Washington Medicaid Study

1
Washington Medicaid Study

• Proposed Final Report
• Joint Legislative Audit Review Committee
• January 7, 2004
• Deborah Frazier and Eric Thomas

2
Study Goals

• JLARC added study to its workplan at the October
  2002 meeting
• Initiated to better understand this driver of 30
  of state appropriations
• Chose to look at Medicaid comprehensively
• Relation to national perspective
• Understand how Medicaid is managed

3
DSHS Administers Medicaid
Report page 2
4
Medicaid Drives DSHS
100
98 7.1b
96 2.2b
90
91 1.2b
82 1.0b
80
76 12.0b
70
60
50
40
24 56m
18 167m
18 42m
30
9 182m
20
6 13 m
10
0
DSHS Med. Aging Dev.
Mental Sub. Childrens Juv. Econ.
Admin. Asst. Dis.
Health Abuse Rehab Svcs.

Report page 11
5
Washington Medicaid Findings and Recommendations

• Management Structure
• Data
• Forecasts and Managing Costs
• DSHS and OFM Concur or Partially Concur with
  Recommendations

Report pages 47-51
6
Key Findings Management Structure

• DSHS is managing a large, complex health system
  with a decentralized management structure
• Structure poses challenges
• No single point of accountability for the
  Medicaid program
• Non-compliance with federal reporting
  requirements for the total Medicaid program
• No regular review of management functions or
  program as a whole
• Cabinet meetings and other cross-organization
  meetings

Report page 47
7
Recommendation Management Structure

• DSHS should create a mechanism for management
  review
• Report by April 2004
• DSHS and OFM both partially concur
• Misreading of recommendation
• Management review does not require change in
  management structure
• Review does require assuring the effective and
  efficient operation of the entire program

Report page 47, 55-65
8
Key Findings Data Systems

• Multiple, aging data systems do not support a
  comprehensive approach to Legislative policy
  making or DSHS management of Washington Medicaid
• An example of data problems is a required federal
  report that is 12 quarters in arrears
• We have a chance, today, to address data issues
  MMIS reprocurement

Report pages 49-51
9
Recommendations Data Systems

• DSHS should become current on federal reporting
• Report by April 2004
• New MMIS should integrate data to support
  comprehensive Legislative policy making and DSHS
  management
• Report by February 2004

Report pages 49-51
10
Key Findings Forecasting and Managing Costs

• Rates for the home and community based programs
  are not consistent
• Both managed by the Aging and Disability Services
  Administration
• More structure and consistency to Agings rates
• Review to determine if DD could use Agings rate
  methods

Report pages 48-49, 67-81
11
Recommendation Forecasting and Managing Costs

• DSHS report its progress ensuring consistent
  rates to the Legislature
• Report by June 2004

Report pages 48-49, 67-81
12
Key Findings Forecasts and Managing Costs

• 5 billion of expenditures not rigorously
  scrutinized
• Includes nursing home care, home and community
  based services for the elderly and disabled, and
  community care for mental health
• Not all Medicaid programs are formally forecast

Report pages 47-50
13
Recommendation Forecasting and Managing Costs
(contd)

• The Legislature should consider engaging a
  consultant to
• Examine 5 billion in biennial expenditures to
  evaluate cost containment efforts and identify
  other cost containment opportunities
• Examine the program elements and data sources to
  assess the best techniques for forecasting future
  caseloads
• Initial report due by November 2004
• Final report due April 2005

Report pages 47-50
14
Conclusions

• JLARCs decision to examine Washington Medicaid
  as one program yielded new insight into 30 of
  state appropriations
• Perspective - comparison to national program
• Comprehensive picture of DSHS management
• Community services rates inventory
• Follow up in coming months