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November 2019

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November 2019 (a) Total Medicaid Expansion enrollment on a monthly basis. Month Enrollees Jul'18 473,307 Aug 476,678 Sep 480,502 Oct 483,690 Nov 487,478 Dec 494,247 Jan'19 502,055 Feb 502,647 Mar 505,503 Apr 465,870 May 457,243 Jun 454,638 NOTE: Data extracted on 07/08/2019. (B) Average Per Member Per Month and Portion of the Per Member Per Month Assocated with Hospitals Expansion Rate Estimate ‐‐ Rate Floor Expansion Adult (Rate Floor) Hospital Portion of Expansion Rate Full Rate $ 571.41 $ 255.21 • Hospital records are identified by CLQ_Claim_Type 01 and 03. • The PMPM above does not include claims related to maternity kick payments. • The PMPM above is the aggregate rate for regular Expansion rate cells (which do not include SBH/NEMT‐only and High Needs rate cells). (c) The aggregate Medicaid claims payment by provider type (for Expansion only). NOTE: 1) Data are based on service provider types. 2) Data extracted by DOP and on 07/08/2019. Provider Description for Provider Type Total (= FFS + Encounters) Provider Type 201807 201808 201809 201810 201811 201812 201901 201902 201903 201904 201905 201906 SFY SUM Type Total $421,974,919 $443,478,341 $416,805,350 $452,286,409 $430,580,719 $438,140,741 $453,889,095 $445,972,863 $490,400,138 $480,484,264 $484,450,452 $487,281,325 $5,445,744,615 Total 00 -2,744 -2,744 00 03 CHILDREN'S CHOICE (WVR)(IN-ST) 7,886 4,829 5,824 8,861 5,555 6,845 3,825 4,830 2,234 938 341 86 52,052 03 04 PEDI DAY HLTH CARE (IN-ST) 21,717 17,673 15,558 1,513 367 335 104 232 344 322 483 215 58,864 04 05 MANAGED CARE ORG - PREPAID 238,646,474 244,528,642 241,526,330 246,590,010 245,314,254 244,701,653 259,396,811 253,811,107 277,288,024 289,012,875 274,832,281 304,674,505 3,120,322,967 05 06 NOW PROFESSIONAL SERVICES 1,764 1,457 3,872 2,594 3,161 2,360 1,653 1,650 3,314 1,419 8,302 5,282 36,827 06 07 CASE MGMT-INFT & TODD (IN-ST) 15,583 19,323 38,828 16,011 8,920 18,940 19,310 18,910 8,718 21,828 30,013 11,760 228,145 07 08 OAAS CASE MGMT (IN-ST) 194 194 08 09 HOSPICE SERVICES (IN-ST) 411,421 670,683 220,196 310,846 371,652 348,883 353,950 367,075 469,593 338,932 332,054 347,015 4,542,300 09 12 MULTI-SYSTEMIC THER (IN-ST) 8,064 10,626 6,513 729 7,165 -321 240 4,223 8,144 8,360 3,196 2,971 59,909 12 14 DAY HABILITAT (WVR) (IN-ST) 348 214 622 254 656 46 2,140 14 15 ENVIR ACC ADAP (WVR) (IN-ST) 524 246 461 1,135 1,231 792 187 441 175 679 621 526 7,018 15 16 PERS EMERG RESP SYS (WVR) 438 2,101 2,608 1,903 522 1,951 752 552 1,426 2,024 537 292 15,107 16 18 COMM MENTAL HLTH CTR/PART HOSP 170,911 150,356 121,269 113,408 93,010 110,052 396,106 113,167 144,217 122,910 97,864 77,286 1,710,555 18 19 DR OF OSTEOPATH MED (IND & GP) 560,032 601,962 588,127 681,360 573,319 566,992 642,357 663,532 744,761 584,051 607,004 564,534 7,378,032 19 20 PHYSICIAN (IND & GP) 25,021,830 26,249,180 24,435,301 29,101,797 24,414,425 24,664,315 26,223,034 25,888,054 27,237,899 25,885,308 26,384,195 23,898,289 309,403,627 20 22 PERSONAL CARE ATTENDANT (WVR) 294 543 163 683 1,684 22 23 INDEPENDENT LAB 4,200,871 4,027,405 3,505,962 4,177,010 4,355,692 3,440,966 3,839,316 4,112,055 4,872,843 4,282,867 