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Interim Section 1115 Demonstration Application Budget Neutrality Table Shell
| 5 YEARS OF HISTORIC DATA | ||||||
|---|---|---|---|---|---|---|
| SPECIFY TIME PERIOD AND ELIGIBILITY GROUP DEPICTED: 4/1/15 - 3/31/2020 | ||||||
| MEG 1: TANF Children 1-20 | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 5,586,129,618 | $ 6,154,412,350 | $ 5,864,911,169 | $ 6,085,145,288 | $ 6,038,323,930 | $ 29,728,922,355 |
| ELIGIBLE MEMBER MONTHS | 22,678,974 | 22,442,438 | 22,526,355 | 22,591,821 | 21,987,344 | |
| PMPM COST | $ 246.31 | $ 274.23 | $ 260.36 | $ 269.35 | $ 274.63 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 10.17% | -4.70% | 3.76% | -0.77% | 1.97% | |
| ELIGIBLE MEMBER MONTHS | -1.04% | 0.37% | 0.29% | -2.68% | -0.77% | |
| PMPM COST | 11.33% | -5.06% | 3.45% | 1.96% | 2.76% | |
| MEG 2: TANF Adults 21-64 | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 2,632,517,110 | $ 3,255,911,193 | $ 3,702,105,232 | $ 4,100,741,642 | $ 4,219,906,530 | $ 17,911,181,708 |
| ELIGIBLE MEMBER MONTHS | 4,466,931 | 4,889,199 | 5,555,130 | 5,825,879 | 5,828,164 | |
| PMPM COST | $ 589.33 | $ 665.94 | $ 666.43 | $ 703.88 | $ 724.05 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 23.68% | 13.70% | 10.77% | 2.91% | 12.52% | |
| ELIGIBLE MEMBER MONTHS | 9.45% | 13.62% | 4.87% | 0.04% | 6.88% | |
| PMPM COST | 13.00% | 0.07% | 5.62% | 2.87% | 5.28% | |
| MEG 3: SSI 0-64 | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 8,029,513,853 | $ 9,092,654,785 | $ 8,898,624,284 | $ 9,608,184,149 | $ 9,557,310,214 | $ 45,186,287,285 |
| ELIGIBLE MEMBER MONTHS | 4,721,231 | 4,712,379 | 4,656,524 | 4,605,201 | 4,495,199 | |
| PMPM COST | $ 1,700.72 | $ 1,929.53 | $ 1,911.00 | $ 2,086.38 | $ 2,126.12 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 13.24% | -2.13% | 7.97% | -0.53% | 4.45% | |
| ELIGIBLE MEMBER MONTHS | -0.19% | -1.19% | -1.10% | -2.39% | -1.22% | |
| PMPM COST | 13.45% | -0.96% | 9.18% | 1.90% | 5.74% | |
| MEG 4: SSI 65+ | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 755,360,818 | $ 873,551,665 | $ 874,568,226 | $ 871,513,244 | $ 834,608,635 | $ 4,209,602,588 |
| ELIGIBLE MEMBER MONTHS | 518,622 | 538,787 | 544,851 | 479,188 | 422,996 | |
| PMPM COST | $ 1,456.48 | $ 1,621.33 | $ 1,605.15 | $ 1,818.73 | $ 1,973.09 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 15.65% | 0.12% | -0.35% | -4.23% | 2.53% | |
| ELIGIBLE MEMBER MONTHS | 3.89% | 1.13% | -12.05% | -11.73% | -4.97% | |
| PMPM COST | 11.32% | -1.00% | 13.31% | 8.49% | 7.88% | |
| MEG 5: Non-duals 18-64 | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 750,875,464 | $ 903,445,918 | $ 949,951,510 | $ 1,083,158,358 | $ 1,274,295,860 | $ 4,961,727,109 |
| ELIGIBLE MEMBER MONTHS | 144,789 | 137,233 | 149,437 | 164,551 | 188,409 | |
| PMPM COST | $ 5,186.00 | $ 6,583.30 | $ 6,356.87 | $ 6,582.51 | $ 6,763.46 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 20.32% | 5.15% | 14.02% | 17.65% | 14.14% | |
| ELIGIBLE MEMBER MONTHS | -5.22% | 8.89% | 10.11% | 14.50% | 6.80% | |
| PMPM COST | 26.94% | -3.44% | 3.55% | 2.75% | 6.86% | |
