DHCF FY12 BRT Presentation Final

DHCF Budget Review Team 2/17/11 - EMBARGOED
The Department of Health Care Finance
FY12 Budget Review Team Presentation
February 17, 2011
Table of Contents
Agency Overview FY12 Budget Development MARC and Adjustments Key Assumptions Savings Proposals Medicaid Enrollment and Expenditure Trends Alliance Enrollment and Expenditure Trends FY11 Savings Initiatives Status Report
Agency Overview
Total Agency FY12 Budget: $2,129,260,361 Total Agency Local Fund FY 12 Budget: $609,441,494
96% of budget spent on Provider Payments (Obj. Class 50)

Influencing Factors: Eligibility Benefits Utilization Provider Rates
FY12 Budget Development: MARC and Adjustments

Maximum Allowable Request Ceiling
FY 2011 Revised Budget Adjustment for stimulus funding [ends 6/30/2011] FY 2012 MARC $529,623,529 $79,817,962 $609,441,491
Budget Adjustments
FY 2011 Revised Budget Adjustment for stimulus funding [ends 6/30/2011] Adjustment to PS and non-50 NPS for RMTS Align fixed costs to estimates Shift ICF/MR spending from Stevie Sellows Fund $529,623,529 $79,817,962 $2,104,339 ($53,695) $3,688,714 $10,449,619 $6,089,796 $1,445,348 ($23,724,118) $609,441,494
February 1st Revision Revised Policy MARC Increase $614,064,283 $4,622,792
Waiver growth Fee-for-service growth Managed care growth Savings TOTAL
FY12 Budget Development: Key Assumptions

Key Assumption
FY11 Savings Initiatives remain in effect
Budget Impact
$16.9M
Relevant History
Likely Resistance
N/A
Possible Unintended Consequences

N/A
No Rate Increases
$21.1M
FY11 Savings Initiatives include: holding nursing facility rates flat; reducing physician, hospital, DD waiver and adult dental rates; correcting non-physician rates; and lowering PCA benefit to 520 hours per year. See Slide 31 for details. This will require holding MCO rates flat for 2 consecutive years - 2011 & 2012.
MCOs may threaten to exit the program. Currently, there are only 2. Fed requires at least 2 for choice.
Maintaining EPD up to $7.3M In FY 2011 DHCF capped the state plan PCA Waiver cap at 3,940 benefit at 520 hours per year. Previously it was 1040 without a PA. Prediction is that many people will move to EPD waiver to continue PCA services. $7.3M figure is based on 140 people per month moving in FY 2011, and 100 per month moving in FY 2012. Current EPD enrollment allows for 1400 more people to enroll before hitting cap.
May not be able to demonstrate actuarial soundness for the MCO rates. If MCOs hold provider rates constant, this could adversely affect provider participation. If DHCF reaches cap, creates a waiting list, and this prevents a disabled beneficiary from leaving an institutional setting, it could aggravate the District's position in the current Olmstead lawsuit.
FY12 Budget Development: Savings Proposals

Concept Estimated Local Savings
$10.6M
Relevant History
Likely Resistance

People waitlisted for the Alliance will show up at hospitals for charity care when they are sick enough or injured.
Capping Alliance enrollment at 18,750
Change treatment of therapies in nursing home rate setting
$2.8M
Current Alliance eligibility is up to 200% FPL for The Alliance has those not eligible for Medicaid. July 2010 never been approximately 35,000 beneficiaries up to 133% capped, so FPL transitioned to Medicaid as a result of Early resistance likely Option. December 2010 another 2,600 between from advocates. 133% - 200% FPL transitioned to Medicaid through a DSH waiver. Current Alliance enrollment is approximately 23,000, so closing enrollment and attriting down to 18,750 in FY 2011 is required. Increase due to revised MARC would be applied here. Increases cap to 21,500. Nursing home rates are being rebased in FY Nursing home 2011 retroactive to FY 2009 based on FY 2007. industry fought This change in treatment of therapies was this before. They attempted, but ultimately not implemented. claimed that Complaint was improper notice. Giving notice homes would go would be required. out of business, but when pressed could not say which one(s).

