2 0 1 6 reports...table 1: division of medicaid and health financing expenditures sfy 2012 – sfy...

A N N U A L R E P O R T

2 0 1 6

of Medicaid & CHIP

STATE FISCAL YEAR 2016 July 2015 - June 2016

Utah Annual Report of Medicaid & CHIP

State Fiscal Year 2016

Joseph K. Miner, MDExecutive Director, Utah Department of Health

Nate Checketts, MPADeputy Director, Utah Department of Health

Director, Division of Medicaid and Health Financing

Eric Grant, MBADirector, Bureau of Financial Services

Prepared By:Bureau of Financial Services

Division of Medicaid and Health Financing

Utah Department of Health

Box 143104 Salt Lake City, UT 84114-3104

Acknowledgments:

Andre Baksh, PhD

DMHF Bureau Directors and Staff

This report can be viewed at: www.health.utah.gov/medicaid

www.health.utah.gov/medicaid

Table of Contents

Table of Contents i List of Figures ii List of Tables iii Director’s Message iv Division of Medicaid and Health Financing (DMHF) 2

2016 Division Highlights 2 Organizational Chart 3 Division Overview 4 Division Expenditures 5

Medicaid 7

Medicaid Finance 7

Means of Finance 7

Offsets to Medicaid Expenditures 9

Medicaid Consolidated Report of Expenditures and Revenues 1 1

Department of Health, Division of Medicaid and Health Financing 15

Department of Human Services 16

Department of Workforce Services 17

Office of the Attorney General 18

Office of Inspector General of Medicaid Services 18

University of Utah Medical Center 19

Medicaid Enrollment 20

Medicaid Benefits 20

Enrollment Statistics 2 1

Medicaid Delivery and Payment of Services 33

Providers 33

Managed Care 37

Utilization and Expenditures 4 1

Long-Term Care 46

Children’s Health Insurance Program (CHIP) 50

Means of Finance 50

CHIP Enrollment 53 APPENDIX A: Federal Poverty Levels 58 APPENDIX B: Glossary 60 APPENDIX C: Waivers 62

i

List of Figures

Figure 1: Division of Medicaid and Health Financing Expenditures SFY 2016 5 Figure 2: Medicaid Expenditures SFY 2016 8 Figure 3: Medicaid Program Total Revenue Sources SFY 2016 9 Figure 4: Medicaid Consolidated Funds SFY 2016 1 1 Figure 5: Average Member Months: All Categories 21 Figure 6: Average Members per Month: Adult Enrollees 22 Figure 7: Average Members per Month: Elderly Enrollees 22 Figure 8: Average Members per Month: Visually Impaired and People with Disabilities 23 Figure 9: Average Members per Month: Children Enrollees 23 Figure 10: Average Members per Month: Pregnant Women Enrollees 24 Figure 11: Average Members per Month: PCN Enrollees 24 Figure 12: Unduplicated Count of Medicaid Enrollees 26 Figure 13: Percent of Medicaid Enrollees by Category of Assistance SFY 2016 28 Figure 14: Average Managed Care Enrollees per Month 37 Figure 15: Managed Care Expenditures 38 Figure 16: ACO Average Members per Month by Rate Category 39 Figure 17: ACO Weighted Average Base Rates 40 Figure 18: Unduplicated Hospital Care Claims 41 Figure 19: FFS Hospital Care Expenditures 42 Figure 20: Unduplicated Physician Services Claims 42 Figure 21: FFS Physician Services Expenditures 43 Figure 22: Unduplicated Pharmacy Services Claims ACO vs FFS 44 Figure 23: FFS Pharmacy Services Expenditures 44 Figure 24: Unduplicated Other Services Claims ACO vs FFS 45 Figure 25: FFS Other Services Expenditures 45 Figure 26: Unduplicated Long-Term Care Expenditures 46 Figure 27: Long-Term Care Expenditures 46 Figure 28: HCBS Waiver Expenditures 48 Figure 29: CHIP Enrollment 53 Figure 30: CHIP Enrollment by Federal Poverty Level SFY 2016 54 Figure 31: Urban and Rural CHIP Enrollment Distribution 55 Figure 32: CHIP Enrollment by Age Range SFY 2016 55 Figure 33: CHIP Enrollment by Race SFY 2016 56 Figure 34: Income Limits for Medical Assistance & Medicaid Cost-Sharing Programs 59

ii

List of Tables

Table 1: Division of Medicaid and Health Financing Expenditures SFY 2012 – SFY 2016 6 Table 2: Federal Medicaid Assistance Percentages (FMAP) for Utah SFY 2006 – SFY 2016 7 Table 3: Expenditures Offsets SFY 2016 10 Table 4: Other Revenue Sources SFY 2016 12 Table 5: Consolidated Medicaid Revenues SFY 2016 13 Table 6: Consolidated Medicaid Expenditures SFY 2016 14 Table 7: Utah Department of Health - Division of Medicaid and Health Financing 15 Table 8: Department of Human Services 16 Table 9: Department of Workforce Services 17 Table 10: Office of the Attorney General 18 Table 11: Office of the Inspector General 18 Table 12: University of Utah Medical Center 19 Table 13: Average Monthly Enrollment as a Percent of County Population 25 Table 14: Enrollment by Race, Age Group and Gender SFY 2012 – SFY 2016 26 Table 15: Statewide Medicaid Enrollment Composition 28 Table 16: Medicaid Enrollment Composition by County 29 Table 17: Number of Participating Fee For Service Providers by Category of Service 33 Table 18: Reimbursement Amounts to Fee For Service Providers by Category of Service 35 Table 19: Behavioral Health Average Monthly Enrollment by County 4 1 Table 20: Nursing Home Expenditures by Locality 47 Table 21: HCBS Waiver Expenditures 49 Table 22: Long-Term Care Institutional and Non-Institutional Expenditure Comparison 49 Table 23: CHIP Sources of Funding SFY 2012 - SFY 2016 5 1 Table 24: CHIP Expenditures SFY 2012 -SFY 2014 52 Table 25: Unduplicated CHIP Enrollment by Fiscal Year, Location, and FPL 54 Table 26: CHIP Enrollment by Age Range and Race 56 Table 27: HHS Poverty Levels 58 Table 28: United States vs Utah Federal Poverty Level Comparison 58

iii

Utah Department of Health

Joseph K. Miner, M.D. Executive Director

Division of Medicaid and Health Financing

Nathan Checketts Deputy Director, Utah Department of Health Director, Division of Medicaid and Health Financing

State of Utah

GARY R. HERBERT Governor

SPENCER J. COX Lieutenant Governor

December 23, 2016

Dear Utahns:

It is my privilege to present to you the 2016 Medicaid and CHIP Annual Report of the Utah Department of Health (DOH). This report includes the Division of Medicaid and Health Financing (Division) activities from July 2015 to June 2016. It provides an overview of the continual efforts by committed state employees and stakeholders to ensure that Utah’s most vulnerable populations maintain the focus of the program.

Throughout the past year, Medicaid continued to explore opportunities and initiatives to improve health care for members, while honoring its obligation to be good stewards of the funds provided by the taxpayer. Some of those activities included:

Expanded the Accountable Care Organization (ACO) model beyond the initial Wasatch Front region. On July 1, 2015, Medicaid members living in nine more counties (Cache, Rich, Morgan, Box Elder, Tooele, Wasatch, Summit, Iron, and Washington) were required to enroll in an ACO as their health plan. Now more than 86 percent of Medicaid members receive Medicaid services through an ACO.

Launched the Medically Complex Children’s Waiver which is intended to serve children with disabilities and complex medical conditions, providing them access to respite services, as well as traditional Medicaid services. After receiving additional funding during the 2016 General Session, the program enrolled an additional 154 children in May 2016, bringing the total number of children served to 341.

Worked to implement House Bill 437 from the 2016 General Session which outlined a limited Medicaid expansion for adults. DOH held public hearings to help determine eligibility criteria for the chronically homeless, those involved in the justice system, and others with behavioral health issues. DOH submitted a waiver amendment request to the federal government seeking approval to implement this program.

Medicaid continues to play an essential role in Utah’s health care system. It meets the medical and behavioral health care needs for thousands of low-income families, individuals who are elderly, or who have disabling conditions. By covering the needs of our fellow-citizens, Medicaid serves a greater purpose in helping individuals avoid becoming medically frail, avoid filing for medical bankruptcy, and reducing intergenerational poverty. DOH and the Division look forward to the continued cooperation with the Governor’s Office, the Utah State Legislature, the Medicaid provider community, and you.

Sincerely,

Nate Checketts Deputy Director, Utah Department of Health Director, Division of Medicaid and Health Financing

288 North 1460 West • Salt Lake City, Utah Mailing Address: P.O. Box 143101 • Salt Lake City, Utah 84114-3101

Telephone (801) 538-6689 • Facsimile (801) 538-6478 • www.health.utah.gov

DIvISIoN oF MEDICAID AND HEALTH FINANCING 2016 Division Highlights

HEALTH CARE REFoRM l Developed the criteria for three new eligibility groups of adults without dependent children and parents,

as directed by the Legislature in House Bill 437 (2016). The Legislature funded a limited expansion planfor specific adult groups upon approval by the federal government. After a series of statewide publichearings and a public comment period, UDOH submitted the proposed 1115 waiver to the Centers for Medicare and Medicaid Services (CMS) on July 1, 2016.

PRovIDER REIMBuRSEMENT INFoRMATIoN SYSTEM FoR MEDICAID (PRISM) l Prepared for Release 3 Go-Live on July 1, 2016, as part of a multi-year project to replace the current

Medicaid Management Information System (MMIS). Release 3 focused on the Provider Enrollment component of PRISM, providing the ability for providers to complete enrollment and make changesonline. Release 3 also implemented eMIPP which supports the provider health information technologyincentives program. Existing provider records were converted from the legacy MMIS to PRISM to easethe transition. Additionally in preparation for Release 3, the Division communicated with providers, developed provider trainings, trained Medicaid staff, and tested the new system.

