Governor's Recommended Budget - State of South Dakota

SOCIAL SERVICES
GOVERNOR'S RECOMMENDED FY 2010 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 2007 ACTUAL
FY 2008 BUDGETED
FY 2009 REQUESTED
FY 2010 GOVERNOR'S RECOMMENDED
FY 2010 RECOMMENDED INC/(DEC)
FY 2010

FUNDING SOURCE:

   General Funds $176,397,336 $208,597,653 $217,353,763 $235,974,618 $224,606,983 $7,253,220

   Federal Funds 337,114,649 379,123,909 413,497,033 451,945,957 437,979,613 24,482,580

   Other Funds 1,797,743 1,551,415 3,491,012 3,491,012 5,650,976 2,159,964

      Total $515,309,729 $589,272,977 $634,341,808 $691,411,587 $668,237,572 $33,895,764

EXPENDITURE DETAIL:

   Personal Services $6,162,719 $6,271,996 $7,680,652 $7,680,652 $7,885,688 $205,036

   Operating Expenses 509,147,010 583,000,981 626,661,156 683,730,935 660,351,884 33,690,728

      Total $515,309,729 $589,272,977 $634,341,808 $691,411,587 $668,237,572 $33,895,764

Staffing Level FTE: 134.1 133.2 145.5 145.5 145.5 0.0

ACTUAL
FY 2007
ACTUAL
FY 2008
ESTIMATED
FY 2009
ESTIMATED
FY 2010

REVENUES:


Total
$0
$0
$0
$0

PERFORMANCE INDICATORS:

   MEDICAL SERVICES:

   Average Persons Eligible:

   Aged/Blind 5,539/91 5,593/84 5,489/84 5,386/84

   Disabled Adults/Children 11,116/2,583 11,226/2,680 11,310/2,784 11,394/2,894

   Low Income Family (LIF) Adults/Children 10,812/18,647 10,800/17,955 10,920/18,201 10,963/18,472

   DSS and DOC Foster Care Children 3,636 3,755 3,807 3,860

   Pregnant Women 1,918 1,903 1,960 1,998

   QMB 3,193 3,311 3,437 3,736

   Medical Services Programs for Children:

   Title XIX Funded 31,628 33,532 33,992 34,497

   Title XXI Funded, Under 140% of FPL 9,012 8,984 9,133 9,280

   Title XXI Funded 140%-200% of FPL 2,218 2,487 2,528 2,568

   Total Title XIX Eligibles 89,163 90,839 91,984 93,132

   Total Title XXI Eligibles 11,230 11,471 11,661 11,848

   Total Avg. Persons Eligible (XIX & XXI) 100,393 102,310 103,645 104,980

   Total Average Cost Per Title XIX Eligible $3,551 $3,884 $4,265 $4,488

   Average Cost Per Title XIX Eligible by Service:

   Physicians $682 $710 $754 $785

   Inpatient Hospital $830 $983 $1,039 $1,109

   Outpatient Hospital $334 $371 $391 $412

   Prescription Drugs $312 $342 $415 $466

   All Other Services $1,393 $1,478 $1,666 $1,716

   Program Utilization (Avg Mo Utiliz/Cost):

   Physician Services 27.10/$200.63 29.29/$199.39 29.94/$204.77 30.60/$208.71

   Inpatient Hospital 1.46/$4,767.90 1.55/$5,371.09 1.54/$5,237.04 1.63/$5,467.75

   Outpatient Hospital 6.61/$418.06 7.05/$438.19 7.08/$439.36 7.61/$450.67

   Other Medical 2.98/$302.21 3.14/$321.35 3.14/$330.99 3.14/$335.96

   Chiropractic Services 0.97/$32.98 1.00/$34.83 1.00/$35.87 1.00/$36.41

   Medicare Crossover 7.99/$178.17 8.19/$197.13 8.19/$212.79 8.23/$229.82

   Indian Health Services 22.79/$500.55 22.38/$507.70 22.79/$533.89 22.79/$533.89

   Prescription Drugs:

   Avg. Utilization/Prescriptions Per Month 23.21/2.65 23.65/2.67 25.07/2.67 25.99/2.67

   Average Cost Per Prescription $67.50 $69.99 $70.59 $73.98

   Adult Services:

   Average Eligible Clients 30,248 27,619 27,803 27,827

   Dental Average Utilization/Cost 100.00/$6.52 5.07/$181.26 5.22/$201.03 5.38/$203.80

   Optometrist Average Utilization/Cost 1.39/$113.72 1.88/$92.35 2.11/$95.12 2.11/$96.55

   Children's Services (EPSDT)

   Avg. Children - LIF/Foster Care 18,647/3,708 17,955/3,755 18,201/3,807 18,472/3,860

   Expanded Medical/Disabled 31,628/2,583 33,532/2,680 33,992/2,784 34,497/2,894

   Avg. Monthly Utilization/Cost:

   Screening 1.60/$53.20 1.47/$68.08 1.60/$70.12 1.60/$71.17

   Dental Services 100.00/$10.40 7.84/$178.85 8.08/$191.35 8.32/$192.62

   Optometric Services 1.19/$98.87 1.53/$82.44 1.83/$84.91 1.83/$86.19

   Treatment Services 1.75/$821.61 1.73/$914.16 1.73/$941.58 1.73/$955.71

   Supplemental Medical Insurance (Buy-In):

   Part A Recipients/Premium 943/$407.05 955/$416.55 991/$431.32 1,044/$451.75

   Part B Recipients/Premium 15,243/$94.98 15,456/$94.95 15,548/$99.98 15,794/$108.25

   Balance Budget Act Expanded SMI/Premium 781/$90.98 846/$94.96 942/$99.98 1,038/$108.25

   Childrens Care Hospital:

   Avg. Residents/Per Diem Paid 55/$328.73 58/$387.69 65/$390.73 65/$428.32

   Renal Disease:

   Avg. Monthly Eligibles 12 10 11 11

   Avg. Monthly Cost Per Eligible $242.46 $171.75 $85.88 $85.88

   Managed Care Program Participants:

   Eligibles/Physicians in Primary Care 73,745/690 80,887/745 81,939/745 82,980/745

   Claims Processing:

   Claims Processed 4,081,669 4,137,672 4,145,800 4,199,200

   Claims Processed Per Eligible Person 41 40 40 40

   Catastrophic County Poor Relief:

   Claims Reviewed and Approved 22 23 22 22

   Participating Counties 61 60 60 60

   Total Paid Out $336,429 $308,195 $600,000 $600,000

   Counties Requesting Reimbursement 10 9 10 10

   Claims Priced Under Medicaid 873 785 800 850

   Claims Reviewed 19 2 10 10



   ADULT SERVICES AND AGING:

   Case Management

   Avg. Monthly Cases/Unduplicated Clients 5,821/8,964 5,568/8,291 6,100/9,100 6,500/9,500

   Title XIX Waiver Program Clients 1,098 1,171 1,200 1,300

   In-Home Services

   Personal Care, Nursing, and Homemaker Clients 4,712 5,701 5,800 6,000

   Contracted Nursing and Aide Hours 354,330 326,937 367,345 400,000

   Respite and Caregiver Clients 712 695 750 825

   Community Support Services

   Transportation Trips/Clients 433,754/10,268 454,316/10,319 465,500/10,500 470,000/11,250

   Elderly Nutrition Program Meals Served 1,539,038 1,529,471 1,562,505 1,607,004

   Average Daily Participation - Clients Served 5,981 6,112 6,250 6,377

   Long Term Care Services

   Nursing Facilities - Clients 3,710 3,647 3,647 3,647

   Assisted Living Centers - Clients 696 695 695 695

   Adult Foster Care 13 17 17 17

   Victims Services

   Unduplicated Victims Served/Sheltered 16,000/3,903 17,942/4,492 18,500/4,750 19,000/5,000

