Agency 300080
Medical Assistance
RCW 43.17, 74.09
| Request | $3,969,713,605 | ||||||||||||||||||
| Net change from current biennium | $454,284,793 | Increase | |||||||||||||||||
| Percent change from current biennium | 12.9% | Increase | |||||||||||||||||
Through the Medical Assistance program, necessary medical care
is made available to recipients of income assistance, beneficiaries
of Supplemental Security Income (SSI), and other eligible people
with low incomes who do not qualify for income assistance, including
pregnant women to 185 percent of the federal poverty level, and
children to 200 percent of the federal poverty level.
Funding is provided through General Fund-State and Health Services
Account-State appropriations, with matching funds supplied by
the federal government for those persons and services covered
under Medicaid (Title XIX of the Social Security Act). Federal
matching funds account for about 52 percent of total program expenditures.
Additionally, local funds are generated through the Intergovernmental
Transfer/Disproportionate Share Hospital program and used to offset
General Fund-State.
Income assistance recipients (including SSI beneficiaries) account
for about 62 percent of the persons eligible and 59 percent of
program expenditures. Low-income pregnant women and children ineligible
for income assistance and persons unable to meet necessary medical
expenses account for the remaining 41 percent of program costs,
with the expanded pregnant women and children being 50 percent
of that amount.
The program covers a broad range of medical services. For that
portion of the program in which the federal government participates
financially (Medicaid), at least the following services must be
provided to eligible clients: inpatient and outpatient hospital
care; physician services; outpatient laboratory and x-ray; home
health nursing care; early and periodic screening, diagnosis,
and treatment (EPSDT) for children; rural health clinic services;
family planning services; and nurse midwife services. In addition,
the state must ensure necessary transportation for recipients
to and from medical providers.
The General Assistance Unemployable (GA-U) and medically needy
service coverages are somewhat more restrictive than identified
above. Services for the Medically Indigent program are limited
to those that occur in a hospital and emergency transportation.
The goals of the program are to: enroll as many clients as appropriate
in managed care plans through Medical Assistance Administration's
(MAA) Healthy Options program, as the primary means for providing
access, ensuring appropriateness and quality of care, and containing
costs of the Medical Assistance Program; maintain the performance
of the fee-for-service system and enhance performance in targeted
priority areas; support low income working families by making
medical coverage available; enhance and maintain a customer focused
administrative orientation within MAA; and provide quality and
timely disability determinations while maintaining cost containment
in disability determination process.
To better meet the objectives and goals of the program, the Medical
Assistance program is moving from a service delivery model based
primarily on fee-for-service to a managed care model. Mandatory
enrollment in managed care for Categorically Needy AFDC clients,
pregnant women and other, non-grant children has been implemented
statewide. Mandatory enrollment in capitated managed care is being
implemented for non-Medicare SSI clients. Enrollment is anticipated
to begin in February 1997 and is expected to be statewide by mid-year,
1998.
Links to Category Level Detail
Medical Assistance Administration
| Operating Budget: Summary by Object
| ||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||
| Salaries And Wages | 21,405,162 | 24,293,030 | 23,983,472 | 25,483,817 | 25,506,270 | |||||||||||||
| Employee Benefits | 5,782,214 | 6,492,512 | 6,468,616 | 6,810,008 | 6,812,180 | |||||||||||||
| Personal Service Contracts | 1,814,871 | 2,122,887 | 704,578 | 1,923,452 | 1,928,160 | |||||||||||||
| Goods And Services | 13,829,038 | 13,734,035 | 10,955,070 | 16,414,272 | 16,453,243 | |||||||||||||
