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Item O1 S BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY ADD-ON Meeting Date:Wed.August 20,2014 Division: BOCC Bulk Item: Yes No XX Department: Comm. David Rice Staff Contact/Phone#:Tamara Lamarche PH: 305 289-6000 AGENDA ITEM WORDING: Discussion of current issues regarding Medicaid Transportation Disadvantaged services in Monroe County. ITEM BACKGROUND: Miami-Dade and Monroe Counties(Region 11) began the transition to Florida's Medicaid Medical Managed Assistance(MMA) Program on July 1,2014. Medicaid transportation services in Monroe County are now at a crisis point. The eleven (11) private insurance providers for Dade-Monroe handling Medicaid MMA services are not stepping up and signing contracts for transportation disadvantaged services(TDS)with Monroe County and the Guidance/Care Center to utilize existing services despite numerous contacts. Additionally,Senate Bill 1520,amending FSS 409, passed in 2013,changed the county contribution rate for the next seven (7)years,which has reduced rates of reimbursement, also affecting transportation for the disadvantaged. The County is continuing to provide transportation to Medicaid-recipients, and others eligible for TDS, but there is no guarantee that the County will be reimbursed from the HMO Medicaid providers for our region as they have not contracted with the County for the established transportation disadvantaged services,which were established by FL Statute 417, 16 years ago,creating the Florida Commission for the Transportation Disadvantaged,and it's funding source through FDOT. If the County continues to pick up this cost on their own and provide this transportation,it will be more unlikely that the private providers will seek a contract, and will continue to allow the County to provide these services without a contractual agreement for reimbursement,at a cost savings for them to enhance their profit margins. The Guidance/Care Center,which has performed a temporary coordination role for this Medicaid MMA transportation during the transition, has notified the County, Friday,August 15, 2014,that they will be discontinuing this assistance as they cannot properly budget for the costs of the services or guarantee any reimbursement rate with no insurance provider contracts in place. PREVIOUS RELEVANT BOCC ACTION: March 19,2014 BOCC approved Resolution 061-2014. CONTRACT/AGREEMENT CHANGES:Note:The current FL Medicaid reimbursement rate for transportation access to medical services, is zero(0)reimbursement over 60 miles, (nearly all the medical specialists for treating chronic illness for Monroe County residents are in Miami with a round trip of 200 miles from Key West), and within the 60 mile limit is nine(9)cents a mile per person per month, up to$300 per person per month. -.---sTAMRECOM MENDATIONS: TOTAL COST:Unknown COST: BUDGETED: Yes _ No XX DIFFERENTIAL OF LOCAL PREFERENCE: COST TO COUNTY:Unknown SOURCE OF FUNDS: REVENUE PRODUCING: Yes_ No AMOUNT PER MONTH Year APPROVED BY: County Atty OMB/Purchasing_ Risk Management DOCUMENTATION: Included XX Not Required DISPOSITION: AGENDA ITEM# 0 Medicaid Managed Medical Assistance Transportation Issues August 20, 2014 BOCC Discussion • Managed Medical Assistance Program (MMA)for Medicaid-eligible recipients under ACA government-subsidized healthcare begins in Dade-Monroe Counties, Region 11 under private insurers, Health Management Organizations (HMO's), or Provider Service Networks(PSN), as of July 1, 2014. • Included with the health care services, was transportation to access covered services. It was assumed that our County Transportation Disadvantaged Service Program, administered by Monroe County and the Guidance/Care Center,which is partially funded by the FDOT Transportation Disadvantaged Program,established by Florida Statute 417 would be utilized by the providers under the MMA program,as Medicaid clients were already being served under this transportation program. • Monroe County has 10 private insurers available to Medicaid MMA recipients. Individuals are required to sign up with the provider of their