NEw wAIvERS AND PRoGRAMS l Implemented autism related services for Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

eligible Medicaid members, offering comprehensive and preventive health care services for individuals under age 21 who are enrolled in Traditional Medicaid. With the updated autism spectrum disorder (ASD) policy, ASD related services available may include diagnostic assessments and evaluations; therapies sucha physical therapy, occupational or speech therapy; and services that are rooted in principles of appliedbehavior analysis (ABA).

l Launched the Medically Complex Children’s Waiver (MCCW) which is intended to serve children with disabilities and complex medical conditions, providing them access to respite services, as well as traditional Medicaid services. After receiving additional funding during the 2016 Legislative Session, the program enrolled an additional 154 children in May 2016, bringing the total number of children served to 341.

CuSToMER SERvICE AND EDuCATIoN l Participated in the CMS Oral Health Initiative Learning Collaborative (OHI). OHI seeks to improve the

use of preventive dental services by children enrolled in Medicaid or CHIP. The Division developedand distributed flyers for school children, dentists, medical providers and community partners. These outreach efforts aimed to educate the targeted audiences and improve preventive dental services by increasing the use of sealants and fluoride as part of dental and well-child exams.

l Launched a new website called ‘MyBenefits.’ This website allows Medicaid and CHIP members to view information about their eligibility status, health or dental plans, co-pays and 1095-B IRS tax documentation online.

l Answered more than 245,000 calls from Medicaid clients and providers by Medicaid customer servicerepresentatives.

l Processed more than 6.1 million claims. l Received 267,762 calls through AccessNow, an automated eligibility line for providers to verify whether

their patients are enrolled in Medicaid. l Enrolled 5,224 new providers (full enrollment) and enrolled 910 providers with limited enrollment. l Provided program and plan education to 88,957 Medicaid members and 12,852 CHIP members. l Received 105,242 calls in the Health Program Representative Unit related to managed care. l Provided training to 1,237 Medicaid providers and staff in the annual statewide provider training. l Converted to ICD-10 (International Classification of Diseases, 10th Edition) successfully on October 1, 2015.

This new coding was mandatory for all payers, providers, and other organizations covered by the HealthInsurance Portability and Accountability Act (HIPAA).

2

SERvICE DELIvERY AND PAYMENT l Expanded the Accountable Care Organization (ACO) model beyond the initial Wasatch Front region.

On July 1, 2015, Medicaid members living in nine more counties (Cache, Rich, Morgan, Box Elder, Tooele,Wasatch, Summit, Iron, and Washington) were required to enroll in an ACO as their health plan. The ACOs include Molina Healthcare of Utah, SelectHealth Community Care, Healthy U and HealthChoice Utah. Now more than 86 percent of Medicaid members receive Medicaid services through an ACO.

l The preferred drug list (PDL) generated annualized savings of approximately $57.9 million in total funds($17.2 million in General Fund).

l Submitted 31 State Plan Amendments and 40 State Administrative Rules.

Mission Statement

The mission of the Division of Medicaid and Health Financing is to provide access to quality, cost

effective health care for eligible utahns.

Organizational Chart

Assistant Division Director

Operations Director

Bureau of Authorization and

Community-Based Services

Bureau of Coverage and

Reimbursement Policy

Bureau of Managed

Health Care

Division Director

Assistant Division Director

Bureau of Eligibility Policy

Bureau of Financial Services

Bureau of Medicaid

Operations

Project Management

Office

Administrative Hearings

3

Division Overview The Utah Department of Health (DOH), Division of Medicaid and Health Financing (DMHF) administers Medicaid and the Children’s Health Insurance Program (CHIP) to provide medical, dental and behavioral health services to needy individuals and families throughout the State. DOH is designated as Utah’s Single State Agency for Medicaid.

The administration of Medicaid and CHIP is accomplished through the Division Director’s office and six bureaus. The Division Director administers and coordinates the program responsibilities delegated to develop, maintain, and administer the Medicaid program in compliance with Title XIX of the Social Security Act and CHIP in compliance with Title XXI of the Act, the laws of the state of Utah, and the appropriated budget. The Director’s office manages and coordinates staff training and development, legacy Medicaid Management Information System (MMIS) projects, the MMIS replacement project, SharePoint workflows, security policies and procedures, the oversight of the state’s 1115 Primary Care Network Demonstration Waiver, as well as Affordable Care Act (ACA) reform initiatives. In addition, each bureau has the following responsibilities:

BuREAu oF FINANCIAL SERvICES The objectives and responsibilities of this bureau include monitoring, coordinating, and facilitating the Division’s efforts to operate economical and cost-effective medical assistance programs. The bureau is responsible for coordinating and monitoring federally mandated financial control systems, including monitoring of the Medicaid, CHIP, Utah’s Premium Partnership for Health Insurance (UPP), and Primary Care Network (PCN) programs. The bureau also performs budget forecasting and preparation, development of appropriation requests and legislative presentations, monitoring of medical assistance programs, administration of expenditures, and federal reporting. The bureau also collects provider assessments for hospitals, nursing facilities, and ambulance service providers.

BuREAu oF MANAGED HEALTH CARE The primary responsibility of this bureau is to administer all managed care federal waivers and contracts for both Medicaid and CHIP. In addition, the bureau is responsible for staff that provide education and assistance to Medicaid and CHIP members regarding the selection of managed care plans and appropriate use of Medicaid and CHIP benefits. This bureau also monitors the performance and quality of services provided by managed care organizations on behalf of Medicaid and CHIP. Managed care includes physical, mental, and dental health services. In addition, the bureau is responsible for the early periodic screening, diagnosis, and treatment (EPSDT) program that provides well-child health care, the Medicaid restriction program, and the School Based Skills Development program.

BuREAu oF AuTHoRIZATIoN AND CoMMuNITY-BASED SERvICES The general responsibilities of this bureau include policy formulation, interpretation, and implementation planning of quality, cost-effective long-term care services that meet the needs and preferences of Utah’s low-income citizens. In addition, the bureau is responsible for prior authorizations of Medicaid services not provided by managed care organizations on behalf of Medicaid members.

BuREAu oF MEDICAID oPERATIoNS This bureau’s main objectives are to oversee the accurate and expeditious processing of claims submitted for covered services on behalf of eligible members and the training of providers regarding allowable Medicaid expenditures and billing practices. The general responsibilities include provider enrollment, processing and adjudication of medical claims, publishing all provider manuals, and being the single point of telephone contact for information concerning member eligibility, claims processing, and general questions about the Medicaid program.

BuREAu oF CovERAGE AND REIMBuRSEMENT PoLICY The general responsibilities of this bureau include benefit policy formulation, interpretation, and implementation planning. This responsibility encompasses scope of service and reimbursement policy for Utah’s Medicaid program. The bureau also maintains the State Plan and oversees the pharmacy program, which includes the Drug Utilization Review Board and the Preferred Drug List.

4

BuREAu oF ELIGIBILITY PoLICY The primary responsibility of this bureau is to oversee eligibility determinations for Medicaid and CHIP. This includes: interpreting federal or state regulations and writing medical eligibility policy; providing timely disability decisions based on Social Security Disability criteria; monitoring the accuracy and timeliness of the Medicaid program by reviewing eligibility determinations under guidance from the Centers for Medicare and Medicaid Services (CMS); purchasing private health insurance plans for Medicaid recipients who are at high risk, which saves Medicaid program dollars; and monitoring for program accuracy. The bureau director also serves as the state CHIP Director.

Division Expenditures Figure 1 shows a breakdown of DMHF state fiscal year (SFY) 2016 expenditures. Medicaid mandatory and optional services comprise 90.6 percent of total expenditures, Medicaid administrative services account for 4.6 percent and CHIP administration and services for 4.8 percent.

Division of Medicaid and Health Financing ExpendituresSFY 2016

Medicaid Optional,

Medicaid Mandatory, $1,468,789,500 ,

55%

$956,050,200 , 36%

Medicaid Admin, $124,128,200 ,

4%

CHIP, $128,113,900 ,

5%

Figure 1

Table 1 breaks down the categories in Figure 1 by expenditure types. Approximately 98 percent of the DMHF expenditures are for pass-through charges. Personnel Services account for one percent of total expenditures. Table 1 provides a break out of these expenditures for state fiscal years (SFY) 2012 to 2016.

5

6

Div

ision

of M

edic

aid

and

Heal

th F

inan

cing

Exp

endi

ture

s SF

Y 20

12 -

SFY

2016

Cat

egor

y Ex

pend

iture

Typ

e SF

Y 20

12

SFY

2013

SF

Y 20

14

SFY

2015

SF

Y 20

16

Med

icai

d Ad

min

Cap

ital E

xpen

ditu

re

$0

$32,

000

$0

$0

$6,7

00

Cur

rent

Exp

ense

$6

,132,

600

$4,8

24,9

00

$4,5

86,0

00

$4,7

19,5

00

$6,4

59,9

00

Dat

a Pr

oces

sing

Cap

ital E

xpen

ditu

re

$309

,600

$1

,086

,500

$0

$0

$1

,509

,600

D

ata

Proc

essin

g C

urre

nt E

xpen

se

$7,7

99,8

00

$8,7

37,9

00

$10,

374,

700

$13,

106,

000

$10,

647,

800

Oth

er C

harg

es/P

ass

Thro

ugh

$67,

488,

000

$68,

543,

700

$81,4

95,4

00

$81,5

11,000

$8

7,71

4,60

0 Pe

rson

nel S

ervi

ces

$14,

268,

100

$15,

034,

000

$16,

357,

100

$17,

378,

000

$17,

738,

700

Trav

el/In

Sta

te

$23,

700

$24,

100

$21,3

00

$15,

300

$21,5

00

Trav

el/O

ut o

f Sta

te

$28,

900

$30,

400

$39,

500

$59,

800

$29,

400

Adm

in T

otal

$9

6,05

0,70

0 $9

8,31

3,50

0 $1

12,8

74,0

00

$116

,789

,600

$1

24,12

8,20

0

Med

icai

d M

anda

tory

Cap

ital E

xpen

ditu

re

$72,

000

$22,

400

$86,

100

$0

$0

Cur

rent

Exp

ense

$3

,154,

800

$3,17

9,00

0 $4

,243

,800

$4

,380

,200

$4

,148,

600

Dat

a Pr

oces

sing

Cur

rent

Exp

ense

$2

,420

,700

$9

,550

,000

$1

5,13

0,80

0 $8

,990

,300

$9

,006

,200

O

ther

Cha

rges

/Pas

s Th

roug

h $1

,048

,141,2

00

$1,15

6,61

9,40

0 $1

,339

,260

,400

$1

,375

,055

,600

$1

,447

,759

,000

Pers

onne

l Ser

vice

s $4

,273

,600

$4

,059

,000

$7

,592

,800

$7

,666

,600

$7

,825

,900

Tr

avel

/In S

tate

$3

0,60

0 $2

6,90

0 $3

3,00

0 $3

6,70

0 $3

8,10

0 Tr

avel

/Out

of S

tate

$1

,500

$8

,100

$15,

900

$24,

600

$11,8

00

Trus

t & A

genc

y D

isbur

sem

ents

$8

7,30

0 ($

3,70

0)

