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Home My WebLink AboutIR 7559 INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7559 October 15, 1991 I OP?' To the Mayor and Members of the City Council PE X cl Subject: ,A71 STATUS OF PUBLIC HEALTH DEPARTMENT MEDICAID PROGRAM BACKGROUND The Tex—as Medical Assistance Program (Medicaid) became effective on September 1, 1967 under the provisions of Title XI of the Federal Social Security Act and Chapter 32 of the Texas Human Resources Code. Participat- ing organizations providing services to Medicaid clients are reimbursed for the cost through the Texas Department of Human Services. On May 29, 1990 , City Council approved M&C G-8641 authorizing the Fort Worth Publ is Health Department to participate in the Medicaid program Initially, the Health Department' s involvement only included maternal an� child health services provided as part of the Maternity Clinic Services and the Early and Periodic Screening, Diagnosis and Treatment (EPSOT) programs. These program activities offer antepartum and postpartum care to eligible clients and well-child health screenings to pediatric clients. Since that time Council has also authorized Medicaid participation for Dental Clinic services (M&C G-8901, dated November 13, 1990) and Sexually Transmitted Disease Clinic services (M&C G-9136, dated May 7, 1991) . The primary on-going objective of each of the programs enrolled as Medicaid participants is to assist eligible Public Health Clinic clients in acces- sing the Medicaid system. By removing all financial obstacles for Medicaid- eligible Fort Worth citizens to obtain health care, existing problems such as infant mortality and sexually transmitted disease within the community can be positively impacted. Other baseline health standards can be in- creased with enhanced access to health care services for the City' s Medicaid-eligible population. FY 89-90 EXPENDITURES: As part of the May 29, 1990 M&C approving Medicaid participation, a supple- mental appropriation of $30,215 was granted the Health Department for start-up costs. Included as part of FY 89-90 expenditures was the hiring of an Administrative Aide to coordinate the completion of enrollment appl i- cations, implement clinic reimbursement procedures, and assist clinic per- sonnel in submitting and tracking claims. Beginning in June 1990, the Public Health Department began its Medicaid pilot program at two of the six Fort Worth Public Health Clinics. By the end of July 1990, all six clinics were operational . Existing clinic staff assisted in initial screening and referral of Medicaid-eligible clients . Clients already on Medicaid began receiving treatment free of charge at the clinics. Reimbursement claim forms were then processed and submitted to the State. REVENUES: The following chart details Maternal and Child Health Clinic Medicaid pro- gram revenues from June through September 1990: ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 75,59 tp M= 2 of S T V To the Mayor and Members of the City Council Subject: STATUS OF PUBLIC HEALTH DEPARTMENT MEDICAID PROGRAM TOTAL PERCENT CLINIC MEDICAID MEDICAID MEDICAID SERVICE VISITS VISITS REIMBURSEMENT REVENUE Maternity 31400 19% $10 $ 7,268 $12 (high-risk) Well-Child 3,342 11% $27 $ 9,417 $ 6 (follow-up) Total: $16 ,685 FY 90-91 MATERNAL AND CHILD HEALTH SERVICES: EXPENDITURES: The adopted General Fund Budget for FY 90-91 expansion of the Health Depart- ment Medicaid Program was $131,589. The expansion included the addition of two Clerk II positions to assist with Medicaid eligibility screenings at Public Health Clinics. Also budgeted was the addition of three Income Assistance Medicaid Workers as consultants to the Health Department' s pro- gram. The primary function of these workers is to determine patients' eli- gibility for Medicaid income assistance and assist with coordination of patient referrals to other community agencies for services. Due to delays in the finalizing of a contract with the Texas Department of Hunan Service (TDHS) , the three Income Assistance Medicaid Workers were unable to begin consulting work until March 1991 . Savings from this delay and other related savings resulted in total actual General Fund expendi- tures of $68,184 for the FY 90-91 Medicaid program. REVENUES: The following chart details projected and actual Maternity and Well-Child FY 90-91 Medicaid revenues: TOTAL PERCENT CLINIC MEDICAID MEDICAID MEDICAID SERVICE VISITS VISITS REIMBURSEMENT REVENUE Maternity: Projected 21,000 50% $101$12 $105,000 Actual 13,334 29% $101$12 $ 42,651 Well-Child : Projected 18,500 50% $271$ 6 $249,750 Actual 11,292 32% $271$ 6 $ 91,401 Totals: Projected $354,750 Actual $134,052 -ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No 7559 AfarrnF To the Mayor and Members of the City Council Sub ect: STATUS OF PUBLIC HEALTH DEPARTMENT MEDICAID PROGRAM Issues contributing to actual revenues totaling only 38% of projections include: 1) Inability to hire and retain nursing staff; 2) Delays in hiring of Medicaid consultants; 3) Overestimating percentage of Medicaid-eligible clients. The Public Health Clinics operated at approximately 65% of nursing capacity for the majority of FY 90-91. The Health Department' s compensation package had dropped far below the rapidly escalating market for nurses. This re- sulted in fewer clinic visits and less time for Medicaid eligibility screen- ing of existing clients. From October 1990 to March 1991, the Medicaid program operated without the assistance of three budgeted Income Assistance Medicaid