| MEG 6: Non-duals 65+ | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 143,965,478 | $ 220,960,402 | $ 295,820,509 | $ 354,334,729 | $ 414,228,082 | $ 1,429,309,201 |
| ELIGIBLE MEMBER MONTHS | 26,401 | 36,198 | 49,898 | 56,381 | 63,001 | |
| PMPM COST | $ 5,453.03 | $ 6,104.22 | $ 5,928.50 | $ 6,284.65 | $ 6,574.94 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 53.48% | 33.88% | 19.78% | 16.90% | 30.24% | |
| ELIGIBLE MEMBER MONTHS | 37.11% | 37.85% | 12.99% | 11.74% | 24.29% | |
| PMPM COST | 11.94% | -2.88% | 6.01% | 4.62% | 4.79% | |
| MEG 7: MLTC Adult 18-64 Duals | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 773,337,264 | $ 1,072,939,162 | $ 1,300,636,638 | $ 1,670,557,639 | $ 2,022,609,178 | $ 6,840,079,881 |
| ELIGIBLE MEMBER MONTHS | 354,048 | 399,610 | 447,328 | 498,836 | 555,092 | |
| PMPM COST | $ 2,184.27 | $ 2,684.97 | $ 2,907.57 | $ 3,348.91 | $ 3,643.74 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 38.74% | 21.22% | 28.44% | 21.07% | 27.17% | |
| ELIGIBLE MEMBER MONTHS | 12.87% | 11.94% | 11.51% | 11.28% | 11.90% | |
| PMPM COST | 22.92% | 8.29% | 15.18% | 8.80% | 13.65% | |
| MEG 8: MLTC Adult 65+ Duals | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 5,694,543,385 | $ 7,721,649,436 | $ 9,012,023,244 | $ 10,989,162,338 | $ 12,779,794,887 | $ 46,197,173,290 |
| ELIGIBLE MEMBER MONTHS | 1,496,246 | 1,756,069 | 2,015,577 | 2,263,607 | 2,519,028 | |
| PMPM COST | $ 3,805.89 | $ 4,397.12 | $ 4,471.19 | $ 4,854.71 | $ 5,073.30 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 35.60% | 16.71% | 21.94% | 16.29% | 22.40% | |
| ELIGIBLE MEMBER MONTHS | 17.36% | 14.78% | 12.31% | 11.28% | 13.91% | |
| PMPM COST | 15.53% | 1.68% | 8.58% | 4.50% | 7.45% | |
| MEG 9: HCBS Expansion | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 7,256 | $ 43,568 | $ 235,956 | $ 632,113 | $ 805,322 | $ 1,724,215 |
| ELIGIBLE MEMBER MONTHS | 8 | 59 | 150 | 285 | 330 | |
| PMPM COST | $ 907.03 | $ 738.45 | $ 1,573.04 | $ 2,217.94 | $ 2,440.37 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 500.43% | 441.58% | 167.89% | 27.40% | 224.57% | |
| ELIGIBLE MEMBER MONTHS | 637.50% | 154.24% | 90.00% | 15.79% | 153.43% | |
| PMPM COST | -18.59% | 113.02% | 41.00% | 10.03% | 28.07% | |
| MEG 10: Institution to Community | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 13,566,824 | $ 12,140,947 | $ 14,407,823 | $ 16,282,446 | $ 17,745,927 | $ 74,143,966 |
| ELIGIBLE MEMBER MONTHS | 4,120 | 5,709 | 4,817 | 4,688 | 5,071 | |
| PMPM COST | $ 3,292.92 | $ 2,126.63 | $ 2,991.04 | $ 3,473.22 | $ 3,499.49 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | -10.51% | 18.67% | 13.01% | 8.99% | 6.94% | |
| ELIGIBLE MEMBER MONTHS | 38.57% | -15.62% | -2.68% | 8.17% | 5.33% | |
| PMPM COST | -35.42% | 40.65% | 16.12% | 0.76% | 1.53% | |
| MEG 11: New Adult Group | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 10,200,637,775 | $ 11,464,039,274 | $ 11,591,828,283 | $ 12,482,866,056 | $ 12,530,067,141 | $ 58,269,438,531 |
| ELIGIBLE MEMBER MONTHS | 20,577,615 | 20,723,285 | 20,631,294 | 20,569,077 | 20,062,096 | |