Concept Estimated Local Savings
$7.8M
Relevant History
Likely Resistance
Nursing home industry will oppose this.
Eliminate incentives in nursing home rate setting methodology
This savings is so substantial that it negates the industry's gains from rebasing the rates. The incentive payments explicitly pay homes more than their cost.
Replace $1.3M Average Wholesale Price (AWP) minus 10% in pharmacy pricing methodology with Wholesale Acquisition Cost (WAC) plus 3%
WAC is estimated to be roughly 82% of AWP, so Pharmacies will WAC+3% is roughly equal to AWP-15%. That's resist the rate cut. a 5% rate cut for drugs subject to this method -brand names without substitutes. AWP is being phased out at the end of FY 2011, so DHCF must change this methodology regardless.

Concept Estimated Local Savings Relevant History Likely Resistance Possible Unintended Consequences
Improved $1.2M management of PCA services
Numerous audits and anecdotal reports have The industry will shown there is waste and abuse in this benefit. resist. The hours were limited to 520 per year in FY 2011. This initiative would do three things: 1) replace the existing assessment tool with one from another state with a proven track record, 2) selected real time monitoring of authorizations, so the wasteful spending is prevented rather than caught after the fact, and 3) promulgating new rules that strictly limit the use of staffing agencies.
Total Estimated $23.8M Savings
Revised Policy MARC: $4,622,792 Increase

Raise enrollment cap on the Alliance by 2,750 (from 18,750 to 21,500)
8
Medicaid Enrollment and Expenditure Trends
District of Columbia Eligibility Levels for Medicaid Groups

Income Eligibility Threshold As A Percent of Federal Poverty: 2011 Federal Poverty Level (One Person) $21,780/yr 200% $32,670/yr $32,670/yr 300% 300% $24,176/yr $21,780/yr 200% 222%
$10,890
$8,059/yr 74%
$10,890/yr 100% $580.80/m o 64% Medically Needy Income Limit
Medicaid Eligibility Groups
Families w/ Children Pregnant Childless Institution Children Age (0-18)* Women* Adults and (Medicaid) Waiver
SSI
Non-SSI ABD
Notes: For all groups in red, eligibility cannot be cut due to maintenance of effort requirements from ARRA (stimulus funding) and the Affordable Care Act (health reform). Yellow denotes Medicaid programs whose eligibility can be changed, and green represents programs that are solely locally funded.
10
At Different Income Thresholds Medicare Beneficiaries Qualify For Some Medicaid Benefits
Income Eligibility Threshold As A Percent of Federal Poverty: $32,670/yr 2011 Federal Poverty Level (One Person) 300%
$21,780/yr 200%
$10,890/yr
$10,890
Medicare Eligibility Groups
100%
Full Duals Medicaid Services & Medicare Premium
Qualified Disabled & Working
Qualified Medicare Beneficiaries
Notes: For all groups in red, eligibility cannot be cut due to maintenance of effort requirements from ARRA (stimulus funding) and 11 the Affordable Care Act (health reform). Yellow denotes Medicaid programs whose eligibility can be changed, and green represents programs that are solely locally funded. ).
Mandatory Medicaid Services Expenditures FY10-FY12 (Proposed)

FY10 Actual ($) Inpatient Hospital Outpatient Hospital Physician's Services Nursing Facilities Lab & X-Ray Transportation Private Clinic FQHC Cost Settlements 307,407,496 35,308,950 52,572,496 212,597,582 11,266,838 20,383,296 16,339,947 13,619,577 6,742,398 FY11 Budgeted ($) 297,311,333 36,187,112 43,630,496 219,497,381 7,055,853 22,619,339 8,977,576 14,297,243 7,666,667 FY12 Proposed ($) 305,165,500 36,187,996 43,980,396 187,228,855 9,672,930 24,286,064 15,719,790 14,187,258 12,000,000
Notes: Certified pediatric and family nurse practitioner services, midwife and nurse practitioner services, and rural health clinic services are also mandatory, but expenditure data were not available. Early and Periodic Screening, Diagnosis, and Treatment services are generally included in other categories of services above.
Source: FY10 Actual figures from CFO$olve ad hoc dated 1/28/11.
12
Optional Medicaid Services Expenditures FY10-FY12 (Proposed)

