FY 2019 HHS Budget Briefing Presentation

Health & Human Services Budget Briefing Fiscal Year 2019
Agenda

Welcome from the Governor's Office

• Chris Kantas, Senior Policy Advisor for Healthcare and Human Services

Agency Budget Presentations

• Director Felicia F. Norwood, Department of Healthcare and Family Services
• Secretary James T. Dimas, Department of Human Services
• Director Jean Bohnhoff, Department on Aging
• Director BJ Walker, Department of Children and Family Services
• Director Nirav D. Shah, Department of Public Health

Q&A

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Illinois Department of Healthcare and Family Services

HFS Mission

The Department of Healthcare and Family Services is committed to:

• Ensuring quality healthcare coverage at sustainable costs;
• Empowering people to make sound decisions about their well-being;
• Maintaining the highest standards of program integrity on behalf of the citizens of Illinois; and,
• Ensuring that families have the opportunities they deserve by establishing and enforcing child support obligations

Child Support Services

• Division of Child Support Services (DCSS) serves about 500,000 families who receive TANF and Medical Assistance or do not receive government assistance, but still need child support services
  • In Fiscal Year 2017, for the thirteenth straight year, the Department achieved collections of more than $1 billion, with a total of $1.42 billion - most of it passed on to families
  • HFS expects to collect $1.44 billion in child support during Fiscal Year 2018 and $1.46 billion in Fiscal Year 2019
• Implemented the Income Shares model, creating a more equitable method for allocating economic support for children
• Fiscal Year 2019 budget assumes that only 15 cents of every child support services operational dollar comes from the General Revenue Fund

Providing Healthcare Coverage

• HFS is the largest insurer in Illinois
• Current Medical Assistance Enrollment (November 2017): 3.08 million*
  • Children: 1.44 million
  • Seniors: 201,089
  • Adults with Disabilities: 244,828
  • Other Adults: 572,646
  • ACA Adults: 619,951

* Excludes enrollees in partial benefit programs

Medical Assistance Average Enrollment

Medical Assistance

Fiscal Year 2019 Budget Highlights

• Maintains current Medical Assistance eligibility and services
  • Including coverage for low income individuals under the Affordable Care Act (ACA)
• Includes Medicaid Transformation Funding
  • 1115 federal demonstration waiver and state plan amendments to better integrate physical and behavioral healthcare for Medicaid clients
• Assumes over 80% of clients enrolled in HealthChoice Illinois, the Medicaid Managed Care reboot
• Reflects a hospital assessment to preserve access to hospital services for Medicaid beneficiaries

Medical Assistance

Fiscal Year 2019 Budget Highlights

• Fiscal Year 2018 Supplemental Appropriation Requests
  • $442.8 million General Revenue Fund deposit to the Healthcare Provider Relief Fund (HPRF) to address the Fiscal Year 2018 HPRF cash shortfall resulting from a previously requested deposit that was not appropriated
  • $50.9 million addition to the Medical Assistance General Revenue Fund appropriation to fund unbudgeted cost increases resulting from the Fiscal Year 2018 Budget Implementation Bill
• Fiscal Year 2019 budget includes appropriation levels sufficient to allow HFS to continue processing Medical Assistance bills to the Comptroller on a timely basis

Medical Assistance

Fiscal Year 2019 Budget Reductions

• 4% provider rate reduction
  • Six months savings assumed in Fiscal Year 2019 - approximately $150 million
• Rescission of certain programmatic and reimbursement changes contained in the Fiscal Year 2018 Budget Implementation Bill
  • approximately $25 million savings

Affordable Care Act (ACA)

Enrollment

• 619,951 enrolled under the ACA as of November 2017
• Costs offset by high federal match rate for newly eligibles
  • Federal government paid 100% of costs through December 31, 2016
  • Match rate declined to 95% on January 1, 2017 and 94% on January 1, 2018; reduces to 93% effective January 1, 2019
  • Decreases to a floor of 90% on January 1, 2020
• 646,185 estimated average monthly enrollment in Fiscal Year 2018
• 654,634 projected average monthly enrollment in Fiscal Year 2019

Affordable Care Act (ACA)

Estimated Cost

• Fiscal Year 2018: $3.28 billion
  • General Revenue & Related Funds: $2.59 billion
    • $142.4 million net state cost
  • Cook County: $0.69 billion
  • $38.0 million net Cook County cost
• Fiscal Year 2019: $3.35 billion
  • General Revenue & Related Funds: $2.50 billion
    • $162.2 million net state cost
  • Cook County: $0.86 billion
    • $55.7 million net Cook County cost

Increases in Fiscal Year 2019 net state/Cook costs are due, in part, to declining ACA federal matching rates