choice, preferably one that includes in their network all their current doctors. (See attached listing.) Not a single private insurer of the 10 has contracted with Monroe County and the Guidance/Care Center to utilize the County Transportation Disadvantaged Program services to date. • The BOCC issued RESOLUTION R061-2014 on March 19, 2014 asking Governor Scott, and the Secretary for Health Care Administration, to delay any change to the Monroe County Coordinated System, including services for the Transportation Disadvantaged and Medicaid, until the potential impact of Medicaid Managed Care on our resident's ridership is determined;to which we received no response. • Over the past 16 years, Monroe County and the Guidance/Care Center,with the services of the Transportation Disadvantaged Coordinator, have developed and managed an effective, cost efficient, and coordinated transportation program to meet the needs of our residents. • As an example, under the new MMA Medicaid transportation scenario, where all 10 of the insurance providers are using their own transportation providers, 5 Monroe residents who need to go to Miami for dialysis treatments will likely be transported by five different transportation providers, rather than by the County-Guidance/Care Center Transportation Disadvantaged Program, creating inefficiency and extra costs. Lamarche-Tamara From: Maureen Grynewicz <maureen.grynewicz@westcare.com> Sent Friday, August 15,2014 6:22 PM To: John P.Irvine Cc: Steven Holmes; BOCCDIS4;Neugent-George;Maria Hernandez;Cristina Tuero;Frank Rabbito;Graham-Sheryl; Florida Keys - Keys Management Team Subject: Medicaid Coordination Contract John, After much thought and great discussion, I regret to inform you that the Guidance/Care Center will not be extending it's Medicaid Coordination contract. Unfortunately,the proposed rates and unpredictable trip numbers make it financially impossible to continue to provide quality, efficient,and cost effective transportation that we have prided ourselves on. On a personal note,it is heart breaking to watch an efficient and effective system that so many have put so much time and effort into creating fall apart at the seams. If you have any questions,please feel free to contact me. Thank you! Mo -- Maureen Grynewicz Guidance/Care Center Site Director, Upper Keys and Director of Transportation Phoney305)434-7660 ext. 31302 Fax: (305)451-8019 Key Largo/ (305)434-9040 Marathon www.guidancecarecenter.ora --CONFIDENTIALITY NOTICE: This email and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to which they are addressed.This communication may contain material protected by HIPAA legislation(45 CFR, Parts 160& 164)or by 42 CFR Part 2. If you are not the intended recipient,be advised that you have received this email in error and that any use,dissemination, forwarding,printing or copying of this email is strictly prohibited. If you have received this email in error, please notify the sender by reply email and destroy all copies of the original message. t • RESOLUTION NO. 061 . 2014 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA URGING THE GOVERNOR AND SECRETARY OF THE AGENCY FOR HEALTH CARE ADMINISTRATION TO DELAY ANY CHANGE TO THE MONROE COUNTY COORDINATED SYSTEM, INCLUDING SERVICES FOR THE TRANSPORTATION DISADVANTAGED AND MEDICAID, UNTIL THE POTENTIAL IMPACT OF MEDICAID MANAGED CARE ON OUR RESIDENTS RIDERSHIP IS DETERMINED. WHEREAS, Sec. 417.011 - 417.017, Florida Statutes establishes the Florida Commission for the Transportation Disadvantaged ("Commission") to accomplish the coordination of transportation services to be provided to the transportation disadvantaged throughout the State of Florida;and WHEREAS, the Commission approves a Designated Official Planning Agency ("Agency") who is responsible for creating a Local Coordinating Board ("Board") and for providing technical assistance to that Board; and WHEREAS, the Commission also approves a Community Transportation Coordinator ("Coordinator"), who is recommended by the Board, for five (5) years for each county in the state who is responsible for arranging