FY10 Actual ($) Inpatient DSH Day Treatment ICF/MR Residential Treatment Dental Optometry/Vision Optician Podiatry Durable Medical Equipment Hospice Rehab Services Mental Health Clinic Sterilization Home Health / Personal Care Aide Pharmacy Managed Care Services Medicare Buy In COBRA Waivers 71,233,573 9,749,532 69,977,621 15,508,322 16,605,070 723,351 768,484 1,351,754 19,664,398 4,989,258 59,246 805,593 3,490 75,180,585 58,893,859 412,289,459 27,958,573 428,995 221,881,398 FY11 Budgeted ($) 75,793,037 23,394,119 69,927,532 24,075,000 14,727,787 614,563 1,294,778 1,156,969 13,886,315 6,126,695 6,205 1,000,828 3,488 95,970,015 69,478,929 569,383,682 33,102,328 493,247 226,830,862 FY12 Proposed Gross ($) 75,256,446 23,755,911 65,112,840 16,155,336 16,081,763 617,625 800,436 967,462 20,515,446 5,470,122 49,819 2,241,504 3,632 101,522,198 58,572,456 586,037,489 46,987,144 446,275 262,412,303 FY12 Proposed Local ($) 21,758,204 7,126,773 19,533,852 4,837,451 4,812,227 185,133 239,905 290,227 6,154,475 1,641,036 14,946 672,236 1,089 30,456,636 17,569,292 158,176,203 14,096,143 133,883 78,723,691
Source: FY10 Actual figures from CFO$olve ad hoc dated 1/28/11.
13
Public Provider Expenditures FY10-FY12 (Proposed)

FY10 Actual ($) FY11 Budgeted ($) FY12 Proposed ($)
D.C. Public Schools OSSE/ Transportation Charter Schools Department of Mental Health Child and Family Services Administration Fire and Emergency Medical Services
8,312,211 162,253 7,780,612 297,864 4,292,854
21,047,044 2,050,000 8,342,531 1,500,000 3,000,000
4,500,000 2,500,000 2,050,000 9,176,784 1,039,606 3,000,000
Notes: FY11 and 12 Budget is based on Provider Agency Budget Submission. Expenditures represent the 70% FMAP only. FY10 budget for transportation for Special Needs children was allocated to D.C. Public Schools
Source: FY10 Actual figures from CFO$olve ad hoc dated 1/28/11
14
Average Monthly Medicaid Enrollment In The District of Columbia, FY99-FY10

250,000
Average Monthly Enrollment
197,624
200,000
150,000
160,665
100,000
50,000
.44% Average Growth
Pre-SPA Post-SPA
2007 2008 2009 2010
0 1999 2000 2001 2002 2003 2004 2005 2006
Notes: D.C. fiscal year is October 1 through September 30; enrollment was averaged from October to September to create average monthly enrollment. The Department of Health Care Finance moved over 30,000 from the Alliance to the Medicaid program in July of 2010 while implementing a new coverage option state plan amendment. Data shown above for 2010 reflect October-June monthly average (pre-SPA) and July-September average (post-SPA). The Department transitioned over 2,700 people in December of 2010 while implementing an 1115 waiver for adult beneficiaries with incomes between 133 and 200 percent of the Federal Poverty Level.
15
Historical and Projected Quarterly DHCF Enrollment, FY07-FY12

300,000 250,000 Fee-For-Service Managed Care Alliance Childless Adult Expansion Total
Quarterly Enrollment
240,607
200,000 150,000 100,000 50,000 0
114,822 65,524 40,260 18,750
Notes: Enrollment projected using data from FY12 budget model. Childless Adult Expansion includes new coverage option state plan amendment, which covers childless adults from 0 to 133% FPL, and childless adult waiver, which includes childless adults from 133 to 200% FPL. Data labels shown are February 2011, October 2012, and September 2012. Projections assume EPD 16 waiver cap of 3,940 beneficiaries, and Alliance program cap of 18,750.
Total Annual DC Medicaid Expenditures, FY06-FY10

$2,000,000,000
$1,800,000,000 $1,600,000,000 $1,400,000,000 $1,200,000,000 $1,000,000,000 $800,000,000 $600,000,000 $400,000,000 $200,000,000 $0 FY2006 FY2007 FY2008
$1,825,679,456 $1,513,653,506 $1,608,210,902
$1,343,625,101
$1,426,504,949
6% Average Annual Growth from FY06 to FY09
13% Annual Growth from FY09 to FY10

