DHFAC Meeting Minutes
February 21, 2004
Present:
- Patricia Blevins
- Bethany Hall-Long
- Joseph Lieberman
- Vincent Meconi(Chair)
- Charles F. Reinhardt
- Dennis Rochford
Absent:
- Joseph DiPinto
- Thomas Grabowski
- Deborah Hudson
- David McBride
- Calvin Wilson
Welcome & Introductions
Secretary Meconi introduced himself and other members of the committee.
Approval of minutes
Minutes from the January 24 meeting were approved without amendment.
Update on the Public Forum
Committee members who attended the public forum on February 13 commented on the meeting. All noted that the information was useful. Themes included tobacco control, services for people with disabilities, and health care for the uninsured. The committee noted that there are more worthy causes than there are funds available.
A summary of public comment will be sent to the committee at least one week prior to the next meeting.
Update on Payment Issues
Securitization-Paula Roy
Paula Roy reported that the State Secretary of Finance, David Singleton, is currently reviewing securitization issues, and requests that further committee discussions be tabled at this time.
Strategic Reserve-Debra Lightsey
Debra Lightsey reviewed a spreadsheet developed by last year's financial subcommittee. Those who participated noted that these projections were based on one set of assumptions. The projections were developed to estimate investments needed to support the Prescription Assistance Program over time.
Projected Future Payments-Debra Lightsey
Debra Lightsey shared projections of future adjustments to Delaware's Tobacco Settlement Receipts. Future adjustments include:
- An inflation adjustment to annual payments (not to initial payments) at the rate of inflation or 3%, whichever is higher.
- A volume adjustment based on reduction in sales of cigarettes from the 1997 base year. The volume adjustment was just under 14% for the first year, but is likely to grow only by 1-1.5% per year. An increase in prices just after the settlement caused the larger volume reduction in the first year.
Applying these adjustments, the following projections were presented:
| 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Base Amount | 9.5 | 25.4 | 27.4 | 32.9 | 33.2 | 27.7 | 27.7 | 27.7 | 27.7 | 34.7 |
| + Inflation Adj. | 0.0 | 0.5 | 1.1 | 2.1 | 2.8 | 4.4 | 5.4 | 6.4 | 7.4 | 10.6 |
| - Volume Adj. | 0.0 | -3.5 | -4.1 | -5.5 | -6.2 | -6.0 | -6.7 | -7.4 | -8.1 | -11.2 |
| Final Amount | 9.5 | 22.3 | 24.3 | 29.4 | 29.8 | 26.1 | 26.4 | 26.7 | 26.9 | 34.2 |
| 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Base Amount | 34.7 | 34.7 | 34.7 | 34.7 | 34.7 | 34.7 | 34.7 | 34.7 | 34.7 | 31.7 |
| + Inflation Adj. | 12.0 | 13.4 | 14.8 | 16.3 | 17.8 | 19.4 | 21.0 | 22.7 | 24.4 | 23.9 |
| - Volume Adj. | -12.2 | -13.3 | -14.4 | -15.6 | -16.8 | -18.1 | -19.5 | -20.9 | -22.4 | -21.8 |
| Final Amount | 34.5 | 34.8 | 35.1 | 35.4 | 35.7 | 36.0 | 36.3 | 36.5 | 36.7 | 33.7 |
Note: Amounts are rounded, and do not reflect accrued interest , deductions for administrative costs, or NPM adjustments. Base payments stay at the 2018 amount in future years, subject to adjustments.
This analysis puts the 2001 payments at $24.3 million, about $2 million higher than previously suggested.
Prescription Assistance Options
Philip Souleé
Delaware Prescription Assistance Enrollment Projections
Phil Souleé shared enrollment growth and projections for future enrollment. Current enrollment in the program was approximately 3,500. His chart showed steady growth, with an average of 180 new clients each month. Continuing at this rate, the full 6,700 people initially expected in the program would be enrolled by the end of State Fiscal Year 2002 (June 30, 2002). Estimates of the eligible population have remained constant.
Delaware Prescription Assistance Program Six Month Report
Phil Soulé shared draft reports and highlighted several of the findings. The committee had several suggestions based on the findings:
- Separate the elderly and disabled enrollment in Sussex County to look for outreach opportunities.
- Encourage physicians to inform patients of the program.
Enhanced Outreach Options
Phil Soulé presented three scenarios for increased outreach. The committee agreed that with program growth as strong as it is, only limited outreach improvements are necessary. Materials for increased outreach in pharmacies were suggested. Phil will look into resources needed to expand activities in this area.
Options for eligibility expansion
Phil Souleé shared projections for a variety of eligibility expansions, including supplementing the Nemours Pharmacy Program and increasing eligibility incrementally up to 350% of the poverty level. The estimates showed costs for the first year and full enrollment costs.
Senator Blevins noted that current initiatives are addressing coverage gaps piecemeal. She asked for cost estimates for expanding coverage to 200% of poverty to compare to these more limited programs.
Paula Roy noted that the Uninsured Action Plan is examining all options for increasing insurance coverage, both in the public and private sector. An update will be provided at the March meeting.
Other business
The committee discussed next steps in developing recommendations. The next meeting will be used to set priorities and start to draw the general outlines of the recommendations. Recommendations will be finalized at the April meeting.
Public Comment
Jamie Wolf of the State Council for Persons with Disabilities, asked the committee to support HB 30, a state Attendant Services program, and implementation of the Work Incentives Improvement Medicaid Buy-in Program. She told her story of being forced not to work in order to keep Medicaid benefits. Without this coverage, she was spending over half of her income on attendant services and fighting for coverage of needed equipment, such as a new wheelchair.
Dr. Robert Frelick, a physician interested in tobacco control, stated that a tobacco excise tax meeting tobacco control goals and provides new funds for programs.
Lillian Jones of the Delaware Parents Association, asked the committee to consider programs that provide alternative activities to youth and parents. These programs go beyond providing information by providing an environment that supports parent/child relationships.