$0

$0

$0

Man

dato

ry T

otal

$1

,058

,181,7

00

$1,17

3,46

1,100

$1,3

66,3

62,8

00

$1,3

96,15

4,00

0 $1

,468

,789

,600

Med

icai

d O

ptio

nal

Cur

rent

Exp

ense

$1

,678

,900

$2

,088

,900

$1

23,0

00

$234

,100

$186

,900

D

ata

Proc

essin

g C

urre

nt E

xpen

se

$20,

400

$2,2

00

$12,

600

$14,

000

$17,

600

Oth

er C

harg

es/P

ass

Thro

ugh

$911,6

58,6

00

$923

,030

,000

$8

97,0

75,7

00

$926

,542

,500

$9

55,0

96,6

00Pe

rson

nel S

ervi

ces

$119

,600

$3

08,0

00

$307

,400

$3

77,0

00

$742

,500

Tr

avel

/In S

tate

$0

$1

,700

$0

$0

$5

,900

Tr

avel

/Out

of S

tate

$1

7,20

0 $1

9,40

0 $0

$0

$7

00

Opt

iona

l Tot

al

$913

,494

,700

$9

25,4

50,2

00

$897

,518

,700

$9

27,16

7,60

0 $9

56,0

50,2

00

Med

icai

d To

tal

$2,0

67,7

27,10

0 $2

,197,

224,

800

$2,3

76,7

55,5

00

$2,4

40,111

,200

$2

,548

,968

,000

CHI

P

Cur

rent

Exp

ense

$9

82,8

00

$333

,000

$1

99,5

00

$237

,300

$2

71,0

00

Dat

a Pr

oces

sing

Cap

ital E

xpen

ditu

re

$2,2

00

$26,

900

$0

$0

$0

Dat

a Pr

oces

sing

Cur

rent

Exp

ense

$4

3,40

0 $2

5,60

0 $1

0,40

0 $5

,600

$8

,800

O

ther

Cha

rges

/Pas

s Th

roug

h $7

1,328

,500

$7

1,330

,100

$72,

829,

600

$102

,788

,100

$127

,162,

000

Pers

onne

l Ser

vice

s $1

,139,

200

$996

,200

$6

84,2

00

$623

,200

$6

70,8

00

Trav

el/In

Sta

te

$2,7

00

$2,5

00

$1,5

00

$600

$1

,200

Tr

avel

/Out

of S

tate

$1

1,800

$7

,500

$4

00

$4,8

00

$0

CHI

P To

tal

$73,

510,

600

$72,

721,8

00

$73,

725,

600

$103

,659

,600

$1

28,113

,800

Tota

l Exp

endi

ture

s $2

,141,2

37,7

00

$2,2

69,9

46,6

00

$2,4

50,4

81,10

0 $2

,543

,770

,800

$2

,677

,081

,800

Table 1

Med

icai

d M

anag

emen

t Inf

orm

atio

n Sy

stem

(MM

IS) e

xpen

ditu

res

are

inclu

ded

in th

e “M

edic

aid

Man

dato

ry” c

ateg

ory

for

fisca

l yea

rs 2

012

and

2013

. Pr

ior

to fi

scal

yea

r 20

14, M

MIS

exp

endi

ture

s w

ere

reco

rded

in a

sep

arat

e lin

e ite

m (L

KAA)

.

Table 1

Med

icai

d M

anag

emen

t Inf

orm

atio

n Sy

stem

(MM

IS) e

xpen

ditu

res

are

inclu

ded

in th

e “M

edic

aid

Man

dato

ry” c

ateg

ory

for

fisca

l yea

rs 2

012

and

2013

. Pr

ior

to fi

scal

yea

r 20

14, M

MIS

exp

endi

ture

s w

ere

reco

rded

in a

sep

arat

e lin

e ite

m (L

KAA)

.

MEDICAID Medicaid Finance

The Utah Department of Health (DOH), Division of Medicaid and Health Financing (DMHF) provides Medicaid funding for medical services to needy individuals and families throughout the state of Utah. Medicaid is financed by state and federal resources.

Means of Finance Medicaid was established by Title XIX of the Social Security Act in 1965. Utah implemented its Medicaid program in 1966 which, at the time, focused on acute and long-term care. DOH is designated as the Single State Agency responsible for making state applications to the federal government for all Medicaid funding and Medicaid-related programs. Medicaid, a partnership program between the federal and state governments, provides coverage for physical health, behavioral health, and dental services, as well as long-term care services. Eligibility for the program is based primarily on income and household size. Program eligibility for aged or disabled Medicaid also considers resource levels.

The Medicaid program is administered under the direction of the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services. CMS sets requirements that include funding, qualification, quality, and extent of medical services. CMS also has the responsibility of to provide federal oversight of the program.

Medicaid is funded by a share of both federal and state funds. This percentage of federal versus state funding is based on the Federal Medical Assistance Percentages (FMAP), which are updated every Federal Fiscal Year (FFY). The FFY runs from October 1 to September 30. The FMAP for each state ranges from 50 percent to 73.4 percent of program cost. The funding formula is based on each state’s latest three year average per capita income. Table 2 is an eleven year historical list of Utah FMAP running from 2006 to 2016, modified to match the State Fiscal Year (SFY), which runs from July 1 on one year to June 30 of the following year.

Federal Medicaid Assistance Percentages (FMAP) SFY 2006– SFY 2016

SFY Federal Percentage State

Percentage 2006 71.11% 28.89% 2007 70.30% 29.70% 2008 71.26% 28.74% 2009 70.94% 29.06% 2010 71.44% 28.56% 2011 71.27% 28.73% 2012 71.03% 28.97% 2013 69.96% 30.04% 2014 70.16% 29.84% 2015 70.50% 29.50% 2016 70.32% 29.68%

Table 2

DMHF receives approximately 65 percent of its funding from the Federal match and 35 percent from the State General fund, transfers, and provider assessments. During fiscal years 2009 – 2011, the federal government provided a temporary increase to the FMAP as specified in the American Recovery and Reinvestment Act (ARRA). Those increases are not specified in Table 2. Medicaid administrative costs are generally matched at 50 percent by federal funds.

7

8

Travel/In State, $65,500

Figure 2 is a breakout of Medicaid program expenditures. The largest component, “Other Charges/Pass Through,” is largely comprised of payments to providers of Medicaid services. Specifically, pass-through charges are incurred for the provision of physical health, behavioral health, dental health and Home and Community-Based services provided through contracted entities and administrative services provided by other state agencies.

Medicaid Expenditures

SFY 2016 Other

Charges/PassThrough,

$2,490,570,200

Data Processing

Current Expense, Personnel Services, $19,671,600 $26,307,000

Capital Expenditure, Data Processing $6,700 Capital Expenditure, Travel/Out of $1,509,600 Current Expense, State, $41,900 $10,795,500

Figure 2

DMHF’s revenues come from various fund sources, namely the State General Fund, Dedicated Credits, Restricted Revenues, Transfers and the associated Federal Funds. Transfers and most Dedicated Credits are funds from other state agencies, local county agencies, or school districts and are often referred to as “seeded funds”, which are used to draw down federal matching funds based on the FMAP. Figure 3 shows a breakout of revenue types, sources and amounts in 2016.

General Fund, $399,038,700 ,

16% Restricted Funds, $102,979,300 ,

4%

Federal Funds, $1,655,033,000 ,

65%

Dedicated Credits, $258,208,700 ,

10%

Transfers, $133,708,300 ,

5%

Medicaid Program Total Revenue Sources SFY 2016

Figure 3

Offsets to Medicaid Expenditures Medicaid expenditures are decreased by means of the following offsets.

Co-PAYMENTS Medicaid clients are required to pay a portion of the cost for some of the services they receive. For example, clients pay up to $3 per prescription up to a maximum of $15 per month.

THIRD PARTY LIABILITY The Office of Recovery Services (ORS) identifies commercial insurance coverage for Medicaid members. This information is used by the Division to cost avoid Medicaid expenditures. In some circumstances, federal regulations require the state to pay a claim and pursue collection from the third party insurance. ORS is responsible for coordination of benefits for fee for service (FFS) Medicaid members. ORS also pursues collection from third parties in personal injury cases involving Medicaid members and for estate recovery in accordance with federal regulations. Managed care organizations are responsible for coordination of benefits for their Medicaid members. These collections are taking into consideration in the rate setting process.

PHARMACY REBATES DOH negotiates supplemental rebates with manufacturers for increased offsets. In addition, the state receives primary rebates which are negotiated by the federal government.

SPENDDowN INCoME If a potential Medicaid member’s income exceeds the eligibility threshold, they have the option to spenddown (or pay part of) their income in order to become eligible for Medicaid.

oTHER CoLLECTIoNS The Attorney General’s Office (AG) and Office of Medicaid Inspector General (OIG) are actively involved in recovering overpayments.

