Governor's Recommended Budget - State of South Dakota

SOCIAL SERVICES
GOVERNOR'S RECOMMENDED FY 2007 BUDGET

083 Medical and Adult 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. To provide a range of in-home and community based services, directly or through service providers to adults and older persons in accordance with the Older Americans Act and other applicable state and federal laws for the purpose of assisting them in maintaining their independence and preventing premature or inappropriate institutionalization. In addition, Victims' Services provides funding for a variety of services to victims of domestic violence and compensation to victims of violent crimes.

ACTUAL
FY 2004 ACTUAL
FY 2005 BUDGETED
FY 2006 REQUESTED
FY 2007 GOVERNOR'S RECOMMENDED
FY 2007 RECOMMENDED INC/(DEC)
FY 2007

FUNDING SOURCE:

   General Funds $134,530,851 $153,776,212 $176,510,528 $191,984,753 $193,054,713 $16,544,185

   Federal Funds 340,999,699 345,282,733 388,947,208 369,062,544 370,991,150 (17,956,058)

   Other Funds 1,408,505 947,382 3,219,443 2,776,613 2,830,649 (388,794)

      Total $476,939,056 $500,006,327 $568,677,179 $563,823,910 $566,876,512 ($1,800,667)

EXPENDITURE DETAIL:

   Personal Services $5,813,612 $5,963,647 $6,281,280 $6,281,281 $6,572,334 $291,054

   Operating Expenses 471,125,443 494,042,680 562,395,899 557,542,629 560,304,178 (2,091,721)

      Total $476,939,056 $500,006,327 $568,677,179 $563,823,910 $566,876,512 ($1,800,667)

Staffing Level FTE: 133.2 137.4 134.5 134.5 134.5 0.0

ACTUAL
FY 2004
ACTUAL
FY 2005
ESTIMATED
FY 2006
ESTIMATED
FY 2007

REVENUES:


Total
$0
$0
$0
$0

PERFORMANCE INDICATORS:

   MEDICAL SERVICES:

   Average Persons Eligible:

   Aged/Blind 5,876/97 5,732/94 5,570/94 5,415/94

   Disabled Adults/Children 10,558/2,368 10,770/2,372 11,026/2,372 11,281/2,372

   Low Income Family (LIF) Adults/Children 10,778/18,334 11,015/19,151 11,646/19,548 12,247/19,856

   Foster Care Children 3,154 3,283 3,349 3,402

   Pregnant Women 1,855 1,856 1,803 1,765

   Catastrophic (QMB) 2,634 2,753 2,874 2,995

   Medical Services Programs for Children:

   Title XIX Funded 29,813 30,376 30,925 31,412

   Title XXI Funded, Under 140% of FPL 7,535 8,189 8,420 8,553

   Title XXI Funded 140%-200% of FPL 2,018 2,228 2,293 2,329

   Total Title XIX Eligibles 85,490 87,393 89,207 90,839

   Total Title XXI Eligibles 9,553 10,417 10,713 10,882

   Total Avg. Persons Eligible (XIX & XXI) 95,043 97,810 99,920 101,721

   Total Average Cost Per Title XIX Eligible $3,683 $3,765 $3,882 $3,828

   Average Cost Per Title XIX Eligible by Service:

   Physicians $579 $602 $649 $697

   Inpatient Hospital $936 $849 $967 $994

   Outpatient Hospital $308 $331 $356 $386

   Prescription Drugs $744 $757 $636 $425

   All Other Services $1,116 $1,226 $1,274 $1,326

   Program Utilization:

   Physician Services 26.98/$171.78 26.61/$181.28 27.22/$192.95 27.58/$207.01

   Inpatient Hospital 1.63/$4,913.37 1.60/$4,538.64 1.63/$4,946.29 1.63/$5,115.64

   Outpatient Hospital 6.60/$388.81 6.81/$404.95 7.26/$408.27 7.64/$420.49

   Other Medical 3.26/$260.96 3.13/$273.24 3.23/$286.93 3.23/$295.54

   Chiropractic Services .91/$34.76 1.04/$34.14 1.04/$34.76 1.04/$35.80

   Medicare Crossover Claims (All Services) 7.32/$145.08 8.25/$160.53 8.49/$169.79 8.49/$179.59

   Indian Health Services 21.89/$460.28 21.21/$451.96 22.04/$533.89 22.04/$533.89

   Prescription Drugs:

   Avg. Utilization/Prescriptions Per Month 31.52/4.12 31.69/4.13 26.42/3.52 26.80/2.93

   Average Cost Per Prescription $60.35 $63.19 $67.52 $72.15

   Adult Services:

