OverviewMedicaid Expansion and the 1115

Waiver ProgramMay 9, 2013

Potential Medicaid Expansion

Estimated Financial Impact for Dallas County

Potential Medicaid Expansion

Affordable Care Act

Under the Affordable Care Act, • the Federal government has offered 100% funding for

expansion of the Texas Medicaid program• program expansion would cover Texas residents who earn up

to 138% of the Federal Poverty Level (FPL) • the 100% Federal funding would be provided through 2016,

after which time the Federal share declines to 90% funding by 2020.

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Dallas County ImpactDemographic Impact

• Dallas County has approximately 600,000 uninsured residents. • The Affordable Care Act will provide subsidies to uninsured residents which

-• absent Medicaid expansion, should reduce the number of uninsured to

approximately 465,000.• Medicaid expansion would reduce the number to approximately

334,000• meaning, an additional 131,000 Dallas County residents would

receive Medicaid coverage• As a result, Dallas County healthcare providers would be paid $580 million• Today these must be covered by safety net hospitals

Source: Center for Public Policy Priorities

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Impact for Dallas County ProvidersFinancial Impact on Providers

Although overall base payments would increase $580 million• Other supplemental payments (Uncompensated Care / UC) currently

received would be reduced• Net Dallas County providers would realize approximately $351 million.• Statewide this would result in additional provider payments of over

$1.6 billion/year• Without Medicaid expansion there will be no incremental Medicaid

payments• Costs fall to the taxpayers and charity programs• Texan’s tax dollars go to fund other states’ Medicaid Expansion

Programs

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The 1115 Waiver

• The 1115 Waiver is known as the Transformation Waiver• The intent is to change healthcare in Texas to provide better care at

less cost

• The Waiver is divided into two parts• Uncompensated Care• DSRIP

• The Waiver is organized into 20 Regions • Dallas County is in Region 9

• Region 9 includes Dallas, Denton and Kaufman Counties

Regional Healthcare Partnership (RHP) Formation – Region 9

Region Nine defined on August 3rd to include Dallas, Denton and Kaufman counties

Organization of RHP Plan participants is well under way–Short list of eight potential IGT Entities in addition to Parkland and UT Southwestern–Organizing meeting of IGT Entities planned for September 7th

Active RHP Work Groups:–UC Task Force: focused on financial implications and mechanics–RHP Plan Writing Work Group: composed of “authorized representatives” of each participant and charged with writing the RHP Plan

Continue to target a mid- to late-September completion and submission date–Each Work Group is proceeding with known facts, draft rules and guidance

Regional Healthcare Partnership (RHP) Formation – Region 9

Funds Flow Mechanics

Anchor Responsibilities

General Duties Serves as single point of contact for the RHP with HHSC Facilitates RHP meetings with interested IGT contributors in the region and communicates

function and purpose of RHPs Includes other stakeholders in RHP discussions Ensures public meeting as part of development of RHP and prior to submission of final plan

RHP Plan Ensures inclusion of key stakeholders in RHP Plan development Coordinates, develops and provides RHP plan to HHSC based on IGT contributing projects

consistent with project menus and on IGT contributors’ input

Administration of DSRIP Projects Coordinates required reporting of all project milestones and metrics within RHP for DSRIP to

HHSC Provides technical assistance to participating providers

OVERVIEW• Hospitalo 700 Adult Bedso 65 NICU Beds• Community Outpatient Careo 13 Centerso 11 School Based Clinicso 4 Mobile Units• Parkland Community Health Plan Since 1999o 200,000 Enrollees• Dallas County Jail System Health Care• Parkland Foundation

HISTORY

• Second Largest Civilian Burn Unit in U.S.

• Leader in Disaster Preparedness and Response

• Admissions from 200 of 254 Texas Counties in 2012

STATISTICS• ED’s average 490 patients per day

• More than 1,000 radiology procedures per day

• More than 1/3 of the total births in Dallas County each year

• In the past 2 years…

– Parkland’s outpatient pharmacies have filled nearly 4.2M prescriptions• Averaging more than 5700 fills per day

PHHS-UTSW Partnership• Primary Teaching Hospital for the University of Texas

Southwestern Medical Center Since 1943

• 2,506 Faculty

• 1,561 Residents in 105 ACGME Programs

• UTSW to Graduate 500 Students in June 2013

• UTSW Represents 1,470 of 1,660 Medical Staff Members

• Fifty Percent of Physicians in Dallas Trained at Parkland

Questions?

Parkland

•Coping with Change- How Healthcare Providers Are Meeting Coping with Change- How Healthcare Providers Are Meeting the Demands of Tomorrowthe Demands of Tomorrow