m RlV BUDGET OVERVIEW I. Information aboutthe Federal, DHHS and CMS budgets. HIGHLIGHTS o Medicare benefitpayments are expectedto increase by 7.5percent from 2002 to 2003 andby 4.6percentfrom 2003 to 2004. o Federaland State Medicaidmedicalassistance paymentsare expectedtoincrease by 10.2percentfrom 2002 to 2003 andby 9.2percentfrom 2003 to 2004. o Program benefitpayments forMedicare, Medicaid, andSCHIPcombined are expectedto increase by 10.4 percentfrom 2002 to 2003 andby 9.0percentfrom 2003 to 2004. 1 ( ( c ' ' CMS Disbursements Fiscal Years 2002 - 2004 2003 2004 2002 Current Current Proposed Actual Law Law Law Dollars in millions CMS Budget Outlays Medicare Benefits $252,207 $271,164 $283,768 $289,768 Medicare Part B Transfer to Medicaid ' 112 118 55 Quality Improvement Organizations 354 346 370 370 Health Care Fraud and Abuse Control (HCFAC) 963 1,075 1,075 1,075 Other Medicare Administrative Expenses " 1,249 1,273 1,246 1,246 CMS Program Management"* 2,403 £.,(1X3 2,779 Medicaid Benefits " 140,239 Toy,boo 173,001 State and Local Administration/Training 7,273 8,449 9,009 9,009 State Children's Health Insurance Program (SCHIP) 3,656 4,700 5,050 5,073 SCHIP Transferto Medicaid y 26 - Ticket to Work Program (P.L. 106-170) 10 20 25 25 Qualified High-Risk Pools grant programs (P.L. 107-210) 1 23 23 I ULcal V-zULIcayo \UIlaUJUoltJU) $408 AQ^ $445,190 $473,013 ^ARO AOA Medicare Premiums -25,951 -28,344 -31,853 -31,853 Offsetting Collections, Non-Federal -60 -106 -58 -259 Reimbursables -5 Total Outlays Netof Medicare Premiums and Offsetting Collections $382,476 $416,741 $441,102 $450,312 ' Medicaretransferto Medicaid Vor Medicare Part B premium assistance. "Includes HCFAC outlays by CMS and otheragencies. " Medicare-related expenses ofotheragencies, e.g., Social SecurityAdministration. "* Includes userfees and reimbursables. " Includes not only Medicaid medical assistance payments (MAP) butalsoTitleXIX outlaysforthe Vaccines for Children Program (FY 2002 - $792.2 million; FY2003 - $1,174.2 million; FY2004 - $1,200.1 million). The FY2002 outlayswere reduced by $137.9 million to reflectthe offsetting collections. In FY 2003, the estimate is reduced by the Medicare Part B transferto Medicaid of$117.7 million. The FY2003 Medicaid benefits amount includes $88 million forthe extension of Transitional Medical Assistance through September2003 (P.L. 108-40). "Thistransfer, required by section 802 ofthe BIPA (P.L.106-554), reimburses TitleXIXforthe cost ofSCHIP-related Medicaid expansions in fiscal years before FY2001. ' Qualified High-Risk Pools grant programs added in FY 2003. NOTES: Fiscal yeardata. Totals do not necessarily equal the sum ofrounded components. SOURCES: FY 2004 Mid-Session Review; CMS/OFM 9 November2003 t 1 t . Program Benefit Payments Selected Fiscal Years Total Medicare 1 Medicaid2 SCHIP 3 Annual Annual Annual Annual Fiscal Percent Percent Percent Percent Year Amount Change Amount Change Amount Change Amount Change Amount in billions Historical 1980 $57.9 — ($p3o3o.9r\ $24.0 — 1985 108.8 12.6 CO K 14.1 39.3 10.4 1990 175.9 15.6 a10r\7~7.2o a13o.8o 68.7 18.4 1991 204.4 16.2 A1A13O.C9\ 6.3 90.5 31.7 1992 245.1 19.9 1?Q ? 13 4 115.9 28.1 1993 268.7 9.6 142.9 10.6 125.8 8.5 1994 296.9 10.5 159.3 11.5 137.6 9.4 1995 328.9 10.8 176.9 11.0 152.0 10.5 1996 344.3 4.7 191.1 8.0 153.2 0.8 1997 367.8 6.8 207.1 8.4 160.7 4.9 1QQR 379.7 3.2 210.1 1.4 169.4 0.0 u.z 1999 390.5 2.8 208.3 -0.9 180.8 fi 7 I.o 2000 413.8 6.0 214.9 3.2 196.1 8.4 2.8 108.6 2001 457.8 10.6 236.6 10.1 217.4 10.9 3.8 oo.o 2002 505.4 10.4 252.3 6.7 247.7 13.9 5.4 41.4 Budget Current law 2003 551.0 9.0 271.3 7.5 273.0 10.2 6.7 24.4 2004 589.2 6.9 283.8 4.6 298.2 9.2 7.2 7.4 ItMllb IUI ni 1 IT! 133U. uiuuues> oivn uansitJi iu ivieuiudiu. Quality Improvement Organization expenditures. - otai computaoie oenetit payments (heaerai ana state combined). Historical data tor hys iybu-iyy4 1 reflect total computable medical assistance payments reported by the States on line 11 ofthe HCFA-64 and predecessorforms. Historical data for FYs 1995-2002 include line 11 total computable medical assistance payments and outlays forthe Vaccines for Children Program but do not include total computable Title XIX expenditures forthe State Children's Health Insurance Program. Budget data for FYs 2003-2004 reflect current law estimates oftotal adjusted computable medical assistance payments and outlays tor tne vaccines tor Uhiiaren Program. nisiuiiudi uaid iui rib iaao-^uuu iiiuiuue luidi uumpuiduie expenuuui ^ i me ai/\ diiu i me aai; itspuiieu by the States forthe State Children's Health Insurance Program (SCHIP). After FY 2000, there is no longer Title XIX funding of SCHIP. Budget data for FYs 2001-2003 reflect estimates oftotal computable Title XXI outlays. In FYs 2001 and 2002, the estimate does not include the SCHIP transferto Medicaid to reimburse Title XIX for the cost ofSCHIP-related Medicaid expansions in fiscal years before FY 2001 NOTE: Percent changes based on unrounded numbers. SOURCE: CMS/OFM November 2003 3 4|