   Average Eligible Clients 29,187 29,467 30,331 30,802

   Dental Average Utilization/Cost 100/$5.00 100/$5.97 100/$5.97 100/$7.04

   Optometrist Average Utilization/Cost 3.07/$89.00 2.90/$90.52 2.95/$90.79 2.95/$93.51

   Children's Services (EPSDT)

   Avg. Children - LIF/Foster Care 18,334/3,154 19,151/3,283 19,548/3,349 19,856/3,402

   Expanded Medical / Disabled 29,813/2,368 30,367/2,372 30,925/2,372 31,412/2,372

   Avg. Monthly Utilization/Cost:

   Screening 1.64/$45.27 1.75/$64.50 1.75/$64.50 1.75/$66.44

   Dental Services 100/$7.97 100/$9.52 100/$9.52 100/$11.22

   Optometric Services 2.69/$84.78 2.55/$83.19 2.46/$84.34 2.46/$86.87

   Treatment Services 1.39/$733.61 1.40/$711.43 1.41/$772.95 1.41/$777.48

   Supplemental Medical Insurance (Buy-In):

   Part A Recipients/Premium 706/$336.92 812/$377.18 966/$385.86 1,110/$407.33

   Part B Recipients/Premium 13,953/$67.36 14,216/$78.59 14,539/$82.88 14,862/$92.68

   Balance Budget Act Expanded SMI 586/$62.68 611/$72.33 605/$91.68 625/$107.49

   Childrens Care Hospital:

   Avg. Residents/Per Diem Paid 63/$279.89 55/$356.90 65/$362.32 65/$373.19

   Renal Disease:

   Avg. Monthly Eligibles 9 9 9 9

   Avg. Monthly Cost Per Eligible $205.25 $230.89 $355.44 $355.44

   Managed Care Program Participants:

   Eligibles/Physicians in Primary Care 70,153/657 72,213/659 74,333/659 76,516/659

   Claims Processing:

   Claims Processed 4,558,942 4,687,262 4,819,194 4,954,840

   Claims Processed Per Eligible Person 48 48 48 48

   Catastrophic County Poor Relief:

   Claims Reviewed and Approved 20 14 20 20

   Participating Counties 60 61 61 61

   Total Paid Out $349,891 $189,892 $600,000 $600,000

   Counties Requesting Reimbursement 10 5 12 12

   Claims Priced Under Medicaid 616 760 700 700

   Claims Reviewed 22 27 25 25



   ADULT SERVICES AND AGING:

   Medical Review:

   Title XIX Level of Care Determinations/

   Redeterminations 7,517 5,937 6,100 6,300

   Case-Mix Validation Reviews 1,328 2,219 1,900 2,000

   Avg. Monthly Cases/Unduplicated Clients 5,998/10,209 6,377/9,794 6,250/10,000 6,250/10,000

   Elderly/Adult In-Home Services:

   Homemaker Services Clients (Unduplicated) 4,059 4,321 4,400 4,400

   Direct Care/Contracted Hours 983/305,648 686/288,893 1,000/300,000 1,000/294,675

   Personal Care Clients Served 914 952 950 950

   Direct Care/Contracted Care Hours 1,752/83,559 1,399/82,712 1,500/89,000 1,500/88,000

   Title XIX Waiver Program Unduplicated Clients 665 978 950 1,000

   Respite Care / Caregiver Program

   Unduplicated Clients 1,512 1,271 1,300 1,300

   Older Americans Act Programs:

   Adult Day Care Hours/Clients 69,885/158 59,058/142 65,000/175 65,000/175

   Transportation--Trips/Clients 434,326/9,221 421,415/9,608 425,629/9,704 425,629/9,704

   Legal Services Hours/Clients 2,939/654 2,241/535 3,200/850 3,200/850

   Adult Protective Services Investigations 305 346 350 350

   Ombudsman Complaints Investigated 799 689 750 770

   Guardianship/Rx Access Clients Served 61/2,450 61/2,481 75/2,500 85/650

   Health Ins. Counseling Hours/Clients 574/397 1,484/3,656 2,500/5,000 2,000/4,000

   Elderly Nutrition Program:

   Congregate Meals/Clients Served 1,142,602/10,714 1,109,867/10,714 1,122,861/10,613 1,122,861/10,613

   Home Delivered Meals/Clients Served 493,491/4,167 496,654/4,167 528,405/4,653 528,405/4,653

   Institutional Services (ave clients paid/day):

   Nursing Facilities/Assisted Living Centers 3,928/694 3,941/690 3,954/810 3,978/876

   Adult Foster Care 12 11 15 15

   Domestic Abuse Program:

   Unduplicated Victims Served/Sheltered 14,467/3,585 15,691/3,911 16,000/4,000 16,000/4,000

