County Medicaid Contributions

Heather Wildermuth3/15/12

Agenda

• Introduction– Chris Holley

• Explanation of the backlog and HB 5301– Heather Wildermuth

• Medicaid Veto Plan– Cragin Mosteller

• Medicaid Legal Discussion– Ginger Delegal

• Conclusion– John Wayne Smith

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County Medicaid Contributions – SB 1988 and HB 5301

• Medicaid Budget Conforming Bill.

• Adds the children of state employees among those eligible for Florida KidCare.

• Directs the Department of Children and Families and the Agency for Health Care Administration to work cooperatively to develop a new system of eligibility determination for Medicaid and the Children’s Health Insurance Program consistent with federal and state laws.

• Limits payment for emergency room services for non-pregnant Medicaid recipients 21 years of age or older to 6 visits per fiscal year.

• Significantly amends Sec. 409.915, F.S., County Contributions to Medicaid.

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County Medicaid Contributions (Continued)

• Removes the requirement that the state work “in consultation” with the counties to determine who is an “eligible recipient” of that county.

• Stipulates that each county’s eligible recipients will be determined by the address contained in the Medicaid eligibility system maintained by DCF.

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County Medicaid Contributions - Backlog

• By August 1, 2012, AHCA must certify each county’s “backlog” which includes disputed bills occurring between November 1, 2001 – April 30, 2012.

• Each county has 1 month after certification (September 1, 2012) to contest the certified amount.

• This procedure is the exclusive method to challenge the amount certified.

• Burden of proof – A preponderance of the evidence.

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County Medicaid Contributions (Backlog Continued)

• By September 15, 2012, AHCA will certify to the Department of Revenue:

– For each county that files a petition the total amount certified.– For each county that does not file a petition, an amount equal to 85%

of the total amount certified.

• Filing a petition will not stay or stop the DOR from reducing your revenue sharing.

• If you are able to demonstrate that the amount certified should be reduced, AHCA will notify DOR of the amount of the reduction. DOR will adjust all future monthly distributions in a manner that results in the remaining total being applied in equal monthly amounts.

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County Medicaid Contributions (Backlog Continued)

• For 12 months beginning with the October 2012 distribution, DOR will reduce each county’s revenue sharing by a third of the amount certified.

• The remaining two-thirds will be spread over 4 years, beginning with the October 2013 distribution. In total, counties will be paying on the backlog for 5 years.

• The state cannot withhold more than 50% of your revenue sharing due to bonding issues.

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Questions?

The phone will be taken off mute for questions on the backlog.

The prospective payments will be covered in the next section.

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County Medicaid Contributions - Prospective Payments

• Beginning May 1, 2012, AHCA will certify to DOR by the 7th of each month the amount of the monthly Medicaid statement for each county.

• DOR will reduce your ½ cent sales tax distribution by that certified amount.

• Again, there are provisions to ensure that each county can make timely bond payments if that situation exists.

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Questions?

The phone will be taken off mute for questions on the prospective payments.

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County Medicaid Contributions – Credits

• AHCA, DOR and FAC will work in consultation to develop a process for “refund” requests which: – Allows counties to submit a written refund request to the

Agency.

– Requires that the Agency determine whether the refund is appropriate and should be approved. Once approved, they will certify the refund to DOR.

– Requires DOR to issue a refund for the certified amount to the county from GR. The “refund” is issued in the form of a credit against reductions to be applied to subsequent monthly distributions.

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County Medicaid Contributions – New Authority

• The Agency is now authorized to adopt rules to administer this section of law.

• New authority in Section 13 of the bill includes the following:

The Agency for Health Care Administration and the Department of Children and Family Services, in consultation with hospitals and nursing homes that serve Medicaid recipients, shall develop a process to update a recipient's address in the Medicaid eligibility system at the time a recipient is admitted to a hospital or nursing home. If a recipient's address information in the Medicaid eligibility system needs to be updated, the update shall be completed within 10 days after the recipient's admission to a hospital or nursing home.

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Questions?

The phone will be taken off mute for questions on HB 5301

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Medicaid Veto Plan

• Veto letters• Veto video• Veto website• Member support– County resolutions– Sample veto letters

• Op-Ed

• Ongoing media push for editorials– Local reporters

• Action Items– Send sample veto

letter– Talk to reporters

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Questions?

The phone will be taken off mute for questions on public relations attempts to veto bill.

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Legal Options

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Questions?

The phone will be taken off mute for questions on legal options.

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Conclusion

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Questions?

The phone will be taken off mute for final questions.

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