This Fiscal Note is not an official copy and should not be quoted or cited.
Fiscal Note - SB 0674 - DOH to Assure Health Care Programs for Children Under 18
L.R. NO. 2372-01
BILL NO. SB 674
SUBJECT: Child; Health; Department of Health; Public Health; Insurance;
Department of Social Services
TYPE: Original
DATE: January 12, 1996
FISCAL SUMMARY
ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
General Revenue $1,196,666 to $1,479,000 to $1,523,452 to
($449,452) ($457,874) ($469,789)
Total Estimated
Net Effect on All
State Funds $1,196,666 to $1,479,000 to $1,523,452 to
($449,452) ($457,874) ($469,789)
*Dependent upon implementation of the Medicaid "Waiver".
ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
None
Total Estimated
Net Effect on All
Federal Funds $0 $0 $0
ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
Local Government $0 $0 $0
FISCAL ANALYSIS
ASSUMPTION
Officials of the Department of Highway and Transportation (DHT), the
Department of Insurance (INS), the Department of Labor and Industrial
Relations (DOLIR) - Division of Employment Security (DES), and the Office of
Administration (OA) assume this proposal would not fiscally impact their
agencies.
Officials of the Department of Health (DOH) assume this would represent a new
program to the DOH. They assume an additional 13 FTE, plus related expense
and equipment, would be required to implement the additional duties outlined
in this proposal. One Program Administrator ($39,252) would plan, direct,
coordinate, and evaluate the activities outlined in this proposal. One
Health Planner III ($33,180) would be responsible for comprehensive planning
and related policy development. One Clerk IV ($19,932) would provide
administrative support for professional staff and maintain communication with
the district health offices. Five Health Program Representative II ($25,020)
would be responsible for the technical work in the program outlined in this
proposal. Five Clerk Typist II ($16,164) would provide clerical and
administrative support to each of the Health Program Representative II. One
Health Program Representative and one Clerk Typist II would be located in
each of the DOH district offices around the state. Expenses would include
rental space for thirteen FTE, office expenses, and travel expenses
($98,461). Equipment would include office furniture and personal computers
for thirteen FTE ($62,171).
Oversight assumes no additional rental space would be needed for the Program
Administrator, the Health Planner III, and the Clerk IV. Rent, office and
travel expenses are assumed by Oversight to be $75,833. Oversight also
assumes the duties specified for the Health Planner III above would duplicate
that of the Program Administrator and therefore have not included related
costs in the fiscal impact.
DOH assumes in estimating costs that the proposed Medicaid waiver (Waiver)
would not become effective. However, if the proposed Waiver would be
implemented to cover children up to 250% of poverty, the population to be
included in DOH's program as outlined in this proposal would be reduced. DOH
is not able to determine what the population is of children between 200% and
250% of poverty. If the proposed Waiver includes a plan to allow a buy in
for health care coverage under Medicaid up to 250% of poverty, DOH assumes
that a majority of the children population would be covered under Medicaid.
DOH assumes that if the Waiver is implemented and a buy in is allowed, the
costs to DOH could be zero.
Officials of the Department of Social Services (DOS) assume an additional FTE
and related expense and equipment would be required to implement the duties
outlined in this proposal. One Project Coordinator ($28,200) for a ten month
time period would work as the DOS - Division of Medical Services liaison
with the DOH. This FTE would provide information to DOH regarding the
benefits available under Medicaid. The FTE would also work with DOH
regarding the duties outlined in this proposal as they relate to school
health model cooperative arrangements. Expenses would include rental space,
office expense, and travel expense ($2,046). Equipment would include office
furniture and a personal computer ($6,962).
Oversight assumes that because this FTE is for only a ten month period no
equipment would be needed and no additional rental space would be included.
Officials from the Department of Mental Health (DMH) estimate the potential
savings from this proposal to be in a range of $0 to $1,436,000 for a full
fiscal year. DMH states the potential savings have been adjusted for
services delivered in a managed care environment. DMH further states that
managed care organizations may not provide the level of service currently
offered by DMH. The potential savings are dependent on the number of
families participating in the proposed program. DMH also states that any
savings would be offset if DMH would be responsible for the insurance
premiums.
Officials from the Missouri Consolidated Health Care Plan (MCHCP) did not
respond to Oversight's request for fiscal information.
FISCAL IMPACT - State Government FY 1996 FY 1997 FY 1998
(10 Mo.)
GENERAL REVENUE FUND
Savings - Department of Mental Health
Direct services $0 to $0 to $0 to
$1,196,666 $1,479,000 $1,523,452
Costs - Department of Health
Personal services (12 FTE) $0 to $0 to $0 to
($226,352) ($278,525) ($285,488)
Fringe benefits $0 to $0 to $0 to
($69,581) ($85,619) ($87,759)
Expense and equipment $0 to $0 to $0 to
($120,380) ($93,730) ($96,542)
Total Costs - Department of Health * $0 to $0 to $0 to
($416,313) ($457,874) ($469,789)
*Dependent upon implementation of the Medicaid "Waiver".
Costs - Department of Social Services
Division of Medical Services
Personal service (.83 FTE) ($24,088) $0 $0
Fringe benefits (7,405) 0 0
Expense and equipment (1,646) 0 0
Total Costs - Department of
Social Services ($33,139) $0 $0
ESTIMATED NET EFFECT ON $1,196,666 $1,479,000 $1,523,452
GENERAL REVENUE FUND to to to
($449,452) ($457,874) ($469,789)
FISCAL IMPACT - Local Government FY 1996 FY 1997 FY 1998
(10 Mo.)
$0 $0 $0
DESCRIPTION
This proposal would require insurers and similar entities to cover uninsured
children who are not eligible for Medicaid and whose household income is
below 250% of the federal poverty level. The Director of the Department of
Health (DOH) would assign children to particular insurers based on the
child's geographic location or to the parents' insurer, if any. The
assignment process must fairly distribute risk among insurers. The Director
of DOH would decide what benefits would be covered except that abortion would
not be covered. The benefits under this proposal would be at least equal to
Medicaid benefits. Premiums would be based on an ability to pay as decided by
the Director of DOH; however, premiums cannot exceed 30% of the average
premium for insured children.
This proposal also requires the Director of DOH, after consulting with the
Department of Social Services - Division of Medical Services, to develop
cooperative arrangements between insurers and schools which receive direct
Medicaid services.
This legislation is not federally mandated, would not duplicate any other
program and would not require additional capital improvements or rental
space.
SOURCES OF INFORMATION
Department of Health
Department of Insurance
Department of Social Services
Department of Corrections
Department of Conservation
Office of Administration
Department of Highways and Transportation
Department of Elementary and Secondary Education
Department of Public Safety
Missouri State Highway Patrol
Department of Mental Health