4,081,185 3,502,400 48,398,573 23 24 PERSONAL CARE SERVICES (IN-ST) 362,161 306,916 305,932 378,820 323,187 307,743 396,695 323,457 335,419 364,204 283,819 264,977 3,953,329 24 25 MOBILE XRAY/RADIATION THRPY CT 39,235 60,258 49,489 42,822 39,703 65,326 35,855 55,331 41,538 52,794 26,182 35,544 544,073 25 26 PHARMACY 47,181,080 51,488,101 46,767,901 50,010,503 48,462,939 52,105,700 50,504,919 46,602,555 51,185,576 45,962,964 57,417,919 47,748,291 595,438,447 26 27 DENTIST (IND & GP) 2,466,361 2,777,339 2,133,011 2,436,520 2,235,378 2,171,816 2,440,190 2,171,338 2,241,921 1,953,326 2,702,044 1,846,179 27,575,423 27 28 OPTOMETRIST (IND & GP) 1,068,017 1,260,891 1,129,648 1,226,694 1,097,389 987,043 1,210,078 1,302,849 1,382,922 1,276,645 1,186,345 841,701 13,970,222 28 29 EARLYSTEPS (IND & GP) (IN-ST) 1,848 1,456 1,299 136 4,739 29 30 CHIROPRACTOR (IND & GP) 21,497 23,579 18,879 27,380 24,871 23,654 23,039 31,448 22,592 25,443 22,115 22,076 286,572 30 31 PSYCHOLOGIST (LIC/MED) (IN-ST) 74,454 95,420 88,908 102,035 77,872 85,816 88,188 87,270 101,699 95,046 96,104 89,317 1,082,129 31 32 PODIATRIST (IND & GP) 186,395 221,174 202,481 256,022 229,571 220,888 204,422 220,565 212,847 231,377 214,680 191,620 2,592,041 32 33 PRESCRIBING ONLY PROVIDER 72,127 71,820 114,903 100,579 95,507 104,627 121,430 102,448 108,970 88,657 86,636 86,572 1,154,276 33 34 AUDIOLOGIST (IN-ST) 14,279 15,682 13,876 15,623 13,094 12,190 12,515 9,302 13,774 34,634 12,997 15,814 183,779 34 35 PHYSICAL THERAPIST (IN-ST) 156,291 202,717 190,424 225,861 203,050 212,032 203,265 241,938 251,949 218,032 241,886 311,347 2,658,789 35 37 OCCUPATIONAL THERAPIST (IN-ST) 11,726 12,188 11,808 18,475 21,788 18,091 18,498 22,620 26,115 21,019 21,542 23,904 227,775 37 38 SCHOOL BSED HEALTH CTR (IN-ST) 0 48 223 135 104 83 366 151 330 1,439 38 39 SPEECH/LANGUAGE THERAP (IN-ST) 481 701 1,180 1,560 998 1,897 1,354 1,321 2,206 855 354 1,338 14,247 39 40 DME 1,894,948 2,041,627 1,806,057 2,563,276 1,814,574 1,997,790 2,007,412 1,999,542 2,393,315 2,294,726 2,250,361 1,920,428 24,984,057 40 41 REGISTERED DIETICIAN (IN-ST) 454 508 691 663 901 570 355 555 777 728 625 1,437 8,263 41 42 NON-EMER MED TRANSPORT (IN-ST) 1,051,368 1,266,435 929,502 1,013,226 1,333,126 1,010,218 954,611 1,221,947 1,297,025 1,055,503 1,193,541 487,268 12,813,770 42 43 CASE MGT - NHV/FTM (IN-ST) 6,694 7,438 5,227 3,173 228 2,682 5,983 5,587 12,197 24,055 74,943 148,208 43 44 HOME HEALTH AGENCY (IN-ST) 429,475 295,039 267,065 331,534 381,438 211,863 349,181 343,664 359,401 326,759 375,429 270,258 3,941,107 44 45 CASE MGMT - CONTRACTOR (IN-ST) 8,146 2,701 1,319 912 724 776 1,132 892 788 1,172 505 140 19,208 45 51 AMBULANCE TRANSPORTATION 2,621,048 2,771,641 2,453,974 2,948,640 2,146,306 2,146,445 2,433,871 2,409,302 2,847,641 2,529,544 2,740,646 2,831,594 30,880,651 51 53 SELF DIRECTED/DIRECT SUPPORT 8 114 6 128 53 54 AMBULATORY SURGI CTR (IN-ST) 103,805 111,748 101,759 109,837 92,185 94,424 172,362 128,375 105,382 104,335 107,859 88,427 1,320,497 54 55 EMERG ACCESS HOSPITAL (IN-ST) 31,577 76,406 52,095 39,328 10,544 7,170 3,410 29,829 24,983 42,574 50,382 28,770 397,069 55 56 PRESCRIBER ONLY FOR MCO 11,270 11,035 11,775 10,864 8,709 6,772 10,071 8,674 8,560 8,001 6,094 6,888 108,713 56 57 OPH