Fiscal Note & Local Impact Statement
127 th General Assembly of Ohio
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BILL: |
DATE: |
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STATUS: |
SPONSOR: |
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LOCAL IMPACT
STATEMENT REQUIRED: |
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CONTENTS: |
To revise the law governing the PASSPORT, Assisted Living
Medicaid waiver, and Residential State Supplement programs and to allow for
the transfer of funds for the operation of the programs |
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STATE FUND |
FY 2007 |
FY 2008 |
FUTURE YEARS |
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General Revenue Fund |
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Revenues |
Potential decrease in
federal Medicaid reimbursement |
Potential decrease in
federal Medicaid reimbursement |
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Expenditures |
- 0 - |
Potential decrease in
Medicaid costs in the millions of dollars; potential transfer out to SSR Fund
4J5; potential minimal increase for administrative costs relating to
reporting requirements |
Potential decrease in |
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State
Special Revenue Fund 4J4 (ALI 490-610, PASSPORT/RSS) |
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Revenues |
- 0 - |
- 0 - |
- 0 - |
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Expenditures |
- 0 - |
Potential transfer out to |
Potential transfer out to |
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State
Special Revenue Fund 4J5 (ALI 600-618, Residential State Supplement Payments) |
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Revenues |
- 0 - |
Potential transfer in from
GRF and Fund 4J4 |
Potential transfer in from
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Expenditures |
- 0 - |
Potential increase |
Potential increase |
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Federal
Special Revenue Fund 3C4 (ALI 490-607, PASSPORT) |
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Revenues |
- 0 - |
Potential increase in
federal Medicaid reimbursement |
Potential increase in
federal Medicaid reimbursement |
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Expenditures |
- 0 - |
Potential increase |
Potential increase |
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Federal
Special Revenue Fund 3G5 (ALI 600-655, Interagency Reimbursement) |
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Revenues |
- 0 - |
Potential increase in
federal Medicaid reimbursement |
Potential increase in
federal Medicaid reimbursement |
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Expenditures |
- 0 - |
Potential increase |
Potential increase |
Note: The state
fiscal year is July 1 through June 30.
For example, FY 2007 is July 1, 2006 – June 30, 2007.
·
Medicaid
expenditures from the General Revenue Fund (GRF) as well as federal Medicaid
reimbursement will likely decrease as persons who would otherwise be served in
a nursing facility would be served in a less costly setting such as their own
homes under the PASSPORT Medicaid waiver program, an assisted living facility
under the Assisted Living Medicaid waiver program, or a residential care
facility through the Residential State Supplement (RSS) program. The savings is likely to be in the millions
of dollars. The PASSPORT and Assisted
Living programs are currently funded out of GRF appropriation item 600-525,
Health Care/Medicaid, in the Department of Job and Family Services' (ODJFS)
budget. Federal Medicaid reimbursement
for expenditures from this appropriation item are deposited directly into the
GRF.
·
PASSPORT,
Assisted Living, and RSS expenditures from the General Revenue Fund as well as
applicable State Special Revenue Fund and Federal Special Revenue Fund
expenditures will likely increase as persons who would otherwise be served in a
nursing facility would instead be served in one of those three programs. The bill requires the Director of Budget and
Management, on a quarterly basis, to transfer the state share of the amount of
the estimated costs for the PASSPORT and RSS programs from GRF appropriation
item 600-525, Health Care/Medicaid, to GRF appropriation items 490-403,
PASSPORT, and 490-412, Residential State Supplement, in the Department of
Aging's budget. In addition, the
Director of Budget and Management is to increase the appropriation in Ohio
Department of Aging Fund 3C4, appropriation item 490-607, PASSPORT, ODJFS Fund
3G5, appropriation item 600-655, Interagency Reimbursement, by the federal
share of the amount of the estimated costs.
·
The
Department of Aging may transfer cash by intrastate transfer vouchers from
appropriation items 490-412, Residential State Supplement, and 490-610,
PASSPORT/Residential State Supplement, to the Department of Job and Family
Services' Fund 4J5, Home and Community-Based Services for the Aged Fund. The funds are to be used to make benefit
payments to Residential State Supplement recipients.