Historical Medical Assistance Liability

GRF and Related Funds

Medical Assistance Program

Integrity Fraud & Abuse Prevention

• In FY 2017, the Inspector General achieved over $195 million in savings, cost avoidance and recoveries
• FY 2019 budget assumes resources for the Inspector General to combat waste, fraud and abuse in the Illinois Medical Assistance program
  • Quality control on Medical Assistance eligibility determinations and provider claims
  • Best Practice data analytics to identify outlier provider and client behavior
  • Provider payment audits
  • Client asset discovery
  • Provider and client investigations

Transforming Medical Assistance

HealthChoice Illinois: Managed Care Reboot

• Expands managed care program to cover over 80% of Medicaid beneficiaries
• Managed care now available in every county across the state
• Prior managed care was available only in 30 counties
• Reduced contracted Managed Care Organizations from twelve to seven
• HealthChoice Illinois contracts became effective January 1, 2018

Transforming Medical Assistance

HealthChoice Illinois

• Enhances focus on quality, outcomes and accountability
• Establishes vital guidelines for better care coordination, quality measures and access
• Emphasizes prevention and managing chronic illnesses to reduce costly and dangerous complications
• Streamlines procedures to better serve patient needs and providers, including uniform credentialing to reduce administrative costs
• Helps to realize the broad vision of the state's 1115 federal waiver proposal to better integrate physical and behavioral healthcare

Transforming Medical Assistance

1115 Federal Demonstration Waiver & State Plan Amendments

• Building a nation-leading behavioral health system
  • Rebalances the behavioral health delivery system, reducing over-reliance on institutional care and shifting to community-based care, where appropriate
  • Promotes integrated delivery of behavioral and physical health care
  • Provides infrastructure for achieving the goals of the N.B. v Norwood Consent Decree

Transforming Information Technology

Developing a state-of-the-art technology platform

• Replaces decades old systems that inhibit efficient and effective reporting, analytics and timely decision making
• New systems that enhance program integrity and increase efficiency and while reducing costs
• Major system milestones:
  • Provider Enrollment System (enabling Uniform Credentialing)
  • Integrated Eligibility System - Phases I & II
  • Pharmacy Benefit Management System
  • Data Analytics Platform (MedInsight) Implementation
  • Long Term Care Billing
  • Medicaid Management Information System (IMPACT - Phase II)
  • Enterprise Resource Planning (ERP) System
• Strong cooperation with the Department of Innovation & Technology (DoIT)

Program Area Appropriations Comparison (Dollars in Millions)

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Illinois Department of Human Services

James Dimas, Secretary

Our Vision, Mission, Values and Motto

Strategy to Execution Alignment

The Five Divisions of IDHS

FY 18-19 Strategic Priorities

• Increasing employment and self-sufficiency for individuals served in IDHS programs
• Improving system waiting time through higher throughput, diversion and more capacity
• Reducing the impact of the current opioid crisis

FY 19 Budget Overview

• Supporting the development and well-being of children aged birth to 3  through expanded Child Care Assistance Program eligibility and full funding of the Early Intervention Program
• Promoting positive development of youth and violence reduction through Community Youth Employment Program and Teen Reach
• Funding for long term supports and specialized housing for individuals with dual diagnoses and exceptional needs
• Supporting non-Medicaid reimbursable treatment and recovery for opioid use disorders
• Enhanced funding for Direct Support Professionals to serve individuals with developmental and intellectual disabilities in our communities
• Continued funding to comply with the reasonable pace standard referenced in the Ligas Consent Decree and seamless transitions to the community in the Williams Consent

FY 18 Outcomes

FY 19 Budget Comparison

Funding Source	Requested FY19 $s in thousands	FY 2018 Estimate Spending - No Supplemental $s in thousands	Change from FY 18 $s in thousands	Change from FY 18 (%)
GRF	$3,753,961.6	$3,742,748.3	$11,213.3	0.3%
Other State	$784,003.3	$771,775.1	$12,228.2	1.6%
Federal	$1,723,833.4	$1,753,287.9	($29,454.5)	(1.7%)
TOTAL	$6,261,798.3	$6,267,811.3	($6,013.0)	(0.1%)

The Division of Alcoholism and Substance Abuse (DASA)

The Division of Developmental Disabilities (DDD)

The Division of Developmental Disabilities (DDD)

The Division of Rehabilitation Services (DRS)

The Division of Rehabilitation Services (DRS)

The Division of Family and Community Services (DFCS)

The Division of Family & Community Services (DFCS)

The Division of Mental Health (DMH)

The Division of Mental Health (DMH)

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Illinois Department on Aging

FY 19 Governor's Introduces Budget

Governor Bruce Rauner

Director Jean Bohnhoff

Deputy Director Jennifer Reif

FY19 Budget Focus

• Encourage independence, dignity, and quality of life
• Sustain programs
• Deliver effective and efficient services and supports
• Increase awareness of abuse, neglect, and financial exploitation
• Maintain match and Maintenance of Effort for Federal programming

IDOA Fund Breakouts

General Funds (GF) includes both the General Revenue Fund and Commitment to Human Services Fund

Community Care Program Growth

• Enrollment in the Department on Aging's Community Care Program (CCP) has been growing reflecting the demographic changes in the overall population.
• Prior to the Managed Care (MCO) migration, the program grew 83% in a decade from 45,746 enrollees in 2007 to 85,424 enrollees in 2014.
• MCO migration began spring of FY14 and the caseload growth going forward reflects this. The MCO expansion in FY18 is reflected in the FY19 budget.
• Over the next 10 years, the projected growth in CCP caseload is 40%.

