FISCAL NOTE
Date Requested: January 15, 2016
Time Requested: 12:20 PM |
| Agency: |
Health and Human Resources, Department of |
|---|
| CBD Number: |
Version: |
Bill Number: |
Resolution Number: |
| 1479 |
Introduced |
SB145 |
|
|---|
| CBD Subject: |
|
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FUND(S):
0403 - Div of Human Services General Administration fund, 8722 - Cons Federal funds Div Human Services Gen Admn Fd
Sources of Revenue:
General Fund,Other Fund Federal
Legislation creates:
Neither Program nor Fund
Fiscal Note Summary
Effect this measure will have on costs and revenues of state government.
The purpose of this bill is to require coverage for preventative dental care for any Medicaid eligible adult who is a recipient of Medicaid benefits.
The Department estimates the costs could be approximately $85 million ($72 million federal, $13 million State).
Fiscal Note Detail
| Effect of Proposal |
Fiscal Year |
2016
Increase/Decrease
(use"-") |
2017
Increase/Decrease
(use"-") |
Fiscal Year
(Upon Full
Implementation) |
| 1. Estmated Total Cost |
0 |
85,000,000 |
85,000,000 |
| Personal Services |
0 |
0 |
0 |
| Current Expenses |
0 |
85,000,000 |
85,000,000 |
| Repairs and Alterations |
0 |
0 |
0 |
| Assets |
0 |
0 |
0 |
| Other |
0 |
0 |
0 |
| 2. Estimated Total Revenues |
0 |
0 |
0 |
Explanation of above estimates (including long-range effect):
There are a number of variables including but not limited to actual enrollment, total number of enrollees throughout a state fiscal year (SFY), actual utilization, appropriate adult reimbursement rates for these services, managed care penetration, and any demographic shifts. The estimates have been developed using the following assumptions: Service frequency -Dental exam and teeth cleaning - 2 per year per member for each service, Bite-wing and Full-mouth X-ray - 1 per year per member for each service; estimated annual cost per member of $254 for all services; Number of adult Medicaid enrollees as of January 16, 2016 is roughly 334,000.
Historical costs and utilization data of adult dental services are not available since preventive dental benefits for adults have historically not been covered. Costs for adult services were estimated by utilizing fee-for-service rates for identical services provided to Medicaid children for SFY 2015; no trending was applied to the service cost from the base year and no managed care savings factor was included as these are preventive services. The estimates above assume 100% utilization rate of the services at the service limits described above; actual utilization may be less and would result in lesser estimated costs (e.g. at 50% utilization total costs would be approximately $42 million; $36 million federal and $6 million state funds).
Memorandum
This change would require CMS approval and a State Plan Amendment (SPA); the legislation directs that application for any required federal approval be made by July 1, 2016. It can take in excess of 6 months to receive approval of a SPA, therefore it is not anticipated that the coverage could be implemented prior to SFY17. Additionally the timing of SPA approval and implementation will impact the total cost incurred during the first SFY; costs presented above assume a full 12 months of utilization by all adult members.
Person submitting Fiscal Note: Karen L. Bowling
Email Address: dhhrbudgetoffice@wv.gov