| PMPM COST | $ 495.72 | $ 553.20 | $ 561.86 | $ 606.88 | $ 624.56 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 12.39% | 1.11% | 7.69% | 0.38% | 5.28% | |
| ELIGIBLE MEMBER MONTHS | 0.71% | -0.44% | -0.30% | -2.46% | -0.63% | |
| PMPM COST | 11.60% | 1.57% | 8.01% | 2.91% | 5.95% | |
| MEG 12: Family of One Non-1915 Children | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ - | $ - | $ - | $ 4,604,373 | $ 32,787,483 | $ 37,391,856 |
| ELIGIBLE MEMBER MONTHS | - | - | - | 818 | 6,882 | |
| PMPM COST | $ - | $ - | $ - | $ 5,628.82 | $ 4,764.24 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 0.00% | 0.00% | 0.00% | 612.09% | 0.00% | |
| ELIGIBLE MEMBER MONTHS | 0.00% | 0.00% | 0.00% | 741.32% | 0.00% | |
| PMPM COST | 0.00% | 0.00% | 0.00% | -15.36% | -15.36% | |
| ALL MEGS: Total | HY 1 (DY17 4/1/15-3/31/16) |
HY 2 (DY18 4/1/16-3/31/17) |
HY 3 (DY19 4/1/17-3/31/18) |
HY 4 (DY20 4/1/18-3/31/19) |
HY 5 (DY21 4/1/19-3/31/20) |
5-YEARS |
| TOTAL EXPENDITURES | $ 34,580,454,844 | $ 40,771,748,702 | $ 42,505,112,874 | $ 47,267,182,376 | $ 49,722,483,189 | $ 214,846,981,985 |
| ELIGIBLE MEMBER MONTHS | 54,988,985 | 55,640,966 | 56,581,361 | 57,060,332 | 56,133,612 | |
| PMPM COST | $ 628.86 | $ 732.76 | $ 751.22 | $ 828.37 | $ 885.79 | |
| TREND RATES | 5-YEAR | |||||
| ANNUAL CHANGE | AVERAGE | |||||
| TOTAL EXPENDITURE | 17.90% | 4.25% | 11.20% | 5.19% | 9.50% | |
| ELIGIBLE MEMBER MONTHS | 1.19% | 1.69% | 0.85% | -1.62% | 0.52% | |
| PMPM COST | 16.52% | 2.52% | 10.27% | 6.93% | 8.94% | |
Health Insurance Flexibility and Accountability Demonstration Cost Data
Demonstration Without Waiver (WOW) Budget Projection: Coverage Costs for Populations
ELIGIBILITY
GROUPTREND
RATE 1MONTHS
OF AGINGBASE YEAR TREND
RATE 2DEMONSTRATION YEARS (DY) TOTAL
WOWDY 22
(4/1/20 - 3/31/21)DY 22
(4/1/20 - 3/31/21)DY 24
(4/1/22 - 3/31/23)DY 25
(4/1/23 - 3/31/24)MEG 1: TANF Children 1-20 Pop Type: Medicaid Eligible Member Months 0.0% 12 21,987,344 0.0% 21,987,344 21,987,344 21,987,344 PMPM Cost 4.8% 12 $ 287.85 4.8% $ 301.71 $ 316.23 $ 331.45 Total Expenditure $ 6,633,801,558 $ 6,953,057,793 $ 7,287,705,169 $ 20,874,564,520 MEG 2: TANF Adults 21-64 Pop Type: Medicaid Eligible Member Months 0.6% 12 5,865,051 0.6% 5,902,172 5,939,527 5,977,119 PMPM Cost 4.7% 12 $ 758.31 4.7% $ 794.19 $ 831.77 $ 871.12 Total Expenditure $ 4,687,445,732 $ 4,940,320,542 $ 5,206,788,032 $ 14,834,554,306 MEG 3: SSI 0-64 Pop Type: Medicaid Eligible Member Months 0.0% 12 4,495,199 0.0% 4,495,199 4,495,199 4,495,199 PMPM Cost 4.6% 12 $ 2,224.79 4.6% $ 2,328.04 $ 2,436.08 $ 2,549.14 Total Expenditure $ 10,465,003,080 $ 10,950,664,380 $ 11,458,891,579 $ 32,874,559,039 MEG 4: SSI 65+ Pop Type: Medicaid Eligible Member Months 0.0% 12 422,996 0.0% 422,996 422,996 422,996 PMPM Cost 4.7% 12 $ 2,066.55 4.7% $ 2,164.44 $ 2,266.96 $ 2,374.34 Total Expenditure $ 915,549,462 $ 958,915,012 $ 1,004,336,323 $ 2,878,800,797 MEG 5: Non-duals 18-64 Pop Type: Medicaid Eligible Member Months 0.9% 12 190,122 0.9% 191,850 193,594 195,354 PMPM Cost 4.6% 12 $ 7,077.34 4.6% $ 7,405.80 $ 7,749.50 $ 8,109.15 Total Expenditure $ 1,420,804,138 $ 1,500,258,894 $ 1,584,156,760 $ 4,505,219,792 MEG 6: Non-duals 65+ Pop Type: Medicaid Eligible