   Victims Compensation Claims Approved 260 196 240 275

generated 11/24/08 10:43:51 AM

	ACTUAL FY 2007	ACTUAL FY 2008	BUDGETED FY 2009	REQUESTED FY 2010	GOVERNOR'S RECOMMENDED FY 2010	RECOMMENDED INC/(DEC) FY 2010
FUNDING SOURCE:
General Funds	$176,397,336	$208,597,653	$217,353,763	$235,974,618	$224,606,983	$7,253,220
Federal Funds	337,114,649	379,123,909	413,497,033	451,945,957	437,979,613	24,482,580
Other Funds	1,797,743	1,551,415	3,491,012	3,491,012	5,650,976	2,159,964
Total	$515,309,729	$589,272,977	$634,341,808	$691,411,587	$668,237,572	$33,895,764

EXPENDITURE DETAIL:
Personal Services	$6,162,719	$6,271,996	$7,680,652	$7,680,652	$7,885,688	$205,036
Operating Expenses	509,147,010	583,000,981	626,661,156	683,730,935	660,351,884	33,690,728
Total	$515,309,729	$589,272,977	$634,341,808	$691,411,587	$668,237,572	$33,895,764

Staffing Level FTE:	134.1	133.2	145.5	145.5	145.5	0.0

	ACTUAL FY 2007	ACTUAL FY 2008	ESTIMATED FY 2009	ESTIMATED FY 2010
REVENUES:
Total	$0	$0	$0	$0
PERFORMANCE INDICATORS:
MEDICAL SERVICES:
Average Persons Eligible:
Aged/Blind	5,539/91	5,593/84	5,489/84	5,386/84
Disabled Adults/Children	11,116/2,583	11,226/2,680	11,310/2,784	11,394/2,894
Low Income Family (LIF) Adults/Children	10,812/18,647	10,800/17,955	10,920/18,201	10,963/18,472
DSS and DOC Foster Care Children	3,636	3,755	3,807	3,860
Pregnant Women	1,918	1,903	1,960	1,998
QMB	3,193	3,311	3,437	3,736
Medical Services Programs for Children:
Title XIX Funded	31,628	33,532	33,992	34,497
Title XXI Funded, Under 140% of FPL	9,012	8,984	9,133	9,280
Title XXI Funded 140%-200% of FPL	2,218	2,487	2,528	2,568
Total Title XIX Eligibles	89,163	90,839	91,984	93,132
Total Title XXI Eligibles	11,230	11,471	11,661	11,848
Total Avg. Persons Eligible (XIX & XXI)	100,393	102,310	103,645	104,980
Total Average Cost Per Title XIX Eligible	$3,551	$3,884	$4,265	$4,488
Average Cost Per Title XIX Eligible by Service:
Physicians	$682	$710	$754	$785
Inpatient Hospital	$830	$983	$1,039	$1,109
Outpatient Hospital	$334	$371	$391	$412
Prescription Drugs	$312	$342	$415	$466
All Other Services	$1,393	$1,478	$1,666	$1,716
Program Utilization (Avg Mo Utiliz/Cost):
Physician Services	27.10/$200.63	29.29/$199.39	29.94/$204.77	30.60/$208.71
Inpatient Hospital	1.46/$4,767.90	1.55/$5,371.09	1.54/$5,237.04	1.63/$5,467.75
Outpatient Hospital	6.61/$418.06	7.05/$438.19	7.08/$439.36	7.61/$450.67
Other Medical	2.98/$302.21	3.14/$321.35	3.14/$330.99	3.14/$335.96
Chiropractic Services	0.97/$32.98	1.00/$34.83	1.00/$35.87	1.00/$36.41
Medicare Crossover	7.99/$178.17	8.19/$197.13	8.19/$212.79	8.23/$229.82
Indian Health Services	22.79/$500.55	22.38/$507.70	22.79/$533.89	22.79/$533.89
Prescription Drugs:
Avg. Utilization/Prescriptions Per Month	23.21/2.65	23.65/2.67	25.07/2.67	25.99/2.67
