Governor's Recommended Budget - State of South Dakota

SOCIAL SERVICES
GOVERNOR'S RECOMMENDED FY 2008 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 2005 ACTUAL
FY 2006 BUDGETED
FY 2007 REQUESTED
FY 2008 GOVERNOR'S RECOMMENDED
FY 2008 RECOMMENDED INC/(DEC)
FY 2008

FUNDING SOURCE:

   General Funds $153,776,212 $167,409,047 $192,568,809 $215,302,335 $212,183,855 $19,615,046

   Federal Funds 345,282,733 340,058,675 370,993,650 372,670,195 368,901,092 (2,092,558)

   Other Funds 947,382 2,775,753 2,830,649 2,830,649 3,486,090 655,441

      Total $500,006,327 $510,243,475 $566,393,108 $590,803,179 $584,571,037 $18,177,929

EXPENDITURE DETAIL:

   Personal Services $5,963,647 $6,074,524 $6,572,334 $6,572,334 $6,845,878 $273,544

   Operating Expenses 494,042,680 504,168,951 559,820,774 584,230,845 577,725,159 17,904,385

      Total $500,006,327 $510,243,475 $566,393,108 $590,803,179 $584,571,037 $18,177,929

Staffing Level FTE: 137.4 136.4 134.5 134.5 134.5 0.0

ACTUAL
FY 2005
ACTUAL
FY 2006
ESTIMATED
FY 2007
ESTIMATED
FY 2008

REVENUES:


Total
$0
$0
$0
$0

PERFORMANCE INDICATORS:

   MEDICAL SERVICES:

   Average Persons Eligible:

   Aged/Blind 5,732/94 5,608/91 5,512/91 5,417/91

   Disabled Adults/Children 10,770/2,372 10,955/2,431 11,140/2,500 11,342/2,550

   Low Income Family (LIF) Adults/Children 11,015/19,151 11,333/19,145 11,645/19,456 11,959/19,669

   Foster Care Children 3,283 3,606 3,692 3,731

   Pregnant Women 1,856 1,832 1,806 1,780

   Catastrophic (QMB) 2,753 2,973 3,280 3,587

   Medical Services Programs for Children:

   Title XIX Funded 30,376 31,204 31,715 32,064

   Title XXI Funded, Under 140% of FPL 8,189 8,679 9,081 9,500

   Title XXI Funded 140%-200% of FPL 2,228 2,417 2,528 2,645

   Total Title XIX Eligibles 87,393 89,178 90,837 92,190

   Total Title XXI Eligibles 10,417 11,096 11,609 12,145

   Total Avg. Persons Eligible (XIX & XXI) 97,810 100,274 102,446 104,335

   Total Average Cost Per Title XIX Eligible $3,765 $3,664 $3,864 $4,110

   Average Cost Per Title XIX Eligible by Service:

   Physicians $602 $654 $719 $792

   Inpatient Hospital $849 $815 $898 $925

   Outpatient Hospital $331 $345 $377 $406

   Prescription Drugs $757 $650 $393 $470

   All Other Services $1,226 $1,200 $1,477 $1,517

   Program Utilization (Avg Mo Utiliz/Cost):

   Physician Services 26.61/$181.28 26.62/$192.81 28.25/$206.67 29.29/$220.10

   Inpatient Hospital 1.60/$4,538.64 1.67/$4,062.10 1.57/$4,764.32 1.57/$4,907.25

   Outpatient Hospital 6.81/$404.95 6.89/$414.40 7.36/$427.00 7.66/$441.83

   Other Medical 3.13/$273.24 3.15/$283.29 3.17/$300.20 3.17/$306.20

   Chiropractic Services 1.04/$34.14 1.01/$33.44 1.01/$34.44 1.01/$35.13

   Medicare Crossover 8.25/$160.53 8.03/$171.23 8.49/$181.50 8.49/$192.39

   Indian Health Services 21.21/$451.96 21.13/$461.88 22.04/$533.89 22.04/$533.89

   Prescription Drugs:

   Avg. Utilization/Prescriptions Per Month 31.69/4.13 27.60/3.55 24.61/2.66 25.43/2.66

   Average Cost Per Prescription $63.19 $64.49 $69.65 $76.62

   Adult Services:

   Average Eligible Clients 29,467 29,819 30,194 30,589

   Dental Average Utilization/Cost 100/$5.97 100/$5.97 100/$6.52 100/$6.85

   Optometrist Average Utilization/Cost 2.90/$90.52 2.28/$93.66 2.71/$95.13 2.71/$97.03

   Children's Services (EPSDT)

   Avg. Children - LIF/Foster Care 19,151/3,283 19,145/3,606 19,456/3,692 19,669/3,731

   Expanded Medical/Disabled 30,376/2,372 31,204/2,431 31,715/2,500 32,064/2,550

   Avg. Monthly Utilization/Cost:

   Screening 1.75/$64.50 1.58/$65.20 1.58/$65.20 1.58/$66.50

   Dental Services 100/$9.52 100/$9.52 100/$10.40 100/$10.93

   Optometric Services 2.55/$83.19 2.03/$85.75 1.92/$87.50 1.92/$89.25

   Treatment Services 1.40/$711.43 1.85/$769.68 1.41/$777.48 1.87/$808.63

   Supplemental Medical Insurance (Buy-In):

   Part A Recipients/Premium 812/$377.18 926/$384.17 975/$403.15 1,035/$423.66

   Part B Recipients/Premium 14,216/$78.59 14,683/$83.41 15,452/$93.62 16,124/$104.31

   Balance Budget Act Expanded SMI/Premium 611/$72.33 663/$83.60 770/$105.62 894/$126.05

   Childrens Care Hospital:

   Avg. Residents/Per Diem Paid 55/$356.90 55/$308.13 55/$326.34 55/$386.94

   Renal Disease:

   Avg. Monthly Eligibles 9 11 11 11

   Avg. Monthly Cost Per Eligible $230.89 $161.89 $166.75 $170.09

   Managed Care Program Participants:

   Eligibles/Physicians in Primary Care 72,213/659 74,585/694 76,199/694 77,604/694

   Claims Processing:

   Claims Processed 4,687,262 5,031,283 5,122,300 5,216,750

   Claims Processed Per Eligible Person 48 50 50 50

   Catastrophic County Poor Relief:

   Claims Reviewed and Approved 14 28 20 20

   Participating Counties 61 61 61 61

   Total Paid Out $189,892 $542,803 $600,000 $600,000

   Counties Requesting Reimbursement 5 13 12 12

   Claims Priced Under Medicaid 760 820 900 900

   Claims Reviewed 27 8 20 20



   ADULT SERVICES AND AGING:

   Case Management

   Avg. Monthly Cases/Unduplicated Clients 6,377/9,794 6,250/9,317 6,250/10,000 6,250/10,000

   In-Home Services

   Title XIX Waiver Program Clients 978 927 1,000 1,000

   Personal Care, Nursing, and Homemaker 5,273 5,074 5,250 5,250

   Contracted Nursing and Aide Hours 411,596 380,653 423,462 423,462

   Respite and Caregiver Clients 1,271 754 850 875

   Community Support Services

   Transportation Trips/Clients 421,415/9,608 424,740/9,680 425,500/9,700 426,700/9,800

   Elderly Nutrition Program Meals Served 1,606,521 1,555,944 1,651,256 1,651,256

   Average Daily Participation - Clients Served 6,248 6,083 6,400 6,400

   Long Term Care Services

   Nursing Facilities - Clients 3,941 3,749 3,978 3,842

   Assisted Living Centers - Clients 690 692 876 876

   Adult Foster Care 11 11 15 15

   Victims Services

   Unduplicated Victims Served/Sheltered 15,691/3,911 16,976/4,113 17,000/4,200 17,000/4,200

