Committee hears Medicaid utilization trends, 1915(i) expansion and claims timing risks

Summary

The Health and Human Services Committee reviewed statewide Medicaid utilization and budget projections, including growth in the 1915(i) behavioral-health-related program, claims-timing distortions from a national billing outage, and provider-enrollment efforts that state staff say will increase access.

Chairman Nelson convened the Health and Human Services Committee for a briefing on Medicaid utilization and the executive budget’s assumptions, focusing on developmental disabilities, long-term care and medical services.

The department told the committee that utilization trend lines are generally flat or rising and that timing of claims — not underlying demand — explains many of the spikes on the department’s graphs. "Providers on average bill us approximately around 45 days after the date of service," said Sarah Aker, executive director of the Division of Medical Services. Aker also said the department’s "average time frame for payment of all claims is 7 days." Those lags and catch-up billings shaped the committee’s view of the budgeted unit counts and cash outlays.

The presentation stressed two budget risks: one administrative and timing-related, and one programmatic. On timing, the committee heard that a national billing vendor outage (Change Healthcare) suppressed submitted claims for several months and produced later spikes when providers resumed filing. On programmatic risk, staff highlighted 1915(i) — a home- and community-based service option for…

Committee hears Medicaid utilization trends, 1915(i) expansion and claims timing risks

Summary

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