Governor's Recommended Budget - State of South Dakota

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

	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