   Victims Compensation Claims Approved 304 260 325 350

generated 12/05/06 10:49:37 AM

	ACTUAL FY 2005	ACTUAL FY 2006	BUDGETED FY 2007	REQUESTED FY 2008	GOVERNOR'S RECOMMENDED FY 2008	RECOMMENDED INC/(DEC) FY 2008
FUNDING SOURCE:
General Funds	$153,776,212	$167,409,047	$192,568,809	$215,302,335	$212,183,855	$19,615,046
Federal Funds	345,282,733	340,058,675	370,993,650	372,670,195	368,901,092	(2,092,558)
Other Funds	947,382	2,775,753	2,830,649	2,830,649	3,486,090	655,441
Total	$500,006,327	$510,243,475	$566,393,108	$590,803,179	$584,571,037	$18,177,929

EXPENDITURE DETAIL:
Personal Services	$5,963,647	$6,074,524	$6,572,334	$6,572,334	$6,845,878	$273,544
Operating Expenses	494,042,680	504,168,951	559,820,774	584,230,845	577,725,159	17,904,385
Total	$500,006,327	$510,243,475	$566,393,108	$590,803,179	$584,571,037	$18,177,929

Staffing Level FTE:	137.4	136.4	134.5	134.5	134.5	0.0

	ACTUAL FY 2005	ACTUAL FY 2006	ESTIMATED FY 2007	ESTIMATED FY 2008
REVENUES:
Total	$0	$0	$0	$0
PERFORMANCE INDICATORS:
MEDICAL SERVICES:
Average Persons Eligible:
Aged/Blind	5,732/94	5,608/91	5,512/91	5,417/91
Disabled Adults/Children	10,770/2,372	10,955/2,431	11,140/2,500	11,342/2,550
Low Income Family (LIF) Adults/Children	11,015/19,151	11,333/19,145	11,645/19,456	11,959/19,669
Foster Care Children	3,283	3,606	3,692	3,731
Pregnant Women	1,856	1,832	1,806	1,780
Catastrophic (QMB)	2,753	2,973	3,280	3,587
Medical Services Programs for Children:
Title XIX Funded	30,376	31,204	31,715	32,064
Title XXI Funded, Under 140% of FPL	8,189	8,679	9,081	9,500
Title XXI Funded 140%-200% of FPL	2,228	2,417	2,528	2,645
Total Title XIX Eligibles	87,393	89,178	90,837	92,190
Total Title XXI Eligibles	10,417	11,096	11,609	12,145
Total Avg. Persons Eligible (XIX & XXI)	97,810	100,274	102,446	104,335
Total Average Cost Per Title XIX Eligible	$3,765	$3,664	$3,864	$4,110
Average Cost Per Title XIX Eligible by Service:
Physicians	$602	$654	$719	$792
Inpatient Hospital	$849	$815	$898	$925
Outpatient Hospital	$331	$345	$377	$406
Prescription Drugs	$757	$650	$393	$470
All Other Services	$1,226	$1,200	$1,477	$1,517
Program Utilization (Avg Mo Utiliz/Cost):
Physician Services	26.61/$181.28	26.62/$192.81	28.25/$206.67	29.29/$220.10
Inpatient Hospital	1.60/$4,538.64	1.67/$4,062.10	1.57/$4,764.32	1.57/$4,907.25
Outpatient Hospital	6.81/$404.95	6.89/$414.40	7.36/$427.00	7.66/$441.83
Other Medical	3.13/$273.24	3.15/$283.29	3.17/$300.20	3.17/$306.20
Chiropractic Services	1.04/$34.14	1.01/$33.44	1.01/$34.44	1.01/$35.13
Medicare Crossover	8.25/$160.53	8.03/$171.23	8.49/$181.50	8.49/$192.39
Indian Health Services	21.21/$451.96	21.13/$461.88	22.04/$533.89	22.04/$533.89
Prescription Drugs:
Avg. Utilization/Prescriptions Per Month	31.69/4.13	27.60/3.55	24.61/2.66	25.43/2.66