Member Months 3.1% 12 64,970 3.1% 67,000 69,094 71,253 PMPM Cost 4.7% 12 $ 6,886.38 4.7% $ 7,212.57 $ 7,554.21 $ 7,912.03 Total Expenditure $ 483,242,808 $ 521,949,364 $ 563,756,038 $ 1,568,948,210 MEG 7: MLTC Adult 18-64 Duals Pop Type: Medicaid Eligible Member Months 0.9% 12 560,138 0.9% 565,230 570,369 575,554 PMPM Cost 4.6% 12 $ 3,812.84 4.6% $ 3,989.79 $ 4,174.95 $ 4,368.71 Total Expenditure $ 2,255,150,822 $ 2,381,261,702 $ 2,514,428,895 $ 7,150,841,419 MEG 8: MLTC Adult 65+ Duals Pop Type: Medicaid Eligible Member Months 3.1% 12 2,597,748 3.1% 2,678,927 2,762,644 2,848,976 PMPM Cost 4.7% 12 $ 5,313.61 4.7% $ 5,565.30 $ 5,828.91 $ 6,105.01 Total Expenditure $ 14,909,033,788 $ 16,103,201,605 $ 17,393,029,021 $ 48,405,264,414 MEG 9: HCBS Expansion Pop Type: Medicaid Eligible Member Months 0.8% 12 333 0.8% 335 338 340 PMPM Cost 4.7% 12 $ 2,556.01 4.7% $ 2,677.13 $ 2,803.99 $ 2,936.86 Total Expenditure $ 896,889 $ 946,506 $ 998,868 $ 2,842,263 MEG 10: Institution to Community Pop Type: Medicaid Eligible Member Months 0.8% 12 5,109 0.8% 5,148 5,187 5,226 PMPM Cost 1.5% 12 $ 3,553.03 1.5% $ 3,607.39 $ 3,662.58 $ 3,718.62 Total Expenditure $ 18,571,304 $ 18,998,274 $ 19,435,089 $ 57,004,667 MEG 11: New Adult Group Pop Type: Medicaid Eligible Member Months 0.0% 12 20,062,096 0.0% 20,062,096 20,062,096 20,062,096 PMPM Cost 4.7% 12 $ 654.11 4.7% $ 685.06 $ 717.47 $ 751.42 Total Expenditure $ 13,743,739,486 $ 14,393,952,017 $ 15,075,060,176 $ 43,212,751,679 MEG 12: Family of One Non-1915 Children Pop Type: Medicaid Eligible Member Months 0.0% 12 6,882 0.0% 6,882 6,882 6,882 PMPM Cost 0.0% 12 $ 4,764.24 0.0% $ 4,764.24 $ 4,764.24 $ 4,764.24 Total Expenditure $ 32,787,500 $ 32,787,500 $ 32,787,500 $ 98,362,499 ALL MEGS Pop Type: Medicaid Eligible Member Months 56,385,180 56,515,270 56,648,340 PMPM Cost $ 985.47 $ 1,039.65 $ 1,096.97 Total Expenditure $ 55,566,026,567 $ 58,756,313,589 $ 62,141,373,450 $ 176,463,713,605 Other Minimum Wage PMPM Impact Pop Type: Medicaid Eligible Member Months 56,385,180 56,515,270 56,648,340 PMPM Cost $ 0.10 $ 0.13 $ 0.15 Total Expenditure $ 5,687,422 $ 7,585,549 $ 8,486,891 $ 21,759,862 Other: MLTC NEMT Carve-out Pop Type: Medicaid Eligible Member Months PMPM Cost Total Expenditure $ 291,604,197 $ 285,749,008 $ 293,236,885 $ 870,590,090 Other: Pharmacy Carve-out Pop Type: Medicaid Eligible Member Months PMPM Cost Total Expenditure $ 6,282,375,003 $ 6,003,296,390 $ 6,007,036,918 $ 18,292,708,311 Demonstration with Waiver (WW) Budget Projection: Coverage Costs for Populations
ELIGIBILITY GROUP DY 22
(4/1/20 - 3/31/21)WW Trend
RateDEMONSTRATION YEARS (DY) TOTAL WW DY 23
(4/1/21 - 3/31/22)DY 24
(4/1/22 - 3/31/23)DY 25