·
The
funds transferred and increased under the bill are appropriated.
·
The
bill creates additional administrative duties for the departments of Aging and
Job and Family Services. The bill
requires the Department of Aging to certify to the Director of Budget and
Management the estimated increase in costs of the RSS and PASSPORT programs
resulting from enrollment of individuals into the programs. Additionally, the Director of Aging must
submit to the General Assembly a report regarding the number of individuals
enrolled in the RSS program and the costs incurred and savings achieved as a
result of the enrollments. Likewise,
the Director of ODJFS must submit to the General Assembly a report regarding
the number of individuals enrolled in the PASSPORT program and the costs
incurred and savings achieved as a result of the enrollments. Lastly, the bill requires the Director of
ODJFS to submit to the U.S. Secretary of Health and Human Services an amendment
to the PASSPORT waiver that authorizes additional enrollments in the PASSPORT
program. These requirements are likely
to increase administrative costs for the departments of Job and Family Services
and Aging. Any increase is likely to be
minimal.
·
The
area agencies on aging will likely experience an increase in administrative
costs. Those increased costs associated
with the PASSPORT and Assisted Living programs would be paid using state and
federal dollars. Increased
administrative costs for case management for the Residential State Supplement
program would be paid for out of state dollars.
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The
bill revises the law governing the PASSPORT Medicaid waiver, Assisted Living
Medicaid waiver, and Residential State Supplement programs and allows for the
transfer of funds for the operation of the programs.
PASSPORT
The PASSPORT program allows
Medicaid long-term care funds to be used for community-based services. The program is provided through a Medicaid
waiver. To be eligible for the program,
the person must be over age 60 and meet Medicaid eligibility for nursing home
care. Costs for care plans may not
exceed 60% of the cost of nursing home care.
The bill provides for an
individual admitted to a nursing facility while on a waiting list for PASSPORT
to be placed in the PASSPORT program if it is determined that the PASSPORT
program is appropriate for the individual and the individual would rather
participate in the PASSPORT program than reside in the nursing facility. The bill also requires the Department of Job
and Family Services (ODJFS) to apply for a waiver with the Secretary of Health
and Human Services to authorize additional enrollments for the PASSPORT
program. The provisions of the bill
dealing with PASSPORT would codify temporary law (Section 206.66.64 of Am. Sub.
H.B. 66 of the 126th General Assembly).
These provisions are currently being implemented as the Home First
program. As of December 31, 2006, there
were 1,526 persons who are being served in PASSPORT as a result of the Home
First program. According to the
Department of Aging, as of January 2007, there were 1,102 persons on the
waiting list for PASSPORT services.
According to ODJFS, the per eligible per month expenditures for PASSPORT
services (including both waiver services and Medicaid card services) was
$1,478.85 in state fiscal year (SFY) 2003.
The state and federal costs of providing PASSPORT services to the 1,102
persons currently on the PASSPORT waiting list onto PASSPORT would be
approximately $19.6 million each year.
Please note the estimated costs and savings provided in this section
of the fiscal note represent a full year's costs and savings for all 1,102
potential participants. This
overestimates the total cost and savings, as not all persons would leave their
current setting. Additionally,
increased enrollment in the PASSPORT program would occur gradually over time,
not all at once as is assumed in the estimate. ODJFS reports the per eligible per month expenditures for nursing
facility (NF) services was $4,600.43 in SFY 2003. The state and federal costs of providing NF services for the
1,102 persons currently on the PASSPORT waiting list would be approximately
$60.8 million each year. The
estimated annual state and federal savings by serving these individuals on the
PASSPORT program rather than in a nursing facility would be approximately $41.3
million. LSC staff estimated the annual
savings by subtracting the estimated PASSPORT costs from the NF services costs
for the 1,102 persons currently on the PASSPORT waiting list. To determine the federal and state shares of
the savings, LSC staff applied the Federal Medicaid Assistance Percentage
(FMAP) for Ohio. For every one dollar
Ohio spends on Medicaid, the federal government gives Ohio approximately 60
cents. Thus, state share savings could
be up to approximately $16.5 million each year.