| Travel | 221,432 | 303,349 | 209,656 | 174,720 | 174,720 | |||||||||||||
| Capital Outlays | 1,183,858 | 1,659,972 | 685,869 | 831,696 | 764,376 | |||||||||||||
| Grants, Benefits & Client Services | 1,576,800,719 | 1,648,801,084 | 1,773,298,732 | 1,878,704,964 | 1,981,994,109 | |||||||||||||
| Debt Service | 59,580 | 61,406 | 41,246 | 41,136 | 41,136 | |||||||||||||
| Interagency Reimbursements | (1,980,668) | (162,483) | 324,500 | 324,500 | ||||||||||||||
| Intra-Agency Reimbursements | 393,713 | 707,789 | 1,067,992 | 2,494,300 | 2,512,046 | |||||||||||||
| Annual Total |
1,619,509,919 |
1,698,013,581 |
1,817,415,231 |
1,933,202,865 |
2,036,510,740 | |||||||||||||
| Operating Budget: Category Summary
| ||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||
| General Medical Assistance | 1,552,685,791 | 1,621,664,929 | 1,758,666,741 | 1,852,221,980 | 1,955,511,125 | |||||||||||||
| Medical Assistance Administration | 66,022,467 | 75,801,173 | 58,345,713 | 80,665,464 | 80,999,615 | |||||||||||||
| Special Projects | 801,661 | 547,479 | 402,777 | 315,421 | ||||||||||||||
| Annual Total |
1,619,509,919 |
1,698,013,581 |
1,817,415,231 |
1,933,202,865 |
2,036,510,740 | |||||||||||||
| Fiscal Year 1993-94 | 1,494,853,876 | |||||||||||||||||
| Biennium Total |
3,114,363,795 |
3,515,428,812 |
3,969,713,605 | |||||||||||||||
| Operating Budget: Change from Preceding Biennium
| ||||||||||||||||||||||||||
| 1993-95 Actual | 1995-97 Estimated | 1997-99 Proposed | ||||||||||||||||||||||||
| Amount | Percent | Amount | Percent | Amount | Percent | |||||||||||||||||||||
| General Medical Assistance | 748,085,716 | 33.3% | 382,634,874 | 12.8% | 427,401,435 | 12.6% | ||||||||||||||||||||
| Medical Assistance Administration | 29,684,596 | 34.5% | 18,312,742 | 15.8% | 27,518,193 | 20.5% | ||||||||||||||||||||
| Special Projects | (2,062,890) | (71.2)% | 117,401 | 14.1% | (634,835) | (66.8)% | ||||||||||||||||||||
| Total |
775,707,422 |
33.2% |
401,065,017 |
12.9% |
454,284,793 |
12.9% | ||||||||||||||||||||
| Employment Summary
| ||||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||||
| FTE Staff Years | 653.1 | 705.6 | 797.1 | 780.1 | 787.9 | |||||||||||||||
| Average FTE Staff Year Costs | 32,775 | 34,429 | 30,088 | 32,667 | 32,372 | |||||||||||||||
| Source of Funds
| |||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | |||||||||||||||
| General Fund - Basic Account - State | 588,107,564 | 673,252,774 | 659,427,789 | 690,478,242 | 706,040,527 | ||||||||||||||
| General Fund - Basic Account - Federal | 868,863,208 | 41,940,251 | 41,230,547 | 28,818,476 | 29,263,289 | ||||||||||||||
| General Fund - Basic Account - Federal Unanticipated | 491,634 | ||||||||||||||||||
| General Fund - Basic Account - Private/Local | 150,218,557 | 94,877,929 | 104,282,071 | 109,550,980 | 111,779,732 | ||||||||||||||
| General Fund - Basic Account - DSHS Medicaid Federal | 820,317,780 | 872,827,671 | 973,927,229 | 1,031,979,538 | |||||||||||||||
| Health Services Account - State | 11,828,956 | 67,624,847 | 139,647,153 | 130,427,938 | 157,447,654 | ||||||||||||||
| Annual Total |
1,619,509,919 |
1,698,013,581 |
1,817,415,231 |
1,933,202,865 |
2,036,510,740 | ||||||||||||||
| Medical Assistance Workload Indicators
| ||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||
| Medicaid Payments--Categorically Needy | ||||||||||||||||
| Average Monthly Persons | 622,053 | 663,952 | 697,846 | 729,632 | 752,527 | |||||||||||
| Average Cost | 192.43 | 190.14 | 197.90 | 201.75 | 208.94 | |||||||||||
| Medicaid Payments--Medically Needy | ||||||||||||||||
| Average Monthly Persons | 14,424 | 11,342 | 9,998 | 9,748 | 9,587 | |||||||||||
| Average Cost | 333.95 | 368.76 | 366.27 | 369.52 | 378.55 | |||||||||||
| General Assistance--Unemployable | ||||||||||||||||
| Average Monthly Persons | 8,372 | 8,756 | 9,985 | 11,252 | 11,822 | |||||||||||
| Average Cost | 135.23 | 144.59 | 147.60 | 155.38 | 164.70 | |||||||||||
| Refugees | ||||||||||||||||
| Average Monthly Persons | 1,665 | 1,504 | 1,381 | 1,244 | 1,107 | |||||||||||
| Average Cost | 282.74 | 278.96 | 301.26 | 310.98 | 322.92 | |||||||||||
This category covers clients eligible under Medicaid and state
funded programs.
