Fiscal Year 2010 Budget in Brief
State Grants and Demonstrations
(dollars in millions)
| 2008 | 2009 | 2010 | 2010 |
Current Law Budget Authority: | ||||
CHIP Outreach and Enrollment Grants | -- | 100 | -- | -100 |
CHIP Grants for Prospective Payment System Transition | -- | 5 | -- | -5 |
Medicaid Integrity Program | 50 | 75 | 75 | -- |
Psychiatric Residential Treatment Demo. and Evaluation | 37 | 49 | 53 | +4 |
Money Follows the Person (MFP): | ||||
MFP Demonstration | 299 | 349 | 399 | +50 |
MFP Evaluations and Technical Support | 1 | 1 | 1 | -- |
Expansion of State Long-Term Care Partnership Program | 3 | 3 | 3 | -- |
Medicaid Transformation Grants | 75 | -- | -- | -- |
Emergency Services for Undocumented Aliens | 250 | -- | -- | -- |
Ticket to Work Grant Programs | 44 | 46 | 46 | -- |
Drug Surveys and Reports | 5 | 5 | 5 | -- |
Total, Current Law B.A. | 764 | 633 | 582 | -51 |
| ||||
High Risk Pools | -- | -- | 75 | +75 |
| -- | -- | 75 | 75 |
| ||||
CHIP Outreach and Enrollment Grants | -- | 10 | 23 | +13 |
CHIP Grants for Prospective Payment System Transition | -- | 3 | 2 | -1 |
Medicaid Integrity Program | 27 | 75 | 75 | -- |
Psychiatric Residential Treatment Demo. and Evaluation | -- | 25 | 40 | +15 |
Money Follows the Person (MFP): | ||||
MFP Demonstration | 12 | 359 | 474 | +115 |
MFP Evaluations and Technical Support | 1 | 3 | 1 | -2 |
Expansion of State Long-Term Care Partnership Program | -- | 3 | 3 | -- |
Medicaid Transformation Grants | 31 | 77 | 39 | -38 |
Emergency Services for Undocumented Aliens | 196 | 133 | 50 | -83 |
Ticket to Work Grant Programs | 56 | 65 | 68 | +3 |
Drug Surveys and Reports | 2 | 1 | -- | -1 |
High Risk Pools/1/2 | 23 | 4 | -- | -4 |
Pilot Background Checks | 4 | 3 | -- | -3 |
State Pharmacy Assistance Program | 2 | 1 | -- | -1 |
Katrina Hurricane Relief | 66 | 96 | -- | -96 |
Program of All-Inclusive Care for the Elderly (PACE): | ||||
PACE Rural Site Development Grants | 5 | 2 | -- | -2 |
PACE Funds for Outlier Costs/1 | -- | 5 | 5 | -- |
Alternate Non-Emergency Network Providers | 2 | 32 | 16 | -16 |
Total, Current Law Outlays | 427 | 897 | 796 | -101 |
| ||||
High Risk Pools | -- | -- | 20 | +20 |
Total, Proposed Law Outlays | -- | -- | 20 | 20 |
| 764 | 633 | 657 | 24 |
| 427 | 897 | 816 | -81 |
1/ FY 2008 and 2009 outlays are from FY 2007 budget authority.
2/ The Omnibus Appropriations Act, 2009 (P.L. 111-8) appropriated $75 million for State High Risk Pools for FY 2009, which are administered in the Program Management budget.
The State Grants and Demonstrations budget funds a diverse group of program activities. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the Deficit Reduction Act of 2005 (DRA), and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added many activities to this area. The President’s FY 2010 Budget proposes funding High Risk Pools here.
CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) (P.L. 111-3)
Outreach and Enrollment Grants
Section 201 of CHIPRA created Outreach and Enrollment Grants in the Children’s Health Insurance Program (CHIP). The Act appropriated $100 million for FY 2009 through FY 2013 for these grants, of which $10 million are set aside for grants to Indian Health Service providers and urban Indian organizations for improving enrollment of Indian children. Another $10 million are set aside for a National Enrollment Campaign to encourage enrollment of eligible children in Medicaid and CHIP.
Grants for Transitioning to a Prospective Payment System
Section 503 provided $5 million for grants to States to help Federally Qualified Health Centers and Rural Health Clinics transition to a Prospective Payment System for CHIP in FY 2009.
DEFICIT REDUCTION ACT (DRA) (P.L. 109-171)
Medicaid Integrity Program
The Medicaid Integrity Program (MIP) was established by section 6034 of the DRA and was implemented in FY 2006. Congress appropriated resources to the MIP as follows: $5 million in FY 2006; $50 million in each of FY 2007 and FY 2008; and, $75 million in FY 2009 and for each year thereafter. HHS has entered into contracts with eligible entities to carry out certain specified activities including reviews, audits, identification of over-payments, education, and technical support to States. These initiatives are highlighted in annual reports which can be found at: http://www.cms.hhs.gov/DeficitReductionAct/021_repcongress.asp.
Home and Community-Based Services Alternatives to Psychiatric Residential Treatment Facilities for Children
The five-year demonstration (FY 2007-FY 2011) authorized by section 6063 of the DRA provided up to 10 States with funds totaling no more than $217 million with the opportunity to provide home and community-based services to individuals under the age of 21 as alternatives to psychiatric residential treatment facilities, including $1 million for evaluation of the program.
Money Follows the Person Demonstration
Section 6071 of the DRA established this demonstration which allows States to work toward sustaining their Medicaid programs while helping individuals achieve independence. States are awarded competitive grants along with an increased Medicaid matching rate for transitioning individuals from an institutional setting to a qualified home or community-based setting. The DRA appropriated $1.75 billion over five years (FY 2007-2011) for this demonstration, with 31 grants committed to States totaling $1.4 billion in FY 2007.
Expansion of State Long-Term Care Partnership Program
The expansion of the State Long-Term Care (LTC) Partnership Program, enacted under section 6021 of the DRA, established authority for all States to implement LTC partnership plans that provide a dollar for dollar disregard of assets or resources equal to the insurance benefit payments on behalf of the individual.
Medicaid Transformation Grants
Established by section 6081 of the DRA, this program provided new grant funds to States for the adoption of innovative methods to improve the effectiveness and efficiency in providing medical assistance under Medicaid.
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT (MMA) (P.L. 108-173)
Federal Reimbursement of Emergency Health Services Furnished To Undocumented Aliens
Section 1011 of the MMA appropriated $250 million per year in FY 2005 through FY 2008 for payments to eligible providers for emergency health services provided to undocumented aliens and other specified non-citizens who are not eligible for Medicaid.
TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT (TWWIIA) (P.L. 106-170)
TWWIIA of 1999 authorized two grant programs designed to assist States in developing services and supports to aid the competitive employment of people with disabilities by extending Medicaid coverage to these individuals. For the Demonstration to Maintain Independence & Employment in section 204 of TWWIAA of 1999, the authority for payments to be provided by the section expires September 30, 2009. Sec. 203, the Medicaid Infrastructure Grants, continues through FY 2011. The Omnibus Appropriations Act of 2009 further rescinded $21.5 million in unspent funds.
LEGISLATIVE PROPOSAL
Qualified High-Risk Pools
State high-risk health insurance pools target certain individuals who cannot otherwise obtain or afford health insurance in the private market, primarily due to pre existing health conditions. The Budget proposes $75 million in mandatory funds for FY 2010 to be used towards helping States offer health insurance options for hard to insure populations.