9

Table 3 reports the Medicaid offsets received in SFY 2016, classified by service category and other sources.

Expenditure Offsets SFY 2016

Category Of Service and Other Sources Co-Payment Third Party Spenddown andOther Collections Total

Ambulatory Surgical Services $700 $423,800 $0 $424,500 Attorney General/MFCU $0 $0 $9,004,200 $9,004,200 Autism Spectrum Disorder $0 $60,600 $0 $60,600 Autism Waiver $0 $26,700 $0 $26,700 Chiropractic Services $200 $20,900 $0 $21,100 Contracted Mental Health Services $0 $50,200 $0 $50,200 Dental Services $0 $1,067,800 $0 $1,067,800 ESRD Kidney Dialysis Services $900 $2,539,100 $0 $2,540,000 Federally Qualified Health Centers $3,100 $85,600 $0 $88,700 Home Health Services $0 $2,798,900 $0 $2,798,900 Independent Lab and/or X-Ray Services $0 $330,600 $0 $330,600 Inpatient Hospital Services, General $402,200 $46,368,200 $0 $46,770,400 Inpatient Hospital Services, Mental $0 -$14,700 $0 ($14,700) Medical Supply Services $0 $2,407,500 $0 $2,407,500 Medical Transportation $0 $5,107,100 $0 $5,107,100 Mental Health Services $0 $1,060,900 $0 $1,060,900 Nursing Facility I (NF I) $0 $11,635,300 $0 $11,635,300 Nursing Facility III (NF III) $0 $36,400 $0 $36,400 Occupational Therapy $0 $31,700 $0 $31,700 Office of Inspector General (OIG) $0 $0 $2,036,700 $2,036,700 Office of Recovery Services (ORS) $0 $12,272,100 $19,431,000 $31,703,100 Optical Supply Services $0 $18,200 $0 $18,200 Osteopathic Services $44,600 $1,454,200 $0 $1,498,800 Outpatient Hospital Services, General $117,900 $13,798,800 $0 $13,916,700 Pediatric/Family Nurse Pract $19,000 $536,000 $0 $555,000 Pharmacy $1,682,800 $5,600,800 $134,161,100 $141,444,700 Physical Therapy Services $0 $260,100 $0 $260,100 Physician Services $150,600 $12,711,500 $0 $12,862,100 Podiatry Services $2,100 $370,200 $0 $372,300 Psychologist Services $0 $432,200 $0 $432,200 QMB-Only Services $0 $4,429,800 $0 $4,429,800 Recovery Audit Contractor (RAC) $0 $0 $3,745,600 $3,745,600 Rural Health Clinic Services $700 $114,400 $0 $115,100 Specialized Nursing Services s $0 $366,300 $0 $366,300 Speech and Hearing Services $0 $18,000 $0 $18,000 Substance Abuse Treatment Services $0 $291,300 $0 $291,300 Targeted Case Management Services $0 $3,600 $0 $3,600 USTS IMR-1 Services $0 $78,500 $0 $78,500 Vision Care Services $300 $151,900 $0 $152,200 Well Child Care (EPSDT) Services $0 $50,000 $0 $50,000 TOTAL $2,425,100 $126,994,500 $168,378,600 $297,798,200

Table 3

10

Medicaid Consolidated Report of Expenditures and Revenues All Medicaid funds are administered by the Utah Department of Health (DOH). As per federal requirements, all funding for Medicaid must flow through DOH and be governed by a memorandum of understanding for all functions performed by other entities including other state agencies, local governments, for profit entities, and not-for-profit entities.

As the Medicaid Single State Agency, DOH is ultimately responsible and accountable for all aspects of Medicaid. DOH is required to exercise administrative discretion on the administration and supervision of the Medicaid State Plan, issues, policies, rules, and regulations relating to Medicaid program matters.

Programs and services for Medicaid are delivered by DOH, the Departments of Human Services (DHS), and a myriad of contracted providers including University of Utah Hospitals (U of U), local county health organizations, not-for-profit entities, and for–profit entities. DOH contracts with the Department of Workforce Services (DWS) to determine eligibility for Medicaid (and CHIP) programs. The Utah Office of Inspector General (OIG) receives Medicaid funding to audit the Medicaid program as well as identify, investigate and prosecute Medicaid fraud, waste and abuse. The Office of Attorney General (AG) also receives funding to provide legal support to DOH, review Medicaid and CHIP contracts and policies, and represent Medicaid and CHIP in administrative and judicial proceedings.

This consolidated report section shows Medicaid funding and the related service expenditures in the following state agencies: DOH, DHS, DWS, U of U, AG, and the OIG. The Governor’s Office of Management and Budget reviews expenditure data from these six state agencies. In addition, DOH passes funding through to local government and other providers.

Figure 4 illustrates Medicaid funding sources. Table 4 details the composition of “Other Revenue Sources” shown in Figure 4.

DOH State Funds, $502,018,000 , 20%

Federal Funds, $1,655,033,000 , 65%

DHS State Funds, $98,994,400 , 4%

DWS State Funds, $13,486,400 , 0%

Other Revenue Sources,

$279,436,200 , 11%

Medicaid Consolidated Funds SFY 2016

Figure 4

11

Table 4 details the composition of the “Other Revenue Sources” in Figure 4.

Other Revenue Sources SFY 2016

Ambulance Assessment Center for Health Data CHIP Allocation DHS (Non-Medicaid) Disease Control and Prevention Disproportionate Share Hospital Family & Health Preparedness Health & Dental Clinics Health Information Technology Healthy U Health Plan Inmate Billing Inpatient UPL Payments Local Health Departments Mental Health Services MFCU/OIG Nursing Facility NSGO UPL Outpatient Hospital UPL Pharmacy Rebates Physician Enhancement Refugee Relocation School Districts Substance Abuse Utah Schools for the Deaf and Blind Other Total

$2,781,700 $222,200

$2,051,500 $1,637,300 $360,000

$8,461,000 $3,358,500 $3,040,300

$13,600 $2,693,000

$477,600 $18,981,500

$745,100 $40,761,700

$10,167,500 $8,483,700

$7,938,600 $134,161,100

$13,956,700 $1,045,400

$12,746,000 $4,272,200

$817,900 $82,100

$279,436,200

Table 4

Table 5 specifies Medicaid funding at the appropriated line item level. Starting in FY 2014, Medicaid Management Information System (MMIS) replacement funding (LHL) is placed under the Mandatory line item.

Table 6 details Medicaid mandatory, optional and administrative expenditures by state agency. Expenditures for the MMIS replacement project are included in DOH mandatory expenditures.

12

13

Con

solid

ated

Med

icai

d Re

venu

esSF

Y 20

16

Man

dato

ry

LHB

-In

patie

ntHo

spita

l LH

C -

Nurs

ing

Hom

e LH

D -

Man

aged

Heal

thC

are

LHE

-Ph

ysic

ian

Serv

ices

LHF

-O

utpa

tient

Ho

spita

l

LHG

-O

ther

Man

dato

rySe

rvic

es

LHH

-C

ross

over

Serv

ices

LH

J -

Med

ical

Su

pplie

s LH

L -

Med

icai

d M

IS

Repl

acem

ent

Tot

al

Gen

eral

Fun

d $3

5,02

2,10

0 $2

6,77

4,40

0 $2

12,6

99,9

00

$13,

110,10

0 $1

2,75

3,80

0 $7

,746

,700

$3

,051

,900

$2

,853

,600

$5

,065

,700

$3

19,0

78,2

00

Fede

ral F

unds

$8

3,57

8,60

0 $1

46,8

76,7

00

$668

,791

,900

$3

1,389

,800

$3

2,64

8,30

0 $3

9,81

4,90

0 $7

,849

,700

$6

,191,5

00

$11,5

71,8

00

$1,0

28,7

13,2

00

Ded

icat

ed C

redi

ts

$0

$7,9

32,6

00

$25,

970,

100

$682

,500

$1

,749

,300

$4

,726

,100

$0

$0

$0

$41,0

60,6

00

Rest

ricte

d Re

venu

e $1

,100,

000

$28,

065,

500

$55,

063,

400

$0

$0

$9,6

07,8

00

$274

,500

$0

$0

$9

4,111

,200

Pa

ss-T

hrou

gh

$9,0

02,2

00

$0

$0

$0

$0

$0

$0

$0

$0

$9,0

02,2

00

Tra

nsfe

rs

$615

,700

$1

0,40

0 $0

$2

64,6

00

$191

,200

$1

,235

,100

$0

$20,

800

$0

$2,3

37,8

00

Begi

nnin

g Ba

lanc

e $0

$0

$0

$0

$0

$0

$0

$0

$3

,500

,000

$3

,500

,000

C

losin

g Ba

lanc

e $0

$0

($

1,539

,500

) $0

$0

$0

$0

$0

($

7,26

0,50

0)

($8,

800,

000)

La

psin

g Ba

lanc

e ($

6,58

2,90

0)

($1,2

46,8

00)

($10

,963

,100)

($

444,

900)

($

736,

600)

$0

$0

($

239,

400)

$0

($

20,2

13,7

00)

$122

,735

,700

$2

08,4

12,8

00

$950

,022

,700

$4

5,00

2,10

0 $4

6,60

6,00

0 $6

3,13

0,60

0 $1

1,176,

100

$8,8

26,5

00

$12,

877,

000

$1,4

68,7

89,5

00

Opt

iona

l

LJA

-Ph

arm

acy

LJB

-Ho

me

&C

omm

unity

Base

d W

aive

rs

LJC

-C

apita

ted

Men

tal H

ealth

Serv

ices

LJ

D -

Buy

In/O

ut

LJE

-D

enta

l Se

rvic

es

LJF

-In

term

edia

teC

are

Faci

litie

s fo

rM

enta

lHe

alth

LJG

-Vi

sion

Car

e LJ

H -

Oth

erO

ptio

nal

Serv

ices

LJK

-No

n-Se

rvic

eEx

pens

es

LJL

-Ho

spic

e LJ

M, &

LJN

-D

SH &

C

lawba

ck

Tot

al

Gen

eral

Fun

d ($

878,

100)

