Rhode Island Annual Medicaid Expenditure Report SFY 2016 · the last five years, not including...

RhodeIslandAnnualMedicaidExpenditureReportSFY2016ExecutiveOfficeofHealthandHumanServicesMay2017

PurposeofthisReport

Thepurposesofthisreportincludethefollowing:§ ComplywiththerequirementsofStatutoryMandateR.I.G.L.42-

7.2-5(d),theauthorizingstatutefortheExecutiveOfficeofHealthandHumanServices(EOHHS),toprovideacomprehensiveoverviewofallMedicaidexpenditures,outcomes,andutilizationrates.

§ ProvidestatepolicymakerswithacomprehensiveoverviewofstateMedicaidexpenditurestoassistinassessingandmakingstrategicchoicesaboutprogramcoverage,costs,andefficiencyintheannualbudgetprocess.

§ SummarizeMedicaidexpendituresforeligibleindividualsandfamiliescoveredbythehealthandhumanservicesdepartments.

§ ShowenrollmentandexpendituretrendsforMedicaidcoveragegroupsbyservicetype,caresetting,anddeliverymechanism.

§ EstablishastandardformatfortrackingandevaluatingtrendsinannualMedicaidexpenditureswithinandacrossdepartments.

RIMedicaidExpenditureReportSFY2016 2

VariancetoOtherReports:ThisreportisbasedonMedicaidsystemsextractsthatincludeclaims,capitationpayments,premiums andproviderpayouts. Capitations,premiumsandpayouts areproportionatelyallocatedtoMedicaidcoveragegroups,servicetypesandcaresettingbasedonrespectiveclaimsandpayoutinformation.Duetotheproportionalallocationmethodusedhere,otherreportsbaseddirectlyonclaimsdatamaydifferfromtheexpenditureamountsinthisreport.Theprimarybasisforidentifyingexpendituresinthisreportistheactualdateofservicewithanadjustmentforincurredbutnotreported(IBNR)claims,ratherthanpaiddate. Expenditureamountsusedinthisreportmayvaryfromexpendituresreportedforfinancialreconciliationorotherpurposesduetodifferencesintiming.

Otherreasonsforvariancemightincludefactorssuchasclaimcompletionandrounding.

Definitionofaverageannualratesmethodology:Thisreportshowstrendsintermsofanaverageannualtrendratebasedonfiveyearsofhistoricaldatainordertopresentlongertermtrendsratherthanyeartoyearvariation.Anaverageannualincreaseof1.0% peryearfrom2011to2015isequivalenttoanincreaseof4.1%intotalfrom2011to2015.

TableofContents


ExecutiveSummary 4

Overview DefinitionsandExclusionsOverallExpendituresandTrendsFederalandStateShareofExpendituresSpendingByDepartment

10

ExpenditureDistributions ByPopulationByProviderTypeByProgram(Managedcare/FFS)

18

HighCostUsers ByExpenditureLevelByProviderTypeByPopulation

30

PopulationDetail EldersAdultswithDisabilitiesChildrenandFamiliesChildrenwithSpecialHealthCareNeeds(CSHCN)Expansion

34

Benchmarks NationalMedicaidTrendsCostandUtilizationBenchmarks

53

Appendices DetailsonExpenditureExclusionsAcronymsSourcesandNotes

59

ExecutiveSummary:OverviewandKeyFindings

OverviewDuringSFY2016RhodeIsland’sMedicaidprogramservedapproximately325,000RhodeIslanders,withanaverageof282,000enrolledatanyonetime.Thisincludes86,000individualsenrolledinMedicaidExpansion,theprogramstartedJanuary1,2014toexpandMedicaideligibilitytoadultswithoutdependentchildrenwithincomeslessthan138%ofthefederalpovertylevel.ProgramexpendituresonMedicaidcoveredservicesforSFY2016 totaled$2.4billion.Medicaidexpendituresaredividedamongseveralstateagencies,with$2billionofexpendituremanagedinSFY2016 bytheExecutiveOfficeofHealthandHumanServices(EOHHS),and$340millionmanagedbytheDepartmentofBehavioralHealthcare,DevelopmentalDisabilityandHospitals(BHDDH).

UndertheMedicaidprogram,thefederalgovernmentistypicallyresponsibleforapproximatelyhalfoftotalexpenditure.InSFY2016 theFederalMedicalAssistancePercentage(FMAP)was50.32%forthebulkofMedicaidexpenditure.ForcertainprogramstheFMAPishigher,includingExpansionpopulation,Children’sHealthInsuranceProgram(CHIP),andothers.


ExecutiveSummary Overview ExpenditureDistributions HighCostUsers PopulationDetail Benchmarks Appendices

KeyFindings:§ DuringSFY2016RhodeIsland’sMedicaidprogramservedanaverage

of282,000enrolleesatanyonetimeduringtheyear.§ TotalexpendituresforMedicaidcoveredservicesforSFY2016were

$2.4billion.§ BetweenSFY2012 and2016,totalMedicaidexpenditureshave

increasedanaverageof2.3%peryear,excludinggrowthfromtheExpansionpopulation.

§ Enrollmenthasincreased2.9%peryearonaverageoverthelastfiveyears,excludinggrowthfromtheExpansionpopulation.

§ Permemberpermonth(PMPM)costshavedecreased0.5%peryear,from$794inSFY2012 to$777inSFY2016,excludingtheExpansionpopulation.WhenincludingtheExpansionpopulation,overallMedicaidPMPMforSFY2016is$717.

§ TheseexpendituretrendscomparequitefavorablytobothnationalMedicaidtotalexpendituresandstatecommercialPMPMcosttrends.

§ Adultswithdisabilitiesaccountfor31%ofexpenditure.Eldersaccountforanother23%.

§ Hospitalsandnursingfacilitiesaccountfornearlyhalf(45%)ofMedicaidexpenditure.

§ NinetypercentofMedicaidrecipientsareenrolledinmanagedcareprograms.BothofRhodeIsland’sMedicaidmanagedcareorganizationswererated4.5outof5bytheNationalCommitteeforQualityAssurance(NCQA).

§ Claimsexpendituresarehighlyconcentrated– thetop6%ofusersaccountfor62%ofclaimsexpenditure.

ExecutiveSummary:Populations

Medicaidservesfivedifferentprimarypopulations:



§ Elders include19,198adultsoverage65,96%ofwhomarealsocoveredbyMedicare.1 Eldersaccountfor$559millionintotalSFY2016Medicaidexpenditure,andhavethehighestaveragePMPMcostof$2,427.Nursingfacilitiesaccountforsixtypercentofexpendituresforthispopulation.

§ Adultswithdisabilitiesinclude32,080adultsunderage65whohaveidentifieddisabilities.Almosthalf(48%)ofthispopulationisalsocoveredbyMedicare.Adultswithdisabilitiesaccountforthelargestshareofexpenditure,withSFY2016expenditureof$754million,andanaveragePMPMcostof$1,958.Thelargestcomponentsofexpenditureforthispopulationareresidentialandrehabilitationservicesforpersonswithintellectualanddevelopmentaldisabilitiesandhospitalcare.

§ Childrenandfamiliesinclude153,342 lowincomechildren,parentsandpregnantwomenwhomeetspecificincomerequirements.Childrenandfamiliesaccountfor54%oftotalenrollmentand22%oftotalexpenditure,withtotalSFY2016expenditureof$537millionandanaveragePMPMofunder$300.Mostexpenditureonthispopulationisforhospitalcareandprofessionalservices.Ninety-fivepercentofthispopulationisenrolledinmanagedcare. Thefederalmatchisincreasedto82.47%for qualifyinglowincomechildrenandpregnantwomenundertheChildren’sHealthInsuranceProgram(CHIP).

§ Childrenwithspecialhealthcareneeds(CSHCN)include12,025individualsunder21whoareeligibleforSupplementalSecurityIncome(SSI),childreninSubstitute(Foster)Care,KatieBeckettchildren,andAdoptionSubsidychildren.Thesechildrenaccountfor7%oftotalMedicaidexpendituresand4%ofenrollees,withSFY2016expendituresof$170million.Eighty-twopercentofthispopulationisenrolledinmanagedcare.

§ Expansionincludes64,989lowincomeadultswithoutdependentchildren,newlyeligibleundertheACAonJanuary1,2014.TheExpansionpopulationaccountedfor23%ofSFY2016enrollmentand17%oftotalSFY2016expenditure,or$402million.Expenditureforthispopulationis100%federallyfundedthroughtheendofcalendaryear2016.Thispopulationmainlyusedhospitalandprofessional services,accountingfor77%ofexpendituresonthispopulation.Nearlyall(95%)wereenrolledinmanagedcare.

Elders $55923%

Adultswithdisabilities$754 31%

Childrenandfamilies

$537 22%

CSHCN$170 7%

Expansion$402 17%

MedicaidExpenditurebyPopulationSFY2016- $Millions

1Enrollmentfiguresrepresentaveragemonthlyenrollmentunlessotherwisespecified.

ExecutiveSummary:MedicaidProviders

Medicaidpaysforservicesofferedbyavarietyofprovidertypes.Hospitalsandnursingfacilitiestogetheraccountfornearlyhalfofprogramexpenditure.

§ Hospitalswerethelargestprovidertype,accountingfor29%ofMedicaidexpenditureinSFY2016.

§ Hospitalexpendituresincreasingat1.1%annuallyoverthelastfiveyears,notincludingexpenditureontheExpansionpopulation.

§ Nursingfacilities(includingbothnursinghomesandhospice)werethenextlargestprovidertype,accountingfor16%ofexpenditureinSFY2016.

§ TotalMedicaidpaymentstonursingfacilitieshavebeenincreasingonaverage2.7%peryearbetweenSFY2012-2016(trendratesdonotincludetheExpansionpopulation).

§ Theprovidertypecategorieswiththehighestaverageannualgrowthtrendswereprofessionalservices,homeandcommunitybasedservices,andpremiums.

§ Otherprovidertypesdetailedinthereportincludepremiums;pharmacy;homeandcommunity-basedservices;andcareprovidedintheSlaterHospital,TavaresandZambarao facilities.



Hospital $70529%

NursingFacilities $391

16%Professional$378 16%

IDD* $23110%

ProfBehavioralHealth $181

7%

Other $53522%

MedicaidExpenditurebyProviderTypeSFY2016- $Millions

*TheIDDprovidertypeincludesresidentialandrehabilitationservicesandgrouphomesforpersonswithintellectualanddevelopmentaldisabilities.

ExecutiveSummary:ManagedCare

NotallpaymentsaremadedirectlybyMedicaidtoserviceproviders.InSFY2016,90%ofMedicaideligibles areenrolledinrisk-basedmanagedcareplans.Theseenrolledpopulationsaccountedfor76%ofMedicaidexpenditure.

§ Forty-ninepercentofMedicaideligibles areenrolledinmanagedcarethroughRIte Care,whichisaMedicaidmanagedcareprogramforchildrenandparents.

§ Another3%ofmanagedcareenrolledeligibles aretheChildrenwithSpecialHealthCareNeedspopulation.

§ Fivepercentofeligibles areenrolledinRhody HealthPartners(RHP),amanagedcareprogramforadultswithdisabilities.

§ TheExpansionpopulationismainlyenrolledinmanagedcare.

§ EnrollmentinMedicaidmanagedcareprogramsisdividedbetweenNeighborhoodHealthPlanandUnitedHealthcare.BothoftheseMedicaidmanagedcareorganizationswererated4.5outof5bytheNationalCommitteeforQualityAssurance(NCQA).

§ Rhody HealthOptions(RHO)isamanagedcareprogramrolledoutinSFY2014inconjunctionwiththeIntegratedCareInitiative.ItisafullycapitatedmodelforlongtermservicesandsupportsandotherMedicaid-fundedservicesdesignedforeligibleswithbothMedicaidandMedicareeligibility.InSFY20167%ofMedicaideligibles areenrolledinRHO.

§ ThreepercentofMedicaideligibles areenrolledinRIte Share,apremiumassistanceprogramforMedicaideligibleswithaccesstocommercialinsurance.ThisminimizesMedicaidexpenditurebyleveragingtheemployers’contributions.



EnrolledinManagedCare

Programs252,35190%

NotEnrolled29,28510%

MedicaidEligibles byEnrollmentSFY2016

ExecutiveSummary:LongTermServicesandSupports



Longtermservicesandsupports(LTSS)includeinstitutionalcare andcommunitycare.Theseservicesaremainlyfocusedontheeldersandadultswithdisabilitiespopulations.ExpendituresonLTSSaccountfor$850millionintotalMedicaidexpenditureinSFY2016,35%oftotal.