Nearly half of this increase due to: - Alliance to Medicaid transition due to Health Reform - Physician rate increase - Medicaid MCO rate increase - Increased PRTF placements
FY2009
FY2010
Notes: Total annual expenditures include local and federal share of spending, but excludes spending on the Alliance. Source: CFO$olve ad hoc report 1/28/2011. Date -of-payment basis including all object 50 spending.
17
Managed Care Is A Growing Component of Medicaid in the District of Columbia

180,000
160,000
140,000
120,000 100,000 80,000 60,000 40,000 20,000 0 FY2007 FY2008 64% 63% 36% 37%
37%
33%
Fee-ForService Managed Care (Medicaid)
63%
67%
Total Enrollment
FY2009
FY2010
Notes: D.C. fiscal year is October 1 through September 30; enrollment was averaged from October to September to create average monthly enrollment. Data were not available for managed care and fee for service enrollment prior to FY2007. Due to new coverage option state plan amendment and an 1115 waiver for childless adult beneficiaries with incomes between 133 percent and 200 percent of the Federal Poverty Level, over 30,000 individuals were moved from Alliance (not included in the data above) onto the Medicaid program. The net result is a rapid increase in managed care enrollment in FY2010 and FY2011, when looking at Medicaid enrollment data only.
18
The Elderly And Disabled Represent 29 Percent Of Medicaid Program Beneficiaries

Demographics Of Beneficiaries In The District of Columbias Medicaid Program
Blind & Disabled
29%
Children Aged
Adults
Notes: Distributions may not sum to 100% due to rounding effects. Distribution of beneficiaries by category is based on average Medicaid enrollment in FY10.
19
Yet They Account For 73 Percent Of Medicaid Program Spending, FY10

Aged
Blind & Disabled
Aged
29% 73%
Blind & Disabled
Adults
Children
Adults Children
Notes: Distributions may not sum to 100% due to rounding effects. Source: Spending from ad hoc MMIS report 1/26/2011. FY 2010 date-of-service spending excluding DSH, cost settlements, Medicare premiums, and drug rebate.
20
The Cost of Serving the Elderly and Disabled Is Substantially Greater Than The Cost of Care For Children in Medicaid, FY10
$30,000
$27,129
Average Annual Per Capita Spending
$25,000
$20,000
$19,171
$15,000
$10,000
$9,920 $5,131
$5,000
$2,969
$0 All Recipients Aged Blind & Disabled Children Adults
Source: Spending from ad hoc MMIS report 1/26/2011. FY 2010 date-of-service spending excluding DSH, cost settlements, Medicare premiums, and drug rebate.
21
Change in Expenditures for Selected Medicaid Provider Types FY08-FY10
39%
Expenditure Rate Increases for FeeFor-Service Episode-Based Care
Expenditure Rate of Spending Increase for Fee-for-Service Long-Term Care 22%
23% 16%
24%
21%
8%
9%
MCOs
-3% -2% Inpatient Hospital
Outpatient (includes ER Services)
Pharmacy
Nursing Facility
Change in Total Expenditures
Change in Per Enrollee Expenditures
Source: Spending from ad hoc MMIS report 1/28/2011. FY 2010 date-of-service spending excluding DSH, cost settlements, Medicare premiums, and drug rebate.
22
Change in Expenditures for Medicaid Home and Community Based Waivers FY08-FY10
113%
79%
45%
18%
DD Waiver
Change in Total Expenditures
EPD Waiver
Change in Per Enrollee Expenditures
Source: Spending is date-of-payment from CFOSolve ad hoc report dated 1/28/2011.
23
Alliance Enrollment and Expenditure Trends
24
Comparison of District of Columbia Income Eligibility Levels for Medicaid and Alliance Programs
Income Eligibility Threshold As A Percent of Federal Poverty: 2011 Federal Poverty Level (One Person) $21,780/yr 200% $32,670/yr 300% $32,670/yr 300% $32,670/yr 300%
$21,780/yr 200%
$21,780/yr 200%
$10,890
Medicaid & Alliance Eligibility Groups
Families w/ Children
Children Age (0-18)*
Pregnant Women*
Childless Adults (Medicaid)
Childless Adults (Alliance)
Immigrant Childrens Program
Federal & Local Funding
Local Funding
Notes: For all groups in red, eligibility cannot be cut due to maintenance of effort requirements from ARRA (stimulus funding) and the Affordable Care Act (health reform). Yellow denotes Medicaid programs whose eligibility can be changed, and green represents programs that are solely locally funded.
25
Covered Services in the Alliance Program
Inpatient Hospital Outpatient Hospital Laboratory & X-Ray Services Hospital Services
Pharmacy Services (Limited)