cost-effective, efficient, unduplicated, and un-fragmented transportation disadvantaged services within its respective service area; and WHEREAS, the Transportation Disadvantaged Service Plan is developed and annually updated by the Community Transportation Coordinator and the Designated Official Planning Agency under the guidance and approval of the Local Coordinating Board in accordance with requirements set out in Rule 41-2,Florida Administrative Code;and WHEREAS, the first Monroe County Transportation Disadvantaged Service Plan was prepared in 1993 with subsequent annual updates;and WHEREAS, local control of the Transportation Disadvantaged Service Plan has been instrumental in solidifying the working relationship of the Monroe County Local Coordinating Board and the Monroe County Community Transportation Coordinator; and WHEREAS,the coordinated system includes Medicaid transportation;and WHEREAS, over the past l6 years Monroe County has developed and managed an effective, cost efficient and coordinated transportation system that meets the needs of our residents; and Page 1 of 2 • e . • WHEREAS, the current system's operations may be substantially impacted due to the possible change in State oversight moving the system from the Department of Transportation to the Medicaid Managed Care providers;and WHEREAS,this change in oversight may result in the disruption of the current effective and cost efficient system mainly due to a lack of information, negotiation of multiple contracts with HMO's, additional layers of communication and reporting, increased expense and overall devolution of our program; NOW THEREFORE,BE IT RESOLVED that the Board of County Commissioners of Monroe County, Florida hereby: I. Urges the Governor and the Secretary of the Agency for Health Care Administration to delay any change to the Monroe County Coordinated System, including services for the Transportation Disadvantaged and Medicaid, until the potential impact of Medicaid Managed Care on our resident's ridership is determined. 2. Directs the Clerk to forward this resolution to Governor Rick Scott, AHCA Secretary; Elizabeth Dudek, Secretary of Transportation; Ananth Prasad, State Representative; Holly Merrill Raschein, District 120; Senator Dwight Bullard, District 39; Senator Jeff Brandes, Senate Committee on Transportation; Representative Daniel Davis, House i Transportation and Highway Safety Subcommittee; Senator Denise Grimsley, Senate Appropriations Subcommittee on Health and Human Services; and Representative Matt Hudson,House Healthcare Appropriations Subcommittee. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County. Florida,at a regular meeting of said Board held on the 196 day of March,2014. Nis N Mayor Sylvia Murphy Tee c. Rs Mayor pro tern Danny L.Koihage Tee z= Commissioner Heather Carruthers Tee Commissioner George Neugeut Tee ,; N Commissioner David Rice Tea re L. BOARD OF COUNTY COMMISSIONERS r OF MONROE COUNT a n d M or Sylvia Murp y �" 'ill AMY HEAVILIN,C I RK illr ~�' y.>© r !/ A 110tiroe C ATTORNEY Deputy Clerk / APPR FORK Page 2 of 2 Oats e—r y A Snapshot of the Florida Medicaid Managed Medical Assistance Proaram Statewide Medicaid Managed Care(SMMC)Managed When will I be notified and be required to enroll? Medical Assistance Program(MMA) a Approximately 60 days prior to each region's start date, a The Florida Medicaid program is implementing a new eligible Medicaid recipients will receive a letter with system through which Medicaid enrollees will receive information about the managed care plans in the region services. This program is called the Statewide Medicaid and information on how to enroll. Managed Care Managed Medical Assistance program. a Eligible recipients who must enroll will have a minimum of a The Managed Medical Assistance program is comprised of several types of managed care plans 30 days from the date they receive their welcome letter to Health Maintenance Organizations choose from the plans available in their region. - Provider Service Networks a Enrollees will have 90 days after enrollment to change to a - Children's Medical Services Network different plan