   Shelter Days 52,056 59,239 60,000 60,000

   STOP - Sexual Assault and Domestic Violence

   Cases Prosecuted/Number of Victims 1,600/1,684 1,429/1,588 1,600/1,800 1,600/1,800

   STOP - Court Advocates: Number of Victims 3,710 2,572 3,000 3,000

   Claims - Final Determinations: Approved/Denied 343/130 304/148 350/150 350/150

generated 11/29/05 12:42:25 PM

	ACTUAL FY 2004	ACTUAL FY 2005	BUDGETED FY 2006	REQUESTED FY 2007	GOVERNOR'S RECOMMENDED FY 2007	RECOMMENDED INC/(DEC) FY 2007
FUNDING SOURCE:
General Funds	$134,530,851	$153,776,212	$176,510,528	$191,984,753	$193,054,713	$16,544,185
Federal Funds	340,999,699	345,282,733	388,947,208	369,062,544	370,991,150	(17,956,058)
Other Funds	1,408,505	947,382	3,219,443	2,776,613	2,830,649	(388,794)
Total	$476,939,056	$500,006,327	$568,677,179	$563,823,910	$566,876,512	($1,800,667)

EXPENDITURE DETAIL:
Personal Services	$5,813,612	$5,963,647	$6,281,280	$6,281,281	$6,572,334	$291,054
Operating Expenses	471,125,443	494,042,680	562,395,899	557,542,629	560,304,178	(2,091,721)
Total	$476,939,056	$500,006,327	$568,677,179	$563,823,910	$566,876,512	($1,800,667)

Staffing Level FTE:	133.2	137.4	134.5	134.5	134.5	0.0

	ACTUAL FY 2004	ACTUAL FY 2005	ESTIMATED FY 2006	ESTIMATED FY 2007
REVENUES:
Total	$0	$0	$0	$0
PERFORMANCE INDICATORS:
MEDICAL SERVICES:
Average Persons Eligible:
Aged/Blind	5,876/97	5,732/94	5,570/94	5,415/94
Disabled Adults/Children	10,558/2,368	10,770/2,372	11,026/2,372	11,281/2,372
Low Income Family (LIF) Adults/Children	10,778/18,334	11,015/19,151	11,646/19,548	12,247/19,856
Foster Care Children	3,154	3,283	3,349	3,402
Pregnant Women	1,855	1,856	1,803	1,765
Catastrophic (QMB)	2,634	2,753	2,874	2,995
Medical Services Programs for Children:
Title XIX Funded	29,813	30,376	30,925	31,412
Title XXI Funded, Under 140% of FPL	7,535	8,189	8,420	8,553
Title XXI Funded 140%-200% of FPL	2,018	2,228	2,293	2,329
Total Title XIX Eligibles	85,490	87,393	89,207	90,839
Total Title XXI Eligibles	9,553	10,417	10,713	10,882
Total Avg. Persons Eligible (XIX & XXI)	95,043	97,810	99,920	101,721
Total Average Cost Per Title XIX Eligible	$3,683	$3,765	$3,882	$3,828
Average Cost Per Title XIX Eligible by Service:
Physicians	$579	$602	$649	$697
Inpatient Hospital	$936	$849	$967	$994
Outpatient Hospital	$308	$331	$356	$386
Prescription Drugs	$744	$757	$636	$425
All Other Services	$1,116	$1,226	$1,274	$1,326
Program Utilization:
Physician Services	26.98/$171.78	26.61/$181.28	27.22/$192.95	27.58/$207.01
Inpatient Hospital	1.63/$4,913.37	1.60/$4,538.64	1.63/$4,946.29	1.63/$5,115.64
Outpatient Hospital	6.60/$388.81	6.81/$404.95	7.26/$408.27	7.64/$420.49
Other Medical	3.26/$260.96	3.13/$273.24	3.23/$286.93	3.23/$295.54
Chiropractic Services	.91/$34.76	1.04/$34.14	1.04/$34.76	1.04/$35.80
Medicare Crossover Claims (All Services)	7.32/$145.08	8.25/$160.53	8.49/$169.79	8.49/$179.59
Indian Health Services	21.89/$460.28	21.21/$451.96	22.04/$533.89	22.04/$533.89
Prescription Drugs:
Avg. Utilization/Prescriptions Per Month	31.52/4.12	31.69/4.13	26.42/3.52	26.80/2.93
Average Cost Per Prescription	$60.35	$63.19	$67.52	$72.15
Adult Services:
Average Eligible Clients	29,187	29,467	30,331	30,802
Dental Average Utilization/Cost	100/$5.00	100/$5.97	100/$5.97	100/$7.04
Optometrist Average Utilization/Cost	3.07/$89.00	2.90/$90.52	2.95/$90.79	2.95/$93.51
Children's Services (EPSDT)
Avg. Children - LIF/Foster Care	18,334/3,154	19,151/3,283	19,548/3,349	19,856/3,402
Expanded Medical / Disabled	29,813/2,368	30,367/2,372	30,925/2,372	31,412/2,372
Avg. Monthly Utilization/Cost:
Screening	1.64/$45.27	1.75/$64.50	1.75/$64.50	1.75/$66.44
Dental Services	100/$7.97	100/$9.52	100/$9.52	100/$11.22
Optometric Services	2.69/$84.78	2.55/$83.19	2.46/$84.34	2.46/$86.87
Treatment Services	1.39/$733.61	1.40/$711.43	1.41/$772.95	1.41/$777.48
Supplemental Medical Insurance (Buy-In):
Part A Recipients/Premium	706/$336.92	812/$377.18	966/$385.86	1,110/$407.33
Part B Recipients/Premium	13,953/$67.36	14,216/$78.59	14,539/$82.88	14,862/$92.68
Balance Budget Act Expanded SMI	586/$62.68	611/$72.33	605/$91.68	625/$107.49
Childrens Care Hospital:
Avg. Residents/Per Diem Paid	63/$279.89	55/$356.90	65/$362.32	65/$373.19
Renal Disease:
Avg. Monthly Eligibles	9	9	9	9
Avg. Monthly Cost Per Eligible	$205.25	$230.89	$355.44	$355.44
Managed Care Program Participants:
Eligibles/Physicians in Primary Care	70,153/657	72,213/659	74,333/659	76,516/659
Claims Processing:
Claims Processed	4,558,942	4,687,262	4,819,194	4,954,840
Claims Processed Per Eligible Person	48	48	48	48
Catastrophic County Poor Relief:
Claims Reviewed and Approved	20	14	20	20
Participating Counties	60	61	61	61
Total Paid Out	$349,891	$189,892	$600,000	$600,000
Counties Requesting Reimbursement	10	5	12	12
Claims Priced Under Medicaid	616	760	700	700
Claims Reviewed	22	27	25	25

