COBI 2015 - Buy-in/Buy-out

Overview
Issues
Financials

Sources Uses

FY 2016 Appropriation

For Buy-out Services, Utah Medicaid determines if new clients have both a high medical need and other options for health insurance. When it is less expensive to help the client purchase their private health plan than pay the full amount of medical claims, Utah Medicaid opts to pay for the qualifying individual's health insurance premiums. Other plan options may include the client's current health insurance plan or a COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986) plan for a client who recently left employment. Buy-in refers to Medicare Part B premiums paid by the State on behalf of Medicare-eligible Medicaid clients. The federal government requires the State to pay Medicare premiums.

Funding History

Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $44,257,200 from all sources for Buy-in/Buy-out. This is a 0 percent change from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $18,189,900 from the General/Education Funds, a change of 0 percent from revised Fiscal Year 2015 estimates.

Intent Language

SB0002: Item 75

The Legislature intends that with the funding appropriated for the building block titled, "Intermediate Care Facilities - Intellectually Disabled," the Department of Health shall: 1) Direct funds to increase the salaries of direct care workers; 2) Increase only those rates which include a direct care service component, including respite; 3) Monitor providers to ensure that all funds appropriated are applied to direct care worker wages and that none of the funding goes to administrative functions or provider profits; In conjunction with Intermediate Care Facilities - Intellectually Disabled providers, report to the Office of the Legislature Fiscal Analyst no later than September 1, 2015 regarding: 1) the implementation and status of increasing salaries for direct care workers, 2) a detailed explanation with supporting documentation of how Intermediate Care Facilities - Intellectually Disabled providers are reimbursed, including all accounting codes used and the previous and current rates for each accounting code, and 3) a conceptual explanation of how Intermediate Care Facilities - Intellectually Disabled providers realize profit within the closed market of providing Intermediate Care Facilities - Intellectually Disabled services.

SB0002: Item 75

The Legislature intends that, if funds are available, Medicaid fee-for-service payments for anesthesia services be increased from the current amount of $18.27 to $23.73 for Fiscal Year 2016.

SB0002: Item 75

The Legislature intends that 5% of all funds provided in the Medicaid program for managed care dental plans be used for contracted plan administration and that any funds provided for the Affordable are Act premium tax not be included in that 5% administrative funds amount.

SB0003: Item 123

Under Section 63J-1-603 of the Utah Code the Legislature intends that up to $3,216,000 of the appropriations provided for the Medicaid Optional Services line item not lapse at the close of Fiscal Year 2016. The use of any nonlapsing funds is limited to a pilot program for assistance for children with disabilities and complex medical conditions to be used in similar amounts over three years with the goal of serving a similar number of clients over three years.

SB0007S01: Item 6

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Optional Services line item: (1) annual state general funds saved through preferred drug list (Target = $8.5 million general fund or more), (2) count of new choices waiver clients coming out of nursing homes into community based care (Target = 390 or more), and (3) emergency dental program savings (Target = $250,000 General Fund savings or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 18

Display By:

Funding Source

Expenditure Category

Appropriation Type:

Appropriation History by

Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
General Fund	13,612,500	15,897,900	17,121,000	15,897,900	17,121,000	1,068,900	18,189,900	0	18,189,900
General Fund, One-time	(788,900)	0	0	0	0	0	0	0	0
Federal Funds	17,917,600	22,298,100	24,886,800	26,067,300	24,886,800	1,180,500	26,067,300	0	26,067,300
American Recovery and Reinvestment Act	1,976,700	0	0	0	0	0	0	0	0
Transfers - Medicaid - DHS	0	0	0	2,300,000	0	0	0	0	0
Transfers - Within Agency	0	3,000,000	0	0	0	0	0	0	0
Lapsing Balance	0	0	0	(8,000)	0	0	0	0	0
Total	$32,717,900	$41,196,000	$42,007,800	$44,257,200	$42,007,800	$2,249,400	$44,257,200	$0	$44,257,200

Show Table | Show Additional Information

Categories of Expenditure	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Other Charges/Pass Thru	32,717,900	41,196,000	42,007,800	44,257,200	42,007,800	2,249,400	44,257,200	0	44,257,200
Total	$32,717,900	$41,196,000	$42,007,800	$44,257,200	$42,007,800	$2,249,400	$44,257,200	$0	$44,257,200

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.