Workers. Projec- tions were based on full year utilization of these workers. With a full year of Medicaid experience, it has become apparent that a 50% estimation of Medicaid-eligible clients for Year One was overly optimistic. As more and more citizens gain access to Medicaid eligibility information and access through the Public Health Clinics , this percentage will in- crease; however, for the first couple of years of operation a 35% average appears more realistic. Also reflected in these actual percentages is a Fort Worth illegal alien population that exceeded projections. As required by the Texas Department of Health (TDH) Local Health Services Contract, any revenues generated by activities fully or partially funded through TDH are divided , based on the percent of program support. In FY 90-91, 33% of all revenues generated through Maternal and Child Health activities represents TDH1s share of program related income which is con- tributed back to the program for expansion or enhancements to services. The City' s share of all revenues was 67%. Despite the failure to meet revenue projections, the City' s share of Medic- aid program Maternal and Child Health revenues for FY 90-91 exceeded actual expenditures by more than 30%. DENTAL CLINIC SERVICES: EXPENDITURES: No additional expenditures were budgeted specifically for Dental Clinic Medicaid participation. Beginning in December 1990, the Dental Clinics implemented the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Dental Program. Activ- ities focus on early detection and treatment of dental health problems of 0011k eligible persons under age 21. REVENUES: FY 90-91 Medicaid program revenues for the Dental Clinic by quarter is detailed as follows: -ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CiTY COUNCIL MEMBERS rya. 7559 or rR==pf :if attrA To the Mayor and Members of the City Council 'raxPy Subject: STATUS OF PUBLIC HEALTH DEPARTMENT MEDICAID PROGRAM TOTAL PERCENT CLINIC MEDICAID MEDICAID MEDICAID SERVICE VISITS VISITS REIMBURSEMENT REVENUE Variety of Services for Clients Under 10,296 2% $ 3-$45 $ 9,125 21 Years of Age. Total: $ 9,125 As required by TDH program related income regulations, 3% of all Dental Clinic revenues are contributed back to the program due to TDH ' s level of financial support. The City' s share equals 97%. SEXUALLY TRANSMITTED DISEASE SERVICES: EXPENDITURES: No additional expenditures were budgeted specifically for Sexually Transmit- ted Disease Clinic Medicaid participation. Beginning September 1, 1991, the Sexually Transmitted Disease Clinic imple- mented the Physician Services: Group Practice (PSGP) specialty. These ser- vices were already in place; however, implementing the PSGP program enables the collection of fees from Medicaid. REVENUES: For the one month in FY 90-91 that the program was operational , $3,443 was collected . As required by TDH program related income regulations, 51% of all Sexually Transmitted Disease Clinic revenues are contributed back to the program due to TDH ' s level of financial support. The City' s share equals 49%. FY 91-92 EXPENDITURES: Medicaid program General Fund support included in the FY 91-92 Adopted Budget totals $129,681. PROGRAM REVISIONS: During FY 91-92 some revisions will take place which will expand the reve- nue generating capabilities of the program. Family planning and case management activities which will be provided at the Public Health Clinics are now reimbursable through Medicaid . Secondly, the EPSDT well-child service allowable reimbursement has been increased from $27 to $40. Both of these revisions will require the approval of Council in order to establish family planning and case management fee structures and to revise ISSUED BY THE established fee for EPSDT charges. M&C' s are forthcoming.FORT WORTH, TEXAS --- INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7-559 1�aw 5 nf To the Mayor and Members of the City Council X Subject: STATUS OF PUBLIC HEALTH DEPARTMENT MEDICAID PROGRAM REVENUES: The following chart details FY 91-92 revenue projections for currently approved Health Department Medicaid program activities: PROJECTED ACTUAL FY 90-91 FY 91-92 PROGRAM SERVICE REVENUES REVENUES Maternal/Child Health Well-Child $ 91,401 (12 mos.) $190,000 Maternity $ 42,651 (12 mos.) $ 80,000 Dental Clinic EPSDT $ 9,125 (10 mos.) $ 36,500 STD Clinic PSGP $ 3,443 (1 mo.) S 40,800 Total: $146,620 $347,300 * - Includes reimbursement increase from $17 to $40. SUMMARY During FY 91-92, the second full year of Medicaid program operation and the first year of full staffing of Medicaid personnel , further community access to the program through the Public Health Clinics will occur. Increasing the number of Medicaid clients will result in the removal of financial obstacles for a greater number of Fort Worth citizens to obtain adequate baseline health care, including a number of specialized medical fields. With further expansion of the program, increases to revenues will also be experienced. Issues have been addressed which prevented realization of FY 90-91 revenue projections for the Medicaid program. For example, Council approved pay range revisions for a number of health care positions which should improve the Health Department' s ability to hire and retain nurses. With every year, the program will continue to build upon itself as more Medicaid-eligible citizens are enrolled through the Public Health Clinics and citizens who are already enrolled continue to visit the Clinics. < D vid y t i Manager DI :g ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS