While Senate president Andy Biggs is proposing a budget plan this week, Speaker of the House Andy Tobin is proposing a ballot measure to let the voters decide the fate of Medicaid expansion.
According to sources, Biggs will bring his plan to the Appropriations Committee tomorrow, and on Thursday it will be heard on the floor.
Biggs is facing a battle with Democrats and a handful of Republicans who are known around the Capitol to support crony capitalism every chance they get.
Speaker Tobin’s proposed Medicaid expansion ballot measure would include a Sunset provision with a date of January 1, 2018. This provision anticipates that the federal government having lured states into expansion, the feds will leave the state on the hook for funding after the first three years.
Details:
Assessment Controls
• Limits on the assessment.
• Prevent cost shift to private payor’s
• Assessment fund subject to legislative appropriations.
Stronger Circuit Breakers
•FMAP is reduced by at least 5 points.
• The assessment expires.
• The assessment along with other dedicated sources is not adequate to raise sufficient revenues.
• The Affordable Care Act is repealed or declared unconstitutional.
Legislative Oversight / Flexibility
• Legislature to adopt necessary legislation to implement and may amend as necessary. Simple majority.
• Any changes to the assessment approved by JLBC.
Budget Implications
• Reduce Medicaid spending from General Fund.
• Structurally Balanced Budget FY’14 – FY’16
• Protect Rainy Day Fund.
Prevent the Cost Shift to Private Payors / Employers
• Create a program that reduces uncompensated and unreimbursed care and incentivizes hospitals/insurance companies to reduce the cost shift and overall cost of healthcare.
• Offset the costs of the assessment and provide increased reimbursement rates to offset AHCCCS cuts (approximately 15% since 2011) / Medicaid shortfalls IF hospitals and/or their private payors provide an attestation that the hospital assessment costs are not being passed on to private payors and the hidden tax cost shift is being reduced.
• If uncompensated care, unreimbursed care and the cost shift are not reduced year to year– hospitals will be penalized and have to repay a portion of the increased reimbursements received.
Required Reporting – To determine impacts.
• Hospitals required to report on uncompensated and unreimbursed care.
• AHCCCS to report on effects of legislation on uncompensated and unreimbursed care and the cost shift.
• DOI to report on effects of legislation on uncompensated and unreimbursed care and the cost shift.
CMS Approval of Program.
Cost Sharing Initiatives / AHCCCS Reforms to Reduce Costs
• Pursue cost-sharing to the maximum extent under federal law.
• Premiums for expansion population
• Co-pays for non-emergency use of the emergency department (childless adults and expansion population)
• Transparency
• Incentivize payment structure to reward outcomes
• Extension of Safety Net Care Pool
• Requirement for AHCCCS to rebid contracts based on expanded eligibility
• Program for cost efficiencies for medically necessary care when covered services are not the most economically efficient. Required standards to meet.
• Study committee on medically necessary utilization of air ambulance
• Health Outcomes Study Committee – To determine impacts.
• Preventative Care Improvements –
• Adult well exams
• Research regarding preventative care: Alzheimer, Cancer, Heart Disease, & Diabetes
Increase Physician Pipeline – Graduate Medical Education
• Prolife
• Clarify that Medicaid monies cannot be used for performing, assisting or encouraging abortion.
• Require that Medicaid providers offer comprehensive healthcare services.
• Require that Medicaid providers not perform abortion on patients who are enrolled Medicaid members.
• Additional reporting requirements to DHS.
The Senate’s budget plan includes:
Department of Economic Security
• DES long-term care – $7.5 million
• DES foster care rate increase – $3 million
Education:
• Education performance funding – $35 million
• Inflationary adjustment for K-12 – $82 million
• Universities – ABOR is required to submit a report to JLBC for review on funding requirement to achieve parity based on FY14 per pupil amounts
Counties
• Graham County
• One time funding for Graham County in the amount of $850,000
• Navajo County
• One time funding for Navajo County in the amount of $400,000 for long-term care relief
Spending/Revenue
• FY14 $8.798 billion in spending
• FY15 $9 billion in spending
• FY16 $9.1 billion in spending
• FY14 revenue growth at 4.9 percent
• FY15 revenue growth 6.1 percent
• FY16 revenue growth 5.6 percent
• Projected revenue growth excludes $450 million from the rainy day fund account.
AHCCCS
• AHCCCS will seek a federal waiver to allow continuation of freeze on the Medicaid population.
• Should the waiver request be rejected, the Prop 204 population is to be funded by the state at a cost of $808 million.
Governor Brewer opposes a vote on the matter due to the fact that it is not popular with the populace and would most likely fail at the polls. She has been trying to cram her proposal through, going so far as to veto legislation in an effort to coerce legislators.