ADULT SERVICES AND AGING:
Medical Review:
Title XIX Level of Care Determinations/
Redeterminations	7,517	5,937	6,100	6,300
Case-Mix Validation Reviews	1,328	2,219	1,900	2,000
Avg. Monthly Cases/Unduplicated Clients	5,998/10,209	6,377/9,794	6,250/10,000	6,250/10,000
Elderly/Adult In-Home Services:
Homemaker Services Clients (Unduplicated)	4,059	4,321	4,400	4,400
Direct Care/Contracted Hours	983/305,648	686/288,893	1,000/300,000	1,000/294,675
Personal Care Clients Served	914	952	950	950
Direct Care/Contracted Care Hours	1,752/83,559	1,399/82,712	1,500/89,000	1,500/88,000
Title XIX Waiver Program Unduplicated Clients	665	978	950	1,000
Respite Care / Caregiver Program
Unduplicated Clients	1,512	1,271	1,300	1,300
Older Americans Act Programs:
Adult Day Care Hours/Clients	69,885/158	59,058/142	65,000/175	65,000/175
Transportation--Trips/Clients	434,326/9,221	421,415/9,608	425,629/9,704	425,629/9,704
Legal Services Hours/Clients	2,939/654	2,241/535	3,200/850	3,200/850
Adult Protective Services Investigations	305	346	350	350
Ombudsman Complaints Investigated	799	689	750	770
Guardianship/Rx Access Clients Served	61/2,450	61/2,481	75/2,500	85/650
Health Ins. Counseling Hours/Clients	574/397	1,484/3,656	2,500/5,000	2,000/4,000
Elderly Nutrition Program:
Congregate Meals/Clients Served	1,142,602/10,714	1,109,867/10,714	1,122,861/10,613	1,122,861/10,613
Home Delivered Meals/Clients Served	493,491/4,167	496,654/4,167	528,405/4,653	528,405/4,653
Institutional Services (ave clients paid/day):
Nursing Facilities/Assisted Living Centers	3,928/694	3,941/690	3,954/810	3,978/876
Adult Foster Care	12	11	15	15
Domestic Abuse Program:
Unduplicated Victims Served/Sheltered	14,467/3,585	15,691/3,911	16,000/4,000	16,000/4,000
Shelter Days	52,056	59,239	60,000	60,000
STOP - Sexual Assault and Domestic Violence
Cases Prosecuted/Number of Victims	1,600/1,684	1,429/1,588	1,600/1,800	1,600/1,800
STOP - Court Advocates: Number of Victims	3,710	2,572	3,000	3,000
Claims - Final Determinations: Approved/Denied	343/130	304/148	350/150	350/150