SOCIAL SERVICES
GOVERNOR'S RECOMMENDED FY 2006 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 2003
ACTUAL
FY 2004
BUDGETED
FY 2005
REQUESTED
FY 2006
GOVERNOR'S RECOMMENDED
FY 2006
RECOMMENDED INC/(DEC)
FY 2006
FUNDING SOURCE:
   General Funds $75,592,782 $88,780,455 $101,842,998 $118,722,005 $118,600,447 $16,757,449
   Federal Funds 187,041,748 242,536,743 250,039,058 281,285,150 281,038,283 30,999,225
   Other Funds 270,702 349,892 800,000 1,087,500 1,087,500 287,500
      Total $262,905,232 $331,667,090 $352,682,056 $401,094,655 $400,726,230 $48,044,174
 
EXPENDITURE DETAIL:
   Personal Services $1,251,111 $1,340,733 $1,321,633 $1,553,946 $1,440,364 $118,731
   Operating Expenses 261,654,121 330,326,357 351,360,423 399,540,709 399,285,866 47,925,443
      Total $262,905,232 $331,667,090 $352,682,056 $401,094,655 $400,726,230 $48,044,174
 
Staffing Level FTE: 33.3 34.2 33.0 40.0 36.0 3.0

  ACTUAL
FY 2003

ACTUAL
FY 2004

ESTIMATED
FY 2005

ESTIMATED
FY 2006

REVENUES:  
      
Total

$0

$0

$0

$0
PERFORMANCE INDICATORS:  
   Average Persons Eligible:
   Aged/Blind 6,024/96 5,876/97 5,799/98 5,707/98
   Disabled Adults/Children 10,482/2,342 10,558/2,368 10,680/2,368 10,774/2,368
   Low Income Family (LIF) Adults/Children 9,985/17,565 10,778/18,334 11,261/19,307 11,828/19,706
   Foster Care Children 2,911 3,154 3,228 3,295
   Pregnant Women 1,809 1,855 1,892 1,924
   Catastrophic (QMB) 2,419 2,634 2,866 3,095
   Medical Services Programs for Children:
   Title XIX Funded 28,561 29,813 30,891 31,530
   Title XXI Funded, Under 140% of FPL 7,131 7,535 7,789 7,950
   Title XXI Funded 140%-200% of FPL 1,798 2,018 2,086 2,129
   Total Title XIX Eligibles 82,194 85,490 88,390 90,325
   Total Title XXI Eligibles 8,929 9,553 9,875 10,079
   Total Avg. Persons Eligible (XIX & XXI) 91,123 95,043 98,265 100,404
   Total Average Cost Per Title XIX Eligible $3,258 $3,683 $3,970 $4,156
   Average Cost Per Title XIX Eligible by Service:
   Physicians $482 $579 $608 $642
   Inpatient Hospital $783 $936 $1,015 $1,049
   Outpatient Hospital $276 $308 $347 $388
   Prescription Drugs $684 $744 $775 $839
   All Other Services $1,033 $1,116 $1,225 $1,237
   Program Utilization: *
   Physician Services 25.21/$153.08 26.98/$171.78 27.69/$177.41 28.42/$184.72
   Inpatient Hospital 1.62/$4,137.10 1.63/$4,913.37 1.65/$5,217.02 1.65/$5,539.43
   Outpatient Hospital 6.24/$369.27 6.60/$388.81 6.90/$419.18 7.21/$451.92
   Other Medical 2.93/$255.70 3.26/$260.96 3.26/$268.68 3.26/$272.71
   Adult Women Chemical Dependency 41/$5,317.49 18/$6,404.86 43/$5,317.49 43/$5,317.49
   Chiropractic Services .74/$32.39 .91/$34.76 .91/$35.80 .91/$36.34
   Medicare Crossover Claims (All Services) 8.22/$146.17 7.32/$145.08 8.22/$146.17 8.49/$157.00
   Indian Health Services 17.70/$441.78 21.89/$460.28 22.04/$533.89 22.04/$533.89
   Prescription Drugs:
   Avg. Utilization/Prescriptions Per Month 30.71/4.02 31.52/4.12 31.71/4.17 31.71/4.17
   Average Cost Per Prescription $56.47 $60.35 $64.92 $69.84
   Adult Services:
   Average Eligible Clients 28,396 29,187 29,730 30,331
   Dental Average Utilization/Cost 100/$4.92 100/$5.00 100/$5.97 100/$6.29
   Optometrist Average Utilization/Cost 2.45/$89.63 3.07/$89.00 2.75/$91.67 2.75/$93.05
   Early and Periodic Screening, Diagnosis,
   and Treatment:
   Avg. Children - LIF/Foster Care 17,565/2,911 18,334/3,154 19,307/3,228 19,706/3,295
   Expanded Medical / Disabled 28,561/2,342 29,813/2,368 30,891/2,368 31,530/2,368
   Avg. Monthly Utilization/Cost:
   Screening 2.13/$49.37 1.64/$45.27 2.02/$46.65 2.02/$47.35
   Dental Services 100/$8.24 100/$7.97 100/$9.52 100/$9.86
   Optometric Services 2.17/$86.01 2.69/$84.78 2.43/$87.32 2.43/$88.63
   Treatment Services .47/$2,582.30 1.39/$1,032.76 1.39/$1,063.74 1.39/$1,079.70
   Supplemental Medical Insurance (Buy-In):
   Part A Recipients/Premium 710/$321.58 706/$336.92 707/$344.50 707/$352.25
   Part B Recipients/Premium 13,906/$59.02 13,953/$67.36 14,273/$68.87 14,593/$70.42
   Balance Budget Act Expanded SMI 695/$50.98 586/$62.68 580/$71.94 587/$82.57
   Childrens Care Hospital:
   Avg. Residents/Per Diem Paid 73/$326.22 63/$279.89 68/$334.13 68/$339.14
   Renal Disease:
   Avg. Monthly Eligibles 6/86.57 28 9 9
   Avg. Monthly Cost Per Eligible $345.09 $205.25 $355.44 355.44
   Managed Care Program Participants:
   Eligibles/Physicians in Primary Care 66,708/631 70,153/657 72,530/657 74,108/657
   Claims Processing:
   Claims Processed 3,598,809 4,008,579 4,127,130 4,216,968
   Claims Processed Per Eligible Person 39 42 42 42
   Catastrophic County Poor Relief:
   Claims Reviewed and Approved 25 20 25 25
   Participating Counties 60 60 61 61
   Total Paid Out $270,702 $349,891 $800,000 $800,000
   Counties Requesting Reimbursement 12 10 15 15
   Claims Priced Under Medicaid 548 616 650 650
   Claims Reviewed 13 22 25 25

generated 12/06/04 03:48:22 PM