$4

,822

,800

$8

,032

,000

$2

0,78

9,90

0 $1

7,79

0,10

0 $7

,566

,800

$4

96,6

00

$11,6

24,3

00

$1,9

00,10

0 $3

,815

,000

$3

4,18

4,90

0 $1

10,14

4,40

0 Fe

dera

l Fun

ds

($30

,616

,200

) $1

60,2

85,9

00

$122

,878

,800

$3

0,95

5,60

0 $4

3,53

1,200

$6

0,79

5,10

0 $7

98,2

00

$87,

419,

000

$36,

672,

000

$11,2

49,9

00

$23,

561,2

00

$547

,530

,700

D

edic

ated

Cre

dits

$1

34,16

1,100

$0

$39,

317,

500

$0

$0

$0

$0

$11,6

21,10

0 $1

4,23

1,900

$0

$8

,304

,500

$2

07,6

36,10

0 Re

stric

ted

Reve

nue

$4,6

00,0

00

$0

$0

$0

$0

$3,4

80,10

0 $0

$0

$0

$0

$0

$8

,080

,100

Pass

-Thr

ough

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

T

rans

fers

$1

56,2

00

$66,

220,

900

$6,12

2,00

0 $0

$4

,500

$1

4,95

0,20

0 $5

,700

$5

,556

,200

$0

$0

$2

78,10

0 $9

3,29

3,80

0 Be

ginn

ing

Bala

nce

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Clo

sing

Bala

nce

$0

($2,

959,

700)

$0

$0

$0

$0

$0

$0

$0

$0

$0

($

2,95

9,70

0)

Laps

ing

Bala

nce

($14

,601

,600

) ($

226,

700)

($

527,

700)

($

1,140,

000)

$6

52,6

00

$239

,300

($

144,

200)

$4

,624

,400

$2

69,7

00

$936

,900

$2

,242

,100

($7,

675,

200)

$92,

821,4

00

$228

,143,

200

$175

,822

,600

$5

0,60

5,50

0 $6

1,978

,400

$8

7,03

1,500

$1

,156,

300

$120

,845

,000

$5

3,07

3,70

0 $1

6,00

1,800

$6

8,57

0,80

0 $9

56,0

50,2

00

Serv

ices

Ad

min

T

otal

Gen

eral

Fun

d $4

29,2

22,6

00

$4,9

05,4

00

$434

,128,

000

Fede

ral F

unds

$1

,576

,243

,900

$7

8,78

9,10

0 $1

,655

,033

,000

D

edic

ated

Cre

dits

$2

48,6

96,7

00

$9,5

12,0

00

$258

,208

,700

Re

stric

ted

Reve

nue

$102

,191,3

00

$788

,000

$1

02,9

79,3

00

Pass

-Thr

ough

$9

,002

,200

$0

$9

,002

,200

T

rans

fers

$9

5,63

1,600

$2

9,07

4,50

0 $1

24,7

06,10

0 Be

ginn

ing

Bala

nce

$3,5

00,0

00

$1,4

75,0

00

$4,9

75,0

00

Clo

sing

Bala

nce

($11,7

59,7

00)

($41

5,70

0)

($12

,175,

400)

La

psin

g Ba

lanc

e ($

27,8

88,9

00)

$0

($27

,888

,900

)

$2,4

24,8

39,7

00

$124

,128,

300

$2,5

48,9

68,0

00

Table 5

Table 6

Con

solid

ated

Med

icai

d Ex

pend

iture

sSF

Y 20

16

Man

dato

ry

DO

H D

HS

U of

U

DW

S AG

O

IG

Tota

l In

patie

nt H

ospi

tal

$94,

250,

800

$0

$28,

484,

900

$0

$0

$0

$122

,735

,700

Nu

rsin

g Ho

me

$208

,412

,800

$0

$0

$0

$0

$0

$2

08,4

12,8

00

Con

trac

ted

Heal

th P

lan

Serv

ices

$7

82,0

18,9

00

$0

$168

,004

,000

$0

$0

$0

$9

50,0

22,9

00Ph

ysic

ian

Serv

ices

$4

4,58

7,00

0 $0

$4

15,10

0 $0

$0

$0

$4

5,00

2,10

0 O

utpa

tient

Hos

pita

l $3

6,97

1,300

$0

$9

,634

,700

$0

$0

$0

$4

6,60

6,00

0 O

ther

Man

dato

ry S

ervi

ces

$53,

274,

700

$0

$9,8

55,9

00

$0

$0

$0

$63,

130,

600

Cro

ssov

ers

$11,17

6,10

0 $0

$0

$0

$0

$0

$1

1,176,

100

Med

ical

Supp

lies

$8,8

26,5

00

$0

$0

$0

$0

$0

$8,8

26,5

00

Med

icai

d M

IS R

eplac

emen

t $1

2,87

7,00

0 $0

$0

$0

$0

$0

$1

2,87

7,00

0 Su

btot

al

$1,2

52,3

95,10

0 $0

$2

16,3

94,6

00

$0

$0

$0

$1,4

68,7

89,7

00

Opt

iona

l D

OH

DHS

U

of U

D

WS

AG

OIG

To

tal

Phar

mac

y $9

2,82

1,300

$0

$0

$0

$0

$0

$9

2,82

1,300

Ho

me

& C

omm

unity

-Bas

ed W

aive

rs

$9,16

0,40

0 $2

18,9

82,8

00

$0

$0

$0

$0

$228

,143,

200

Men

tal H

ealth

Ser

vice

s $1

75,8

22,6

00

$0

$0

$0

$0

$0

$175

,822

,600

In

term

edia

te C

are

Faci

litie

s $3

5,57

1,900

51

,459

,600

$0

$0

$0

$0

$8

7,03

1,500

O

ther

Opt

iona

l Ser

vice

s $1

20,8

45,6

00

$0

($60

0)

$0

$0

$0

$120

,845

,000

In

patie

nt U

PL P

aym

ents

$6

24,7

15

$0

$27,

636,

300

$0

$0

$0

$28,

261,0

15

Buy

In /

Out

$5

0,60

5,50

0 $0

$0

$0

$0

$0

$5

0,60

5,50

0 D

enta

l Ser

vice

s $6

1,978

,400

$0

$0

$0

$0

$0

$6

1,978

,400

D

ispro

port

iona

te S

hare

Hos

pita

l $5

,209

,600

$9

34,6

00

$28,

682,

800

$0

$0

$0

$34,

827,

000

Cla

wba

ck P

aym

ents

$0

$0

$3

3,74

3,80

0 $0

$0

$0

$3

3,74

3,80

0 No

n-Se

rvic

e Ex

pend

iture

s $4

,378

,955

$0

$0

$0

$0

$0

$4

,378

,955

Ho

spic

e C

are

Serv

ices

$1

6,00

1,800

$0

$0

$0

$0

$0

$1

6,00

1,800

UU

MG

Phy

sicia

n En

hanc

emen

t ($

1,116,

689)

$0

$1

5,36

4,30

0 $0

$0

$0

$1

4,24

7,61

1 G

radu

ate

Med

ical

Edu

catio

n $1

,549

,019

$0

$4

,637

,100

$0

$0

$0

$6,18

6,119

Vi

sion

Car

e $1

,154,

700

$0

$1,6

00

$0

$0

$0

$1,15

6,30

0 Su

btot

al

$574

,607

,800

$2

71,3

77,0

00

$110

,065

,300

$0

$0

$0

$9

56,0

50,0

00

Adm

inist

rativ

e D

OH

DHS

U

of U

D

WS

AG

OIG

To

tal

$50,

393,

300

$20,

496,

500

$0

$49,

971,2

00

$720

,700

$2

,546

,600

$1

24,12

8,30

0

Tota

l Exp

endi

ture

s D

OH

DHS

U

of U

D

WS

AG

OIG

To

tal

$1,8

74,7

56,8

00

$291

,873

,500

$3

26,4

59,9

00

$49,

971,2

00

$720

,700

$2

,546

,600

$2

,548

,968

,000

14

64.4%

Each agency in state government that participates in Medicaid service delivery has provided the following summary information.

uTAH DEPARTMENT oF HEALTH - DIvISIoN oF MEDICAID AND HEALTH FINANCING The Utah Department of Health (DOH) was created in 1981 to protect the public’s health by preventing avoidable illness, injury, disability and premature death; assuring access to affordable, quality health care; promoting healthy lifestyles; and monitoring health trends and events.

Table 7 shows SFY 2016 Medicaid mandatory, optional and administrative expenditures managed within DOH.

Utah Department of Health / Division of Medicaid and Health Financing Service Expenditures Mandatory Total Expenditures Percent of Total

Inpatient Hospital $94,250,800 7.53% Nursing Home $208,412,800 16.64% Contracted Health Plan Services $782,018,900 62.44% Physician Services $44,587,000 3.56% Outpatient Hospital $36,971,300 2.95% Other Mandatory Services $53,274,700 4.25% Crossovers $11,176,100 < 1.0% Medical Supplies $8,826,500 < 1.0% Medicaid MIS Replacement $12,877,000 1.03% Total Mandatory $1,252,395,100 100.00%

Optional Total Expenditures Percent of Total Pharmacy $92,821,300 16.15% Home & Community Based Waivers $9,160,400 1.59% Mental Health $175,822,600 30.60% Buy In / Out $50,605,500 8.81% Dental Services $61,978,400 10.79% Intermediate Care Facilities $35,571,900 6.19% Vision Care $1,154,700 < 1.0% Other Optional Services $120,845,600 21.03% Non-Service Expenditures $5,436,000 < 1.0% Hospice Care Services $16,001,800 2.78% DSH Expenditures $5,209,600 < 1.0% Clawback Payments $0 < 1.0% Total Optional $574,607,800 100.00%

Total Service Expenditures UDOH/DMHF $1,827,002,900 100.00%

Administrative Expenditures Responsibilities: Claims payment, rate setting, cost settlement, contracting, prior authorization of services, waiver management, and client plan selection.

