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Legislative Update 2012 • Medicaid • DOH Reorganization George A. Ralls M.D. Health Services Department February 7, 2012 Medicaid F.S. 409.915: County contributions to Medicaid 35% of inpatient hospitalization costs 60 Days to pay Days 11 to 45 State can withhold revenue sharing funds if not paid $55 per month, per Medicaid recipient in a nursing home Medicaid Orange County Medicaid Billed/Paid FY07-11 Medicaid: Proposed Changes Collection of • Recovery of last 4 years of previously denied bills Unpaid Bills Attributing Costs to Counties Payment Method • Changes the way Medicaid costs are assigned to each County • Eliminates our ability to scrutinize bills and deny payment Medicaid: Proposed Changes Collection of Unpaid Bills for last 4 Years • Balance between what we’ve paid and 75% of total billed – Approximately $20 Million Dollars • 36 monthly installments directly out of revenue sharing dollars – $556,000 per month Medicaid: Proposed Changes Attributing Costs to Counties • County’s eligible recipients will be determined solely on the address listed in the DCF system • If no address, eligibility is based on the county where services were rendered – Tertiary referral centers – High risk obstetrics – Neonatal intensive care centers Medicaid: Proposed Changes Payment Method • Beginning Dec. 2012: – Future unpaid billings will be taken from revenue sharing after 6 months – Counties will be paying the entire bill – No reconciliation process or “re-billing” Medicaid: Proposed Changes Summary of local impact: • $20 Million in past denied bills • Loss of our ability to determine County residence • Services rendered at any of our tertiary referral centers may contribute to costs • Mandate to pay entire bill submitted to us – 2011 billed amount was $29.5 M, versus $17.4 M paid DOH Reorganization • HB 1263 • Rep. Matt Hudson DOH Reorganization HB 1263 - Department of Health (DOH) DOH Reorganization • All CHDs have responsibilities in three functional areas: – Infectious disease prevention & control • Surveillance, diagnosis, treatment, risk reduction – Basic family health care services • Primary care, pre-natal care, school based health care – Environmental health services • Sanitary nuisances, on-site sewage disposal systems, water well monitoring DOH Reorganization • Orange County Health Department: – Neighborhood Centers for Families – HUG-Me Program – Office of Community Health • • • • Health Disparities Chronic Disease and Tobacco Prevention Risk Communication Prevention Research, Informatics, and Health Education Center (PRIHEC) • “All In” – PCAN Partner DOH Reorganization Orange County Health Dept Revenues Expenditures $45 M $45.6 M OCHD FY10 Annual Report DOH Reorganization OCHD Revenue Sources Local Revenue •$21.7 Million State Revenue •$12.5 million Federal Revenue •$10.8 Million FY10 DOH Reorganization OCHD Expenditures Salaries • $31.2 million Misc. Expenses • $6.2 million Contractural Services • $3.5 Million FY10 DOH Reorganization • Summary of HB 1263: – Counties to take over local health depts • Health dept employees become county employees – DOH contracts with counties to maintain primary health department functions • Environmental Health • Communicable Disease • Primary Care – State block grants will offset county costs DOH Reorganization Concerns: • A significant shift of responsibilities. • A significant increase in the County workforce. • Will services be compromised? • Will State block grants offset the added County costs? • Amount based on population • No mention of funding formula yet Legislative Update 2012 • Medicaid • DOH Reorganization George A. Ralls M.D. Health Services Department February 7, 2012