# Presentation: 295202

## The Federal Match Taking the confusion out of the Federal file 

## Growing Demands on Medicaid

- Rising costs
- Growing caseloads
- Increasing elder population
- Long Term Care spending estimated to increase over 250% between 2000 and 2040
- Medicaid one of largest payers

**Notes:**
Spending on LTC could nearly quadruple in constant dollars between 2000 and 2050, to $379 billion, according to some estimates.
See GAO-05-564T, April 2005.

## Aging of Population

**People 65 and Older as a Share of the U.S. Population, Selected Years, 1900 to 2050 **

- Source: Congressional Budget Office based on Bureau of the Census, *U.S.. Interim Projections by Age, Sex, Race, and Hispanic Origin*, Table 2a, "Projected Population of the United States, by Age and Sex: 2000 to 2050" (March 2004), available at
- www.census.gov/ipc/www/usinterimproj/natprojtab02a.pdf

**Notes:**
Predictions on the future of Medicaid and Medicare are dire.
GAO Testimony (GAO-05-564T), April 2005:  “In general, the aging of the baby boom generation will lead to a sharp growth in federal entitlement spending that, absent meaningful reforms, will represent an unsustainable burden on future generations.  As the estimated 76 million baby boomers born between 1946 and 1964 become elderly, Medicare, Medicaid, and Social Security will nearly double as a share of the economy by 2035... absent substantive reform of entitlement programs, a rapid escalation of federal spending...is virtually certain to overwhelm the rest of the federal budget.”  - Kathryn G. Allen, Director, Health Care – Medicaid and Private Health Insurance Issues.

Our efforts may not necessarily amount to radical reforms, they do attempt to mitigate pressures on Medicaid and particularly Long-Term Care spending, and, at the same time, connect veterans and families to their proper benefits earned through service and sacrifice to this country.

## Federal File

- Data sources:
- Department of Defense
- Office of Personnel Management
- Data uses:
- Income Verification
- Third Party Liability
- Military Health Insurance (TRICARE)

**Notes:**
Introduce aspects and uses of Federal (D0D) file.

## Data Sources

- Department of Defense
- Active Duty Military
- Reserves Military
- Retired Military
- Civilian Employees
- Office of Personnel Management
- Civil Service Employees
- Civil Service Retired

## Washington’s Use of Federal Data

- WA State’s match sends SSNs for all
- recipients; and
- financially responsible assistance unit members
- Quarterly Matches joined with the Department eligibility system
- Hits from matches trigger alerts to case workers
- Case workers review alert information and take action

## Department of Defense (TRICARE)  

- TRICARE Beneficiary Categories
- Reservists on active duty > 30 days – under Federal orders
- Retired reservists and family members
- Active duty and retired service members
- Spouses and unmarried children (including stepchildren) of active duty or retired service members
- Widows or widowers and unmarried children of deceased active duty or retired service members

**Notes:**
Even more important than the useful income verification, the Federal file provides verification of individuals with Third Party Liability health insurance (TRICARE).

## TRICARE Identification

- Record Type field
- 	MA 	Military Active Duty
- 	MR 	Military Retired Pay
- 	MV 	Military Reserves (if active duty over 	30 days – under Federal orders)

**Notes:**
“Record Type” verifies which clients are Military Active Duty and Military Retired (Military Reserves are eligible for TRICARE only under certain conditions).

The “Case number” field is important here, because many of these individuals may not be recipients of Medicaid, but rather non-members (non-applying spouses or ineligible parents) associated with Medicaid recipients.

## TRICARE Identification Process

- Primary TRICARE sponsor
- Identifies only military personnel
- Does not identify spouse or children
- Match case numbers of TRICARE sponsors with Medicaid recipients case numbers without known TRICARE
- Refer to Coordination of Benefits for update of TRICARE TPL
- Some may need DEERS enrollment  (Defense Enrollment Eligibility Reporting System)
- Notify recipients

## Office of Personnel Management

- Income Verification
- Civil Service
- Civil Service Retired
- Alerts sent to case workers
- Case workers
- Compare income to eligibility system
- Income may effect program eligibility
- Update eligibility system
- Change letter sent to recipient

## Other Benefits of Federal File

- Retroactive claim adjustments (TRICARE)
- Efficient income verification
- Improved accuracy of benefits
- Saves staff time
- Reduces paperwork

## QUESTIONS? 

- Payment Review Program
- Veterans Benefit Enhancement Project
- WA Department of Social and Health Services
- Phone: (360) 725-1020
- E-mail:  allmawa@dshs.wa.gov
- Paige WallPayment Review Program Manager
- Health & Recovery Services AdministrationWA Department of Social and Health ServicesPhone: 360-725-2117E-mail: wallpg@dshs.wa.gov

**QUESTIONS?**** **