Assisted Living Medicaid Waiver Program
The Assisted Living program,
which is a Medicaid waiver program, was created in Am. Sub. H.B. 66 of the
126th General Assembly and began July 1, 2006.
The program offers an alternative service delivery in the community for
people who are coming from a nursing home or from a home and community-based
services (HCBS) waiver. The program is
only available in licensed residential care facilities. To be eligible for the program, a person
must be a current nursing facility resident or existing Medicaid waiver
participant, be age 21 or older, need hands-on assistance with certain
activities of daily living such as dressing and bathing, be able to pay room
and board, and meet the financial criteria for Medicaid eligibility.
The bill provides for an
individual admitted to a nursing facility who is eligible for the Medicaid
program to be provided with information about how to apply for the Assisted
Living program. The bill also expands
eligibility for the Assisted Living program.
The following groups are added to the list of eligible
participants: (1) a resident of a
residential care facility who has resided in a residential care facility for at
least six months immediately before the date the individual applies for the
Assisted Living program, and (2) an individual who is on a waiting list for the
Residential State Supplement (RSS) program.
Enrollment in the Assisted Living program is capped at 1,800. According to the Office of Budget and
Management (OBM), there were 1,713 open slots for the Assisted Living Medicaid
waiver program (1,800 slots with 87 slots taken as of December 31, 2006). According to OBM, the average monthly cost
for Assisted Living services was $1,800 per month in SFY 2006. The cost for enrolling individuals into the
1,713 open Assisted Living slots would be approximately $37.0 million each
year. Funds in GRF appropriation item
600-525 for SFYs 2006 and 2007 have been made available to fund Assisted
Living. Please note the estimated
costs and savings provided in this section of the fiscal note represent a full
year's costs and savings for all 1,713 potential participants. This overestimates the total cost and
savings, as not all persons would leave their current setting. Additionally, increased enrollment in the
Assisted Living program would occur gradually over time, not all at once as is
assumed in the estimate. ODJFS
reports the per eligible per month expenditures for NF services was $4,600.43
in SFY 2003. The state and federal
costs for NF services for the 1,713 persons would be approximately $94.6
million each year. The estimated annual
state and federal savings by serving these individuals on the Assisted Living
program rather than in a nursing facility would be up to $57.6 million. LSC staff estimated the total annual state
and federal savings by subtracting the Assisted Living costs from the NF
services costs for the 1,713 open Assisted Living slots. To determine the federal and state shares of
the savings, LSC staff applied the Federal Medicaid Assistance Percentage
(FMAP) for Ohio. For every one dollar
Ohio spends on Medicaid, the federal government gives Ohio approximately 60
cents. Thus, state share savings could
be up to approximately $23.0 million each year.
Residential State Supplement
(RSS)
The
RSS program provides a cash supplement to qualified individuals to assist in
obtaining housing in approved living arrangements. The arrangements include adult foster homes, adult care
facilities, residential care facilities, rooms or apartments licensed by the
Ohio Department of Mental Health (ODMH), and residential facilities licensed by
ODMH. The RSS program is paid for with
state funding. To be eligible for the
program, a person must be 18 years of age or older, not need 24-hour
supervision, require a protective level of care, require less than 120 days of
skilled nursing care, and not have a monthly income greater than $800 ($700 if
living in an adult family home or adult foster home). Also, persons may not have more than $1,500 in assets.
The bill provides for an
individual admitted to a nursing facility while on a waiting list for the RSS
program to participate in the RSS program if it is determined that the RSS
program is appropriate for the individual and the individual would rather
participate in the RSS program than continue to reside in the nursing
facility. According to documents
provided by the Department of Aging, there are approximately 1,000 persons on
the waiting list for RSS services.