§ Communitycareservicesareprovidedtoat-riskpopulationsasalternativestomorecostlynursinghome/institutionaloptionsandaccountfor$348million,41%oftheLTSSexpenditure.

§ Institutionalcareservicesaccountfortheremaining$503millionofLTSSexpenditure.Thelargestcategoryisnursinghomeservices,accountingfor43%ofLTSSexpenditureoverall.OtherinstitutionalcareexpenditureisforhospiceandcareintheSlaterHospital,TavaresandZamabaranofacilities.

§ Thebalanceofexpenditurebetweennursingfacilitiesandhomeandcommunitybasedcare(HCBS,asubsetofCommunityCare)hasbeenshiftingoverthelast5years.InSFY2016HCBSaccountedfor23%ofthecombinedexpenditureonbothnursingfacilitiesandHCBScomparedto20%inSFY2012.

§ ExpenditureonHCBShasbeengrowingat7.2%peryearonaverageoverthelast5years.Nursinghomeexpenditurehasbeengrowingat3.0%peryearonaverage.

§ Acute,chronicandpreventiveservicesaccountfortheremaining65%ofMedicaidexpenditure.

InstitutionalCare $503

21%

CommunityCare $348

14%

Acute,ChronicandPreventativ

eCare$1,571 65%

MedicaidExpenditurebyProviderTypeCategorySFY2016-- $Millions

ExecutiveSummary:HighCostUsers



ThetopsixpercentofMedicaidusers,thosewithover$25,000inclaimsexpenditureperyear,accountfornearlytwo-thirds(62%)ofclaimsexpenditures.

§ Thisanalysisexaminesthecharacteristicsof“highcost”users,thosewithover$15,000ofclaimsexpenditureofperyear.

§ NinepercentofMedicaidusersare“highcost”usersandaccountfor71%ofclaimsexpenditure.

§ HighCostuserstypicallypresentwithmultiple,complexconditions,requiringcarecoordinationacrossavarietyofprovidertypes.

§ Forty-onepercentofclaimsexpenditureforhighcostusersisfornursingfacilitiesandresidentialandrehabilitationservicesforpersonswithintellectualanddevelopmentaldisabilities.Hospitalservicesaccountforanother24%ofhighcostuserclaimsexpenditure.

§ Together,eldersandadultswithdisabilitiesaccountfor71%ofclaimsexpenditureforhighcostusers.Forbothofthesepopulations,aboutthree-quartersoftotalpopulationexpenditureisattributabletohighcostuserclaims.

Top6%ofUsersClaimsExpenditure$1,206 62%

ClaimsExpendituresforotherusers $740

38%

MedicaidUserClaimsExpenditureSFY2016-- $Millions

6%ofuniqueuserswithover$25,000annualclaimsexpenditure

94%ofusers

TotalExpenditures:DefinitionsandExclusions

$2,020

$402

$174

SFY2016

§ Medicaidexpenditurewassplitbetweenstateandfederalfunds.ThisreportincludesallMedicaidexpenditures,includingbothstateandfederalfunds.

§ StartingJanuary1,2014,RhodeIslandexpandedMedicaidcoveragetoadultswithoutdependentchildrenunder138%FPL.ExpenditureonthispopulationduringSFY2016was$402millionandthestatereceived100%federalmatchingfundsforthispopulation.

§ Theanalysesinthisreportexclude$141millioninDisproportionateShareHospital(DSH)payments,$16millionincostsnototherwisematchable (CNOM),paymentsof$18milliontoLocalEducationAuthorities(LEAs),andEOHHSadministrativeexpenditure.MoredetailonexcludedpaymentsisprovidedintheAppendix.

§ Inpreviousyears,thisreporthasexcludedMedicare“clawback”payments.Officiallyknownasthe“phased-downstatecontribution”,theclawback isamonthlypaymentmadebyeachstatetothefederalMedicareprogramtohelpfinancetheMedicaredrugbenefit.Thisreportincludes$53millioninclawback payments,andallhistoricaldatashownhasbeenupdatedtoincludeclawback paymentsaswell.

Note:ThisreportlooksatMedicaidexpendituresforcoveredservicesanddoesnotincludestateoverheadandadministrativecostsrelatedtomanagingtheMedicaidprogram.

MedicaidexpendituresinSFY2016totaledapproximately$2.6billion.Expendituresforcoveredservicestotaled$2.4billion,including$402millionforMedicaidExpansion.


Summary:TotalMedicaidExpendituresSFY2016- $Millions

7%Exclusions(DSH,LEAs,CNOMs)

TotalMedicaidExpenditure:$2,596M

MedicaidExpenditureexcludingExpansion

78%

MedicaidExpansion15%

FocusofthisReport:TotalMedicaidExpendituresforCoveredServices1$2,422

ExecutiveSummary Overview Distributions HighCostUsers PopulationDetail Benchmarks Appendices

1ExpendituresreflectmedicalbenefitsonlyanddonotincludeEOHHScentralmanagementexpenditures.

MedicaidExpenditureTrends

$1,841 $1,849 $1,930 $1,987 $2,020

$136$391 $402

SFY2012 SFY2013 SFY2014 SFY2015 SFY2016

§ IncludingtheExpansionpopulation,expenditureincreasesforSFY13-14andSFY14-15were11.7%and15.1%respectively.HowevertotalexpendituregrowthincludingExpansionforSFY15-16hasslowedto1.8%.

§ Thestatereceivesfederalmatchingfundstocover100%oftheExpansionpopulationexpendituresforSFY2016.ForSFY2017,FMAPforthispopulationwillbe97.5%andforSFY2018itisexpectedtobe94.5%.

§ OnecontributingfactortotheincreaseinexpenditureinSFY2013-15wastheACA-mandatedprimarycarephysicianrateincreaseineffectforcalendaryears2013and2014.§ Thisresultedinincreasedpaymentsto

primarycarephysiciansforcertainservicestomatchtheMedicarePhysicianFeeSchedule.

§ Thisrateincrease,whichwas100%federallyfunded,addedapproximately$24millioninspendingforcalendaryears2013and2014.

§ RoughlyhalfofthetotalincreasedamountoccurredinSFY2014.

Overthepastfiveyears,RhodeIslandMedicaidexpenditureshaveincreased2.3%peryearonaverage,excludingtheMedicaidexpansionpopulation.


TotalMedicaidExpenditureforCoveredServices1SFY2012-2016- $Millions

MedicaidExpansion

AnnualExpGrowth

ExcludingExpansion 0.4% 4.4% 2.9% 1.7% 2.3%

WithExpansion 11.7% 15.1% 1.8% 7.1%

1AnnualexpenditureincludesthespendingforMedicareclawback paymentsthatwereexcludedinpreviousyearversionsofthisReport.2Calculatedascompoundedannualgrowthrate(CAGR)overperiodSFY2012-2016asshown.

$2,066

$2,422$2,378


Avg AnnualGrowthSFY2012-20162

MedicaidExpenditureTrends:Enrollment

193,279 195,637 201,102 212,785 216,646

20,227

58,482 64,989


§ ACAimplementationonJanuary1,2014,resultedinenrollmentincreasesforbothExpansionandnon-Expansionpopulations,aseligibilityruleschangedandoutreachincreased.

§ IncludingtheExpansionpopulation,totalMedicaidenrollmentincreased3.8%fromSFY2015toSFY2016.

§ Therewasasurgeinnon-Expansionenrollmentof5.8%fromSFY2014toSFY2015,buttherateofincreaseslowedtohistoricallevelsfromSFY2015toSFY2016.

§ Overall,includingExpansion,Medicaidenrollmentincreasedfrom193,279averageeligiblesinSFY2012to281,635averageeligiblesinSFY2016,anaverageannualincreaseof9.9%,withthebulkoftheincreasecomingduringtheExpansionperiod.

§ EligibilitycountsreflectmemberseligibleforfullMedicaidbenefitsanddoesnotincludePartialDualswhoreceiveassistanceonlywiththeirMedicarepremiumpayments.

AverageannualMedicaidenrollmenthasincreased2.9%peryearonaverage,excludingMedicaidExpansion.


TotalMedicaidEnrollmentAverageEligibles - SFY2012-2016

MedicaidExpansion

221,329

281,635271,267


AnnualEnrollmentGrowth

ExcludingExpansion 1.2% 2.8% 5.8% 1.8% 2.9%WithExpansion 13.1% 22.6% 3.8% 9.9%


MedicaidExpenditureTrends:PMPM

$794 $788 $800 $778 $777$778$730 $717


ExcludingExpansionIncludingExpansion

§ ExcludingExpansion,PMPMcostshavedecreased0.5%peryearonaveragesinceSFY2012.ThePMPMcostforSFY2016excludingExpansionislowerthananyofthelast5years.

§ IncludingtheMedicaidExpansionpopulation,theaveragePMPMforMedicaidoverallis$717,adecreaseof1.9%fromSFY2015.

§ OverallaverageMedicaidPMPM,includingExpansion,hasdecreased2.5%onaverageoverthelast5years,from$794inSFY2012to$717inSFY2016.

§ SFY2016reductioninPMPMreflectsimplementationofGovernorGinaRaimondo’sReinventingMedicaidsavingsinitiativesthatincludedcertainprogrammaticchanges,suchasa2.5%cuttohospitalreimbursementratesanda2.0%cuttonursinghomereimbursementrates.

AverageannualMedicaidPMPMhasdecreased0.5%peryearonaverage,excludingMedicaidExpansion.


TotalMedicaidPMPMSFY2012-2016


AnnualPMPMGrowth

ExcludingExpansion -0.8% 1.6% -2.8% -0.1% -0.5%WithExpansion -1.2% -6.1% -1.9% -2.5%


MedicaidExpenditureTrends:UniqueRecipients

193,279 195,637221,329

271,267 281,635

228,854 231,012

288,368

317,940 325,146


AvgEligibles UniqueRecipients§ Uniquerecipientsisameasureofthe

numberofindividualsenrolledinMedicaidatanytime duringthefiscalyear. Averageeligibleenrollmentisannualfulltimeequivalents,or12monthsofeligibility.

§ Theturnoverratiocomparesuniquerecipientstoaverageeligibles.Ifthenumberofuniquerecipientsisequaltotheaverageeligibles,thatindicatesthatthereisasteadypopulationofeligiblesthatremainontheprogramforthefullyear.Ifthenumberofuniquerecipientsisabove theaverageeligibles(aturnoverratioof>1),thisindicatesthatsomeRhodeIslandersareusingMedicaidforshorterperiodsoftime.

§ ThehigherturnoverratioforSFY2014isduetothefactthattheExpansionpopulationwasenrolledforatmost6monthsoftheyearandmanywereenrolledforlessthanthat.InSFY2015-6,theturnoverratioismuchclosertothetypicalannualturnoverratio.

IncludingtheExpansionpopulation,about31%ofRhodeIsland’spopulationwereenrolledinMedicaidforsomepartofSFY2016.


AverageEligiblesandUniqueRecipientsSFY2012-2016

TurnoverRatio 1.18 1.18 1.30 1.17 1.15

UniqueRecipients%ofRIPop1

22% 22% 27% 30% 31%

1Source:PopulationDivision,USCensusBureau.


FederalandStateShareofExpenditures

52.33% 51.48% 50.40% 50.30% 50.32%

47.67% 48.52% 49.60% 49.70% 49.68%


StateShare

FMAP

§ WhilethisreportwillreviewtrendsintotalMedicaidmedicalexpenditure,itisimportanttorecognizethatlessthanhalfofthisexpenditurefallstotheRhodeIslandbudget.

§ ThereareseveralinstancesofvariationfromtheFMAPlevelsshownonthechartatleft:

• TheFMAPfortheMedicaidExpansionpopulationis100%forSFY2016.ForSFY2017,FMAPforthispopulationwillbe97.5%andforSFY2018itisexpectedtobe94.5%.

• DuringCY2013-2014,theStatewasrequiredtoincreasepaymentstoprimarycarephysiciansforcertainservicestomatchtheMedicarePhysicianFeeSchedule.Theadditionalcostofthisrequirementwasfundedwith100%federalmatchingfunds.

• Thefederalmatchisenhancedfor24,571 enrolleesintheCHIPprogram,whichprovidesinsurancecoveragetouninsuredchildrenandpregnantwomenfromfamilieswithincomesupto250%ofthefederalpovertylevelwhoarenototherwiseeligibleforMedicaid.InSFY2016,RhodeIslandreceiveda82.47%combinedCHIP/FMAPfederalmatchonCHIPchildrenandpregnantwomen.