(4/1/23 - 3/31/24)MEG 1: TANF Children 1-20 Pop Type: Medicaid Eligible Member Months 21,987,344 0.0% 21,987,344 21,987,344 21,987,344 PMPM Cost $ 282.50 2.9% $ 290.59 $ 298.92 $ 307.49 Total Expenditure $ 6,389,302,293 $ 6,572,456,868 $ 6,760,888,407 $ 19,722,647,568 MEG 2: TANF Adults 21-64 Pop Type: Medicaid Eligible Member Months 5,865,051 0.6% 5,902,172 5,939,527 5,977,119 PMPM Cost $ 745.45 3.0% $ 767.47 $ 790.15 $ 813.50 Total Expenditure $ 4,529,739,704 $ 4,693,117,420 $ 4,862,386,427 $ 14,085,243,551 MEG 3: SSI 0-64 Pop Type: Medicaid Eligible Member Months 4,495,199 0.0% 4,495,199 4,495,199 4,495,199 PMPM Cost $ 2,240.79 5.4% $ 2,361.65 $ 2,489.03 $ 2,623.28 Total Expenditure $ 10,616,086,718 $ 11,188,685,167 $ 11,792,165,633 $ 33,596,937,518 MEG 4: SSI 65+ Pop Type: Medicaid Eligible Member Months 422,996 0.0% 422,996 422,996 422,996 PMPM Cost $ 2,079.51 5.4% $ 2,191.67 $ 2,309.88 $ 2,434.47 Total Expenditure $ 927,067,643 $ 977,070,000 $ 1,029,771,072 $ 2,933,908,716 MEG 5: Non-duals 18-64 Pop Type: Medicaid Eligible Member Months 190,122 0.9% 191,850 193,594 195,354 PMPM Cost $ 6,819.41 0.8% $ 6,875.82 $ 6,932.70 $ 6,990.05 Total Expenditure $ 1,319,127,374 $ 1,342,131,084 $ 1,365,535,841 $ 4,026,794,299 MEG 6: Non-duals 65+ Pop Type: Medicaid Eligible Member Months 64,970 3.1% 67,000 69,094 71,253 PMPM Cost $ 6,629.34 0.8% $ 6,684.18 $ 6,739.48 $ 6,795.23 Total Expenditure $ 447,840,632 $ 465,656,541 $ 484,180,664 $ 1,397,677,838 MEG 7: MLTC Adult 18-64 Duals Pop Type: Medicaid Eligible Member Months 560,138 0.9% 565,230 570,369 575,554 PMPM Cost $ 3,673.88 0.8% $ 3,704.27 $ 3,734.92 $ 3,765.82 Total Expenditure $ 2,093,766,222 $ 2,130,282,268 $ 2,167,433,092 $ 6,391,481,582 MEG 8: MLTC Adult 65+ Duals Pop Type: Medicaid Eligible Member Months 2,597,748 3.1% 2,678,927 2,762,644 2,848,976 PMPM Cost $ 5,115.27 0.8% $ 5,157.59 $ 5,200.26 $ 5,243.28 Total Expenditure $ 13,816,808,361 $ 14,366,465,630 $ 14,937,980,643 $ 43,121,254,635 MEG 9: HCBS Expansion Pop Type: Medicaid Eligible Member Months 333 0.8% 335 338 340 PMPM Cost $ 2,556.01 4.7% $ 2,677.13 $ 2,803.99 $ 2,936.86 Total Expenditure $ 896,889 $ 946,506 $ 998,868 $ 2,842,263 MEG 10: Institution to Community Pop Type: Medicaid Eligible Member Months 5,109 0.8% 5,148 5,187 5,226 PMPM Cost $ 3,553.13 1.5% $ 3,607.59 $ 3,662.88 $ 3,719.02 Total Expenditure $ 18,572,334 $ 18,999,830 $ 19,437,180 $ 57,009,344 MEG 11: New Adult Group Pop Type: Medicaid Eligible Member Months 20,062,096 0.0% 20,062,096 20,062,096 20,062,096 PMPM Cost $ 654.11 4.7% $ 685.06 $ 717.47 $ 751.42 Total Expenditure $ 13,743,739,486 $ 14,393,952,017 $ 15,075,060,176 $ 43,212,751,679 MEG 12: Family of One Non-1915 Children Pop Type: Medicaid Eligible Member Months 6,882 0.0% 6,882 6,882 6,882 PMPM Cost $ 4,764.24 0.0% $ 4,764.24 $ 4,764.24 $ 4,764.24 Total Expenditure $ 32,787,500 $ 32,787,500 $ 32,787,500 $ 98,362,499 ALL MEGS Pop Type: Medicaid Eligible Member Months 56,385,180 56,515,270 56,648,340 PMPM Cost $ 956.56 $ 994.11 $ 1,033.19 Total Expenditure $ 53,935,735,158 $ 56,182,550,832 $ 58,528,625,501 $ 168,646,911,492 Other Minimum Wage PMPM Impact Pop Type: Medicaid Eligible Member Months PMPM Cost Total Expenditure $ 291,604,197 $ 285,749,008 $ 293,236,885 $ 870,590,090 Other: Pharmacy Carve-out Pop Type: Medicaid Eligible Member Months PMPM Cost Total Expenditure $ 6,282,375,003 $ 6,003,296,390 $ 6,007,036,918 $ 18,292,708,311 NOTES
For a per capita budget neutrality model, the trend for member months is the same in the with-waiver projections as in the without-waiver projections. This is the default setting.