Average Cost Per Prescription	$63.19	$64.49	$69.65	$76.62
Adult Services:
Average Eligible Clients	29,467	29,819	30,194	30,589
Dental Average Utilization/Cost	100/$5.97	100/$5.97	100/$6.52	100/$6.85
Optometrist Average Utilization/Cost	2.90/$90.52	2.28/$93.66	2.71/$95.13	2.71/$97.03
Children's Services (EPSDT)
Avg. Children - LIF/Foster Care	19,151/3,283	19,145/3,606	19,456/3,692	19,669/3,731
Expanded Medical/Disabled	30,376/2,372	31,204/2,431	31,715/2,500	32,064/2,550
Avg. Monthly Utilization/Cost:
Screening	1.75/$64.50	1.58/$65.20	1.58/$65.20	1.58/$66.50
Dental Services	100/$9.52	100/$9.52	100/$10.40	100/$10.93
Optometric Services	2.55/$83.19	2.03/$85.75	1.92/$87.50	1.92/$89.25
Treatment Services	1.40/$711.43	1.85/$769.68	1.41/$777.48	1.87/$808.63
Supplemental Medical Insurance (Buy-In):
Part A Recipients/Premium	812/$377.18	926/$384.17	975/$403.15	1,035/$423.66
Part B Recipients/Premium	14,216/$78.59	14,683/$83.41	15,452/$93.62	16,124/$104.31
Balance Budget Act Expanded SMI/Premium	611/$72.33	663/$83.60	770/$105.62	894/$126.05
Childrens Care Hospital:
Avg. Residents/Per Diem Paid	55/$356.90	55/$308.13	55/$326.34	55/$386.94
Renal Disease:
Avg. Monthly Eligibles	9	11	11	11
Avg. Monthly Cost Per Eligible	$230.89	$161.89	$166.75	$170.09
Managed Care Program Participants:
Eligibles/Physicians in Primary Care	72,213/659	74,585/694	76,199/694	77,604/694
Claims Processing:
Claims Processed	4,687,262	5,031,283	5,122,300	5,216,750
Claims Processed Per Eligible Person	48	50	50	50
Catastrophic County Poor Relief:
Claims Reviewed and Approved	14	28	20	20
Participating Counties	61	61	61	61
Total Paid Out	$189,892	$542,803	$600,000	$600,000
Counties Requesting Reimbursement	5	13	12	12
Claims Priced Under Medicaid	760	820	900	900
Claims Reviewed	27	8	20	20

ADULT SERVICES AND AGING:
Case Management
Avg. Monthly Cases/Unduplicated Clients	6,377/9,794	6,250/9,317	6,250/10,000	6,250/10,000
In-Home Services
Title XIX Waiver Program Clients	978	927	1,000	1,000
Personal Care, Nursing, and Homemaker	5,273	5,074	5,250	5,250
Contracted Nursing and Aide Hours	411,596	380,653	423,462	423,462
Respite and Caregiver Clients	1,271	754	850	875
Community Support Services
Transportation Trips/Clients	421,415/9,608	424,740/9,680	425,500/9,700	426,700/9,800
Elderly Nutrition Program Meals Served	1,606,521	1,555,944	1,651,256	1,651,256
Average Daily Participation - Clients Served	6,248	6,083	6,400	6,400
Long Term Care Services
Nursing Facilities - Clients	3,941	3,749	3,978	3,842
Assisted Living Centers - Clients	690	692	876	876
Adult Foster Care	11	11	15	15
Victims Services
Unduplicated Victims Served/Sheltered	15,691/3,911	16,976/4,113	17,000/4,200	17,000/4,200
Victims Compensation Claims Approved	304	260	325	350