• Therearealsoafewsmallprogramswitha90%match,includingBreast&CervicalCancerPrevention&Treatment(BCCPT)andExtendedFamilyPlanning(EFP).

FundingforMedicaidexpendituresissplitbetweenstateandfederaldollars,withRhodeIslandtypicallyresponsibleforjustunderhalfofprogramexpenditures.


FederalMedicaidAssistancePercentage(FMAP)SFY2012-2016

FMAPsshownreflectaverageduringstatefiscalyearperiodanddonotapplytoExpansion,primarycarerateincrease,CHIP,andselectedotherprograms.


ExpenditurebyDepartment

$1,642

$402

$340

$38

$2,422

EOHHS EOHHS- MedicaidExpansion

BHDDH DCYF Total

§ InSFY2016,thestatedepartmentsresponsibleforadministeringcomponentsoftheMedicaidprogramwere:theExecutiveOfficeofHealthandHumanServices(EOHHS);theDepartmentofBehavioralHealthcare,DevelopmentalDisabilityandHospitals(BHDDH);andtheDepartmentofChildren,YouthandFamilies(DCYF).

§ EOHHSistheleadadministratorfortheMedicaidcontractwithCMS.TheSingleStateMedicaidAgencydesignationwastransferredfromDHStoEOHHSeffectiveJuly1,2011.

§ TheDepartmentofBehavioralHealthcare,DevelopmentalDisabilityandHospitals(BHDDH)administersthesecondlargestshareofMedicaidexpenditure(14%).NotethatfundingforintensivebehavioralhealthserviceswastransferredfromBHDDHtoEOHHSasofJuly1,2014.

§ Detailforeachdepartmentisshownonthenextpage.

Themajorityofexpenditure(84%)isadministeredbyEOHHS,includingallexpenditurefortheExpansionpopulation.


ExpenditurebyDepartmentSFY2016- $Millions

%of Total 68% 17% 14% 2% 100%

3.5% -2.2% 0.1%Avg AnnExp Growth 2012-6

MedicaidExpansion

EOHHStotal=$2,044M,84%


ExpenditurebyDepartment:StateAgencyDetail

§ EOHHSoverallaccountsfor84%ofMedicaidexpenditure.Thebiggestportionofthatisforhospital-basedservices,accountingfor34%ofEOHHSexpenditure.Professionalservicesaccountfor26%ofEOHHSexpenditure,andinstitutionalcareisanother19%.

§ BHDDHexpendituresincludethreeprimaryareas:themanagementofSlaterHospital,residentialfacilitiesforpersonswithintellectualanddevelopmentaldisabilities,andcommunitybasedservices.

§ DCYFaccountsfor$38Million(2%)ofMedicaidexpenditure.DCYFadministersprogramsservingchildreninthechildwelfaresystem,childreninsubstitutecareandchildrenwithbehavioralhealthconditions.

Expenditureamountsusedinthisreportmayvaryfromexpendituresreportedforfinancialreconciliationorotherpurposes. Reasonsforanyvariancemightincludefactorssuchasclaimcompletionandrounding.

EOHHSfundsmosttraditionalMedicaidservices,includinghospital-basedservices,professionalservices,institutionalcare,andpharmacy.


ExpenditurebyDepartmentDetailSFY2016- $Millions

MedicaidExpansion

$497

$395

$394

$101

$109

$103

$42

$230

$106

$4

$31

$7

$208

$128

$3

$55

$3

$5

Hospital

ProfessionalSvcs

InstitutionalCare

Pharmacy

Home&CommBasedSvcs

MedicarePremiums/Clawback

OtherPremiums

IDDResidential/Rehab

SlaterHospital/Zambarano

PersonalCare/Respite/Other

ChildWelfare

ChildMentalHealth

1Includesprofessionalservicesforbehavioralhealth.2Totalexpenditureshownisnetofpharmacyrebates.3IDDDResidential/RehabisResidentialandRehabilitationServicesforpersonswithintellectualanddevelopmentaldisabilities,includinggrouphomes.

EOHHS:$2,044M84%(incl Expansion)

BHDDH:$340M14%

DCYF:$38M2%

1

2


3

ExpenditureDistributions

$2,020

$402

SFY2016

Medicaidexpenditurescanbebrokendowninseveralways.


MedicaidExpendituresforCoveredServicesSFY2016- $Millions

Total:$2,422M

MedicaidExpenditureexcludingExpansion

MedicaidExpansion

Expenditure Distributionsinclude:

Breakdownbypopulation:§ Elders§ AdultswithDisabilities§ ChildrenandFamilies§ ChildrenwithSpecialHealthCareNeeds§ MedicaidExpansion

BreakdownbypopulationshowsexpenditurebyMedicaidrecipientageandcategoryofneed

Breakdownbyprovidertype:§ Hospital§ NursingFacility§ IDDResidential/Rehab,GroupHomes§ BehavioralHealth§ Home &CommunityBasedServices§ LongTermServices&Supports§ ProfessionalServices§ Premiums

Breakdownbyprovidertypeshowsexpenditurebytheinstitutionorthetypeofprofessionalperformingtheservices

LTSSDetails:§ TypesofLTSSProviders§ LTSS Trends

FurtherdetailsonLongTermServices&Supportsexpenditures

Breakdownbyprogram:§ ManagedCare§ Fee-for-service (FFS)

Breakdownbyprogramshowsexpenditurebytypeofmanagedcareprogramandamountoffee-for-servicespending


ExpenditurebyPopulation

Elders $55923%

Adultswithdisabilities $754

31%

Childrenandfamilies $537

22%

CSHCN $1707%

Expansion $40217%

OverhalfofMedicaidexpenditure(54%)isforEldersandAdultswithDisabilities.



Total:$2,422M § Eldersareadultsoverage65,includingthosealsoeligibleforMedicare.Thispopulationaccountsfor23%ofMedicaidexpenditure,or$559million.

§ AdultswithDisabilitiesare adultsunderage65whohaveidentifieddisabilities(doesnotincludeRIte Careenrolledadults).Thispopulationaccountsfor$754millioninMedicaidexpenditure,thelargestportionofexpenditureat31%oftotal.

§ ChildrenandFamiliesarelowincomechildren,parentsandpregnantwomenwhomeetspecificincomerequirements.Thispopulationaccountsforanother22%ofMedicaidexpenditure,$537million.

§ ChildrenwithSpecialHealthCareNeeds(CSHCN)areindividualsunder21eligibleforSupplementalSecurityIncome(SSI),childreninSubstitute(Foster)Care,KatieBeckettchildren,andAdoptionSubsidychildren.Thispopulationaccountsfor7%ofMedicaidexpenditure.

§ MedicaidExpansionareadultswithoutdependentchildrenwithincomesunder138%FPLwhowerenewlyeligibleforMedicaidasofJanuary1st 2014underACAexpansionrules.Thispopulationaccountsfor17%ofMedicaidexpenditure.

ExecutiveSummary Overview

ExpenditureDistributionsHighCostUsers Population

Detail Benchmarks AppendicesByPopulation ByProviderType LTSSDetails ByProgram

ExpenditurebyPopulation

$559

19,198

$754

32,080

$537

153,342

$17012,025

$40264,989

ExpenditurebyPopulation EnrollmentbyPopulation

TheMedicaidprogramservedanaverageof281,635eligiblesinSFY2016,atanaveragecostpermemberpermonthof$717.However,PMPMcostsvaryconsiderablybypopulation.



§ Elders accountfor23%ofexpenditureand7%ofenrollment,withaPMPMcostof$2,427.ThispopulationhasthehighestPMPMofthepopulationgroupsshowninthisreport.

§ AdultswithDisabilitiesaccountfor31%ofexpenditureand11%ofenrollment,withaPMPMcostof$1,958.

§ Together,eldersandadultswithdisabilitiesaccountfor54%ofexpenditureand18%oftotaleligibles.

§ Childrenandfamiliesaccountforoverhalfoftotalenrollment(54%)and22%oftotalexpenditurewithaPMPMcostof$292.

§ CSHCNaccountfor7%ofexpenditureand4%ofeligiblesataPMPMof$1,177.

§ MedicaidExpansionaccountsfor23%ofeligiblesand17%ofoverallexpenditure,withaPMPMof$516.

TotalProgram $2,422M 281,635 $717

Elders

Adultswithdisabilities

Childrenandfamilies

CSHCN

Expansion

PMPMCost

$2,427

$292

$516

$1,958

$1,177

11%

4%

7%

54%

23%

31%

7%

23%

22%

17%




ExpenditurebyPopulation:Trends

1.9% 1.1%

3.7%

-0.4%

11.1%

1.2% 1.0%

-0.8%

0.0%

-7.5%

3.1%2.1%

2.9%

-0.4%

2.8%

Elders Adultswithdisabilities

Childrenandfamilies

Childrenw/specialhealthcareneeds

MedicaidExpansion(1yrtrend)

Enrollment PMPM TotalExpenditure

§ Thetotalexpendituretrendcanbebrokenintotwocompositepieces- thepermemberpermonth(PMPM)costtrendandtheenrollmenttrend.

§ Eldershaveexperienceda3.1%averageannualincreaseinexpendituresinceSFY2012.Thisincreaseisabout2/3duetoanincreaseinenrollmentand1/3duetoanincreaseinPMPM.

§ Adultswithdisabilitiesexpenditurehasincreased2.1%peryearonaverageoverthelast5years.

§ Childrenandfamiliesexperienceda2.9%averageexpendituregrowthoverthepast5yearsandanaverageenrollmentgrowthof3.7%.ThispopulationhadanaverageannualPMPMdecreaseof0.8%.

§ ChildrenwithspecialhealthcareneedshaveexperiencedadecreaseinPMPMandoverallexpendituresinceSFY2012.

§ TheMedicaidExpansionpopulationhasexperienceda2.8%increaseinexpendituresinceSFY2015eventhoughenrollmenthasgrown11.1%inthesameoneyearperiod.

ExpendituretrendsbetweenSFY2012andSFY2016differedforthevariouspopulationgroups.


AverageAnnualTrendsSFY2012-2016– MedicaidExpansionTrendsforSFY2015-2016

$559M(23%)

$754M(31%)

$537M(22%)

$170M(7%)

$402M(17%)

2016Expenditure byPopulation




ExpenditurebyProviderType

$389$277

$231

$155$101 $145 $113

$111

$3

$101

$27$55 $5

$3

Hospital NursingHome

/Hospice

Professional IDDResdntl/Rehab,Group

Homes

ProfessionalBH

Pharmacy Premiums HomeandCommBased

Svcs

SlaterHospital/

Zambarano/Tavares

§ Hospitalswerethelargestprovidertype,accountingfor29%ofMedicaidexpendituresinSFY2016.

§ IncludingExpansion,hospitalpaymentshaveincreased4.9%intheoneyearfromSFY2015toSFY2016.

§ NotincludingexpendituresontheExpansionpopulation,hospitalpaymentshavebeenincreasingatanaverageof1.1%peryearoverthelast5years,.

§ Nursingfacilitiesandprofessionalserviceseachaccountedfor16%ofexpenditure.

§ Expansionpopulationexpenditurewasconcentratedinhospital,professional,andpharmacyservices.

§ Two-thirdsofthePremiumsexpenditureisforMedicareclawback paymentsandMedicarepremiums.Theremainderisfortransportation,PACE,andRIteSharepremiums.

§ Detaileddefinitionsofeachprovidertypeisincludedonthenextpage.

Medicaidprogramfundsareusedtoreimburseavarietyofproviders.Together,hospitalsandnursingfacilitiesaccountfornearlyhalf(45%)ofprogramexpenditureinSFY2016.


MedicaidExpenditurebyProviderTypeSFY2016-- $Millions

MedicaidExpansion

29% 16% 16% 10% 7% 6% 6% 5% 5%%of2016Expenditure1.1% 2.7% 4.9% 3.0% -3.8% 1.6% 6.9% 7.2% 0.7%

Avg AnnGrowth2012-16(excludingExpansion)

OP$106

IP$101

OP$213

IP$284

Total:$2,422M

$705

$378$391

$157 $151$117

$181




Premiumsincludes:$53Clawback$50Medicare

$30Transportation$12PACE

$5RIteShare

ExpenditurebyProviderType:Definitions

Medicaidproviderscanbegroupedintothreecategories– acutecare,institutionalcare,andcommunity-basedservices.


Acute,ChronicandPreventiveCare

Hospital Hospitalincludesinpatientandoutpatientservices.

Professional Professionalincludes Physician,Dental,DME/Supplies,X-Ray/Lab/Tests,Ambulance,etc.

