Governor's Recommended Budget - State of South Dakota

SOCIAL SERVICES
GOVERNOR'S RECOMMENDED FY 2005 BUDGET

0823 Medical Services

MISSION:
To provide medical assistance to eligible South Dakotans under Title XIX of the Social Security Act (Medicaid) and applicable state laws to enable them to have access to medical services necessary to maintain good health.

ACTUAL
FY 2002 ACTUAL
FY 2003 BUDGETED
FY 2004 REQUESTED
FY 2005 GOVERNOR'S RECOMMENDED
FY 2005 RECOMMENDED INC/(DEC)
FY 2005

FUNDING SOURCE:

   General Funds $69,334,527 $75,592,782 $84,140,682 $96,309,395 $101,084,715 $16,944,033

   Federal Funds 175,931,517 187,041,747 211,245,225 239,280,789 248,501,727 37,256,502

   Other Funds 284,377 270,702 800,000 800,000 800,000 0

      Total $245,550,421 $262,905,231 $296,185,907 $336,390,184 $350,386,442 $54,200,535

EXPENDITURE DETAIL:

   Personal Services $1,042,379 $1,251,110 $1,271,682 $1,271,682 $1,271,682 $0

   Operating Expenses 244,508,042 261,654,121 294,914,225 335,118,502 349,114,760 54,200,535

      Total $245,550,421 $262,905,231 $296,185,907 $336,390,184 $350,386,442 $54,200,535

Staffing Level FTE: 28.2 33.3 33.0 33.0 33.0 0.0

ACTUAL
FY 2002
ACTUAL
FY 2003
ESTIMATED
FY 2004
ESTIMATED
FY 2005

REVENUES:


Total
$0
$0
$0
$0

PERFORMANCE INDICATORS:

   Average Persons Eligible:

   Aged/Blind 6,071/96 6,024/96 5,888/97 5,772/97

   Disabled Adults/Children 10,397/2,358 10,482/2,342 10,678/2,400 10,911/2,400

   Low Income Family (LIF) Adults/Children 9,076/16,692 9,985/17,565 10,715/18,709 11,702/19,267

   Foster Care Children 2,646 2,911 3,044 3,153

   Pregnant Women 1,755 1,809 1,855 1,898

   Catastrophic (QMB) 2,166 2,419 2,666 2,916

   Medical Services Programs for Children:

   Title XIX Funded 26,672 28,561 29,748 30,679

   Title XXI Funded, Under 140% of FPL 6,260 7,131 7,615 7,851

   Title XXI Funded 140%-200% of FPL 1,327 1,798 1,904 1,963

   Total Avg. Persons Eligible (XIX & XXI) 85,516 91,123 95,319 98,609

   Managed Care Program Participants:

   Eligibles/Physicians in Primary Care 63,533/608 66,708/631 70,018/634 72,570/636

   Eligibles in Hospital Care Management 2,400 2,400 2,400 2,400

   Avg. Persons Receiving Services Monthly:

   Physician Services 18,801 20,721 22,008 23,131

   Inpatient/Outpatient Hospital Services 1,246/4,516 1,332/5,129 1,390/5,354 1,438/5,807

   Prescription Drugs 23,156 25,242 26,349 27,269

   Other Medical/Chiropractic Services 2,369/515 2,408/608 2,557/635 2,691/657

   Adult Women Chemical Dependency 21 41 42 43

   Medicare Crossovers (All Services) 5,585 6,756 7,259 7,512

   Adult Dental/Optometric Services 27,395/737 28,396/696 29,233/798 30,380/829

   EPSDT - Screening/Treatment 990/242 1,094/241 1,148/270 1,182/278

   EPSDT - Dental/Optometric 47,368/1,156 51,379/1,115 53,901/1,283 55,499/1,321

   Supplemental Medical Insurance-SMI 13,967 14,616 14,932 15,249

   BBA Expanded SMI 499 695 666 783

   Indian Health Service 6,931 5,731 6,722 6,722

   Childrens Care Hospital 68 73 73 73

   Title XXI Funded, Under 140% FPL 2,679 3,240 3,469 3,483

   Title XXI Funded, 141%-200% of FPL 601 714 735 871

   Renal Disease Service 9 6 6 7

   Claims Processing:

   Claims Processed 3,331,943 3,598,809 3,717,441 3,845,751

   Claims Processed Per Eligible Person 39 39 39 39

   Provider Inquiries 400,000 400,000 400,000 400,000

   Program Utilization: *

   Physician Services 24.44/$146.67 25.21/$153.08 25.65/$157.37 26.05/$160.82

   Inpatient Hospital 1.62/$4,015.80 1.62/$4,137.10 1.62/$4,258.66 1.62/$4,335.32

   Outpatient Hospital 5.87/$313.78 6.24/$369.27 6.24/$369.27 6.54/$375.92

   Other Medical 3.08/$225.41 2.93/$255.70 2.98/$255.70 3.03/$260.30

   Adult Women Chemical Dependency 21/$4,946.00 41/$5,317.49 42/$5,317.49 43/$5,317.49