Total Expenditures Percent of Total Capital Expenditure $6,700 < 1.0% Current Expense $6,459,900 13.53% Data Processing Capital Expenditure $1,509,600 3.16% Data Processing Current Expense $10,647,800 22.30% Other Charges/Pass Through $13,979,700 23.75% Personnel Services $17,738,700 37.15% Travel/In State $21,500 < 1.0% Travel/Out of State $29,400 < 1.0%

Total Admin Expenditures UDOH/DMHF $50,393,300 100.00%

Total DOH Medicaid Expenditures $1,877,396,200 100.00%

Total UDOH Expenditures in SFY 2016 $2,909,224,200

Medicaid as a % of Expenditures 64.4%

Table 7

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DEPARTMENT oF HuMAN SERvICES The Department of Human Services (DHS), authorized under UCA 62A-1-102, provides direct and contracted social services to persons with disabilities, children and families in crisis, juveniles in the criminal justice system, individuals with mental health or substance abuse issues, vulnerable adults, and the elderly. In addition, DHS is responsible for the administration of the child support services program.

Table 8 shows Medicaid expenditures by DHS by category of service and funding source, as well as administrative costs for SFY 2016.

Department of Human Services Service Expenditures - Actual (Through DHS) Federal Funds State Funds Total

Percent of Total

People with Disabilities $177,689,100 $74,505,600 $252,194,700 86.4% (Includes Developmental Center)

Utah State Hospital $13,796,900 $5,385,400 $19,182,300 6.6% Total Service Expenditures DHS $191,486,000 $79,891,000 $271,377,000 93.0%

Administrative Expenditures – Actual Total Administrative Expenditures DHS $10,761,200 $9,735,300 $20,496,500 7.0%

TOTAL Expenditures (Through DHS) $202,247,200 $89,626,300 $291,873,500 100.0%

Service Expenditures - Direct Billed to DOH (State participation from DHS to DOH) Child and Family Services $5,546,700 Aging and Adult Services $1,621,700 Administrative Fee $1,558,300

Total State Funds for Direct Billed Expenditures $9,368,100

Total DHS Expenditures $988,491,600


Table 8

DHS Divisions are as follows:

Executive Director’s Operations (EDO) - provides direction, guidance, and fiscal support. Services include licensing, review, and public guardian.

Division of Substance Abuse and Mental Health (DSAMH) - promotes prevention education, early intervention, residential treatment, and recovery support for individuals who suffer from substance abuse or mental illness. The Utah State Hospital (USH), an entity of DSAMH, provides care specializing in services for individuals with severe and persistent mental illness.

Division of Services for People with Disabilities (DSPD) - provides a wide range of in-home and out-of-home services for people with intellectual disabilities, physical disabilities, and acquired brain injuries. The Utah State Developmental Center (USDC), an entity of DSPD, provides facility-based care and treatment for people with severe disabilities.

Office of Recovery Services (ORS) - provides child support collection services and third-party Medicaid recovery services.

Division of Child and Family Services (DCFS) - provides child welfare and domestic violence services in partnership with communities, including child abuse prevention; child protective services; in-home services; foster care; adoption; and domestic violence supports, treatment, and shelter.

16

Division of Aging and Adult Services (DAAS) – promotes a wide variety of home and community-based services for elderly individuals to be protected from abuse, neglect, and exploitation, and to maintain their independence by living at home rather than residing in nursing facilities.

Division of Juvenile Justice Services (DJJS) – provides services to youth offenders with a comprehensive array of programs including intervention, home detention, secure detention, day reporting centers, case management, community alternatives, observation and assessment, long-term secure facilities, transition, rehabilitation, and youth parole.

DEPARTMENT oF woRKFoRCE SERvICES The Department of Workforce Services (DWS) was created in 1997, per UCA 35A-1-103(1), to provide employment and support services for customers to improve their economic opportunities. Costs of DWS for the Eligibility Services Division are computed by taking a random moment time sample. DWS eligibility workers are sampled and asked to record the time they spent on fourteen public assistance programs. Total costs are allocated on a quarterly basis to the various programs based on the percent of time derived from the sample.

Table 9 shows DWS Medicaid administrative expenditures in SFY 2016 by cost type and funding source.

Department of Workforce Services

Administrative Expenditures - Actual Federal Funds State Funds Total Percent of Total

Direct Costs $36,484,800 $13,486,400 $49,971,200 100.0% Total Admin Expenditures DWS $36,484,800 $13,486,400 $49,971,200 100.0%

Total DWS Expenditures $913,405,400


Table 9

Divisions and budget areas within DWS are as follows:

Eligibility Services Division - The Eligibility Services Division was created in 2009 to centralize the State’s public assistance eligibility process using the State’s eligibility system, eREP, to process applications. The Division determines eligibility for the Medicaid, CHIP, and other federal and state public assistance programs.

Eligibility for the different medical programs varies depending upon the program. Some major elements of consideration include citizenship, income level, Utah residency, assets, and the presence of dependents in the home. Generally, those who receive coverage must renew their coverage annually to confirm continued eligibility.

Medical Programs - Medical Programs is a specific budget area at DWS and includes Medicaid, CHIP, PCN, and UPP eligibility. Prior to SFY 2008, DOH conducted about 60 percent of medical determinations, including all of the CHIP and UPP determinations. DWS performed about 40 percent of the determinations. In SFY 2008, DOH transferred the entire eligibility determination component of these programs to DWS. However, general administration and oversight of these programs remains within DOH.

Medical Programs are funded by General Fund and Federal Funds for Medicaid, CHIP, PCN and UPP. DWS receives funding to provide eligibility determinations within each of these programs. All payments for medical services are made by DOH.

Medical Programs Performance Measures - DWS performance on behalf of Medicaid and CHIP is measured in several ways. Federal regulation requires that a decision be made on a medical application within 45 days following the date of application and 90 days for Disability Medicaid. However, federal policy allows extensions for the applicant to provide proof of eligibility. DOH has established a timeliness benchmark of 30 days matching other programs that DWS administers, such as Supplemental Nutritional Assistance Program (formerly known as Food Stamps).

17

oFFICE oF THE ATToRNEY GENERAL The Environment and Health Division, Health Section, within the Office of the Attorney General also provides legal support to DOH, reviews Medicaid and CHIP contracts and policies, and represents Medicaid and CHIP in administrative and judicial proceeding. Table 10 shows the Office of the Attorney General Medicaid Expenditures for SFY 2016.

Office of the Attorney General

Administrative Expenditures - Actual Federal Funds State Funds Total

AG Total Administrative Expenditures $360,300 $360,400 $720,700

Table 10

oFFICE oF INSPECToR GENERAL, FoR MEDICAID SERvICESThe Office of Inspector General (OIG) is an independent office of program evaluation and review located within the Department of Administrative Services. The purpose of this office is to ensure adequate internal controls are in place, effective policies and procedures are established and followed in the Medicaid program, and to investigate and identify potential or actual fraud, waste, or abuse in the state Medicaid program.

Table 11 shows Medicaid administrative expenditures in SFY 2016. OIG expenditures are considered 100 percent Medicaid related.

Office of Inspector General

Administrative Expenditures - Actual Federal Funds State Funds Total

OIG Total Administrative Expenditures $1,381,300 $1,165,300 $2,546,600

Table 11

uNIvERSITY oF uTAH MEDICAL CENTER The University of Utah is involved in four Medicaid program areas:

Inpatient Disproportionate Share Hospital – These funds come from finite federal allocation to states and are used to pay hospitals that serve a disproportionate share of Medicaid and uninsured patients. The funds are intended to offset some of the hospitals costs in serving these clients.

Direct Graduate Medical Education (GME) – These funds offset some of the costs of residency programs that serve Medicaid clients. The funds cannot be used for academic programs but are used to cover some of the patient care costs associated with the care provided by residents. These funds are subject to the calculated Upper Payment Limit (UPL) authorized by CMS. The non-federal share of GME is provided by DOH.

Inpatient Upper Payment Limit (UPL) – These funds reimburse the hospital up to the Medicare upper limit.The funds help offset some of the medical care costs. All of the UPL funds are matched by the University and are subject to the calculated UPL as authorized by CMS.

University of Utah Medical Group (UUMG) Supplemental Payments – These funds supplement the physician payments up to the average commercial rate. The non-federal share is provided by UUMG to be matched to the extent allowed by CMS.

18

Table 12 shows where the University of Utah expended Medicaid funds during SFY 2016.

University of Utah Medical Center

Service Expenditures - Actual

Mandatory Inpatient Services Contracted Health Plan Physician Services Outpatient Hospital Other Mandatory Services Total Mandatory

Optional Vision Care Disproportionate Share Hospital Graduate Medical Education Clawback Payments Inpatient UPL Payments UUMG Physician Enhancement Other Optional Services Total Optional

Expenditures $28,484,900

$168,004,000 $415,100

$9,634,700 $9,855,900

$216,394,600

Expenditures $1,600

$28,682,800 $4,637,100

$33,743,800 $27,636,300 $15,364,300

-$600 $110,065,300

Percent of Total 8.73% 51.46% < 1.0% 2.95% 3.02%

66.29%

Percent of Total < 1.0% 8.79% 1.42%

10.34% 8.47% 4.71% < 1.0% 33.71%

Total Service Expenditures U of U $326,459,900 100%

Table 12

19

MEDICAID Medicaid Enrollment

Eligibility determinations for Medicaid are made primarily by the Department of Workforce Services (DWS), with a limited number completed by the Department of Human Services (DHS). Eligibility requirements for Medicaid are based on Title XIX of the Social Security Act. There are more than 30 types of Medicaid classifications, each with varying eligibility requirements. Household income is a primary consideration for eligibility. Eligibility for some programs is limited by the amount of assets an individual or a household possesses. The Affordable Care Act (ACA) has required that states raise the minimum income level to at least 133 percent of the federal poverty level (FPL), add an income disregard equal to five percentage points of the FPL, and remove the Medicaid asset test for children, effective January 1, 2014.