ProfessionalBH

ProfessionalBehavioralHealthincludesDHS,BHDDHandDCYFexpenseincluding,butnotlimitedto,ProfessionalMentalHealth/SubstanceAbuse,Cedarservices(Comprehensive,evaluation,diagnosis,assessment,referral,re-evaluationservices),CMHC,andResidentialDCYF.

Pharmacy Prescriptionandover-the-countermedications,netofpharmacyrebates

Premiums

PremiumsincludesMedicarepremiumspaidforqualifyingindividuals,Medicareclawback payments,transportationpremiums,premiumsforPACE(ProgramofAll-InclusiveCareoftheElderly)andRIteSharepremiums,whicharetheemployeeshareofprivateinsurancepremiumspaidonbehalfofMedicaideligibleswhohaveaccesstoprivateinsurance.

InstitutionalCare

NursingHome/Hospice

Nursinghomeincludesskillednursingfacilities.Hospiceincludes home-based,inpatient,andnursingfacility-basedhospicecare.

SlaterHospital,Tavares,andZambarano

SlaterHospital,TavaresandZambarano arespecializedfacilitiesforseverelydisabledadultsorchildren.

CommunityCare IDDResdntl/

Rehab,GroupHomes

ResidentialandRehabilitationServicesforpersonswithintellectualanddevelopmentaldisabilities,including publicandprivateIDDgrouphomes,IDDrehabilitation,andotherBHDDHexpense(includingresidentialhabilitative,dayhabilitative,adultdayprogram,respite,homemodificationsandsupportedemployment).

HCBS HomeandCommunityBasedServices(HCBS)areservicesprovidedasanalternativetonursinghome/institutionaloptions,suchaspersonalcare,assistedliving,andcasemanagement.




Pleasenotethatadministrativedollarspaidtohealthplansareallocatedacrossprovidertypesbasedondistributionofclaimsforpurposesofthisreport.

ExpenditurebyProviderTypeSummary

InstitutionalCare $503 21%

CommunityCare$348 14%Acute,Chronic

andPreventativeCare $1,571

65%

Overall,35%ofMedicaidexpenditureisforInstitutionalCareandCommunityCare,togetherreferredtoasLongTermServicesandSupports(LTSS).


MedicaidExpenditurebyProviderTypeCategorySFY2016-- $Millions

Total:$2,422M § Overone-third(35%)ofMedicaidexpenditureisforLongTermServicesandSupports(LTSS),includinginstitutionalcare andcommunitycare.

§ InstitutionalcareincludesnursingfacilitiesandcareintheSlaterHospitalandTavaresandZambarano facilities.

§ CommunityCareincludeshomeandcommunity-basedservices,residentialandrehabilitationservicesfortheintellectuallyanddevelopmentallydisabled,andgrouphomes.

§ Theother65%ofMedicaidexpenditureisforacute,chronicandpreventivecareservicessuchashospital,professionalservices,andpharmacy.

§ Nearlyall(98%)oftheexpenditurefortheExpansionpopulationfallsintotheAcute,Chronic,andPreventativeCarecategory.

§ ThereareseveralwaystocategorizeMedicaid-providedservices.Otherreportsmaygrouptogetherservicesindifferentwaysfordifferentneeds.

Acute,ChronicandPreventiveCareIncludes:• Hospital• Professional• ProfessionalBH• Pharmacy• PremiumsNearlyallExpansionexpenditureinthiscategory

InstitutionalCareIncludes:• NursingHome• Hospice• SlaterHospital,

Tavares,andZambarano

CommunityCareIncludes:• HCBS• Residentialand

RehabServicesfortheIntellectuallyandDevelopmentallyDisabled

• AssistedLiving• PublicandPrivate

IDDGroupHomes




ProviderTypeDetail:LTSSDetail

$231

$98

$9 $4 $5

$365

$103

$27$8

IDDResdntl/Rehab

PersonalCare AdultDayCare

AssistedLiving

OtherHCBS

NursingHome

Slater Hospice Tavares/Zambarano

§ The1115MedicaidWaivergrantedRhodeIslandtheabilitytoqualifycertainpopulationswhomeetspecifiedlevelsofcareforhomebasedservices.Theseprogramsareintendedtoallowstatestoprovidehomeandcommunitybasedservicestoat-riskpopulationsasalternativestomorecostlynursinghome/institutionaloptions.

§ Institutionalcareservicesaccountfor59%ofLTSSexpenditure.Thelargestcategoryofinstitutionalcareisnursinghomes,accountingfor43%ofLTSSspendingand73%ofspendingoninstitutionalcare.

§ Forty-onepercentoflongtermservicesandsupportexpenditure($348million)isforCommunityCareservices,includingservicesfortheIDDpopulationandHCBS.

§ OnedriverofthegrowthinCommunityCareexpendituresisforHCBSforthenon-intellectually/developmentallydisabledpopulation.Theseservices,suchaspersonalcareandassistedliving,arelessexpensivealternativestonursinghomeorinstitutionaloptions.

Longtermservicesandsupports,includingbothinstitutionalcareandcommunitycare,accountedfor$850millioninSFY2016,about35%ofMedicaidexpenditure.


LTSSExpenditurebyProviderTypeSFY2016-- $Millions

27% 12% 1% 0% 1% 43% 12% 3% 1%%ofLTSSExpenditure3.0% 7.5% 20.3% -6.8% 0.0% 3.0% 1.1% -0.7% -3.4%

Avg AnnGrowth2012-16(excludingExpansion)

TotalLTSSExpenditure:$850M

CommunityCare$348M(41%)

InstitutionalCare$503M(59%)

1OtherHCBSincludesDME(e.g.HomeModifications),CaseManagement,Meals,SharedLivingandother.

1

HCBSTotal:$117M




ExpenditurebyProviderType:LTSSRebalancing

§ AkeyconsiderationforLTSSservicesisthetransitionawayfromnursingfacilitiesandintohomeandcommunitybasedservices(HCBS).

§ Onewaytomeasuretherebalancingtrendistoexaminetheratioofexpenditurebetweennursingfacilityservices(partofInstitutionalCare)andHCBS(partofCommunityCare).

§ ThebalanceofexpenditurebetweennursingfacilitiesandHCBShasbeenshiftingoverthelast5years.InSFY2016HCBSaccountedfor23%ofthetotalexpenditureonbothnursingfacilitiesandHCBScomparedto20%inSFY2012.

Overthelast5years,theratioofnursingfacilityexpendituretoHCBSexpenditurehasdecreased.


BalanceofNursingFacilityandHCBSExpenditureSFY2012-2016-- $Millions

%HCBS 20% 20% 21% 21% 23%

%NursingFacilities 80% 80% 79% 79% 77%

$349 $357 $381 $392 $391

$86 $91$100 $106 $117


HomeandCommBasedSvcs

NursingFacilities




ProviderTypeDetail:NursingHomeTrends

3.0%

-4.2%

-1.4%

4.6%

NursingHomeExpenditure

NursingHomeDays/thousand

NursingHomeTotalDays

NursingHomeCostperDay

§ Nursinghomeexpenditureaccountedfor$365millioninSFY2016,withanaverageannualincreaseof3.0%peryearonaveragesinceSFY2012.

§ Overthesameperiod,daysperthousandfornursinghomesdecreasedby4.2%peryearonaverage.

§ Nursinghomedaysintotaldecreased1.4%peryearonaveragebetweenSFY2012andSFY2016.

§ Nursinghomecostperday(calculatedastotalexpendituredividedbytotaldays)hasincreasedfrom$160to$191betweenSFY2012andSFY2016,about4.6%onaverageperyear.

§ Totalexpenditurefornursinghomesincludesallocatedcapitationandpremiumpayments,sothecalculatedcostperdayshownheremaydifferfromtheactualpaymentrates.

Nursinghometotaldaysanddaysperthousandhavedecreasedoverthelastfiveyears,whiletotalnursinghomeexpenditurehasincreased.


NursingHomeServicesAverageAnnualTrendRatesSFY2012-2016

SFY2016Expenditure $365M 1,910,645 $191/day




ExpenditurebyManagedCareEnrolledandNotEnrolled

§ NinetypercentofMedicaideligibles areenrolledinmanagedcareprograms,includingRIte Care,RIteShare,Rhody HealthPartners,Rhody HealthOptions,andPACE.Theseenrolledpopulationsaccountforaboutthree-quarters(76%)ofMedicaidexpenditureinSFY2016.

§ Ofthe$1,834millioninexpenditureonmanagedcareenrolledpopulations,$1,488millionwaspaidthroughmanagedcareprograms,accountingfor61%oftotalMedicaidexpenditure.

§ Theremaining$346millioninexpenditureonmanagedcareenrolledpopulationswaspaidforFFSclaimsandpremiumsformanagedcareenrolledeligibles.

§ FFSclaimsincludeservicessuchasNeonatalIntensiveCareUnit(NICU),certainbehavioralhealthservices,specializedservicesforchildrenwithspecialhealthcareneeds,anddentalcare

§ PremiumsformanagedcareenrolleesincludeMedicarepremiumsandtransportation.

§ OnJanuary1,2016,EOHHSmovedtheexpendituresforcertainbehavioralhealthservicesforchildrenandadultsenrolledinmanagedcareintothepaymentsmadetothehealthplans,reducingFFSexpendituresforthemanagedcareenrolledpopulation.

Overall,61%oftotalMedicaidexpenditureispaidthroughmanagedcareprograms.


Managed CareEnrolled252,351Eligibles (90%)

NotEnrolled129,285Eligibles (10%)

TotalExpenditure

ManagedCareExpenditure

$1,488M61%

ManagedCareExpenditureforManagedCareEnrolledEligibles

$1,488M61%

OtherExpenditure

$346 M14%

OtherExpenditureforManagedCareEnrolledEligibles (forservicesnotcoveredbyManagedCare)

$588M24%

ExpenditureforEligiblesNotEnrolledinManagedCare

$934M39%

TotalExpenditure

$1,834M76%

$588M24% $2,422M

ExpenditureforEnrolledPopulationsSFY2016




1Unenrolledpopulationsinclude2,357Medicaideligibles enrolledinConnectCareChoiceandConnectCareChoiceCommunityPartners,whichareprimarycarecasemanagementprograms(PCCM)whereMedicaidpaysprovidersforenhancedcaremanagementwithinthefee-for-servicestructure.

ManagedCareEnrollment

25,879

139,158

19,726 14,4909,063 7,528

278

3,405

62,107

NotEnrolled RIteCare MedicaidExpansion

RhodyHealthOptions

RhodyHealthPartners

CSHCN&Substitute

Care

RIteShare PACE

§ ManagedcareenrollmentisdividedbetweenRhodeIsland’stwoMedicaidManagedCareOrganizations(MCOs),NeighborhoodHealthPlan(NHP)andUnitedHealthcare(UHC).

§ RIte Caremainlyserveschildrenandparents.Rhody HealthPartners isisamanagedcareprogramforadultswithdisabilities.

§ TheMedicaidExpansionandCSHCNpopulationsarealsoenrolledinmanagedcareprograms.

§ RIte ShareisaprogramdesignedtoallowMedicaideligibleswithaccesstoqualifiedemployer-basedinsurancecoveragetoretainthatcommercialcoveragebyhavingMedicaidpaytheemployee’sshareofthepremium.ThisminimizesMedicaidexpenditurebyleveragingtheemployer’scontribution.

§ Rhody HealthOptionsisafullycapitatedmanagedcareprogramforlongtermcare,longtermservicesandsupports,andotherMedicaid-fundedservicesdesignedforeligibleswithbothMedicaidandMedicareeligibility.

MedicaidenrolleeswhodonothaveotherinsuranceareenrolledinMedicaidmanagedcareplans.About90%ofMedicaidaverageeligiblesareenrolledinsomesortofmanagedcareprograms.


ManagedCareEnrollmentSFY2016

MedicaidExpansion

10% 49% 22% 7% 5% 3% 3% <1%%of2016Enrollment

281,635TotalAverageEligibles

1TheNotEnrolledcategoryincludespersonsinperiodsofeligibilitypriortomanagedcareenrollment,aswellascertainpersonswithotherinsurance,suchasMedicare.

1

29,285

90%enrolledinmanagedcare




HighCostUsers:ByExpenditureLevel

53%

3%

38%

26%

3%

9%

6%

62%

%ofUsers %ofClaimsExpenditure

Medicaidclaimsexpendituresarehighlyconcentrated.Thetop6%ofMedicaidusersaccountforalmosttwothirds(62%)ofMedicaidclaimsexpenditure.


