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