MACStats Section 3 72 EXHIBIT 25. Medicaid Supplemental Payments to Non-Hospital Providers by State, FY 2018 (millions) insert exhibit here State1 Total Mental health facilities2 Total Supplemental Medicaid Supplemental payments as payments payments % of total $6,112.3 $3,065.5 Alabama 87.0 0.8 Alaska 32.6 Arizona 33.6 50.2% Nursing facilities and ICF/IDs3 Total Supplemental Medicaid Supplemental payments as payments payments % of total $50,539.3 $3,468.7 0.9 932.1 – 15.1 46.4 167.6 28.5 84.8 57.4 6.9% Physicians and other practitioners4 Total Supplemental Medicaid Supplemental payments as payments payments % of total $10,420.7 $1,315.1 12.6% – 462.0 – – – 205.5 – – 8.7 15.2 56.6 – – – Arkansas 111.4 0.8 0.7 867.8 – – 363.5 37.5 10.3 California5 676.2 -0.0 -0.0 3,193.3 288.1 9.0 799.5 150.0 18.8 Colorado Connecticut Delaware District of Columbia 7.0 – – 822.1 109.5 13.3 859.5 134.1 15.6 185.2 105.6 57.0 1,435.3 – – 665.2 5.1 0.8 17.9 5.7 31.7 34.2 – – 12.7 – – 12.5 6.5 52.3 343.7 – – 51.7 – – Florida6 336.1 117.1 34.8 839.5 – – 549.3 329.9 60.1 Georgia 8.6 – – 1,505.3 134.7 8.9 413.5 39.7 9.6 – – – 10.6 2.4 22.4 0.2 – – Hawaii 2.0 – – 284.8 49.5 17.4 154.5 – – Illinois 188.4 89.3 47.4 1,635.2 – – 387.7 – – Indiana 49.2 – – 2,693.0 1,020.3 37.9 95.1 9.1 9.5 4.4 – – 84.6 – – 41.8 18.0 43.1 Kansas Iowa 29.4 29.4 99.8 82.1 – – 5.0 0.1 1.2 Kentucky 38.6 37.4 97.1 1,157.4 0.7 0.1 26.5 – – Louisiana 85.1 77.6 91.2 1,412.9 5.7 0.4 37.9 5.3 13.9 Maine 109.0 43.4 39.9 389.2 – – 114.8 2.6 2.3 Maryland 175.0 53.7 30.7 1,220.5 – – 173.1 – – Massachusetts6, 7 205.4 81.8 39.8 1,488.0 – – 336.5 0.2 0.1 Michigan 185.4 140.2 75.6 1,938.7 410.5 21.2 315.3 170.7 54.1 Minnesota 131.4 0.0 0.0 1,099.3 – – 380.9 56.0 14.7 December 2019 Mississippi 60.0 – – 1,015.7 – – 114.9 9.1 7.9 Missouri 232.5 207.6 89.3 1,129.7 – – 21.9 – – Montana 25.4 – – 194.4 24.2 12.4 179.6 – – 1.8 1.8 100.0 447.3 20.3 4.5 6.6 – – 41.9 – – 292.8 102.6 35.0 161.7 4.3 2.7 Nebraska Nevada Section 3: Program Enrollment and Spending—Medicaid Benefits Idaho insert exhibit here State1 New Hampshire Mental health facilities2 Total Supplemental Medicaid Supplemental payments as payments payments % of total $38.0 $36.5 96.3% Nursing facilities and ICF/IDs3 Total Supplemental Medicaid Supplemental payments as payments payments % of total $398.8 $96.0 24.1% Physicians and other practitioners4 Total Supplemental Medicaid Supplemental payments as payments payments % of total $12.0 – – New Jersey 475.4 357.4 75.2 1,219.1 – – 61.4 – New Mexico 2.9 – – 29.4 – – 75.6 $5.8 7.7% New York 936.3 537.8 57.4 6,502.7 357.2 5.5 469.9 43.9 9.3 North Carolina 166.6 161.8 97.1 1,306.1 – – 960.7 111.5 11.6 North Dakota 25.3 0.7 2.9 346.2 1.7 0.5 52.2 – – Ohio 93.5 93.4 99.9 2,211.5 – – 204.1 43.2 21.1 Oklahoma 61.1 3.3 5.4 624.2 – – 477.7 – – Oregon 24.8 20.0 80.4 454.4 – – 64.9 – – 383.8 294.8 76.8 4,112.9 609.8 14.8 60.8 – – Pennsylvania Rhode Island – 3.8 – – 157.6 – – 8.0 – – South Carolina 69.3 60.9 87.9 786.3 16.5 2.1 119.1 20.0 16.8 South Dakota 3.8 0.8 19.8 180.8 5.0 2.8 64.8 – – Tennessee Texas6, 8 Utah 41.7 – – 213.6 – – 32.3 – – 296.9 292.5 98.5 1,665.4 5.1 0.3 315.6 56.2 17.8 16.2 – – 348.3 83.0 23.8 76.0 18.0 23.7 – – – 124.3 – – – – – Virginia 123.7 7.3 5.9 461.2 14.1 3.1 144.1 34.8 24.2 Washington 183.2 137.2 74.9 886.2 9.3 1.0 72.2 9.8 13.6 West Virginia 59.9 18.9 31.5 749.4 – – 42.9 0.2 0.4 Wisconsin 20.1 – – 848.2 58.1 6.8 64.7 – – Wyoming 12.9 – – 138.3 35.7 25.8 48.6 – – Vermont Section 3: Program Enrollment