MedicaidUserClaimsExpenditureDistributionSFY2016– includesMedicaidExpansion


§ Inordertolookatspendingbyuser,itisnecessarytolookat“uniqueusers”ratherthanaverageeligibles.Auniqueuserisanindividualassociatedwithamedicalclaimorcapitationpayment.Averageeligibleenrollmentisannualfulltimeequivalents,or12monthsofeligibility.

§ Thisanalysisexaminesthecharacteristicsof“highcost”users,thosewithover$15,000ofclaimsexpenditureofperyear.Thereare27,357ofthese“highcost”users(9%)whoaccountfor$1,385million(71%)inclaimsexpenditure.

§ HighCostuserstypicallypresentwithmultiple,complexconditions,requiringcarecoordinationacrossavarietyofprovidertypes.

§ Ontheotherendofthespectrum,53%ofMedicaidusersaccessservicesatacostoflessthan$1,000peryearandaccountfor3%ofclaimsexpenditure,averaging$310inannualclaimsexpenditureperuser.

Total 325,165Unique Users1 $1,946MClaims-based Expenditure2

1Includesoverlapinusersacrosscostcategories.2Totalofclaims-specificpayments.Certainexpenditures(e.g.UPL,MedicareandPACEPremiums)notattributabletospecificusers.

AnnualMedicalClaimsExpenditure

rangeperuser:

<$1,000

$1,000-$15,000

$15,000- $25,000$25,000+

HighCostUsers

Avg ClaimsExp/User/Year

$310

$4,062

$19,278

$66,705

172,854Users

124,954Users

18,087Users9,270Users

$179M

$508M

$1,206M

$54M

HighCostUsers:ByProviderType

$352

$241$227

$112 $111 $101 $92 $91$58

NursingHome/Hospice

HospitalInpatient

IDDResdntl/Rehab,Group

Homes

SlaterHospital/

Zambarano/Tavares

OtherProfessional

HospitalOutpatient

ProfessionalBH

HomeandCommBased

Svcs

Pharmacy

§ Nursingfacilitiesaccountfor25%oftheclaimsexpenditureforhighcostusers,andresidentialandrehabilitationservicesforpersonswithintellectualanddevelopmentaldisabilitiesaccountforanother16%.

§ Hospitalservicesaccountfor24%ofhighcostuserclaimsexpenditure,including17%forinpatientand7%foroutpatient.InpatientincludesNeonatalIntensiveCareUnit(NICU)services.

§ 90%ofthetotalexpenditurefornursingfacilitiesand100%ofthetotalexpenditureforSlaterHospital,Zambarano andTavaresisforclaimsexpenseforhighcostusers.Thisisduetoextendedstaysininstitutionsforusersofthoseservices.

About41%ofclaimsexpenditureonhighcostusersisonnursingfacilitiesandresidentialandrehabilitationservicesforpersonswithintellectualanddevelopmentaldisabilities.


HighCostUserClaimsExpenditurebyProviderUserswithAnnualMedicaidClaimsExpenditureover$15,000SFY2016-- $Millions– includesMedicaidExpansion

25% 17% 16% 8% 8% 7% 7% 7% 4%%ofTotalHighCostUserClaimsExpenditure90% 63% 98% 100% 29% 32% 51% 78% 37%

%ofProviderTypeTotal ExpenditureattributabletoHighCostUserClaims

TotalHighCostUserClaimsExpenditure1:$1,385M


1Basedonclaims-specificpaymentsonly.

HighCostUsers:ByPopulation

$428

$556

$138$112

$151

Elders Adultswithdisabilities

Childrenandfamilies

Childrenw/specialhealthcareneeds

Expansion

§ Eldersaccountfor31%ofclaimsexpenditureforhighcostusersandhavethehighestproportionoftotalexpenditureforhighcostuserclaims,with77%oftotalexpenditureattributabletohighcostuserclaimsexpenditure.

§ Adultswithdisabilitiesaccountfor40%ofhighcostuserclaimsexpenditure,and74%ofadultswithdisabilitiestotalexpenditureisattributabletohighcostuserclaimsexpenditure.

§ Childrenandfamiliesaccountfor10%ofhighcostuserclaimsexpenditurewith26%oftotalexpenditureattributabletohighcostusersclaims.Childrenwithspecialhealthcareneedsaccountforanother8%ofclaimsexpenditure.

§ TheExpansionpopulationaccountedfor11%ofhighcostuserclaimsexpenditure.

Eldersandadultswithdisabilitiesaccountfor71%ofclaimsexpenditureforhighcostusers.


HighCostUserClaimsExpenditurebyPopulationUserswithAnnualMedicaidClaimsExpenditureover$15,000SFY2016-- $Millions– includesMedicaidExpansion

%ofHighCostUserClaimsExpenditure 31% 40% 10% 8% 11%

#HighCostUniqueUsers1 8,219 9,251 4,140 2,477 4,748%ofPopulationGroupTotalExpenditureattributabletoHighCostUser Claims

77% 74% 26% 66% 38%

TotalHighCostUserClaimsExpenditure:$1,385M


1Totalhighcostuniqueusersbypopulationdoesnotequaloveralltotalduetooverlapbetweeneligibilitygroups.

HighCostUsers:ByPopulationDetail

71%

35%

49%

42% 44%

11%

16%

19% 25% 21%12%

17%

10%17%

10%12%

18% 37% 15% 13%6%

Elders Adultswithdisabilities Children&Familes CSHCN Expansion

§ Thelargestcategoryofclaimsexpenditureforhighcosteldersisnursingfacilities,accountingfor71%ofclaimsexpenditureonhighcostelders.

§ Thelargestcategoryofexpenditureforhighcostadultswithdisabilitiesisresidentialandrehabilitationservicesfortheintellectuallyanddevelopmentallydisabled,accountingfor35%ofclaimsexpenditure.

§ 68%ofhighcostclaimsexpenditureforchildrenandfamiliesand65%ofhighcostclaimsexpenditurefortheExpansionpopulationishospital-related,includingbothinpatientandoutpatientservices.

§ Professionalbehavioralhealthservicesaccountfor42%ofhighcostuserclaimsexpenditureforthehighcostusersinthechildrenwithspecialhealthcareneedspopulation.

Theservicesusedbyhighcostusersvariesbypopulation.


HighCostUserClaimsExpenditureUserswithAnnualMedicaidClaimsExpenditureover$15,000SFY2016

$428 $556 $138 $112 $151HighCostUserClaimsExpenditure$M

TotalHighCostUserClaimsExpenditure:$1,385M


Other

Other

OtherOther

Other

NursingHome/Hospice

HCBSHCBS

IDDResdntl/Rehab,Group

Homes

Slater/Tavares/Zamb

HospitalIP

HospitalInpatient

HospitalInpatient

HospitalInpatient

Pharmacy

ProfServices

ProfessionalBehavioralHealth

ProfServicesProfSvcs

HospitalOutpatient Hospital

Outpatient

ExpenditureDetailbyPopulation

Elders $55923%

Adultswithdisabilities$754 31%

Childrenandfamilies $537

22%

CSHSN$170 7%

Expansion$402 17%

Inordertogetaclearerpictureofthecharacteristicsofeachpopulation,itisusefultolookatexpenditures,enrollment,andutilizationforeachgroupseparately.Thissectioncontainsdetailsonexpendituresforeachpopulationgroupasfollows:



Total:$2,422M


§ Elders:• Expenditurebyprovidertype• Managedcareenrollmentbytypeofprogram• DualenrollmentinMedicare• NursingfacilityandHCBSutilization

§ AdultswithDisabilities:• Expenditurebyprovidertype• Managedcareenrollmentbytypeofprogram• DualenrollmentinMedicare• Acutecareservicesutilization– hospitaldaysand

admissions,officevisits,pharmacyclaims• NursingfacilityandHCBSutilization

§ ChildrenandFamilies:• Expenditurebyprovidertype• Managedcareenrollmentbytypeofprogram• Acutecareservicesutilization

§ ChildrenwithSpecialHealthcareNeeds(CSHCN):• Expenditurebyprovidertype• Managedcareenrollmentbytypeofprogram• Acutecareservicesutilization

§ Expansion:• Expenditurebyprovidertype• Managedcareenrollmentbytypeofprogram• Acutecareservicesutilization

Elders:ExpenditurebyProviderType

$24

$338

$14$34

$5 $1

$68 $58

$18


/Hospice

Professional IDDResdntl/Rehab,

GroupHomes

ProfessionalBH


Svcs

SlaterHospital/

Zambarano/Tavares

§ Medicaidexpendituresonelderstotaled$559millioninSFY2016andhasbeenincreasingat3.1%peryearoverthepast5years.

§ ThelargemajorityofeldersarealsoeligibleforMedicare,whichwastheprimarypayerformostmedicalservices(e.g.hospital,professional).ConsequentlythoseexpenditureswerenotpaidbyMedicaidandarenotincludedhere.

§ Theincreaseinnursingfacilityexpenditurehasbeenlowerthantheincreaseinoverallexpenditureforthispopulation- anaverageannualincreaseof2.0percentperyear.

§ MostofthegrowthinMedicaidexpenditureforeldershasbeeninnursingfacilityservicesandhomeandcommunitybasedservices.Theincreaseinhomeandcommunitybasedservicesisdueinparttoanefforttoinvestinalternativestoinstitutional/nursinghomecare

Nursingfacilities(includingnursinghomesandhospice)accountforsixtypercentoftotalMedicaidexpenditureonelders.


Elders:MedicaidExpenditurebyProviderTypeSFY2016-- $Millions

ExecutiveSummary Overview Distributions HighCost

UsersPopulation Detail

Benchmarks AppendicesElders Adultsw/Disabilities Children &Families CSHCN Expansion

4% 60% 3% 6% 1% <1% 12% 10% 3%%of2016Expenditure0.0% 2.0% 16.0% 3.0% -0.3% 1.0% 7.8% 5.3% -0.4%

Avg AnnGrowth2012-16

EldersExpenditure=$559M%of2016Expenditure=23%

Avg AnnualGrowth=3.1%

(IP$15/OP$9)

Elders:ManagedCareandDualEnrollment

50% 47%

3% 0%

96%

4%

NotEnrolled RhodyHealthOptions

RhodyHealthPartners

Other MedicareMedicaidEligibles(MMEs)

MedicaidOnly(Non-MMEs)

§ Ninety-sixpercentofeldersarecoveredbybothMedicareandMedicaid(calledMMEsordualeligibles).

§ Fortheelderswhoareduallyenrolled,Medicareistheprimarypayerformostacuteandandprimarycareservices(e.g.,hospital,professional,pharmacy).

§ Rhody HealthOptionsisafullycapitatedmanagedcareprogramforlongtermcare,longtermservicesandsupports(LTSS),andotherMedicaid-fundedservicesdesignedtomorefullymeettheneedsofpeoplewithbothMedicaidandMedicareeligibility.

§ TheNotEnrolledcategoryincludes935eldersenrolledinConnectCareChoiceandConnectCareChoiceCommunityPartners(CCC/CP),whichareprimarycarecasemanagementprograms(PCCM)whereMedicaidpaysprovidersforenhancedcaremanagementwithinthefee-for-servicestructure.

Rhody HealthOptionsrolledoutin2013andhasenrollednearly20,000eligibles,about9,000ofwhomareelders,inamanagedcareprogramfordualsand/ormembersneedinglongtermservicesandsupports.


Elders:ManagedCareandMME(Dual)EnrollmentSFY2016




EldersExpenditure=$559MEldersAverageEligibles=19,198

1Chartdoesnotincludeapprox.10,000adultswithdisabilitiespopulationenrolledinRhody HealthOptions.

MME/Non-MMEEnrollment


AverageEligibles 9,691 8,957 539 11 18,473 725

1


Elders:HCBSUtilization

2,319

1,097

452349 284

711

PersonalCare DME AdultDayCare IDDResdtl/Rehab

AssistedLiving OtherHCBS

§ Thelargestcategoryofhomeandcommunitybasedservices(HCBS)ispersonalcareservices,withanaveragemonthlycensusforeldersof2,319recipientsinSFY2016.Themonthlycensusforeldersforthiscategoryhasincreasedat4.1%peryearsinceSFY2012.

§ Thecategorywiththehighestincreaseinaveragemonthlycensusisadultdaycare,withanaverageannualincreaseof15.6%peryear.

§ Someeligiblesmaybereceivingmorethanoneservice,resultinginoverlapintheaveragenumberofeligiblesserved.

Homeandcommunitybasedservicesenablesomeelderstoremaininacommunitysettingratherthanbeadmittedtoorremaininanursinghome.