   Chiropractic Services .67/$33.50 .74/$32.39 .74/$33.48 .74/$33.48

   Medicare Crossover Claims (All Services) 7.26/$136.08 8.22/$146.17 8.46/$146.17 8.46/$151.37

   Indian Health Services 22.22/$429.75 17.70/$441.78 22.04/$533.89 22.04/$533.89

   Prescription Drugs:

   Avg. Utilization/Prescriptions Per Month 30.10/3.94 30.71/4.02 30.71/4.02 30.71/4.05

   Average Cost Per Prescription $52.56 $56.47 $58.73 $61.08

   Adult Services:

   Average Eligible Clients 27,395 28,396 29,233 30,380

   Dental Average Utilization/Cost 100/$4.65 100/$4.92 100/$5.00 100/$5.25

   Optometrist Average Utilization/Cost 2.69/$88.05 2.45/$89.63 2.73/$89.63 2.73/$89.63

   Early and Periodic Screening, Diagnosis,

   and Treatment:

   Avg. Children - LIF/Foster Care 16,692/2,646 17,565/2,911 18,709/3,044 19,267/3,153

   Expanded Medical / Disabled 26,672/2,358 28,561/2,342 29,748/2,400 30,679/2,400

   Avg. Monthly Utilization/Cost:

   Screening 2.09/$47.09 2.13/$49.37 2.13/$50.75 2.13/$51.66

   Dental Services 100/$7.62 100/$8.24 100/$7.97 100/$8.37

   Optometric Services 2.44/$83.39 2.17/$86.01 2.38/$86.01 2.38/$86.01

   Treatment Services .51/$2,600.55 .47/$2,582.30 .50/$2,582.30 .50/$2,628.78

   Supplemental Medical Insurance (Buy-In):

   Part A Recipients/Premium 719/$315.95 710/$321.58 709/$323.73 709/$325.90

   Part B Recipients/Premium 13,248/$54.26 13,906/$59.02 14,223/$62.74 14,540/$66.69

   Balance Budget Act Expanded SMI 499/$42.07 695/$50.98 666/$60.95 783/$65.45

   Childrens Care Hospital:

   Avg. Residents/Per Diem Paid 68/$263.11 73/$326.22 73/$335.35 73/$341.39

   Renal Disease:

   Avg. Monthly Eligibles/Utilization % 9/41.81 6/86.57 6/86.57 7/86.57

   Avg. Monthly Cost Per Utilization $154.90 $345.09 $345.09 $351.30

   Catastrophic County Poor Relief:

   Claims Reviewed and Approved 22 25 25 25

   Participating Counties 58 60 61 61

   Total Paid Out $279,583 $270,702 $800,000 $800,000

   Counties Requesting Reimbursement 15 12 15 15

   Claims Priced Under Medicaid 417 548 600 600

   Claims Reviewed 23 13 20 20

generated 12/01/03 10:19:30 AM

	ACTUAL FY 2002	ACTUAL FY 2003	BUDGETED FY 2004	REQUESTED FY 2005	GOVERNOR'S RECOMMENDED FY 2005	RECOMMENDED INC/(DEC) FY 2005
FUNDING SOURCE:
General Funds	$69,334,527	$75,592,782	$84,140,682	$96,309,395	$101,084,715	$16,944,033
Federal Funds	175,931,517	187,041,747	211,245,225	239,280,789	248,501,727	37,256,502
Other Funds	284,377	270,702	800,000	800,000	800,000	0
Total	$245,550,421	$262,905,231	$296,185,907	$336,390,184	$350,386,442	$54,200,535

EXPENDITURE DETAIL:
Personal Services	$1,042,379	$1,251,110	$1,271,682	$1,271,682	$1,271,682	$0
Operating Expenses	244,508,042	261,654,121	294,914,225	335,118,502	349,114,760	54,200,535
Total	$245,550,421	$262,905,231	$296,185,907	$336,390,184	$350,386,442	$54,200,535