if they so choose. a Most Medicaid recipients must enroll in the MMA program. Who Is NOT rMr}rhed to participabe? What MMA Standard(Non-Specialty)plans are available in my region? a The following individuals are NOT required to enroll, 1 2 31, a 5 a y a s tD 11 although they may enroll if choose to' a AmagrOPP x x x x - Medicaid recipients who have ether creditable health oases care coverage,excluding Medicare - Health x I x x - Persona eligible br refugee assistance a Coventry x - Medicaid recipients who are residents of a First coast developmem r.al disability center AU.. Mg• x - Medicaid recipients enrolled in the developmental Humana x - X x x x disabilities home and community based services • rnno.r z x waiver or Medicaid recipients waiting for waiver PMNemed X X x services • Medical x Who is NOT eligible to participate? • ercccsae x x X x x x x x X a The following individuals are NOT eligible to enroll: • s:mgy x - Women who are eligible only for family planning • cupids x x x x x x x x x services • _ emits x x x x - Women who are eligible through the breast and • staywen x X X x x XX x cervical cancer services program Note'Formal protest pending in Region 11 for MMA Standard - Persons who are eligible for emergency Medicaid for plans. allens What are MMA Specialty plans? - Children receiving services in a presolbed pediatric extended care center •S Five companies were selected to provide specially plans When will the Managed Medical Aaaiabnpe program that will serve populations with a distinct diagnosis or begin? chronic condition.These plans are tailored to meet the specific needs of the specialty population. a The Managed Medical Assistance Program is expected to 2. Information on each specialty plan will be available in the begin in May 2014. choice counseling information provided in each region that a The rollout schedule is as follows. the specialty plans are available. i Rollout schedule What do I have to do to choose a Managed Medical Regions Enrollment Date Assistance plan? 2.3 and 4 May 1.2014 44 Choice counselors are available to assist recipients in s,a and a June 1.2014 selecting a plan that best meets their needs. This 10 and 11 Jwy 1,2014 assistance will be provided by phone. In-person visits are • 1,1 nor a Angus/1,2014also available by request for recipients with special needs. What region am I in? O. Recipients can also enroll online at: • mom flmedicaidmanabedcare.corn. f asoon- _ counties 1 Eemnlw,Okaoosa.Santa Rosa.and Mallon Day,Calhoun,Franklin,Gxdtlat.GA.Hdmm,Jackson, Jabr.a,Leon,Liberty,Madison,Taylor.W.kde.our WaSrni1o, - youtube.cem/AHCAFIontla z AISCSUS ar 1lM,Citrus.Columba,Oiue.Glt'nst.Hamiaon, Hernando.Lwayerre,Lake.Levy,Mann,Putnam.Sumter, 1113 Face0ook.cam/AHCAFIDrida Suwannee,and Union 'Bawr.CI ,oust Finley Nauau.Si.Jim..and venial. _ Pasco and PinellasTwittercom/AHCA FL Hardee,HgNenda,Hillsborough,Manatee,and Palk award.Orange.Osceola.eta Seminole Charlotte,Collar,DeSdo,Gases,Hendry.Lee.end Sara t. _ _ Indian River.Mello.Okeechobee.Pam endBeach,e Sr.Lucie 0 Bmward e 1 M1emt.Dade and Monroe WK..yx•ty ,Wpvp yym,ormncw January 6, 2014 A Snapshot of the Florida Medicaid Managed Medical Assistance Program Can 1 change my MMA plan once I make a selection? Will my MMA plan continue the services I ant receiving a Recipients are encouraged to work with a choice now? counselor to choose the managed care plan that best a The new plan is required to continue existing services for meets their needs up to 60 days,OR until the enrollee's primary care a After joining a plan,the redolent has 90 days to change to practitioner r behavioral health provider reviews the another plan offered within their region_ enrollee's treatment plan. a After the 904ey deadline,recipients may only change plans for good cause reasons. What providers will be included in the Managed a After the initial 12-month period,recipients may change Medical Asfistana plans? plans during an open enrollment period. a Managed Medical Assistance plans may limit the providers in their networks based on credentials,quality indicators. What Medicaid covered services are provided