Elders:HomeandCommunityBasedServicesAverageMonthlyCensusSFY2016




EldersAverageEligibles=19,198

4.1% 1.0% 15.6% 0.7% -6.9% -6.0%Avg AnnGrowth2012-2016

Elders:NursingFacilityUtilization(MMEonly)

7,050

90,168

HospiceDays/thousand


§ Ninety-sixpercentofeldersareMedicaidMedicareeligibles(MMEs,alsocalledduals).FortheseelderscoveredbybothMedicareandMedicaid,MedicareistheprimarypayerforthemajorityofacuteandprimarycareserviceswhileMedicaidcoverslongtermservicesandsupports.

§ Thetotalnursinghomedaysforthispopulationhasdecreasedby1.9%peryearonaverageoverthelast5years.

§ NursinghomedaysperthousandforMMEelderswere90,168inSFY2016.Thismeasurehasdecreasedbyanaverageannualrateof3.7%sinceSFY2012.

§ HospicedaysperthousandforMMEeldershavedecreasedatarateof7.3%onaverageperyearoverthelast5yearsto7,050perthousandinSFY2016.

ForMMEElders,nursinghomedaysperthousandeligiblesdecreased3.7%peryearfromSFY2012to2016.


MMEElders:NursingFacilityUtilizationSFY2016




MMEElders:18,47396%ofElders

Avg AnnGrowth2012-2016 -1.9% -7.3% -3.7%

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

SFY2012

SFY2013

SFY2014

SFY2015

SFY2016

NursingHomeTotalDays NursingFacilityUtilizationperThousand

AdultswithDisabilities:ExpenditurebyProviderType

$150

$50

$71

$197

$52 $48$59

$38

$90


/Hospice


GroupHomes

ProfessionalBH


Svcs

SlaterHospital/

Zambarano/Tavares

§ AdultswithdisabilitiesaccountforthelargestshareofMedicaidexpenditures,withtotalSFY2016expenditureof$754million.Expenditureforthispopulationhasincreasedbyapproximately2.1%peryearoverthepast5years.

§ Hospitalandresidentialandrehabilitationservicesforpersonswithintellectualanddevelopmentaldisabilitiesaccountfor20%and26%ofexpenditure,respectively.

§ However,expenditureforhospitalserviceshasbeendecreasing2.4%peryearonaverageoverthelast5years.

§ Similartotheelderspopulation,bothnursingfacilityservicesandhomeandcommunitybasedserviceshaveexperiencedhighgrowthratesfortheadultswithdisabilitiespopulation.

Foradultswithdisabilities,hospitalservicesandresidentialandrehabilitationservicesforpersonswithintellectualanddevelopmentaldisabilitiesaccountforjustunderhalfofexpenditures.


AdultswithDisabilities:MedicaidExpenditurebyProviderTypeSFY2016-- $Millions




20% 7% 9% 26% 7% 6% 8% 5% 12%%of2016Expenditure-2.4% 8.1% 6.5% 3.1% -4.2% 3.9% 9.1% 5.5% 0.8%


AdultswithDisabilitiesExpenditure=$754M%of2016Expenditure=31%


OP$68

IP$82

AdultswithDisabilities:ManagedCareEnrollment

23%

43%

32%

1%

48%52%

NotEnrolled RhodyHealthPartners

RhodyHealthOptions

Other MedicareMedicaidEligibles(MMEs)


§ Forty-eightpercentofadultswithdisabilitiesarecoveredbybothMedicareandMedicaid(calledMMEsordualeligibles).

§ Fortheadultswithdisabilitieswhoareduallyenrolled,Medicareistheprimarypayerformostacuteandandprimarycareservices(e.g.,hospital,physician,pharmacy).

§ Adultpopulationshadhistoricallybeenservedinfee-for-serviceMedicaidbuthavebeentransitionedtomanagedcareoverthelastseveralyears.InSFY201677%ofthispopulationwasenrolledinmanagedcare.

§ Inaddition,1,413adultswithdisabilitiesintheNotEnrolledcategorywereenrolledinSFY2016inConnectCareChoiceandConnectCareChoiceCommunityPartners,PCCMprogramswhereMedicaidpaysprovidersforenhancedcaremanagementwithinthefee-for-servicestructure.

Morethanthree-quarters(77%)ofadultswithdisabilitiesareenrolledinmanagedcare.


AdultswithDisabilities:ManagedCareandMME(Dual)EnrollmentSFY2016




AdultswithDisabilitiesExpenditure=$754MAverageEligibles=32,080

1Chartdoesnotincludeapprox.9,000elderspopulationenrolledinRhody HealthOptions.

MME/Non-MMEEnrollment


AverageEligibles 7,292 13,938 10,424 426 15,369 16,711

1


AdultswithDisabilities:AcuteCareUtilization

54

PharmacyClaimsperaverageeligible

§ Fifty-twopercentofadultswithdisabilitiesarecoveredbyonlyMedicaid.UtilizationshownhereisfortheadultswithdisabilitieswithoutMedicarecoverage(Non-MMEs).

§ Acutecareutilizationisnotshownfordualenrolledadultswithdisabilities(MMEs)becauseMedicareistheprimarypayerformostacutecareservices.

§ Non-MMEadultswithdisabilitiesaveraged7,940officevisitsperthousandeligiblesperyearinSFY2016,anincreaseof3.7%peryearonaverageinthelast5years.

§ Overthesameperiod,inpatientadmissions/thousandandinpatientdays/thousandforthispopulationhavedecreasedatanannualrateof1.8%and8.1%respectively.

§ Pharmacyclaimsfornon-MMEadultswithdisabilitiesaverage54claimsperaverageeligibleperyear,andhavebeenincreasingatarateof0.2%peryearonaverageoverthelast5years.

Bothinpatientadmissionsanddaysperthousandhavedeclinedoverthelast5yearsforadultswithdisabilitieswithMedicaid-onlycoverage(non-MMEs).


AdultswithDisabilities:Non-MMEs:AcuteCareUtilizationSFY2016




Non-MMEAdultswithDisabilities=16,71152%ofAdultswithDisabilities

Avg AnnGrowth2012-2016 -1.8% -8.1% -1.3% 3.7% 0.2%

473

2,278

1,475

7,940

InpatientAdmissions/thousand

InpatientDays/thousand

EmergencyRoomVisits/thousand

OfficeVisits/thousand

AdultswithDisabilities:HCBSUtilization

§ ResidentialandrehabilitationservicesforintellectuallyanddevelopmentallydisabledindividualshadanaveragemonthlycensusinSFY2016of2,070recipientsforMMEadultswithdisabilitiesand1,125recipientsforNon-MMEadultswithdisabilities.

§ ThesecondlargestcategoryofHCBSforthispopulationispersonalcareservices,withanaveragemonthlycensusof936recipientsinSFY2016forMMEadultswithdisabilitiesand1,118recipientsforNon-MMEadultswithdisabilities.

§ Themonthlycensusforpersonalcareservicesisgrowingat5.4%peryearonaverageforMMEadultswithdisabilitiesandat19.8%peryearonaverageforNon-MMEadultswithdisabilities.

Thelargestcategoriesofhomeandcommunitybasedservicesforadultswithdisabilitiesareresidentialandrehabilitationservicesfortheintellectuallyanddevelopmentallydisabledandpersonalcareservices.


AdultswithDisabilities:HomeandCommunityBasedServicesAverageMonthlyCensusSFY2016




Non-MMEAdultswithDisabilities=16,711MMEAdultswithDisabilities=15,369

2,070

936

403317

45134

1,125 1,118

151 17511 48

IDDResdtl/Rehab

PersonalCare DME AdultDayCare

AssistedLiving OtherHCBS

MedicareMedicaidEligibles(MMEs)


MMEs 0.2% 5.4% 7.9% 18.6% -4.4% -7.7%Non-MMEs 3.4% 19.8% -2.7% 15.4% -10.4% -20.2%


AdultswithDisabilities:NursingFacilityUtilization

352

9,409

193

4,810

HospiceDays/thousand


MedicareMedicaidEligibles(MMEs)MedicaidOnly(Non-MMEs)

§ LongtermservicessupportsareprimarilycoveredthroughMedicaidforbothMMEandNon-MMEadultswithdisabilities.

§ ForMMEadultswithdisabilities,hospicedaysdecreased 2.9%peryearandnursinghomedaysperthousanddecreased0.4%peryearonaveragesinceSFY2012.

§ Nursinghomedayswere9,409perthousandforMMEadultswithdisabilitiesand4,810perthousandforNon-MMEadultswithdisabilitiesinSFY2016.

§ Notethatnursinghomedaysforthispopulationrepresent12%oftotalMedicaidnursinghomedayssinceeldersaccountforthemajorityofnursinghomedaysoverall.

Nursinghomedaysperthousandhaveincreased4.6%peryearsinceSFY2012fornon-MMEadultswithdisabilitiesanddecreased0.4%peryearforMMEadultswithdisabilities.


AdultswithDisabilities:NursingFacilityUtilizationSFY2016

020,00040,00060,00080,000

100,000120,000140,000160,000

SFY2012

SFY2013

SFY2014

SFY2015

SFY2016

MedicareMedicaidEligibles(MMEs)MedicaidOnly(Non-MMEs)

NursingHomeTotalDays NursingFacilityUtilizationperThousand




Non-MMEAdultswithDisabilities=16,711MMEAdultswithDisabilities=15,369

MMEs 2.1% -2.9% -0.4%Non-MMEs 4.4% -13.9% 4.6%Avg AnnGrowth2012-2016

ChildrenandFamilies:ExpenditurebyProviderType

$273

$166

$-

$33 $43$17

$5 $-


/Hospice


GroupHomes

ProfessionalBH


Svcs

SlaterHospital/

Zambarano/Tavares

§ Childrenandfamiliesaccountforaboutone-fourth(22%)oftotalMedicaidexpenditures,withSFY2016expenditureof$537million.Expenditureforthispopulationhasincreasedby2.9%peryearoverthepast5years.

§ Mostexpenditureonchildrenandfamiliesisdividedbetweenprofessionalandhospitalcare,withhospitalcareaccountingformorethanhalf(51%)ofexpenditure.

§ Amajorcomponentofexpenditurerelatestoprenatalcareandbirths.Annually,approximately47%ofRhodeIsland’sbirthsarecoveredthroughRIteCare.1

§ Federalmatchisenhancedfor24,571qualifyinglowincomechildrenandpregnantwomenundertheCHIPprogram.InSFY2016,RhodeIslandreceivedan82.47%federalmatchonCHIPenrollees.

Inthechildrenandfamiliespopulation,hospitalandprofessionalservicesarethelargestcontributorstoexpenditureincreases.


ChildrenandFamilies:MedicaidExpenditurebyProviderTypeSFY2016-- $Millions




51% 0% 31% 0% 6% 8% 3% 1% 0%%of2016Expenditure3.2% 6.9% 4.6% N/A -3.3% 0.2% -1.9% N/A N/A


ChildrenandFamiliesExpenditure=$537M%of2016Expenditure=22%


OP$122

IP$150

N/Aindicatesexpenditureinthiscategorytoosmalltocalculateameaningfultrendrate.1Ratebasedoncurrentlyavailabledatafor2008– 2012.Source:http://www.health.ri.gov/data/birth/

<$1

ChildrenandFamilies:ManagedCareEnrollment

5%

91%

4%

NotEnrolled RIteCare RIteShare Other

§ Ninety-onepercentofchildrenandfamiliesareenrolledinaMedicaidmanagedcareprogramthroughRIte Care.TheseenrolleesaredividedbetweenNeighborhoodHealthPlan(NHP)andUnitedHealthcare(UHC).

§ RIte ShareisaprogramdesignedtoallowMedicaideligibleswithaccesstoqualifiedemployer-basedinsurancecoveragetoretainthatcommercialcoveragebyhavingMedicaidpaytheemployee’sshareofthepremium.ThisminimizesMedicaidexpenditurebyleveragingtheemployer’scontribution.InSFY2016therewere6,630MedicaideligiblechildrenandparentsenrolledintheRIteShareprogram.

§ Theunenrolledchildrenandfamiliesincludethosewithotherinsuranceandnewenrolleesduringtheperiodpriortoenrollmentinahealthplan.

Nearlyallchildrenandfamiliesareenrolledinmanagedcare.


ChildrenandFamilies:ManagedCareEnrollmentSFY2016


AverageEligibles 7,028 139,158 6,630 526




ChildrenandFamiliesExpenditure=$537MAverageEligibles=153,342

<1%

ChildrenandFamilies:AcuteCareUtilization

9


§ Forchildrenandfamilies,hospital-basedacutecareutilizationmeasureshavedecreasedsinceSFY2012.Inpatientadmissionsperthousandandemergencyroomvisitsperthousandhavedecreased6.3%peryearand1.2%peryear,respectively,sinceSFY2012.