and Spending—Medicaid Benefits MACStats: Medicaid and CHIP Data Book EXHIBIT 25. (continued) Notes: FY is fiscal year. ICF/ID is intermediate care facility for people with intellectual disabilities. Includes federal and state funds. Excludes payments made under managed care arrangements. All amounts in this table are as reported by states in CMS-64 data during the fiscal year to obtain federal matching funds; amounts include expenditures for the current fiscal year and adjustments to expenditures for prior fiscal years, which may be positive or negative. Amounts reported by states for any given category (e.g., nursing facility) sometimes show substantial annual fluctuations. – Dash indicates zero; $0.0 or -$0.0 indicates an amount between $0.05 million and -$0.05 million that rounds to zero; 0.0% or -0.0% indicates an amount between 0.05% and -0.05% that rounds to zero. 73 MACStats Section 6 Section 5 Section 4 Section 3 Section 2 Section 1 MACStats Section 3 74 EXHIBIT 25. (continued) 1 Not all states had certified their CMS-64 financial management report (FMR) submissions as of June 17, 2019. California’s fourth quarter submissions were not certified. Figures presented in this exhibit may change if states revise their expenditure data after this date. 2 Includes inpatient psychiatric services for individuals under age 21 and inpatient hospital or nursing facility services for individuals age 65 and older in an institution for mental diseases. Supplemental payments include disproportionate share hospital (DSH) payments made in accordance with Section 1923 of the Social Security Act (the Act) as well as uncompensated care pool and other non-DSH supplemental payments made under waiver expenditure authority of Section 1115 of the Act. States are not instructed to break out non-DSH supplemental payments for mental health facilities. Supplemental payments to nursing facilities and ICF/IDs include those made in addition to the standard fee schedule or other standard payments for a given service, including payments made under institutional upper payment limit rules and uncompensated care pools made under Section 1115 waiver expenditure authority. 3 Includes the physician and other practitioner categories in CMS-64 data; excludes additional categories (e.g., dental, nurse-midwife, nurse practitioner) for which states are not instructed to break out supplemental payments. Supplemental payments include those made in addition to the standard fee schedule payment as well as uncompensated care pool payments made under Section 1115 waiver expenditure authority. There is no regulatory upper payment limit for physicians and other practitioners (as there is for institutional providers). 4 5 California reported negative DSH payments to mental health facilities due to prior period adjustments. 6 State made payments to physicians and other practitioners through an uncompensated care pool under Section 1115 waiver expenditure authority. 7 State made non-DSH payments to mental health facilities through an uncompensated care pool or made other non-DSH supplemental payments under Section 1115 waiver expenditure authority. 8 State made payments to nursing facilities through an uncompensated care pool under Section 1115 waiver expenditure authority. December 2019 Section 3: Program Enrollment and Spending—Medicaid Benefits Source: MACPAC, 2019, analysis of CMS-64 Schedule C waiver report data as of October 21, 2019, and CMS-64 FMR net expenditure data as of June 17, 2019.