Staffing Level FTE:	28.2	33.3	33.0	33.0	33.0	0.0

	ACTUAL FY 2002	ACTUAL FY 2003	ESTIMATED FY 2004	ESTIMATED FY 2005
REVENUES:
Total	$0	$0	$0	$0
PERFORMANCE INDICATORS:
Average Persons Eligible:
Aged/Blind	6,071/96	6,024/96	5,888/97	5,772/97
Disabled Adults/Children	10,397/2,358	10,482/2,342	10,678/2,400	10,911/2,400
Low Income Family (LIF) Adults/Children	9,076/16,692	9,985/17,565	10,715/18,709	11,702/19,267
Foster Care Children	2,646	2,911	3,044	3,153
Pregnant Women	1,755	1,809	1,855	1,898
Catastrophic (QMB)	2,166	2,419	2,666	2,916
Medical Services Programs for Children:
Title XIX Funded	26,672	28,561	29,748	30,679
Title XXI Funded, Under 140% of FPL	6,260	7,131	7,615	7,851
Title XXI Funded 140%-200% of FPL	1,327	1,798	1,904	1,963
Total Avg. Persons Eligible (XIX & XXI)	85,516	91,123	95,319	98,609
Managed Care Program Participants:
Eligibles/Physicians in Primary Care	63,533/608	66,708/631	70,018/634	72,570/636
Eligibles in Hospital Care Management	2,400	2,400	2,400	2,400
Avg. Persons Receiving Services Monthly:
Physician Services	18,801	20,721	22,008	23,131
Inpatient/Outpatient Hospital Services	1,246/4,516	1,332/5,129	1,390/5,354	1,438/5,807
Prescription Drugs	23,156	25,242	26,349	27,269
Other Medical/Chiropractic Services	2,369/515	2,408/608	2,557/635	2,691/657
Adult Women Chemical Dependency	21	41	42	43
Medicare Crossovers (All Services)	5,585	6,756	7,259	7,512
Adult Dental/Optometric Services	27,395/737	28,396/696	29,233/798	30,380/829
EPSDT - Screening/Treatment	990/242	1,094/241	1,148/270	1,182/278
EPSDT - Dental/Optometric	47,368/1,156	51,379/1,115	53,901/1,283	55,499/1,321
Supplemental Medical Insurance-SMI	13,967	14,616	14,932	15,249
BBA Expanded SMI	499	695	666	783
Indian Health Service	6,931	5,731	6,722	6,722
Childrens Care Hospital	68	73	73	73
Title XXI Funded, Under 140% FPL	2,679	3,240	3,469	3,483
Title XXI Funded, 141%-200% of FPL	601	714	735	871
Renal Disease Service	9	6	6	7
Claims Processing:
Claims Processed	3,331,943	3,598,809	3,717,441	3,845,751
Claims Processed Per Eligible Person	39	39	39	39
Provider Inquiries	400,000	400,000	400,000	400,000
Program Utilization: *
Physician Services	24.44/$146.67	25.21/$153.08	25.65/$157.37	26.05/$160.82
Inpatient Hospital	1.62/$4,015.80	1.62/$4,137.10	1.62/$4,258.66	1.62/$4,335.32
Outpatient Hospital	5.87/$313.78	6.24/$369.27	6.24/$369.27	6.54/$375.92
Other Medical	3.08/$225.41	2.93/$255.70	2.98/$255.70	3.03/$260.30
Adult Women Chemical Dependency	21/$4,946.00	41/$5,317.49	42/$5,317.49	43/$5,317.49
Chiropractic Services	.67/$33.50	.74/$32.39	.74/$33.48	.74/$33.48
Medicare Crossover Claims (All Services)	7.26/$136.08	8.22/$146.17	8.46/$146.17	8.46/$151.37
Indian Health Services	22.22/$429.75	17.70/$441.78	22.04/$533.89	22.04/$533.89
Prescription Drugs:
Avg. Utilization/Prescriptions Per Month	30.10/3.94	30.71/4.02	30.71/4.02	30.71/4.05
Average Cost Per Prescription	$52.56	$56.47	$58.73	$61.08
Adult Services:
Average Eligible Clients	27,395	28,396	29,233	30,380
Dental Average Utilization/Cost	100/$4.65	100/$4.92	100/$5.00	100/$5.25
Optometrist Average Utilization/Cost	2.69/$88.05	2.45/$89.63	2.73/$89.63	2.73/$89.63
Early and Periodic Screening, Diagnosis,
and Treatment:
Avg. Children - LIF/Foster Care	16,692/2,646	17,565/2,911	18,709/3,044	19,267/3,153
Expanded Medical / Disabled	26,672/2,358	28,561/2,342	29,748/2,400	30,679/2,400
Avg. Monthly Utilization/Cost:
Screening	2.09/$47.09	2.13/$49.37	2.13/$50.75	2.13/$51.66
Dental Services	100/$7.62	100/$8.24	100/$7.97	100/$8.37
Optometric Services	2.44/$83.39	2.17/$86.01	2.38/$86.01	2.38/$86.01
Treatment Services	.51/$2,600.55	.47/$2,582.30	.50/$2,582.30	.50/$2,628.78
Supplemental Medical Insurance (Buy-In):
Part A Recipients/Premium	719/$315.95	710/$321.58	709/$323.73	709/$325.90
Part B Recipients/Premium	13,248/$54.26	13,906/$59.02	14,223/$62.74	14,540/$66.69
Balance Budget Act Expanded SMI	499/$42.07	695/$50.98	666/$60.95	783/$65.45
Childrens Care Hospital:
Avg. Residents/Per Diem Paid	68/$263.11	73/$326.22	73/$335.35	73/$341.39
Renal Disease:
Avg. Monthly Eligibles/Utilization %	9/41.81	6/86.57	6/86.57	7/86.57
Avg. Monthly Cost Per Utilization	$154.90	$345.09	$345.09	$351.30
Catastrophic County Poor Relief:
Claims Reviewed and Approved	22	25	25	25
Participating Counties	58	60	61	61
Total Paid Out	$279,583	$270,702	$800,000	$800,000
Counties Requesting Reimbursement	15	12	15	15
Claims Priced Under Medicaid	417	548	600	600
Claims Reviewed	23	13	20	20