Budget Neutrality Summary
Without-Waiver Total Expenditures
Medicaid Populations DEMONSTRATION YEARS (DY) TOTAL DY 23 (4/1/21 - 3/31/22) DY 24 (4/1/22 - 3/31/23) DY 25 (4/1/23 - 3/31/24) MEG 1: TANF Children 1-20 $ 6,633,801,558 $ 6,953,057,793 $ 7,287,705,169 $ 20,874,564,520 MEG 2: TANF Adults 21-64 $ 4,687,445,732 $ 4,940,320,542 $ 5,206,788,032 $ 14,834,554,306 MEG 3: SSI 0-64 $ 10,465,003,080 $ 10,950,664,380 $ 11,458,891,579 $ 32,874,559,039 MEG 4: SSI 65+ $ 915,549,462 $ 958,915,012 $ 1,004,336,323 $ 2,878,800,797 MEG 5: Non-duals 18-64 $ 1,420,804,138 $ 1,500,258,894 $ 1,584,156,760 $ 4,505,219,792 MEG 6: Non-duals 65+ $ 483,242,808 $ 521,949,364 $ 563,756,038 $ 1,568,948,210 MEG 7: MLTC Adult 18-64 Duals $ 2,255,150,822 $ 2,381,261,702 $ 2,514,428,895 $ 7,150,841,419 MEG 8: MLTC Adult 65+ Duals $ 14,909,033,788 $ 16,103,201,605 $ 17,393,029,021 $ 48,405,264,414 MEG 9: HCBS Expansion $ 896,889 $ 946,506 $ 998,868 $ 2,842,263 MEG 10: Institution to Community $ 18,571,304 $ 18,998,274 $ 19,435,089 $ 57,004,667 MEG 11: New Adult Group $ 13,743,739,486 $ 14,393,952,017 $ 15,075,060,176 $ 43,212,751,679 MEG 12: Family of One Non-1915 Children $ 32,787,500 $ 32,787,500 $ 32,787,500 $ 98,362,499 MLTC NEMT Carve-out $ 291,604,197 $ 285,749,008 $ 293,236,885 $ 870,590,090 Pharmacy Carve-out $ 6,282,375,003 $ 6,003,296,390 $ 6,007,036,918 $ 18,292,708,311 TOTAL $ 55,566,026,567 $ 58,756,313,589 $ 62,141,373,450 $ 176,463,713,605 TOTAL less Carve-outs $ 48,992,047,366 $ 52,467,268,190 $ 55,841,099,647 $ 157,300,415,204 With-Waiver Total Expenditures
Medicaid Populations DEMONSTRATION YEARS (DY) TOTAL DY 23 (4/1/21 - 3/31/22) DY 24 (4/1/22 - 3/31/23) DY 25 (4/1/23 - 3/31/24) MEG 1: TANF Children 1-20 $ 6,389,302,293 $ 6,572,456,868 $ 6,760,888,407 $ 19,722,647,568 MEG 2: TANF Adults 21-64 $ 4,529,739,704 $ 4,693,117,420 $ 4,862,386,427 $ 14,085,243,551 MEG 3: SSI 0-64 $ 10,616,086,718 $ 11,188,685,167 $ 11,792,165,633 $ 33,596,937,518 MEG 4: SSI 65+ $ 927,067,643 $ 977,070,000 $ 1,029,771,072 $ 2,933,908,716 MEG 5: Non-duals 18-64 $ 1,319,127,374 $ 1,342,131,084 $ 1,365,535,841 $ 4,026,794,299 MEG 6: Non-duals 65+ $ 447,840,632 $ 465,656,541 $ 484,180,664 $ 1,397,677,838 MEG 7: MLTC Adult 18-64 Duals $ 2,093,766,222 $ 2,130,282,268 $ 2,167,433,092 $ 6,391,481,582 MEG 8: MLTC Adult 65+ Duals $ 13,816,808,361 $ 14,366,465,630 $ 14,937,980,643 $ 43,121,254,635 MEG 9: HCBS Expansion $ 896,889 $ 946,506 $ 998,868 $ 2,842,263 MEG 10: Institution to Community $ 18,572,334 $ 18,999,830 $ 19,437,180 $ 57,009,344 MEG 11: New Adult Group $ 13,743,739,486 $ 14,393,952,017 $ 15,075,060,176 $ 43,212,751,679 MEG 12: Family of One Non-1915 Children $ 32,787,500 $ 32,787,500 $ 32,787,500 $ 98,362,499 MLTC NEMT Carve-out $ 291,604,197 $ 285,749,008 $ 293,236,885 $ 870,590,090 Pharmacy Carve-out $ 6,282,375,003 $ 6,003,296,390 $ 6,007,036,918 $ 18,292,708,311 TOTAL $ 53,935,735,158 $ 56,182,550,832 $ 58,528,625,501 $ 168,646,911,492 TOTAL less Carve-outs $ 47,361,755,957 $ 49,893,505,434 $ 52,228,351,699 $ 149,483,613,090 VARIANCE $ 1,630,291,409 $ 2,573,762,756 $ 3,612,747,948 $ 7,816,802,114 Disproportionate Share Hospital (DSH)
