Periodically, the Commonwealth issues a statement on the state’s financial condition for Wall Street types who buy the state’s bonds. It used to be available only to Wall Street folks. In a blow for transparency, the Patrick Administration now makes it publicly available. In a blow against transparency, they don’t seem to tell anyone, as far as we can tell. This time, WBUR’s Martha Bebinger found it: THE COMMONWEALTH OF MASSACHUSETTS INFORMATION STATEMENT: Dated April 16, 2008. For health junkies, the sections of interest run from A-24 to A-30. Here are some morsels we found interesting:
MassHealth:
Based on MassHealth’s most recent forecast, fiscal 2008 expenditures are currently projected to be approximately $50 million over the current fiscal 2008 spending authorization. … MassHealth’s recent forecast also indicates that fiscal 2009 costs for the program may increase between $100 million and $200 million above earlier projections reflected in the Governor’s fiscal 2009 budget recommendations filed in January, 2008. The revised estimate reflects, in large part, a projected increase in enrollment. (A-26)Annual percentage growth in
per enrollee expenditures: (A-26)
FY 03: 11.0%
FY04: 10.0%
FY05: 0.0%
FY06: 7.0%
FY07: 4.0%
FY08: 3.0%Commonwealth Care:
The fiscal 2008 budget included $472 million for the Commonwealth Care program. However, enrollment has been considerably higher than initially projected, and the Commonwealth currently anticipates spending for Commonwealth Care to be as much as $647 million. (A-28)Faster-than-projected enrollment will also affect fiscal 2009 costs for Commonwealth Care. Previous enrollment estimates projected that 225,000 residents would be enrolled in Commonwealth Care by the end of fiscal 2009, a projection reflected in the $869 million allocated for the program in the fiscal 2009 budget filed by the Governor in January, 2008. However, updated estimates guided by recent enrollment trends suggest that enrollment in Commonwealth Care will be higher. A most likely estimate within a range of projections is that the program will enroll 255,000 residents by the end of fiscal 2009. This revised estimate reflects strong growth in membership and the continued challenge of estimating enrollment for this program in light of its relative newness and varying estimates of the overall number of uninsured. This enrollment projection suggests that Commonwealth Care will cost $1.082 billion in fiscal 2009, also accounting for costs associated with final bids from managed care organizations for providing plan coverage and enrollee premiums and co-payments for fiscal 2009 recently approved by the Connector Authority. Enrollment remains an area of significant uncertainty and could be lower or higher than 255,000 by the end of fiscal 2009. The cost estimates discussed above represent projections of gross funding needs for Commonwealth Care and thus do not account for federal reimbursement. (A-28)
255,000? Up from 225,000 which we also thought was high. $1.082B for CommCare for FY09? Up from $869M in the Governor, House and soon-to-be released Senate budget plans.
Two other interesting (and related) items in that document. The revenue projections from individuals and employers who don’t comply with the mandates, and the Medicaid 1115 waiver renewal. (See below) These are related because the waiver is predicated on whatever the state does as being budget neutral, and the $15.3 million projected for 2008 from the “fair share” penalty ($6.7M) and individual mandate tax ($8.5M) provision seems like it might be a bit optimistic – but necessary to keep things “budget neutral.”
From page A-27: “On June 29, 2007, the Commonwealth submitted an application to CMS to renew the waiver through June 30, 2011. The provisions of the waiver will guide how the Commonwealth moves forward in designing not
only the Medicaid program, but also the broader health care reform initiative, including the Commonwealth Care program and Health Safety Net Trust Fund. As such, the waiver agreement will reflect the federal reimbursement the
Commonwealth can expect for several important programs, including (but not limited to):
• Medicaid waiver populations (i.e., individuals that are not eligible under traditional Medicaid rules, but for
which CMS has agreed to allow eligibility)
• Commonwealth Care
• Health Safety Net Trust Fund
• Hospital Supplemental Payments
• Children’s Behavioral Health Services (specifically related to the Rosie D. et al v. Romney lawsuit. See
“LEGAL MATTERS.”)
One condition of the 1115 waiver is that the cost of services provided under the waiver must not exceed the cost of the traditional Medicaid program if a waiver had not been granted. The Commonwealth must periodically submit statements of “budget neutrality” in order to affirm that the state has not violated this provision of the waiver agreement. The Commonwealth submitted a budget neutrality statement to CMS in support of the renewal application on December 24, 2007. Discussions with CMS to finalize the terms of the waiver are ongoing, and the Commonwealth’s goal is to have a new agreement in place by July 1, 2008.”