Pregnancy Testing Routine and Emergency Contraception Family Planning Services Screening, Counseling, and Immunizations Emergency Services Specialist Services Primary Care Services Adult Wellness Services Dental (Limited) Nursing Home Care
26
Average Annual Enrollment in the Alliance FY07-FY11

60,000 50,000 40,000 30,000 20,000 10,000 0 2007 2008 2009 2010
53,894 48,694 44,884
56,435
Enrollment shifted to Medicaid as a result of expanded eligibility due to health reform
25,487
Pre-SPA Post-SPA
Notes: D.C. fiscal year is October 1 through September 30; enrollment was averaged from October to September to create average monthly enrollment. The Alliance program in its current form began enrolling beneficiaries in March of 2006. Average enrollment for FY06 is 27,193, but not shown above because due to high monthly variability as the program began. In July of 2010, the Department of Health Care Finance moved over 30,000 from the Alliance to the Medicaid program while implementing a new coverage option state plan amendment. Data shown above for 2010 reflect October-June monthly average (pre-SPA) and July-September average (post-SPA). The Department transitioned over 2,700 people in December of 2010 while implementing 27 an 1115 waiver for childless adult beneficiaries with incomes between 133 and 200 percent of the Federal Poverty Level.
Distribution of Alliance Enrollment, by Gender, FY10

Pre-SPA Post-Spa
Female 42% Male 58%
Female 55%
Male 45%
Notes: In July of 2010, the Department of Health Care Finance moved over 30,000 from the Alliance to the Medicaid program while implementing a new coverage option state plan amendment. Pre-SPA enrollment above reflects OctoberJune monthly average, and post-SPA reflects July-September monthly average.
28
Distribution of Alliance Enrollment, by Race, FY10

Pre-SPA Post-SPA
Hispanic 27%
Black 31%
Other 6%
Black 65%
Hispanic 57% Other 11%
White 2%
White 1%
Notes: Other includes Other Known Race (1% pre-SPA/2% post), Asian or Pacific Islander (1% pre-SPA/2% post), American Indian or Alaskan Native (<1% both pre and post-SPA), and Unknown (4% pre-SPA/7% post). In July of 2010, the Department of Health Care Finance moved over 30,000 from the Alliance to the Medicaid program while implementing a new coverage option state plan amendment. Pre-SPA enrollment above reflects October-June monthly average, 29 and post-SPA reflects July-September monthly average.
Distribution of Alliance Enrollment, by Ward, FY10

40% 36% 35% 31% 30% 25% 20% 15% 10% 5% 0% Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 18% 13% 10% 12% 12% 13% 22%
Pre-SPA Post-SPA
9%
9% 3% 5% 3%
2% 1%
Notes: In July of 2010, the Department of Health Care Finance moved over 30,000 from the Alliance to the Medicaid program while implementing a new coverage option state plan amendment. Pre-SPA enrollment above reflects October-June monthly average, and post-SPA reflects July-September monthly average.
30
FY11 Savings Initiatives Status Report

Amendment Hold Medicaid nursing facility rates flat Budgeted Updated Spending Notes Savings Savings Pressure $1.1m $0.59m $0.51m Public notice done. SPA drafted. Submitted to Council for passive approval 1/12/2011. SPA submission to CMS planned after 30 day passive approval. Budget assumed 10/1/2010 effective date, 1/1/2011 is more likely. Savings reduced to $590K based on revised estimate and delay in implementation. $2.50m $1.88m $0.63m Public notice done. SPA drafted. Submitted to Council for passive approval 1/12/2011. SPA submission to CMS planned after 30 day passive approval. Budget assumed 10/1/2010 effective date, 1/1/2011 is more likely. Savings reduced to $2.08M based on revised estimate and delay in implementation. $7.10m $3.55m $3.55m SPA in development. The savings estimate was based on a 10/1/2010 effective date. $3.55M potential pressure assumes an April 1, 2011 implementation date. $0.90m $0.45m $0.45m Waiver amendment in development. $450,000 potential pressure assumes an April 1, 2011 implementation date. $0.20m $0.20m $0.00m SPA in development. The budget assumed a 4/1/2011 effective date. This is on track. $0.35m $0.35m $0.00m Combined with physician SPA above. Public notice done. SPA drafted. Submitted to Council for passive approval 1/12/2011. SPA submission to CMS planned after 30 day passive approval. $0.00m Public notice done. SPA pending CMS approval. When approved, the effective date will be 1/1/2011. Budget assumed 1/1/2011 31 effective date.
Reduce Medicaid physician payment to 80% of Medicare
Reduce Hospital rates
Reduce DD Waiver provider rates Reduce rates for adult dental care to align with national average Correct certain nonphysician provider rates Lower cap on PCA state plan benefit to 520 hours per year
$3.98m
$3.98m