REGISTERED NURSE (IN-ST) 2,503 1,730 1,430 2,856 2,582 1,636 2,455 1,148 1,187 934 591 5,707 24,757 57 58 NOT ASSIGNED 119 119 58 59 NEURO REHAB HOSPITAL (IN-ST) 82,300 43,780 68,343 124,131 256,678 179,594 84,373 226,117 208,644 43,579 65,293 37,593 1,420,426 59 60 HOSPITAL 61,335,530 73,170,027 60,564,245 75,479,680 68,222,187 70,660,525 70,998,548 72,872,695 83,096,737 72,583,416 78,514,159 70,481,020 857,978,768 60 61 VENERIAL DISEASE CL (IN-ST) 180 332 44 30 36,442 24,956 38,121 40,650 140,755 61 62 TUBERCULOSIS CLINIC 300 139 139 128 20 88 120 419 343 953 276 581 3,506 62 64 MENTAL HLTH HOSP (FREE-STAND) 5,508,057 5,531,373 5,619,794 6,304,595 4,948,422 4,865,997 5,019,222 5,270,663 5,582,987 5,201,791 5,130,228 4,969,559 63,952,686 64 65 REHABILITATION CENTER (IN-ST) 109,132 119,475 89,601 123,062 75,580 96,831 119,552 89,159 96,455 82,583 62,919 79,294 1,143,643 65 66 KIDMED SCREENING CLINIC 43,643 27,135 19,689 44,422 34,497 33,452 24,443 26,260 34,410 33,698 32,063 22,009 375,720 66 68 SUBS/ALCOH ABSE CTR (X-OVERS) 62,622 101,608 52,018 59,467 41,478 51,911 73,512 105,270 100,864 53,110 95,671 117,029 914,559 68 69 DIST PART PSYCH HOSP (IN-ST) 2,029,535 2,314,950 2,225,710 2,484,118 2,016,393 2,056,345 2,475,053 2,280,310 2,749,251 2,584,173 2,417,562 2,128,531 27,761,931 69 70 EPSDT HEALTH SERVICES (IN-ST) 2,374 2,533 1,362 769 568 1,090 1,809 1,692 115,718 52,134 36,310 38,981 255,339 70 71 FMLY PLANNING CLINIC (IN-ST) 54,309 45,207 35,664 37,260 42,966 29,744 37,700 30,347 36,263 31,981 31,486 33,566 446,492 71 72 FED QUALIFIED HLTH CTR (IN-ST) 347,340 428,235 427,958 513,625 468,602 533,687 496,537 700,392 849,441 770,850 670,980 372,325 6,579,972 72 73 LIC CL SOCIAL WORKER (IN-ST) 624,674 815,264 713,164 957,803 861,409 796,223 855,813 886,288 1,304,195 927,605 617,376 374,751 9,734,565 73 74 MENTAL HEALTH CLINIC (IN-ST) 434,075 398,867 322,595 437,092 321,402 382,267 327,511 294,423 375,524 286,388 174,889 105,921 3,860,956 74 75 OPTICAL SUPPLIER 43,152 51,246 39,655 46,588 44,653 38,434 61,161 63,426 60,783 57,382 53,109 41,608 601,196 75 76 HEMODIALYSIS CENTER (IN-ST) 449,285 472,702 425,279 565,277 396,407 488,216 605,370 520,535 486,060 565,825 608,219 515,996 6,099,171 76 77 MENTAL REHAB AGENCY (IN-ST) 2,069,577 1,826,180 1,679,988 1,983,545 1,317,343 1,383,773 1,402,136 1,109,743 1,058,495 939,909 938,318 864,410 16,573,415 77 78 NURSE PRACTITIONER (IND & GP) 4,839,372 5,399,557 4,964,885 5,635,013 4,691,188 4,772,542 5,282,117 5,590,098 5,736,926 5,352,833 5,465,796 4,701,748 62,432,075 78 79 RURAL HLTH CL(PROV-BSE)(IN-ST) 176,130 112,324 113,092 132,464 133,423 177,703 137,908 165,436 181,831 209,935 153,924 100,785 1,794,954 79 80 NURSING FACILITY (IN-ST) 442,027 323,661 426,920 464,605 403,324 560,956 399,616 472,918 544,894 454,209 548,982 410,461 5,452,572 80 82 PERS CARE ATTEND (WVR) (IN-ST) 202 -190 1,579 0 638 427 2,655 82 Provider Description for Provider Type Total (= FFS + Encounters) Provider Type 201807 201808 201809 201810 201811 201812 201901 201902 201903 201904 201905 201906 SFY SUM Type 84 SUBSTIT FMLY CARE (WVR)(IN-ST) 82 131 751 82 305 302 212 212 372 720 258 206 3,633 84 85 ADLT DAY HLTH CA (WVR) (IN-ST) 1,762
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