Panel 1: Historic DSH Claims for the Last Five Fiscal Years: RECENT PAST FEDERAL FISCAL YEARS 20__ 20__ 20__ 20__ 20__ State DSH Allotment (Federal share) State DSH Claim Amount (Federal share) DSH Allotment Left Unspent (Federal share) $ - $ - $ - $ - $ -
Panel 2: Projected Without Waiver DSH Expenditures for FFYs That Overlap the Demonstration Period FEDERAL FISCAL YEARS THAT OVERLAP DEMONSTRATION YEARS FFY 00 (20__) FFY 01 (20__) FFY 02 (20__) FFY 03 (20__) FFY 04 (20__) FFY 05 (20__) State DSH Allotment (Federal share) State DSH Claim Amount (Federal share) DSH Allotment Left Unspent (Federal share) $ - $ - $ - $ - $ - $ -
Panel 3: Projected With Waiver DSH Expenditures for FFYs That Overlap the Demonstration Period FEDERAL FISCAL YEARS THAT OVERLAP DEMONSTRATION YEARS FFY 00 (20__) FFY 01 (20__) FFY 02 (20__) FFY 03 (20__) FFY 04 (20__) FFY 05 (20__) State DSH Allotment (Federal share) $ - $ - $ - $ - $ - $ - State DSH Claim Amount (Federal share) Maximum DSH Allotment Available for Diversion (Federal share) Total DSH Alltoment Diverted (Federal share) $ - $ - $ - $ - $ - $ - DSH Allotment Available for DSH Diversion Less Amount Diverted (Federal share, must be non-negative) $ - $ - $ - $ - $ - $ - DSH Allotment Projected to be Unused (Federal share, must be non-negative) $ - $ - $ - $ - $ - $ -
Panel 4: Projected DSH Diversion Allocated to DYs DEMONSTRATION YEARS DY 01 DY 02 DY 03 DY 04 DY 05 DSH Diversion to Leading FFY (total computable) FMAP for Leading FFY DSH Diversion to Trailing FFY (total computable) FMAP for Trailing FFY Total Demo Spending From Diverted DSH (total computable) $ - $ - $ - $ - $ - Dropdown
- Population Status Drop-Down
- Medicaid
- Hypothetical
- Expansion
DY 21 (4/1/2019 - 3/31/2020) - Expenditures by MEG and COS
MEG Total Paid 1 2 3 4 5 6 7 8 9 10 11 12 Category of Service Description TANF CHILD TANF ADULT SSI 0-64 SSI 65+ Non-Duals 18-64 Non-Duals 65+ MLTC 18-64 Duals MLTC 65+ Duals HCBS Expansion Institution to Community New Adult Group Family of One Non-1915 Children Hospital Inpatient $1,501,086,130 $906,495,206 $1,677,840,493 $119,605,327 $166,004,401 $47,595,769 $31,574,780 $153,471,161 $25,307 $1,324,538 $2,374,509,498 $953,727 Hospital Outpatient $646,743,264 $445,358,666 $731,310,449 $36,325,257 $33,682,127 $6,845,729 $22,950,894 $50,391,463 $4,043 $337,364 $1,492,547,573 $363,079 Skilled Nursing Facilities $28,768,212 $419,003 $232,759,588 $83,258,089 $3,379,727 $333,165 $2,866,821 $15,402,061 $85,511 $375,236 $8,931,174 $118,634 Intermediate Care Facility for the Developmentally Disabled $10,117,305 $1,937,554 $730,927,810 $114,362,191 $2,427,241 $110,065 $914,645 $8,411,743 $0 $7,171 $14,525,788 $0 Free Standing Clinics $320,851,657 $130,662,357 $426,259,556 $18,559,371 $24,950,767 $4,325,221 $22,456,799 $40,155,109 $8,190 $238,107 $461,484,504 $163,800 Physicians $979,153,944 $633,253,436 $990,758,377 $109,199,282 $124,504,523 $43,794,858 $393,319,322 $2,449,068,524 $2,526 $113,719 $1,819,784,005 $57,817 Dental $289,220,917 $57,686,829 $39,595,650 $2,017,036 $1,186,468 $315,641 $3,589,012 $11,553,263 $173 $6,087 $182,023,075 $8,271 Other Practitioners $77,628,871 $48,664,055 $124,647,338 $5,139,059 $4,614,226 $367,678 $3,928,633 $11,892,354 $466 $13,761 $144,675,773 $13,632,516 Child Care Medical $8,115,947 $23,847 $9,832,138 $0 $204,060 $0 $0 $0 $0 $0 $0 $0 Personal Care Services $3,722,917 $508,789 $459,232,967 $49,413,698 $488,027,481 $220,001,821 $883,306,586 $8,260,829,674 $533,713 $1,311,844 $3,811,117 $5,340,374 Home Health Services $6,982,893 $25,908 $120,908,952 $7,587,491 $2,060,182 $1,801 $1,998,135 $327,762 $40,821 $252,065 $842,035 $142,293 Rehabilitation & Therapy $5,715,586 $2,201,823 $40,271,320 $1,773,852 $470,541 $127,953 $846,558 $3,584,201 $0 $32,769 $13,838,832 $852,114 Drugs & Supplies $531,151,341 $553,956,142 $1,785,029,610 $81,255,907 $157,865,570 $31,287,154 $24,457,699 $100,990,842 $25,716 $488,896 $2,957,666,549 $2,196,402 Eye Appliances & DME $43,115,070 $18,763,719 $71,887,333 $3,247,419 $5,812,761 $918,926 $4,515,299 $18,322,267 $1,784 $70,159 $72,770,822 $230,933 Case Management $995,386,490 $1,159,616,392 $905,387,560 $106,285,846 $229,469,425 $51,173,957 $556,476,902 $1,448,080,859 $33,236 $12,169,169 $2,005,115,527 $5,059,439 Transportation $42,432,056 $80,767,705 $267,382,712 $15,384,563 $19,730,434 $4,207,258 $53,061,960 $202,142,256 $41,128 $886,308 $286,737,160 $110,647 Lab & X-Ray $65,883,697 $121,577,649 $76,240,337 $8,444,897 $3,906,812 $1,149,784 $1,541,155 $6,615,554 $472 $20,494 $366,279,000 $9,957 Referred Ambulatory $52 $0 $2,574 $2 $179 $0 $882 $35 $0 $0 $21 $0 Hospice $316,973 $785,343 $6,466,443 $2,184,873 $1,075,660 $1,889,109 $304,932 $3,551,943 $0 $0 $6,656,254 $0 Rehab Option Services Total $385,991,420 $1,082,626 $317,613,063 $1,238,138 $5,473,347 $162,329 $15,596,516 $6,359,250 $0 $40,446 $33,730,714 $3,538,640 Assisted Living Plans $0 $0 $2,355,903 $2,289,541 $559,949 $0 $568,703 $580,152 $0 $0 $0 $0 Other $95,939,187 $56,119,482 $540,600,040 $67,036,798 ($1,110,021) ($380,138) ($1,667,056) ($11,935,585) $2,236 $57,795 $284,137,721 $8,841 Grand Total $6,038,323,930 $4,219,906,530 $9,557,310,214 $834,608,635 $1,274,295,860 $414,228,082 $2,022,609,178 $12,779,794,887 $805,322 $17,745,927 $12,530,067,141 $32,787,483
MEG Total Paid 1 2 3 4 5 6 7 8 9 10 11 12 Category of Service Description TANF CHILD TANF ADULT SSI 0-64 SSI 65+ Non-Duals 18-64 Non-Duals 65+ MLTC 18-64 Duals MLTC 65+ Duals HCBS Expansion Institution to Community New Adult Group Family of One Non-1915 Children DY 21 (4/1/19 - 3/31/20) 21,987,344 5,828,164 4,495,199 422,996 188,409 63,001 555,092 2,519,028 330 5,071 20,062,096 6,882
MEG Total Paid 1 2 3 4 5 6 7 8 9 10 11 12 Category of Service Description TANF CHILD TANF ADULT SSI 0-64 SSI 65+ Non-Duals 18-64 Non-Duals 65+ MLTC 18-64 Duals MLTC 65+ Duals HCBS Expansion Institution to Community New Adult Group Family of One Non-1915 Children DY 21 (4/1/19 - 3/31/20) $274.63 $724.05 $2,126.12 $1,973.09 $6,763.46 $6,574.94 $3,643.74 $5,073.30 $2,440.37 $3,499.49 $624.56 $4,764.24
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