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DHCF Budget Review Team 2/17/11 - EMBARGOED

The Department of Health Care Finance

FY12 Budget Review Team Presentation

February 17, 2011

DHCF Budget Review Team 2/17/11 - EMBARGOED

DHCF Budget Review Team 2/17/11 - EMBARGOED

96% of budget spent on Provider Payments (Obj. Class 50)

DHCF Budget Review Team 2/17/11 - EMBARGOED

FY12 Budget Development: MARC and Adjustments

February 1st Revision Revised Policy MARC Increase $614,064,283 $4,622,792

Waiver growth Fee-for-service growth Managed care growth Savings TOTAL

DHCF Budget Review Team 2/17/11 - EMBARGOED

FY12 Budget Development: Key Assumptions

Possible Unintended Consequences

DHCF Budget Review Team 2/17/11 - EMBARGOED

FY12 Budget Development: Savings Proposals

Possible Unintended Consequences

Capping Alliance enrollment at 18,750

Change treatment of therapies in nursing home rate setting

DHCF Budget Review Team 2/17/11 - EMBARGOED

FY12 Budget Development: Savings Proposals

Possible Unintended Consequences

Eliminate incentives in nursing home rate setting methodology

DHCF Budget Review Team 2/17/11 - EMBARGOED

FY12 Budget Development: Savings Proposals

Improved $1.2M management of PCA services

Total Estimated $23.8M Savings

Revised Policy MARC: $4,622,792 Increase

DHCF Budget Review Team 2/17/11 - EMBARGOED

Medicaid Enrollment and Expenditure Trends

DHCF Budget Review Team 2/17/11 - EMBARGOED

District of Columbia Eligibility Levels for Medicaid Groups

$10,890/yr 100% $580.80/m o 64% Medically Needy Income Limit

Medicaid Eligibility Groups

DHCF Budget Review Team 2/17/11 - EMBARGOED

Full Duals Medicaid Services & Medicare Premium

Qualified Disabled & Working

Qualified Medicare Beneficiaries

DHCF Budget Review Team 2/17/11 - EMBARGOED

Mandatory Medicaid Services Expenditures FY10-FY12 (Proposed)

Source: FY10 Actual figures from CFO$olve ad hoc dated 1/28/11.

DHCF Budget Review Team 2/17/11 - EMBARGOED

Optional Medicaid Services Expenditures FY10-FY12 (Proposed)

Source: FY10 Actual figures from CFO$olve ad hoc dated 1/28/11.

DHCF Budget Review Team 2/17/11 - EMBARGOED

Public Provider Expenditures FY10-FY12 (Proposed)

8,312,211 162,253 7,780,612 297,864 4,292,854

21,047,044 2,050,000 8,342,531 1,500,000 3,000,000

4,500,000 2,500,000 2,050,000 9,176,784 1,039,606 3,000,000

Source: FY10 Actual figures from CFO$olve ad hoc dated 1/28/11

DHCF Budget Review Team 2/17/11 - EMBARGOED

Average Monthly Medicaid Enrollment In The District of Columbia, FY99-FY10

Average Monthly Enrollment

.44% Average Growth

0 1999 2000 2001 2002 2003 2004 2005 2006

DHCF Budget Review Team 2/17/11 - EMBARGOED

Historical and Projected Quarterly DHCF Enrollment, FY07-FY12

200,000 150,000 100,000 50,000 0

114,822 65,524 40,260 18,750

DHCF Budget Review Team 2/17/11 - EMBARGOED

Total Annual DC Medicaid Expenditures, FY06-FY10

$1,825,679,456 $1,513,653,506 $1,608,210,902

6% Average Annual Growth from FY06 to FY09