For this report, the Medicaid classifications are summarized in the following aid groups:

• Children (individuals under age 19) • Parents (adults in families with dependent children) • Pregnant women • Individuals with disabilities (individuals determined disabled by the state or Social Security) • The elderly (individuals aged 65 or older) • Visually impaired individuals (individuals of any age who meet Social Security’s criteria for statutory

blindness) • Individuals with breast cancer or women with cervical cancer • Individuals who participate in a Medicare Cost-Sharing Program • Primary Care Network (PCN) program (low-income adults who do not meet criteria for any of the

above listed groups)

Medicaid serves as the nation’s primary source of health insurance coverage for low-income populations. Medicaid provides funding for individuals and families who meet the eligibility criteria established by the state of Utah and approved by CMS. Providers of health care services delivered to Medicaid members are reimbursed by DMHF.

In order to receive federal funding participation, the state of Utah agrees to cover certain groups of individuals (mandatory groups) and offer a minimum set of services (mandatory services). Through waivers, the state of Utah is also able to receive federal matching funds to cover additional services (optional services), as well as additional qualifying groups of individuals (optional groups).

Each state sets an income limit within federal guidelines for Medicaid eligibility groups and determines what income counts toward that limit. Family size plays a part in the financial qualification for Medicaid. See Appendix A for the 2016 HHS Federal Poverty Levels (FPL).

Medicaid enrollment numbers and corresponding expenditures are impacted by economic and demographic factors. The percentage of the Utah population living under the Federal Poverty Levels (FPL) influences the level of state reliance on the Medicaid program services. See Appendix A for details.

Medicaid Benefits Medicaid benefits vary, depending on differences in: • Age • Pregnancy • Category of Assistance

Differences in benefits include: • Limited benefits in the PCN program which covers only primary care services • Individuals who are not pregnant or are not a child may have co-payment or cost-sharing requirements

20

• Children are generally entitled to greater benefits as long as they are medically necessary

The Medicaid program is required to provide medical services to “Categorically Needy” individuals. Many categorically needy optional groups and medically needy individuals are covered in Utah as a state option. “Medically Needy” individuals have enough income to meet basic living costs, but are unable to afford vital medical care.

In previous years, all supplemental payments were coded to the Elderly category of assistance. Since supplemental payments are paid on behalf of all populations, supplemental payments were carved out of the analysis and then distributed proportionally. This accounts for the proportional reduction of the Elderly category versus this figure in previous versions of the annual report.

Enrollment Statistics A Medicaid member is defined as an individual who meets the established eligibility criteria of the program, who has applied and has been approved by Medicaid to receive services, regardless of whether the member received any service or any claim has been filed on his or her behalf.

AvERAGE MEMBERS PER MoNTH BY CATEGoRY oF AID “Member months” are defined as the number of Medicaid clients enrolled in each month over a fiscal year. Individuals, in this measure, can be counted multiple times depending on the number of months they are eligible to receive Medicaid services. The average members per month (the average monthly enrollment) in a fiscal year is computed by dividing total member months by 12.

Figure 5 shows the average members per month for all categories of assistance combined.

Average Member Months:

All Categories

0 SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016

Count 275,525 278,972 289,084 307,901 313,575

YOY % Change 1.3% 3.6% 6.5% 1.8%

350,000

300,000

250,000

200,000

150,000

100,000

50,000

Figure 5

21

Figure 6 provides a look at average monthly adult members.


Count 32,023 32,950 33,018 31,799 32,849

YOY % Change 2.9% 0.2% -3.7% 3.3%

Average Members per Month:Adult Enrollees

35,000

30,000

25,000

20,000

15,000

10,000

5,000

Figure 6

Figure 7 illustrates the average monthly enrollment for individuals aged 65 and older.

Average Members per Month:Elderly Enrollees

14,000

12,000

10,000

8,000

6,000

4,000

2,000

22


Count 13,017 13,479 13,497 12,242 11,461

YOY % Change 3.5% 0.1% -9.3% -6.4%

Figure 7

Figure 8 shows average monthly enrollment for the visually impaired and people with disabilities.


Count 39,497 40,190 41,861 43,850 45,729

YOY % Change 1.8% 4.2% 4.8% 4.3%

Average Members per Month: Visually Impaired and People with Disabilities

50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000

Figure 8

Figure 9 depicts the average members per month for Medicaid enrolled children.

Average Members per Month:Child Enrollees

200,000180,000160,000140,000120,000100,00080,00060,00040,00020,000


Count 164,622 167,648 176,370 191,682 197,426

YOY % Change 1.8% 5.2% 8.7% 3.0%

Figure 9

23

Figure 10 portrays the average monthly enrollment of pregnant women.

Average Members per Month:Pregnant Women Enrollees

12,000

10,000

8,000

6,000

4,000

2,000


Count 10,930 10,801 10,718 10,709 9,974

YOY % Change -1.2% -0.8% -0.1% -6.9%

Figure 10

Figure 11 show the average members per month for PCN members. Unlike other categories of aid, the number of PCN member months is dependent on the number of open enrollment events.

Average Members per Month:

Primary Care Network (PCN) Enrollees

18,00016,00014,00012,00010,0008,0006,0004,0002,0000

SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016 Count 15,436 13,904 13,619 17,620 16,137

YOY % Change -9.9% -2.0% 29.4% -8.4%

Figure 11

24

Table 13 provides a county level look at the average monthly Medicaid enrollment as a percent of population.

Average Monthly Enrollment as a Percent of County Population

SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016

BEAVER 11.8% 12.1% 11.8% 13.0% 12.4% BOX ELDER 9.4% 9.8% 10.2% 11.4% 11.3% CACHE 9.3% 9.3% 9.7% 11.2% 10.7% CARBON 14.7% 15.3% 15.9% 16.8% 17.2% DAGGETT 4.0% 4.5% 4.7% 3.7% 3.7% DAVIS 7.1% 7.1% 7.3% 8.0% 7.6% DUCHESNE 11.9% 11.0% 10.4% 11.8% 14.4% EMERY 11.0% 11.1% 11.6% 12.1% 12.1% GARFIELD 8.2% 9.1% 9.0% 8.8% 9.3% GRAND 12.1% 11.6% 12.5% 13.9% 13.3% IRON 14.6% 14.3% 15.0% 17.0% 16.1% JUAB 11.2% 11.1% 11.1% 12.2% 12.5% KANE 9.0% 8.9% 8.5% 10.0% 10.8% MILLARD 11.7% 11.7% 11.7% 13.4% 12.7% MORGAN 3.7% 3.6% 3.8% 4.4% 4.0% PIUTE 14.4% 13.0% 14.0% 16.0% 14.9% RICH 8.2% 7.5% 7.5% 9.2% 7.3% SALT LAKE 10.2% 10.2% 10.4% 11.3% 10.7% SAN JUAN 23.5% 23.8% 24.4% 25.5% 25.0% SANPETE 12.0% 11.8% 12.1% 13.5% 12.8% SEVIER 13.4% 13.5% 14.1% 15.6% 14.8% SUMMIT 3.8% 3.6% 3.7% 4.5% 4.1% TOOELE 9.7% 10.0% 10.5% 11.4% 11.1% UINTAH 8.7% 8.5% 8.8% 9.6% 11.6% UTAH 8.7% 8.6% 8.7% 9.9% 9.2% WASATCH 6.2% 6.3% 6.3% 6.9% 6.3% WASHINGTON 12.2% 12.0% 12.3% 13.7% 12.6% WAYNE 8.4% 7.9% 8.1% 11.1% 11.5% WEBER 11.4% 11.5% 11.7% 12.8% 12.3%

STATEWIDE 9.8% 9.8% 10.0% 11.0% 10.5%

Table 13

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uNDuPLICATED MEDICAID ENRoLLMENT An unduplicated member is one who is counted only once within a specific fiscal year, regardless of the number of months that individual was eligible for Medicaid services. Thus an individual who was eligible for 12 months of service will be counted the same as an individual who was eligible for only one month of service.

Figure 12 is an illustration of the unduplicated number of members who were eligible for Medicaid services.

Unduplicated Count of Medicaid Enrollees

450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000


Count 380,959 383,309 405,897 415,843 418,356

YOY % Change 0.6% 5.9% 2.5% 0.6%

Figure 12

Table 14 breaks down the unduplicated enrollment count by race, age group, and gender. Members are given the option to self-report their race. In the event race is not reported, members are placed in the “other” category.