§ Officevisitsperthousandhavestayedessentiallyflatoverthesameperiod.

§ Pharmacyclaimsforchildrenandfamiliesaverage9claimsperaverageeligiblepersonperyearandhavedecreased1.9%peryearonaverageoverthelast5years.

§ About41%ofinpatientadmissionsand42%ofinpatientdaysarematernityrelated(includingmaternity,nurseryandNICU).Annually,approximately47%ofallRIbirthsarecoveredthroughRIte Care.1

Forchildrenandfamilies,inpatientadmissionsandinpatientdaysperthousandhavedecreasedonaveragesinceSFY2012.


ChildrenandFamilies:AcuteCareUtilizationSFY2016

Avg AnnGrowth2012-2016 -6.3% -5.1% -1.2% 0.0% -1.9%

95393

564

3,755








ChildrenandFamiliesAverageEligibles=153,342

1Ratebasedoncurrentlyavailabledatafor2008– 2012.Source:http://www.health.ri.gov/data/birth/

ChildrenwithSpecialHealthCareNeeds(CSHCN):ExpenditurebyProviderType

$51

$26

$64

$10

$2

$13

$4


/Hospice


GroupHomes

ProfessionalBH


Svcs

SlaterHospital/

Zambarano/Tavares

§ ChildrenwithSpecialHealthCareNeeds(CSHCN)comprisearelativelysmallpopulation,accountingforsevenpercentoftotalMedicaidexpendituresandfourpercentofenrollees.

§ Expenditureforthispopulationisdominatedbyprofessionalbehavioralhealthservices,whichaccountfor$64millioninCSHCNexpenditures(38%).ProfessionalbehavioralhealthservicesincludeCedar(Comprehensive,evaluation,Diagnosis,assessment,referral,re-evaluation)andCedarDirectservices,residentialDCYFservices,andprofessionalmentalhealth,substanceabuse,andotherservices.

Inthepopulationofchildrenwithspecialhealthcareneeds,professionalbehavioralhealthaccountsfor38%ofallexpenditure.

RIMedicaidExpenditureReportSFY201647

CSHCN:MedicaidExpenditurebyProviderTypeSFY2016-- $Millions



Benchmarks AppendicesElders Adultsw/Disabilities Children&Families CSHCN Expansion

30% <1% 15% <1% 38% 6% 1% 8% 2%%of2016Expenditure2.0% N/A -1.1% N/A -3.8% -2.3% 6.9% 14.5% 4.0%


CSHCNExpenditure=$170M%of2016Expenditure=7%

Avg AnnualGrowth= -0.4%

OP$14

IP$37

N/Aindicatesexpenditureinthiscategorytoosmalltocalculateameaningfultrendrate.

<$1 <$1

ChildrenwithSpecialHealthCareNeeds:ManagedCareEnrollment

18%

75%

7%

NotEnrolled CSHCN&SubstituteCare

RIteShare Other

§ In2008,enrollmentinMedicaidmanagedcarebecamemandatoryforchildrenwithspecialhealthcareneeds(CSHCN)withoutotherinsurance.InSFY201682%wereenrolledinmanagedcare.

§ Theunenrolledchildrenwithspecialhealthcareneedsincludethosewithotherinsuranceandnewenrolleesduringtheperiodpriortoenrollmentinahealthplan.

Over80%ofchildrenwithspecialhealthcareneedsareenrolledinmanagedcare.


CSHCN:ManagedCareEnrollmentSFY2016


AverageEligibles 2,146 9,063 787 29




CSHCNExpenditure=$170MAverageEligibles=12,025

<1%

ChildrenwithSpecialHealthCareNeeds:AcuteCareUtilization

15


§ Inpatientadmissionsperthousandhaveincreasedoverthelast5yearsatanaveragerateof3.6%peryearto179perthousandinSFY2016.

§ Officevisitsperthousandhaveincreasedatanaveragerateof5.3%peryearsinceSFY2012to3,938visitsperthousandinSFY2016.

§ Almosthalf(45%)ofinpatientadmissionsperthousandareforbehavioralhealth.Intermsofinpatientdays,52%arerelatedtobehavioralhealth.1

§ Pharmacyclaimsperaverageeligiblehaveincreasedat0.1%peryearoverthelast5years.

Forchildrenwithspecialhealthcareneeds,emergencyroomvisitsperthousandhavedecreasedby1.3%peryearonaveragesinceSFY2012.


CSHCN:AcuteCareUtilizationSFY2016

Avg AnnGrowth2012-2016 3.6% 4.2% -1.3% 5.3% 0.1%

179

1,810

604

3,938








CSHCN AverageEligibles=12,025

1IncludesdaysintheChildren’sResidentialandFamilyTreatment(CRAFT)programatBradleyHospital.

Expansion:ExpenditurebyProviderType

$208

$3

$101

$27

$55

$5 $3 $-


/Hospice


GroupHomes

ProfessionalBH


Svcs

SlaterHospital/

Zambarano/Tavares

§ TheExpansionpopulationbecameeligibleforMedicaidstartingJanuary1,2014.

§ Thispopulationaccountedfor$402millioninexpenditureinSFY2016,17%oftotalMedicaidexpenditure.

§ ThetwolargestprovidertypesfortheExpansionpopulationarehospitalandprofessionalservices,accountingfor77%ofexpenditure.

§ TheExpansionpopulationusedalmostnolongtermservicesandsupports.

TheExpansionpopulationmainlyuseshospitalandprofessionalservices.


Expansion:MedicaidExpenditurebyProviderTypeSFY2016-- $Millions




52% 1% 25% <1% 7% 14% 1% 1% 0%%of2016Expenditure

ExpansionExpenditure=$402M%of2016Expenditure= 17%

OP$106

IP$101

<$1

Expansion:ManagedCareEnrollment

5%

95%

NotEnrolled Enrolled

§ TheMedicaidExpansionpopulationisexpectedtoentirelyenrollinmanagedcare.Howevernewenrolleesexperienceaninitialperiodinfee-for-servicepriortoenrollmentinahealthplan.

§ ExpansioneligibilitycommencedinJanuary2014andwasstillphasinginduringSFY2015.EnrollmenthasmainlystabilizedforSFY2016,increasingby2,505eligiblesbetweenJuly2015andJune2016.

TheExpansionpopulationismainlyenrolledinmanagedcareprograms


Expansion:ManagedCareEnrollmentSFY2016




ExpansionAverageEligibles=64,989

AverageEligibles 3,405 61,584

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Jul-14 Jan-15 Jul-15 Jan-16

ExpansionEnrollmentbyMonth

SFY2015AverageEligibles=58,488

SFY2016AverageEligibles=64,989

Expansion:AcuteCareUtilization

19


§ TheMedicaidExpansionpopulationhad310inpatientadmissionsperthousandand853inpatientdaysperthousandduringSFY2016.

§ TheExpansionpopulationusedabout4.5officevisitsperaverageeligible.

§ TheExpansionpopulationwasnewlyeligibleduringSFY2014,sodataisnotavailabletocalculateafive-yearaveragegrowthrate.However,trendratesfromSFY2015to2016showadecreaseinutilizationfortheExpansionpopulationforinpatientdays,ERvisits,andofficevisitsperthousand.

TheExpansionpopulationhadanaverageof19pharmacyclaimsper12monthsofeligibility.


Expansion:AcuteCareUtilizationSFY2016

310

853 724

4,507








ExpansionAverageEligibles=64,989

GrowthSFY2015-2016 12.5% -2.4% -2.6% -0.9% 4.3%

Note:Growthrateonthischartisforoneyear,nottheaverageannualrateforfiveyears.

MedicaidTrends:NationalMedicaidandStateCommercial

RIMedicaidtrendswerecomparabletonationalMedicaidtrendsincludingtheexpenditureontheExpansionpopulation.RIMedicaidtrendswerenotablylowerthanregionalCommercialexperienceoverasimilarperiod.


RhodeIslandMedicaidvs.NationalandCommercialTrendsSFY2012-20161,seebelowforsources


§ Overallexpendituregrowthovertheyears2012-2016wassimilartothenationalMedicaidexpendituretrend.AccordingtoCentersforMedicare&MedicaidServices(CMS),Medicaidnationalexpendituretrendoverthistimeperiodincreasedanaverage7.5%peryear,vs.RhodeIslandMedicaid’strendof7.1%.

§ ThenationalmeasureincludedprojectionsthatnotallstateswouldexpandMedicaidandwouldpresumablyhavebeenhigherifallstatesnationwidehadexpandedMedicaideligibilityunderACA.

§ RhodeIslandMedicaidPMPM(permemberpermonth)costtrendscomparefavorablytolocalcommercialbenchmarks.BetweenSFY2012and2016,thestateMedicaidprogramexperiencedadecreaseinaverageannualPMPMcostof2.5%peryear,includingExpansion.TheaverageannualmedicalPMPMcostforRIcommercialhealthplansoverasimilarperiodincreased3.1%peryear.1

§ TheRIcommercialbenchmarkmayunderestimatePMPMgrowthbecauseitonlyincludestotalincurredclaimsreportedbythecarriers,notanyoutofpocketcostsbornebymembers.Medicaidplansgenerallyhaveverylow,ifany,outofpocketcostsformembers.

1RICommercialtrendforCY2011-2015.NationaltrendforFFY2012-2016.Sources:NationalMedicaidTrendfrom2016CMSNationalHealthExpenditureReport.RICommercialtrendfromOfficeoftheHealthInsuranceCommissioner(OHIC),2016carrierratefilings,Incurredclaimspermemberpermonth,includesbothsmallgroupandlargegroupclaimsfromBlueCrossBlueShieldRI,UnitedHealthcareofNewEnglandandTuftsHealthPlan.

2.3%

ProjectedNational

Medicaid,7.5%

-0.5%

RICommercial3.1%

7.1%

-2.5%

Avg AnnualExpenditureGrowth Avg AnnualPMPMGrowth

RIMedicaidIncludingExpansion

RIMedicaidExcludingExpansion

RIMedicaidIncludingExpansion

RIMedicaidExcludingExpansion

ManagedCare:QualityIndicators

§ NCQAratingsconsistsofthreetypesofqualitymeasuredomains:clinicalquality,consumersatisfaction,andresultsfromNCQA’sreviewoftheHealthPlan’shealthqualityprocesses.

§ SelectedHEDIS®qualitymeasuresareshownatleftdemonstratingthecombinedperformanceofRIMedicaidManagedCareOrganizations.

§ OntheHEDIS®measuresassessingthepercentageofenrolleeswhohadsixormorewell-childvisitsduringtheirfirst15monthsoflife,bothofRhodeIsland’sMedicaidHealthPlansrankedabovethe90thpercentilecomparedwithMedicaidhealthplansnationally.

§ OntheHEDIS®measuresofcervicalcancerscreening,follow-upaftermentalillnesshospitalization,andmedicationmanagementforpeoplewithasthma,RhodeIsland’sMedicaidHealthPlansrankedabovethe75th percentilecomparedwithotherplansnationwide.

BothofRhodeIsland’sparticipatingMedicaidManagedCareOrganizations(MCOs)receivedanoverallplanratingof4.5outof5fromtheNationalCommitteeforQualityAssurance(NCQA)for2016.


81%

70%75%

39%

89%

Well-childVisits(6visitsinfirst15

mo)

CervicalCancerScreening

(Women21-64)

FollowupafterMentalIllnessHospitalization

(30days)

Medicationmanagementforpeoplewithasthma

AdultswithanAmbulatory/

PreventiveCareVisit(45-64)

CombinedPerformanceofRIMedicaidManagedCarePlansonSelectedHEDISQualityMeasuresCY2015

Performanceforthesemeasuresexceeded75thpercentileofallMedicaidplansnationwide

Performanceexceeded90thpercentilenationwide

1HEDIS2016retiredtheUseofAppropriateMediationsforPeoplewithAsthmaandreplacedwithMedicationManagementforPeoplewithAsthma.Sources:NCQAdatafromKaiserFamilyFoundaiton report:MedicaidMCOQualityRatings,basedonNCQA2016-2017ratings.HEDISdatafromMonitoringQualityandAccessinRIte CareandRhody HealthPartners,RIEOHHS,October2016.Resultsarereportedinaggregate,notbyhealthplan.

1

Performancedidnotexceed75thpercentilenationwide


MedicaidTrends:MedicaidEnrolledPopulation

AccordingtoNovember2016enrollmentdata,RhodeIsland’sMedicaidenrollmentis30%ofitspopulationunder65,thehighestpercentageoftheNewEnglandstates.