The objective is to assure necessary medical care to eligible low-income people by balancing health care needs with responsible use of funds.
| Budget Unit Data
| |||||||||||||
| 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||
| Refugee Assistance | 6,048,455 | 8,846,173 | 4,726,479 | 4,452,700 | |||||||||
| Medicaid - Categorically Needy | 1,515,524,524 | 1,652,547,425 | 1,747,210,816 | 1,844,825,295 | |||||||||
| Medicaid - Medically Needy | 52,368,761 | 48,655,846 | 43,535,414 | 44,213,200 | |||||||||
| State Only GA-U | 27,648,205 | 23,589,961 | 38,706,949 | 43,630,950 | |||||||||
| State Only Medical Indigent | 6,997,474 | 4,457,874 | 7,600,979 | 7,794,712 | |||||||||
| Indian Health Facilities | 3,636,752 | 3,678,321 | 4,536,589 | 4,908,998 | |||||||||
| Medicaid Family Planning | 9,440,758 | 16,891,141 | 5,904,754 | 5,685,270 | |||||||||
| Expenditure Detail
| ||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||
| Grants and Subsidies | 1,552,736,359 | 1,621,664,929 | 1,758,666,741 | 1,852,221,980 | 1,955,511,125 | |||||||||||||
| Other Operating Costs | (50,568) | |||||||||||||||||
| Annual Total |
1,552,685,791 |
1,621,664,929 |
1,758,666,741 |
1,852,221,980 |
1,955,511,125 | |||||||||||||
| Fiscal Year 1993-94 | 1,445,011,005 | |||||||||||||||||
| Biennium Total |
2,997,696,796 |
3,380,331,670 |
3,807,733,105 | |||||||||||||||
| Source of Funds
| |||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | |||||||||||||||
| General Fund - Basic Account - State | 576,992,730 | 659,972,780 | 645,963,494 | 675,885,016 | 691,545,561 | ||||||||||||||
| General Fund - Basic Account - Federal | 814,699,931 | 8,002,610 | 8,361,218 | ||||||||||||||||
| General Fund - Basic Account - Private/Local | 150,218,557 | 94,877,929 | 104,282,071 | 109,550,980 | 111,779,732 | ||||||||||||||
| General Fund - Basic Account - DSHS Medicaid Federal | 800,861,220 | 872,268,341 | 931,276,798 | 989,441,322 | |||||||||||||||
| Health Services Account - State | 10,774,573 | 65,953,000 | 136,152,835 | 127,506,576 | 154,383,292 | ||||||||||||||
| Annual Total |
1,552,685,791 |
1,621,664,929 |
1,758,666,741 |
1,852,221,980 |
1,955,511,125 | ||||||||||||||
Medical Assistance
Administration
Medical Assistance Administration is responsible for overall program
planning; medical policies and procedures; managed care implementation;
financial eligibility policies and procedures; pre-authorization
of services when needed; liaison with medical entities, the federal
government, and other states; provider enrollment; client-focused
programs, such as targeted programs for pregnant women and children;
the Title XIX State Plan; informing clients of services they are
entitled to receive; program audits and medical reviews; reimbursement
rates; claims processing; third-party recovery; and operation
of the Medicaid Management Information System (MMIS).
