESS 19

QUESTIONS and/or Comments? 20