Average Cost Per Prescription	$67.50	$69.99	$70.59	$73.98
Adult Services:
Average Eligible Clients	30,248	27,619	27,803	27,827
Dental Average Utilization/Cost	100.00/$6.52	5.07/$181.26	5.22/$201.03	5.38/$203.80
Optometrist Average Utilization/Cost	1.39/$113.72	1.88/$92.35	2.11/$95.12	2.11/$96.55
Children's Services (EPSDT)
Avg. Children - LIF/Foster Care	18,647/3,708	17,955/3,755	18,201/3,807	18,472/3,860
Expanded Medical/Disabled	31,628/2,583	33,532/2,680	33,992/2,784	34,497/2,894
Avg. Monthly Utilization/Cost:
Screening	1.60/$53.20	1.47/$68.08	1.60/$70.12	1.60/$71.17
Dental Services	100.00/$10.40	7.84/$178.85	8.08/$191.35	8.32/$192.62
Optometric Services	1.19/$98.87	1.53/$82.44	1.83/$84.91	1.83/$86.19
Treatment Services	1.75/$821.61	1.73/$914.16	1.73/$941.58	1.73/$955.71
Supplemental Medical Insurance (Buy-In):
Part A Recipients/Premium	943/$407.05	955/$416.55	991/$431.32	1,044/$451.75
Part B Recipients/Premium	15,243/$94.98	15,456/$94.95	15,548/$99.98	15,794/$108.25
Balance Budget Act Expanded SMI/Premium	781/$90.98	846/$94.96	942/$99.98	1,038/$108.25
Childrens Care Hospital:
Avg. Residents/Per Diem Paid	55/$328.73	58/$387.69	65/$390.73	65/$428.32
Renal Disease:
Avg. Monthly Eligibles	12	10	11	11
Avg. Monthly Cost Per Eligible	$242.46	$171.75	$85.88	$85.88
Managed Care Program Participants:
Eligibles/Physicians in Primary Care	73,745/690	80,887/745	81,939/745	82,980/745
Claims Processing:
Claims Processed	4,081,669	4,137,672	4,145,800	4,199,200
Claims Processed Per Eligible Person	41	40	40	40
Catastrophic County Poor Relief:
Claims Reviewed and Approved	22	23	22	22
Participating Counties	61	60	60	60
Total Paid Out	$336,429	$308,195	$600,000	$600,000
Counties Requesting Reimbursement	10	9	10	10
Claims Priced Under Medicaid	873	785	800	850
Claims Reviewed	19	2	10	10

ADULT SERVICES AND AGING:
Case Management
Avg. Monthly Cases/Unduplicated Clients	5,821/8,964	5,568/8,291	6,100/9,100	6,500/9,500
Title XIX Waiver Program Clients	1,098	1,171	1,200	1,300
In-Home Services
Personal Care, Nursing, and Homemaker Clients	4,712	5,701	5,800	6,000
Contracted Nursing and Aide Hours	354,330	326,937	367,345	400,000
Respite and Caregiver Clients	712	695	750	825
Community Support Services
Transportation Trips/Clients	433,754/10,268	454,316/10,319	465,500/10,500	470,000/11,250
Elderly Nutrition Program Meals Served	1,539,038	1,529,471	1,562,505	1,607,004
Average Daily Participation - Clients Served	5,981	6,112	6,250	6,377
Long Term Care Services
Nursing Facilities - Clients	3,710	3,647	3,647	3,647
Assisted Living Centers - Clients	696	695	695	695
Adult Foster Care	13	17	17	17
Victims Services
Unduplicated Victims Served/Sheltered	16,000/3,903	17,942/4,492	18,500/4,750	19,000/5,000
Victims Compensation Claims Approved	260	196	240	275