According to the Association of Area Agencies on Aging, the state
provided a monthly cash supplement of, on average, $470 in SFY 2005. The cost for enrolling the 1,000 persons
currently on the RSS waiting list onto RSS would be approximately $5.6 million
each year. Please note the estimated
costs and savings provided in this section of the fiscal note represent a full
year's costs and savings for all 1,000 potential participants. This overestimates the total cost and
savings, as not all persons would leave their current setting. Additionally, increased enrollment in the
RSS program would occur gradually over time, not all at once as is assumed in
the estimate. ODJFS reports the per
eligible per month expenditures for NF services was $4,600.43 in SFY 2003. The state and federal costs for NF services
for the 1,000 persons currently on the RSS waiting list would be approximately
$55.2 million each year. The
estimated annual savings by serving these individuals on the RSS program rather
than in a nursing facility could be up to approximately $49.6 million. LSC staff estimated the total annual savings
by subtracting the estimated RSS costs from the estimated NF services costs for
the 1,000 persons currently on the RSS waiting list. Moreover, some of the 1,000 persons, those who have been a
resident of a residential care facility for at least six months, might move
from RSS to Assisted Living under the bill.
For these people the savings would be less than what is estimated above.
Funding
On a quarterly basis, on
receipt of the certified costs, the Director of Budget and Management must do
all of the following:
(1)
Transfer
the state share of the amount of the estimated costs from GRF appropriation
item 600-525, Health Care/Medicaid, to GRF appropriation item 490-403,
PASSPORT;
(2)
Increase
the appropriation in Ohio Department of Aging Fund 3C4, appropriation item
490-607, PASSPORT, by the federal share of the amount of the estimated costs;
(3)
Increase
the appropriation in ODJFS' Fund 3G5, appropriation item 600-655, Interagency
Reimbursement, by the federal share of the amount of the estimated costs.
In addition, on a quarterly
basis, on receipt of the certified costs, the Director of Budget and Management
must do all of the following:
(1)
Transfer
the state share of the amount of the estimated costs from GRF appropriation
item 600-525, Health Care/Medicaid, to GRF appropriation item 490-412,
Residential State Supplement;
(2)
The
Department of Aging may transfer cash by intrastate transfer vouchers from the
foregoing appropriation items 490-412, Residential State Supplement, and
490-610, PASSPORT/Residential State Supplement, to the Department of Job and
Family Services' Fund 4J5, Home and Community-Based Services for the Aged
Fund. The funds must be used to make
benefit payments to Residential State Supplement recipients.
The funds transferred and
increased under this division are appropriated.
Local Costs
The area agencies on aging
will likely experience an increase in administrative costs as a result of the
bill. Those increased costs associated
with the PASSPORT and Assisted Living programs would be paid using state and
federal dollars. Increased
administrative costs for case management for the Residential State Supplement
program would be paid for out of state dollars.
Additional Requirements
The bill requires the
Director of ODJFS to submit to the U.S. Secretary of Health and Human Services
an amendment to the PASSPORT waiver that authorizes additional enrollments in
the PASSPORT program. The bill requires
the Department of Aging to certify to the Director of Budget and Management the
estimated increase in costs of the PASSPORT program resulting from enrollment
of individuals into the program.
Additionally, not later than the last day of each calendar year, the
Director of ODJFS must submit to the General Assembly a report regarding the
number of individuals enrolled in the PASSPORT program and the costs incurred
and savings achieved as a result of the enrollments. The bill requires the Department of Aging to certify to the
Director of Budget and Management the estimated increase in costs of the RSS
program resulting from enrollment of individuals into the program. Additionally, not later than the last day of
each calendar year, the Director of Aging must submit to the General Assembly a
report regarding the number of individuals enrolled in the RSS program and the
costs incurred and savings achieved as a result of the enrollments.
The requirements listed
above are likely to increase administrative costs for the departments of Aging
and Job and Family Services. Any
increase is likely to be minimal.
LSC fiscal
staff: Wendy Risner,
Senior Budget Analyst