under the and price but they must include the following statewide Managed Medical Assistance program? essential providers: MMYnum Covered Santee abUNMe MMA Program RwNNad Essential Network Providers Advanced wetted nurse pMElo,c MCMCel supply.equipment.proetheels Faculty Plans al Florida Medical Regional Pennaa'Menthe Can semen and Mhbn Schools Coolers(RP CCS) Amnpnry aupiul4eYmeMcaXY FNMA Care Providers serving Wetherell Mantel Mesh eenias Complex CMdnn.as Mbnnrid by the aarvw Specialty Childrena Hospital SIMe. einnproMNsentas Nuralqun Clarepatic gamins Optical seeps and wPpges a Plans must have a sufficient provider network to serve the needs of their plan enrollees,as determined by the State. Denial Mimi OMomMq rime Additional quailed Providers thew ON.MMA Program Include: Ease Perlvdicecreening dlgnbis I'd PhNiCS oauPationq,mpirslay.rk AnWMuolcglro Caaiolagra treatment services for*sapient*under speech anrepY age 2l Cardowculer Surgeons Chimpntlon Emagenry streeaz Podinric aenion Dematobpigs EndoMmb9W Farley Plinmrg garrote and supping PAysaan services.including physician Gaalmenwmlgisn Genera Dentists (some exogio) n15t nt wmba General Surgeons 'macaws gaarses HanhY Sian SONGS"!(some Prtrngio&MP Midwifes Nephrdodms anpbene Newclowea Neurowlgsn, Hearing arms Renal dialysis services Home health Agency services Respraluy MubmaM and supplies OMI°IrYYGynerdagiW Oncologists Omlhslmro,sn Opo einms Hospice mutes Rural health dine arvlcw OM Surgeons OrtvdoMgs HG.P4d inpatient',MEM Substrce Shale Intamorrt winless OnhttNllc Surgeons OlarpYlMnn TransTransportation lv flea covered Hsoed oulpmoR Motu a PNMIngats PedalC Primary Cen Prosaism serreas sod Spans Laboratory and rang Mama __ PM,MY. Peaodrmigs What benefit not otherwise covered by Medicaid are Pamon ocate RheumMYAglgs available from MMA plans? The Pea Urologists Pharmacies Bead certified or Board Battle 8 h GIe F Psvmenets flu of Expended Menefee — Vf'inx — S ! mam Coned Practlionen tithe Holing Arts inpatient Substance stance Abuse oelprCUMn Urw e r - yi :I et LL Fully Accredited Pe hCrnmua lsw CORM SbEillzation UM n (OSUY FnMaoina P.tFMC Spermity Hoieo. Ad' dental Sewn YYV TYYYVYY YYY — MYl hearing service ' Y Y r YYY YYYY Adult Y,Yon senates YY YVYYYYVVVYY re rpy r Y Y Y Y Eq lie therapy Where can I find more information? nom.nesnn can tor rmmprWmm areas r r r Y r r r r YYYY a Visit our SMMCwebsite at: influenzavrolN YYYYYYYYY YYYY_ Merunv aimed biting slow Y Y T Y Y Y Y htto//ahca.mvfloridacom(SMMC Neabomoromosom YYYY Y Y Y YYYYYY • ----Nutmpns ouneding Y Y T Y Y Y YYY a Email questions about the program to: Outwerni lrpapam lemon v v V YYY VY V Y FLMedicaidManarledCare(3ahca.mvflorida.Lom O lMounterrrledicabon and supplies V Y Y V Y Y Y V Y Y Y Y Pet meMM V V V a Keep up to date by signing up to receive program Phyaiaan home isila Y V V Y Y YYYY updates at httr:ltahca mvflorida.com/SMMC .Click Pneumonia vaccine YYY r r V r r V V v v ' the red'Sign Up for Program Updates'box on the Past reraniacherot meals V Y V Y Y V T Y Y r right hand side of the gig9e Pte1P anneal Eels Y Y YYYYY YYYY ght page. Primary care wits brrMprcrwrl eddls r Y Y Y V Y V T r Y V V Y Y Shingles vaccine YYVYY r Y YYrY Wavedoparsenn VY YVrYYYIYYYY NOTE' Details regarding scope d revered bwMl may wry by msnspsd care Mee January 6, 2014 AN ANALYSIS OF THE IMPACT OF THE FORMULA CHANGES WITHIN THE STATE COUNTY MEDICAID COST SHARE PROGRAM ON FLORIDA COUNTIES SB 1520 July 23,2013 Information Compiled by Chris Doolin and Sarah Harris Robert P.Jones& Associates For Analysis and Use by the members of the Small County Coalition INTRODUCTION CHANGES IN COUNTY MEDICAID COST-SHARE PAYMENT METHOD WILL IMPACT OVER THE NEXT SEVEN YEARS Senate Bill I520 modified the method of calculoling what each county is required to pay in the State County Medicaid Cost Share from a formula based on"Utilization" to a formula based on "Enrollment". • Prior to SB 1520,the historical method of payment for counties has been based on the portion of the state total that is attributed to how much service is provided to county residents,a factor referred to as Utilization. • SB 