Enrollment by Race, Age Group and GenderSFY 2012 - SFY 2016

Race Age Gender SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016

Asian Age < 19 F 1,690 1,658 1,880 1,461 1,354 M 1,834 1,784 1,983 1,580 1,441

Age < 19 Total 3,524 3,442 3,863 3,041 2,795 Age 19 - 64 F 1,888 2,000 1,931 1,697 1,629

M 1,163 1,180 1,070 961 903 Age 19 - 64 Total 3,051 3,180 3,001 2,658 2,532 Age 65 or Older F 761 778 759 776 773

M 441 454 438 433 427

Age 65 or OlderTotal 1,202 1,232 1,197 1,209 1,200

Asian Total 7,777 7,854 8,061 6,908 6,527 Black Age < 19 F 3,079 3,019 3,055 2,578 2,514

M 3,323 3,263 3,374 2,914 2,807 Age < 19 Total 6,402 6,282 6,429 5,492 5,321 Age 19 - 64 F 2,105 2,251 2,208 2,206 2,154

M 1,310 1,412 1,377 1,371 1,338 Age 19 - 64 Total 3,415 3,663 3,585 3,577 3,492

Table 14

26

Enrollment by Race, Age Group and Gender Continued SFY 2012 - SFY 2016

Race Age Gender SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016

Black Age 65 or Older

Age 65 or OlderTotal

F M

138 93

231

141 105

246

135 101

236

153 120

273

159 126

285 Black Total 10,048 10,191 10,250 9,342 9,098 Native American Age < 19

Age < 19 Total

F M

3,425 3,524 6,949

3,272 3,387 6,659

3,366 3,492 6,858

2,999 3,148

6,858

3,014 3,157 6,171

Age 19 - 64

Age 19 - 64 Total

F M

958 465

1,423

974 459

1,433

996 453

1,449

994 466

1,460

1,070 489

1,559 Age 65 or Older


F M

418 216

634

414 208

622

392 204

596

435 217

652

437 226

663 Native American Total 9,006 8,714 8,903 8,970 8,393 Pacific Islander Age < 19

Age < 19 Total

F M

1,730 1,866 3,596

1,740 1,876 3,616

1,730 1,892 3,622

1,278 1,408

2,686

1,144 1,304

2,448 Age 19 - 64

Age 19 - 64 Total

F M

852 455

1,307

943 461

1,404

896 415 1,311

771 373 1,144

731 373 1,104

Age 65 or Older


F M

92 68

160

91 73

164

84 63

147

87 61

148

86 62

148 Pacific Islander Total 5,063 5,184 5,080 3,978 3,700 White Age < 19

Age < 19 Total

F M

79,623 84,152

163,775

74,204 78,439 152,646

81,018 84,333 165,351

68,146 71,792

139,938

64,270 67,733 132,003

Age 19 - 64

Age 19 - 64 Total

F M

76,024 37,370 113,394

76,699 36,909 113,609

74,623 35,476 110,099

73,002 36,214

109,216

71,996 36,390 108,386

Age 65 or Older


F M

8,800 3,873

12,673

8,808 3,912

12,720

8,243 3,672

11,915

8,843 4,006

12,849

8,755 3,971

12,726 White Total 289,842 278,971 287,365 262,003 253,115 Other Age < 19

Age < 19 Total

F M

20,857 21,972

42,829

26,881 28,261 55,144

33,328 35,377 68,705

48,339 51,383

99,722

53,584 56,809 110,393

Age 19 - 64

Age 19 - 64 Total

F M

10,134 4,244 14,378

10,105 4,698 14,803

9,724 5,084 14,808

13,287 7,747 21,034

14,331 8,605

22,936 Age 65 or Older


F M

1,330 686

2,016

1,659 791

2,450

1,850 875

2,725

2,590 1,296

3,886

2,746 1,448

4,194 Other Total 59,223 72,395 86,238 124,642 137,523 Grand Total 380,959 383,309 405,897 415,843 418,356

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Figure 13 shows each of the categories of assistance as a percent of total, statewide unduplicated Medicaid enrollment for FY 2016.

Adult (Ages 19-64), 10.5%

The Elderly (Ages65+), 3.7% Visually Impaired

and People with Disabilities, 14.6%

Children, 63.0%

PCN, 5.1%

Pregnant Women, 3.2%

Percent of Medicaid Enrollees byCategory of Assistance

Figure 13

Table 15 presents the same information as Figure 13 from SFY 2012 to SFY 2016.

Statewide Medicaid Enrollment Composition

Category of Assistance Adult (Ages 19-64) Children PCN Pregnant Women The Elderly (Ages 65+) Visually Impaired and People with Disabilities

Statewide Total

SFY 2012 14.1%

57.0% 6.1%

7.0% 4.1% 11.7%

SFY 2013 14.4%

56.7% 5.9% 6.9% 4.2% 11.9%

SFY 2014 13.8%

59.0% 5.0% 6.4% 4.0% 11.8%

SFY 2015 13.0% 59.1% 5.9% 6.1% 3.8% 12.1%

SFY 2016 10.5%

63.0% 5.1% 3.2% 3.7%

14.6%

100.0% 100.0% 100.0% 100.0% 100.0%

Table 15

Table 16 breaks out each category of assistance as a percent of each county’s Medicaid enrollment. Table 15 in conjunction with Table 16 allows for comparisons between each county’s Medicaid enrollment composition with that of the State’s.

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Medicaid Enrollment Composition by County

County Category of Assistance SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016

BEAVER Adult (Ages 19-64) 11.4% 11.6% 10.7% 10.5% 8.0% Children 53.5% 50.3% 53.7% 56.5% 60.9% PCN 12.2% 13.1% 11.1% 9.2% 8.2% Pregnant Women 6.9% 6.3% 6.1% 5.5% 3.2% The Elderly (Ages 65+) 5.5% 6.7% 6.4% 6.0% 5.1%

Visually Impaired and People with Disabilities 10.5% 12.1% 12.0% 12.3% 14.6%

BOX ELDER Adult (Ages 19-64) 13.3% 14.2% 13.1% 12.9% 10.8% Children 57.3% 56.4% 58.9% 59.2% 61.9% PCN 7.4% 6.8% 5.3% 5.6% 5.1% Pregnant Women 6.5% 6.5% 6.6% 5.7% 3.3% The Elderly (Ages 65+) 3.3% 3.4% 3.1% 3.0% 2.8%


CACHE Adult (Ages 19-64) 13.8% 14.4% 13.7% 13.2% 11.2% Children 58.9% 58.2% 61.1% 61.4% 66.4% PCN 5.4% 5.4% 4.5% 5.2% 4.5% Pregnant Women 9.8% 9.7% 8.9% 8.5% 4.5% The Elderly (Ages 65+) 2.7% 2.6% 2.4% 2.5% 2.4%


CARBON Adult (Ages 19-64) 15.3% 15.9% 15.7% 14.9% 12.4% Children 48.6% 48.4% 49.8% 49.5% 52.1% PCN 7.3% 7.3% 7.1% 7.6% 6.3% Pregnant Women 6.3% 5.8% 4.9% 4.7% 2.5% The Elderly (Ages 65+) 4.5% 4.7% 4.6% 4.4% 4.1%


DAGGETT Adult (Ages 19-64) 20.3% 13.0% 11.8% 12.9% 4.4% Children 54.4% 56.5% 56.5% 61.4% 68.0% PCN 11.4% 13.0% 8.2% 7.1% 13.7% Pregnant Women 2.5% 4.3% 4.7% 5.7% 2.2% The Elderly (Ages 65+) 2.5% 4.3% 4.7% 2.9% 2.6%


DAVIS Adult (Ages 19-64) 11.4% 11.6% 10.7% 10.5% 11.7% Children 53.5% 50.3% 53.7% 56.5% 63.0% PCN 12.2% 13.1% 11.1% 9.2% 4.7% Pregnant Women 6.9% 6.3% 6.1% 5.5% 3.1% The Elderly (Ages 65+) 5.5% 6.7% 6.4% 6.0% 2.8%


DUCHESNE Adult (Ages 19-64) 13.3% 14.2% 13.1% 12.9% 12.6% Children 57.3% 56.4% 58.9% 59.2% 60.2% PCN 7.4% 6.8% 5.3% 5.6% 5.9% Pregnant Women 6.5% 6.5% 6.6% 5.7% 3.5% The Elderly (Ages 65+) 3.3% 3.4% 3.1% 3.0% 3.8%


Table 16

29

Medicaid Enrollment Composition by County Continued

County Category of Assistance SFY 2012 SFY 2013 SFY 2014 SFY 2015 SFY 2016 EMERY Adult (Ages 19-64) 13.8% 14.4% 13.7% 13.2% 10.7%

Children 58.9% 58.2% 61.1% 61.4% 60.5% PCN 5.4% 5.4% 4.5% 5.2% 6.7% Pregnant Women 9.8% 9.7% 8.9% 8.5% 2.5% The Elderly (Ages 65+) 2.7% 2.6% 2.4% 2.5% 3.8%


GARFIELD Adult (Ages 19-64) 15.3% 15.9% 15.7% 14.9% 8.6% Children 48.6% 48.4% 49.8% 49.5% 59.8% PCN 7.3% 7.3% 7.1% 7.6% 6.8% Pregnant Women 6.3% 5.8% 4.9% 4.7% 2.6% The Elderly (Ages 65+) 4.5% 4.7% 4.6% 4.4% 6.2%


GRAND Adult (Ages 19-64) 20.3% 13.0% 11.8% 12.9% 8.1% Children 54.4% 56.5% 56.5% 61.4% 58.4% PCN 11.4% 13.0% 8.2% 7.1% 7.2% Pregnant Women 2.5% 4.3% 4.7% 5.7% 4.1% The Elderly (Ages 65+) 2.5% 4.3% 4.7% 2.9% 5.8%


IRON Adult (Ages 19-64) 20.3% 13.0% 11.8% 12.9% 11.0% Children 54.4% 56.5% 56.5% 61.4% 61.7% PCN 11.4% 13.0% 8.2% 7.1% 7.2% Pregnant Women 2.5% 4.3% 4.7% 5.7% 3.7% The Elderly (Ages 65+) 2.5% 4.3% 4.7% 2.9% 2.5%


JUAB Adult (Ages 19-64) 20.3% 13.0% 11.8% 12.9% 8.4% Children 54.4% 56.5% 56.5% 61.4% 62.5% PCN 11.4% 13.0% 8.2% 7.1% 5.7% Pregnant Women 2.5% 4.3% 4.7% 5.7% 3.2% The Elderly (Ages 65+) 2.5% 4.3% 4.7% 2.9% 3.8%


KANE Adult (Ages 19-64) 11.4% 11.6% 10.7% 10.5% 9.9%

Children 53.5% 50.3% 53.7% 56.5% 59.7%

PCN 12.2% 13.1% 11.1% 9.2% 7.7%

Pregnant Women 6.9% 6.3% 6.1% 5.5% 3.4%

The Elderly (Ages 65+) 5.5% 6.7% 6.4% 6.0% 5.9%


MILLA

2 0 1 6 reports...table 1: division of medicaid and health financing expenditures sfy 2012 – sfy...

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