MedicaidEnrollmentasPercentofUnder65PopulationNovember2016Source:Manatt analysisofCMSMedicaid/CHIPenrollmentdataandCensusBureauPopulationData


§ CMScompilesMedicaidenrollmentdataforallstatesmonthly.Thisenrollmentdatawasconvertedforthepurposesofthischarttopercentofpopulationunder65foreachstateusingdatafromtheUSCensusBureau.

§ AfterRhodeIsland,VermonthadthesecondhighestpercentageMedicaidenrollmentoftheNewEnglandstates.

§ Nationally27%ofthepopulationunder65isenrolledinMedicaid.

27%

30% 30% 29%

25% 24%

15%

UnitedStates RhodeIsland Vermont Massachusetts Connecticut Maine NewHampshire

72,395,517 290,809 166,794 1,665,877 750,009 269,051 186,377MedicaidEnrollment,Nov2016

MedicaidTrends:ManagedCareEnrollment

RhodeIslandandNewHampshirehavethehighestratesofmanagedcareenrollmentcomparedtotheotherNewEnglandstates.


ManagedCareEnrollmentasPercentofMedicaidEnrollmentJanuary2014Source:KaiserFamilyFoundationreport,basedonCMSenrollmentdata


§ TotalMedicaidenrollmentforthischartisdefinedasbeneficiariesenrolledinanyMedicaidmanagedcareprogram,includingcomprehensiveMCOs,limitedbenefitMCOs,andPCCMs.

§ NationallytheaveragepercentofMedicaidmanagedcareenrollmentis77%.

§ Thisdatadiffersfromthemanagedcareenrollmentdatashownearlierinthisreportbecauseitisbasedondatafrom2014inordertoallowcomparisontonationalandregionaldata.

§ ForSFY2016,RhodeIslandmanagedcareenrollmentis90%ofeligibles,anincreasefromthe85%showninthisKaiserreport.

77%85% 85%

62% 59%

42%

UnitedStates RhodeIsland NewHampshire

Maine Massachusetts Vermont Connecticut

Datanotavailable

1

1TheDepartmentofVermontHealthAccess,astateagency,actsasVermont'ssingleMCOentity.

MedicaidTrends:ShareofState/FederalSpending

MedicaidspendinginRhodeIslandaccountedforabout25%ofstatefundsinthestatebudgetforSFY2015.


MedicaidSpendingasaShareofStateandFederalFundsinStateBudgetsSFY2015Source:Manatt analysisofNationalAssociationofStateBudgetOfficers(NASBO)data


§ Acrossallstates,theaverageshareofstatefundsdedicatedtoMedicaidspendingisabout28%,andtheaverageshareofbothstateandfederalfundsdedicatedtoMedicaidspendingisabout16%.

§ InMaine,NewHampshireandVermont,MedicaidspendingrepresentsahighershareofstateandfederalfundsthaninRhodeIsland.

28%

33%

30% 29%

25%24% 24%

16%

19% 19%18%

15% 14% 15%

UnitedStates Maine NewHampshire

Vermont RhodeIsland Massachusetts Connecticut

ShareofStateFunds

ShareofState&FederalFunds

MedicaidTrends:Cost/UtilizationBenchmarks

AccordingtoaUSGovernmentAccountabilityOfficereport,RhodeIslandisfairlyconsistentwithnationalbenchmarksintermsoftheamountofMedicaidexpenditureattributabletothehighestcostenrollees.


DistributionofExpendituresamongMedicaid-onlyEnrolleesFFY2011(excludesMMEs– Medicaredualeligibles)Source:USGovernmentAccountabilityOfficeReport


§ TheGAOreportfrom2011showedthatbothnationwideandinRhodeIsland,thetop1%ofMedicaidenrolleesaccountforaboutone-quarteroftotalMedicaidexpenditure.Thetop5%ofenrolleesaccountfornearlyhalf.

§ Ontheotherendofthespectrum,thelowest50%ofenrolleesaccountfor10%ofMedicaidexpenditureinRhodeIslandand7%nationally.

§ ThisdatadiffersfromthehighcostuserstatisticsshownearlierinthisreportbecauseitexcludesdualeligiblesinMedicareandisbasedondatafrom2011inordertoallowcomparisontoavailablenationaldata.

25%

45%

57%

74%

10%

26%

48%

60%

79%

7%

Highest1%ofenrollees




Lowest50%ofenrollees

RhodeIsland UnitedStates

PercentageofexpendituresforMedicaid-onlyenrolleesattributabletoselectedportionsofenrollees

Exclusions:(1)DisproportionateShareHospitals(DSH)

Disproportionatesharehospital(DSH)paymentsareintendedtosubsidizethecostofprovidingcaretoindigentandverylowincomepeople.


DSHDistributionbyHospitalSFY2016-- $Millions


§ Atotalof$141millioninDSHfundswaspaidouttohospitalsinSFY2016.

§ Thestate’stwolargesthospitals– RhodeIslandandWomenandInfants– togetheraccountedfor55%oftotalDSHpayments

§ DSHpaymentsarenotincludedintheMedicaidexpenditureanalysisinthisreport.

$18

$12 $11

$59

$10$5

$8 $7$4 $3 $2 $2

Women&Infants

Memorial Kent Butler RhodeIsland

Miriam Newport Bradley St.Joseph RogerWilliams

Landmark SouthCounty

Westerly Slater

13% 8% 8% <1% 42% 7% 3% <1% 6% 5% 3% 2% 2% 1%%of2016DSHPayments

<$1 <$1

Total SFY2016DSHExpenditure=$141M

CareNewEngland$41M,30%

LifeSpan$74M,52%

Other/Unaffiliated$11M,8%

CharterCare$15M,11%

Exclusions:(2)LocalEducationAuthorities(LEA)


MedicaidFundingtoLocalEducationAuthorities(LEAs)SFY2016


§ LEAsprovidespecialeducationservicesintheirdistricts.

§ ForLEAexpenditures,thematchtothefederalshareispaidwithLEAfunds.

§ LEApaymentsarenotincludedintheMedicaidexpenditureanalysisinthisreport.

$2,358,207$1,559,386

$1,060,950$940,769

$857,981

$772,969$770,234

$690,974$684,737

$598,484$476,081

$413,236$413,114$402,839$400,949$384,996$355,606$348,568

$308,513$301,404$286,010$257,794$254,222$243,740$234,553$207,147$196,238

$147,971$143,346$136,953

$54,283$43,172$40,033$37,130$28,940$67,933

ProvidenceSchoolDistrictWoonsocketEducationDepartment

WesterlyPublicSchoolsEastProvidenceSchoolDepartment

CranstonPublicSchoolsWarwickPublicSchoolsJohnstonPublicSchools

NewportCountyRegionalSpecialEdNorthProvidenceSchoolDepartment

TownofLincolnPublicSchoolsProvidenceSchoolDepartmentPawtucketSchoolDepartment

CentralFallsSchoolDistrictCoventryPublicSchools

SouthKingstownSchoolDepartmentNorthKingstownSchoolDepartment

BristolWarrenRegionalSchoolDistrictBarringtonPublicSchools

WestWarwickSchoolDepartmentCumberlandSchoolDepartmentCharihoRegionalSchoolDistrictBurrillvilleSchoolDepartmentEastGreenwichPublicSchools

NewportPublicSchoolsExeterWGreenwichRegSchoolDistrict

TownofNarragansettSchoolSystemNorthSmithfieldSchoolDepartment

PortsmouthSchoolDistrictSmithfieldSchoolDepartment

TownofScituateSchoolDepartmentJamestownSchoolDepartment

Foster- GlocesterRegionalSchoolDistNewShorehamPublicSchools

TownofGlocesterKingstonHillAcademyIncFosterSchoolDepartment

PaulCuffeeSchoolOther

Total SFY2016LEAExpenditure=$18M

LocalEducationAuthorities(LEAs)accountfor$18millionintotalexpendituresin54schooldistricts.

Otherincludes:BlackstoneValleyPrep,AchievementFirstProvidence,MetropolitanRegionalCareer&TechCtr,CVSHighlanderCharterSchool,BlackstoneAcademyCharterSchool,TheCompassSchool,LearningCommunityCharterSchool,InternationalCharterSchool,TrinityAcademyforthePerformingArts,WilliamMDaviesJrCareer&TechHS,BeaconCharterSchool,SheilaC.SkipNowell LeadershipAcad,VillageGreenVirtualCharterSchool,TheGreeneSchool,TheHopeAcademy,RhodeIslandSchoolfortheDeaf,andUrbanCollaborativeAcceleratedProgram

Exclusions:(3)CostsNotOtherwiseMatchable (CNOM)

CostsNotOtherwiseMatchable (CNOMs)accountfor$15millionintotalexpenditures.


CostsNotOtherwiseMatchable (CNOMs)SFY2016-- $Millions


§ UnderthetermsofRhodeIsland’s1115WaiverDemonstrationagreementwiththefederalgovernment,certainstateprogramsnottraditionallyallowableunderMedicaidfundmatchingrulescanreceivefederalfundingiftheyforestalltheneedforpersonsservedtobecomefullyMedicaideligible.

§ TheseCNOMexpendituresarenotpartofthecoreMedicaidprogramandassucharenotincludedintheMedicaidexpenditureanalysisinthisreport.

$5.0

$4.4

$2.3$2.7

$0.2

Core/PreventiveSvcs,CSHCN

ABDatriskforLTC,<300%FPL

YouthatriskforMedicaid<300%

FPL

Elders<200%,atriskforLTC

Lowincomeadultswith

mentalillness

Total SFY2016CNOMExpenditure=$15M

AcronymsandAbbreviations

ACA: AffordableCareActBCBSRI: BlueCrossBlueShieldofRhodeIslandBHDDH: BehavioralHealthcare,DevelopmentalDisability,

andHospitalsCHIP: Children’sHealthInsuranceProgramCMHC: CommunityMentalHealthCenterCMS: CentersforMedicareandMedicaidServicesCNOM: CostsNotOtherwiseMatchableCSHCN: ChildrenwithSpecialHealthCareNeedsDCYF: DepartmentofChildren,YouthandFamiliesIDD: IntellectuallyandDevelopmentallyDisabledDEA: DepartmentofElderlyAffairsDSH: DisproportionateShareHospitalsDHS: DepartmentofHumanServicesDME: DurableMedicalEquipmentDOH: DepartmentofHealthEOHHS: ExecutiveOfficeofHealthandHumanServicesER: EmergencyRoomFFY: FederalFiscalYearFMAP: FederalMedicaidAssistancePercentage



HCBS: HomeandCommunity-BasedServicesHEDIS: HealthcareEffectivenessDataandInformationSetIP: HospitalInpatientLEA: LocalEducationAgenciesLTSS: LongTermServicesandSupportsMCO: MedicaidManagedCareOrganizationMME: MedicaidMedicareEligiblesNHPRI: NeighborhoodHealthPlanofRhodeIslandNICU: NeonatalIntensiveCareUnitOP: HospitalOutpatientPACE: ProgramofAll-InclusiveCareoftheElderlyPCCM: PrimaryCareCaseManagementPMPM: PermemberpermonthRIPTA: RhodeIslandPublicTransitAuthoritySA: SubstanceAbuseSFY: StateFiscalYearSSI: SupplementalSecurityIncomeUHCNE: UnitedHealthCareofNewEnglandUPL: UpperPaymentLimit

Thefollowingacronymsandabbreviationshavebeenusedinthisreport.

SourcesandNotes

SourceDataandAnalyticMethodThisreportisbasedonSFY2016andafiveyearhistoricalRhodeIslandMedicaidsystemsextracts:

§ Includingclaims,capitationpayments,premiums andproviderpayouts.

§ ReflectingdatabasedondateofservicewithanestimateforIBNR(incurredbutnotreported)forclaimspaidthroughNovember2016

§ Capitations,premiumsandpayouts areproportionatelyallocatedtoMedicaidcoveragegroups,servicetypesandcaresettingbasedonrespectiveclaimsandpayoutinformationwithIBNR.



VariancetoOtherReportsThepurposeofthisreportistoprovideacomprehensiveoverviewofstateMedicaidexpenditurestoassistinassessingandmakingstrategicchoicesaboutprogramcoverage,costs,andefficiencyintheannualbudgetprocess. Expenditureamountsusedinthisreportmayvaryfromexpendituresreportedforfinancialreconciliationorotherpurposes. Reasonsforanyvariancemightincludefactorssuchasclaimcompletion,roundingandallocationofnon-claimsbasedexpenditures.

Rhode Island Annual Medicaid Expenditure Report SFY 2016 · the last five years, not including...

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