Community Care Program

Case Management

• $5.5 million increase for the overall enhancement of quality CCP service delivery, including:
  • Renewed focus on evolving client needs through redesigning of intensive casework and intensive monitoring.
  • Person-Centered Planning for all CCP participants to ensure compliance with the new federal Waiver requirements.
  • Renewed plan to enhance compliance with federal requirements for annual redeterminations for CCP participants.

Adult Protective Services

Long-term Care Ombudsman Services

• Beginning October 1, 2017, the Regional Ombudsman Programs are required to visit Medically Complex for the Developmentally Disabled Facilities (MC/DD) for residents ages 18+.
• As of June 1, 2017, individuals in the Home Services Program previously receiving assistance through the Client Assistance Program at the Department of Human Services (DHS) receive advocacy services through the Home Care Ombudsman Program.

 Nutrition Services

*Includes Appropriations for Home Delivered Meals, National Lunch Program, Nutrition Services Incentive Program, and Title III Meals Programs

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DCFS

FY 2019 Budget Briefing

February 14, 2019

Bruce Rauner, Govenor

BJ Walker,  Acting Director

Moral Imperatives

1. No child should grow up in foster care because every child needs a permanent family.
2. Every child who comes into our line of sight should be better off as a result.
3. We owe our front line staff a real opportunity to make the right decision on every family every time.

DCFS Operational Priorities

1. Decrease death and serious harm to children who come to the attention of DCFS.
2. Lift Illinois out of last place in the nation for achieving timely permanency.
3. Decrease the number of youth who are in inappropriate institutional placements - in psychiatric hospitals, in juvenile detention, in emergency shelters, or in congregate care beyond the time of its therapeutic value.
4. Achieve and maintain at least 95% compliance with court-ordered (B.H.) caseload standards as a key measure of our success in giving our staff the time to do high-quality work.
5. Ensure that every child, including those aging out of care, has a strong, healthy attachment to at least one stable, responsible, caring adult.

Child Protection Vacancies

Appropriation Summary

FY19 Budget Highlights

• Adoption/Guardianship:
  • +$4.0M for Faster Permanency Achievement
  • +$4.0M for Enhanced Post-Permanency Support (includes annualization of $2.9M award)
  • +$5.5M FY18 appropriation right-sizing
• Foster Care: -$3M shift to Adoption/Guardianship
• All Other Grants: Appropriation right-sizing as tax check-off funds are spent out.
• Personal Services: Fund 32 Intact positions to move 10% of the high risk cases back to the Department.
• All other operations: Fully funds staff at the Attorney General Bureau of Child Welfare Litigation
• Federal Funds: Appropriation right-sizing based on prior year expenditures & future projections for direct federal grants.

Child Welfare Financing Initiatives

Older Youth: Incentives for Independence - increased flexibility, self-determination, and Federal reimbursement

Title IV-E Capped Waiver - increased flexibility to invest in services to reduce foster care caseloads, decreased high cost placements, and increased permanency rates.

Federal Reimbursement Increase ($ in millions)

Category	FY16	FY17	FY18	FY19
Older youth	$15.2	$12.3	$11.7	$10.2
Title IV-E Capped Waiver		$17.4	$34.4	$26.2
Increased Claiming Revenue	$15.2	$29.7	$46.1	$36.4

FY19 Budget by Fund

Contact Information

The DCFS Budget Briefing Book will be available for review or download from the DCFS Website under the "DCFS Features" heading.

www.DCFS.illinois.gov

Proposed FY2019 Budget

Nirav D. Shah, M.D., J.D.

Human Services Budget Briefing

February 14, 2018

FY2019 IDPH Proposed Appropriations $620 Million

 Budget Comparisons:

FY2018 - Proposed FY2019 (millions)

FY2019 Proposed Budget Highlights

• New $1.6 million GRF appropriation to combat the opioid overdose crisis.
• $1.7 million GRF increase to maintain food, drug and dairy inspection and EMS testing programs.
• $100,000 GRF increase for the childhood vision and hearing testing program.
• $33 million increase in federal appropriations to enable additional federal spending where available.
• Local Health Protection Grant maintained at $18 million and continues to be funded from the PPTR fund.
• $15 million capital appropriation to partner with local contractors to remove sources of lead exposure from the residences of children with Elevated Blood Lead levels.