1520 changed the method of payment from how much each county pays for resident Utilization to county's%of residents who are enrolled in Medicaid,a factor that will be referred to as Enrollment. What does the Change in Payment Method do? • The change in payment method has a seven year implementation schedule that changes the County Cost Share formula from being 100% Utilization based to 100% Enrollment Based. • In the first two years(FY 13-14 and FY 14-15),the county payment is based on the% of what the county utilization share has been of the state total plus a predetermined% increase. In FY 13-14-all counties will pay a 7.24% increase. In FY 14-15-all counties will pay a 2.74%increase. • In years 3-7(FY I5-16 though FY 19-20)the number of" Medicaid enrollees"in the county is transitioned in as a factor for determining how much a county pays. • Beginning in FY 16-20-the impact of the shift skews the county cost share—with some counties receiving decreases(5.29%decrease in Pinellas)while other counties receive double digit increases(35%increase in Lafayette.) • The broad range of decreases/increases hold throughout the years 3 to 7 of the program- while the formula shifts to"Enrollment." Implementation Schedule Transitioning Prom Utilization to Enrollment FYI3-14-County Shares Based 100%on Utilization and 0%on Medicaid Enrollees FY14-I5-County Shares Based 100%on Utilization and 0%on Medicaid Enrollees FY15-16-County Shares Based 80%on Utilization and 20%on Medicaid Enrollees FYI6-17-County Shares Based 60%on Utilization and 40%on Medicaid Enrollees FY 17-I8-County Shares Based 40%on Utilization and 60%on Medicaid Enrollees FY18-19-County Shares Based 20%on Utilization and 80%on Medicaid Enrollees FY19-20-County Shares Based 0%on Utilization and l00%on Medicaid Enrollees Concern • The use of enrollees as the predominant distribution factor will have a profound impact on many small and mid-sized counties substantially increasing the% of how much many small and mid-sized counties will have to pay over the current"Utilization based" formula. • Many counties will experience annual Medicaid cost share increases that exceed the%of the increase in the statewide total. • While the State Total of County Medicaid Cost Share increases 24%over the seven year implementation schedule,forty-eight counties experience increase in excess of the state 3 The State Total of County Medicaid Cost Share is estimated to increase 24%by FY 19-20 Over the next seven years,from FY 12-13 to FY 19-20,the Statewide County Medicaid Cost Share total is estimated to increase 24%,growing from$251.4 million in FY 2012-13 to $312.3 million in FY 19-20. What is the impact of the change on each county over the seven year transition period? • 3 Counties will experience decreases in actual payment obligation. • 19 Counties will experience art increase less than the 24%growth of the state total. • 48 Counties will experience increases greater than the 24%of growth in the total program. . • 31 Counties will experience an increase greater than 50%over what they have been paying. • 5 counties will experience an increase greater than 100%over what they have been paying. • 1 county will experience an increase projected to exceed 200%over what they have been paying. The formula change will have the following impact on the counties below: Alachua County's share is estimated to increase 1.6%. Lake Countys.slare is estimated so increase 19% Baker County's share is estimated to increase 74%. Lee Couno's shore is estimated to increase 48% Bay County's share is estimated to increase 102% Leon Camay's share is estimated to increase 42% Bradford County's share is estimated to increase 20% Levy County's share is estimated to increase 27% Brevard County's share is estimated to increase 15.5% Liberty County's share is estimated to increase 19% Heyward County's share is estimated to increase 10.74% Madison County's share is estimated to increase/09% Calhoun County's share is estimated to increase 38% Manatee County's share is estimated to increase 12% ^,w dome County's share is estimated to increase 30.7% Marion