The Division of Disability Determination Services is responsible for disability determination for Social Security, SSI, and medically needy applicants. In most of its work, the Division acts as the contracted agent of the federal Social Security Administration and is almost entirely funded by the Social Security Administration.
| Budget Unit Data
| |||||||||||||
| 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||
| Office of Disability Insurance | 19,955,993 | 21,749,481 | 22,056,262 | 22,153,233 | |||||||||
| FFP for Other Entities | 19,141,044 | 19,000,000 | 19,000,000 | ||||||||||
| Medical Assistance Administration | 36,704,136 | 36,596,232 | 39,609,202 | 39,846,382 | |||||||||
| Category Employment
| ||||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||||
| FTE Staff Years | 633.0 | 690.2 | 785.1 | 772.1 | 779.9 | |||||||||||||||
| Average FTE Staff Year Costs | 32,713 | 34,321 | 30,287 | 32,805 | 32,705 | |||||||||||||||
| Expenditure Detail
| ||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||
| Salaries and Benefits | 26,313,783 | 30,025,828 | 30,187,670 | 32,099,508 | 32,318,450 | |||||||||||||
| Grants and Subsidies | 24,048,703 | 26,987,189 | 14,483,116 | 26,482,984 | 26,482,984 | |||||||||||||
| Other Operating Costs | 15,659,981 | 18,788,156 | 13,674,927 | 22,082,972 | 22,198,181 | |||||||||||||
| Annual Total |
66,022,467 |
75,801,173 |
58,345,713 |
80,665,464 |
80,999,615 | |||||||||||||
| Fiscal Year 1993-94 | 49,811,677 | |||||||||||||||||
| Biennium Total |
115,834,144 |
134,146,886 |
161,665,079 | |||||||||||||||
| Source of Funds
| |||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | |||||||||||||||
| General Fund - Basic Account - State | 10,629,254 | 13,106,075 | 13,464,295 | 14,514,460 | 14,494,966 | ||||||||||||||
| General Fund - Basic Account - Federal | 53,847,196 | 41,576,779 | 41,081,672 | 20,815,866 | 20,902,071 | ||||||||||||||
| General Fund - Basic Account - Federal Unanticipated | 491,634 | ||||||||||||||||||
| General Fund - Basic Account - DSHS Medicaid Federal | 19,446,472 | 305,428 | 42,413,776 | 42,538,216 | |||||||||||||||
| Health Services Account - State | 1,054,383 | 1,671,847 | 3,494,318 | 2,921,362 | 3,064,362 | ||||||||||||||
| Annual Total |
66,022,467 |
75,801,173 |
58,345,713 |
80,665,464 |
80,999,615 | ||||||||||||||
Special Projects include time-limited projects needed for the administration of the Medical Assistance program.
| Budget Unit Data
| |||||||||||||
| 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||
| Medical Assistance Administration | 530,206 | 148,875 | |||||||||||
| Special Projects | 17,273 | 253,902 | 315,421 | ||||||||||
| Category Employment
| ||||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||||
| FTE Staff Years | 20.1 | 15.4 | 12.0 | 8.0 | 8.0 | |||||||||||||||
| Average FTE Staff Year Costs | 34,721 | 39,253 | 17,116 | 19,424 | ||||||||||||||||
| Expenditure Detail
| ||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | ||||||||||||||
| Salaries and Benefits | 873,593 | 759,714 | 264,418 | 194,317 | ||||||||||||||
| Grants and Subsidies | 15,657 | 148,966 | 148,875 | |||||||||||||||
| Other Operating Costs | (87,589) | (361,201) | (10,516) | 121,104 | ||||||||||||||
| Annual Total |
801,661 |
547,479 |
402,777 |
315,421 | ||||||||||||||
| Fiscal Year 1993-94 | 31,194 | |||||||||||||||||
| Biennium Total |
832,855 |
950,256 |
315,421 | |||||||||||||||
| Source of Funds
| |||||||||||||||||||
| 1994-95 Actual | 1995-96 Estimated | 1996-97 Estimated | 1997-98 Proposed | 1998-99 Proposed | |||||||||||||||
| General Fund - Basic Account - State | 485,580 | 173,919 | 78,766 | ||||||||||||||||
| General Fund - Basic Account - Federal | 316,081 | 363,472 | 148,875 | ||||||||||||||||
| General Fund - Basic Account - DSHS Medicaid Federal | 10,088 | 253,902 | 236,655 | ||||||||||||||||
| Annual Total |
801,661 |
547,479 |
402,777 |
315,421 | |||||||||||||||