Fiscal Highlights - June 2013

In FY 2012, the Medicaid program in Utah spent $484,499,800 General Fund and $5,322,300 Education Fund ($2,061,536,100 total funds). The $484,499,800 represents 23% of all the $2,122,199,500 General Fund spending statewide in FY 2012.  Funding flowed through five state agencies in the following amounts:

Of the $2,061,536,100 total funds spent on Medicaid in FY 2012, 5% or $97,766,200 went for State administration. The other 95% or $1,963,769,900 paid for medical services. The federal government provided 69% or $1,424,559,100 of the total funding with the remaining $636,977,000 or 31% from matching funds.  Of the $636,977,000 in matching funds, the State General Fund provided $484,499,800 or 77%, the Education Fund another $5,322,300 or 1%, and other entities provided the remaining $147,154,900. Generally these entities are seeding money because those entities are receiving the federal match.

There are four general categories of offsets to Medicaid expenditures, which totaled $356,813,500 in FY 2012. Most offsets result in the Medicaid program avoiding a payment, but in some cases the Medicaid program uses the money collected to offset the total expenditures. The list below includes a discussion on each offset:

• Third party liability - Medicaid charged/collected $244,936,700 from third parties (Medicare, private insurance, or parties causing medical injury to Medicaid clients). In FY 2012 about 1/4 of Medicaid clients had another medical insurance.
• Pharmacy rebates - the State collected $90,003,000 in rebates from volume discounts which the program used to offset expenditures.
• Client contributions - Medicaid clients contributed $13,743,800 to participate in the Medicaid program. The list below includes a discussion of three categories in which client contributions take place:
  • Spenddown Income - clients spent down or paid $6,922,200 of their income to participate in the Medicaid program. This spenddown allows the client to qualify for Medicaid by lowering their income via qualified medical expenses.
  • Co-payments - these are reduced from the reimbursement paid to providers and represented $6,519,500 or 0.3% of all expenditures in FY 2012. Sixty-nine percent of the co-payments came from pharmacy co-payments.
  • Primary Care Network Premiums - clients paid annual premiums totaling $302,100 to participate in this program.
• Office of Inspector General and Attorney General Collections - these two agencies recovered $8,130,000 in overpayments to providers.

For more information please visit the following:

• http://le.utah.gov/interim/2013/pdf/00000649.pdf
• http://health.utah.gov/medicaid/pdfs/annual_report2012.pdf