County'%share is estimated to increase 48% items Countys.share is estimated to increase 28% Martin County's share is estimated to increase 59% lay County's share is estimatedw increase 45% Monroe County's share is estimated to increase 6% oilier County's share is estimated to increase 36% Nassau Colony'.sshare is estimated to increase 54% alumina Gmnty's share is estimated to increase 2% Okaloosa County's share is estimated to increase 65% e de Countv's share is estimated to increase 11.3% Okeechobee County's share is estimated to increase 48% •eSato County's share is estimated to increase 76% Orange County's share is estimated to increase 22% isle County's share is estimated to increase 51% Osceola County's share is estimated to increase 73% uw t Coway's share is estimated to increase 20% Palm Beach County's share is esnmwed to increase scambia County's share is estimated to increase 38% 18.6% !ogler County's share is estimated to increase 33% Pasco County's share is estimated to increase/R620% rank/in County's share is estimated to decrease l 7%1 Pinellas County's share is estimated to decrease R27%) 'adsden County's share is estimated to increase 90% Polk County's share is estimated to increase 28% .ilahristCounry9share is estimated to increase 56% Putnam County's.shore is estimated to increase 84% lades Coann's.share is estimated to decrease(19%) Santa Rosa Camay's share is estimated to increase 57% ulf County's share is estimated to increase 27% Sarasota County's share is estimated 10 increase 37% amilton County's share is estimated to increase 75% Seminole Coaty's share is estimated to increase 5.4% ardee County's share is estimated to increase 153% St Johns County's share is estimated to increase 37% endry County%sham is estimated to increase 156% Si-Lucie County's share is estimated to increase 62% emend°County's share is estimated to increase 36% Sumter County's share is estimated to increase 64% ighiands County's share is estimated to increase 51% Suwannee County's share is estimated to increase 49% Hillsborough County's share is estimated to increase 31% Taylor County%share is estimated to increase 73% Holmes County's share is estimated to increase 94% Union Como's share is estimated to increase 34% Indian River County's share is estimated to increase 83% Volusia County's share is estimated to increase 40% Jackson County's share is estimated to increase 82% Wakul/a County's share is estimwed to increase 63% Jefferson Countys share is estimated to increase 22% Walton County's share is estimated to increase 29% Lafayette County's share is estimated to increase 221% Washington County's share is estimated to increase 77% 4 Monroe County's share is estimated to increase 6% • Monroe County's utilization share in FY 12-13 was 0.262% of statewide total or approximately$685,885.00. • Monroe County payment will shift over 7 years to.22%based on the use of enrollees as the formula factor. • Statewide the total County Medicaid Cost Share payments are scheduled to increase 24% statewide from$251 million in 12-13 to$312 million in 19-20. • Under SB 1520,Monroe n County's payment is projected to increase from$685,885.00 in FY 12-13 to$698,212 FYI9-20 or an overall increase of 6%. (1) (2) (3) (4) (5) (6) Year Statewide Statewide Monroe's Share Monroe's Monroe's County Cost % Formula/Payment Projected Annual Share—AB (*crease Basis—Under SB 1520 Payment Counties Under SB Increase 1520 Under SB 1520 2012.13 251A06,686 ------ Monroe pays.239%of 685,885.00 ----- County Statewide costs 2013-14 269,600,000 7.24% County share based 706,566.00 7.24% on.239%utilization 2014-15 270,000,000 2.74% County share based 725,960.00 2.74% on.239%utilization 1_2015-16 284,257,400 2.62% 80% based on 723,075.00 (0A01% utilization/20%based _ oo enrollees 2016-17 290,823,746 231% 60%based on 717,367.00 (0.79)% utilization/40%based on enrollees 2017-18 297,439,986 2.28% 40%based on 710,766.00 (0.92)% utilization/20%based on enrollees 2018-19 304,920,602 2.52% 20% based on 705,145.00 (0.79)% utilization/80% based on enrollees 2019-20 312,330,172 2A3% 100%based on 698,212 .00 (0.98)% utilization 33