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19233 |
Prepared by the North Dakota Legislative Council staff for the Budget Committee on Government Services |
| March 2000 |
DEPARTMENT OF HUMAN SERVICES - TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) AND MEDICAL ASSISTANCE EXPENDITURES
TOTAL TANF AND MEDICAID EXPENDITURES
For the period July 1999 through January 2000, TANF and medical assistance (Medicaid) expenditures have totaled $160.5 million, $9.6 million, or 5.67 percent, less than estimated expenditures of $170.1 million. Of the $9.6 million savings to date, $2.8 million is from the general fund.
Appendix A is a schedule providing the detail of TANF and Medicaid appropriations and expenditures.
TANF
Appropriation
The 1999 Legislative Assembly appropriated $25 million for the TANF program for the 1999-2001 biennium. As appropriated by the Legislative Assembly, $18.6 million was federal funds and $6.4 million of other funds. In October 1999, the Department of Human Services received Emergency Commission and Budget Section approval to transfer $5.5 million of general fund moneys from foster care to the TANF program with a corresponding transfer of $5.5 million of federal funds from the TANF program to foster care. The change resulted from a TANF regulation that became effective on October 1, 1999, which requires state funds to be spent on cash assistance under the TANF program in order to meet the state's maintenance of effort requirements. As adjusted, funding for the TANF program includes $5.5 million from the general fund, $13.1 million of federal funds, and $6.4 million of other funds.
Expenditures to Date
Through January 2000, actual TANF expenditures were $7,227,000, $91,000, or 1.28 percent, more than estimated expenditures of $7,136,000.
Appendix B provides charts comparing actual caseloads and average monthly payments to projections for the 1999-2001 biennium. The charts indicate that the number of cases was more than estimated while the average monthly payment was less than estimated. Representatives of the department have reported that the average payment has been less than estimated primarily due to the recipient families' earned income being more than projected.
MEDICAL ASSISTANCE
Appropriation
The 1999 Legislative Assembly appropriated $667.1 million, $192.7 million of which is from the general fund, for medical assistance grants for the 1999-2001 biennium.
Expenditures to Date
Actual Medicaid expenditures through January 2000 total $153.3 million, $9.7 million less than estimated expenditures of $163 million. Of the $9.7 million savings, $2.6 million is from the general fund.
Major expenditure variances among service areas through January 2000 include:
| Service | Expenditure Variance
Under (Over) |
Percentage Variance
Under (Over) |
|
Nursing home care |
$3,753,192 | 6.28% |
|
Outpatient hospital |
$2,526,152 | 29.81% |
|
Inpatient hospital |
$2,464,132 | 15.72% |
|
Drugs (net) |
($2,057,224) | (16.28%) |
|
Community-based DD care |
$1,280,659 | 3.49% |
Major reasons for these variances include:
- Nursing home care - There have been four percent fewer recipients than anticipated and the cost per recipient has been approximately one percent less than estimated.
- Outpatient hospital - Although the number of recipients has been slightly greater than anticipated, the cost per recipient has been 35 percent less than estimated.
- Inpatient hospital - There have been 16 percent fewer recipients than anticipated and the cost per recipient has been three percent less than estimated.
- Drugs (net) - The number of recipients has been six percent greater than anticipated and the cost per recipient has been 10 percent more than estimated.
- Community-based DD care - Although actual expenditures are reflected as being less than estimated, because of delays in approving new rates for providers, a number of providers are still operating under last year's rates. When the new rates are approved, they will be adjusted retroactively to July 1, 1999. These adjustments are anticipated to significantly reduce the positive variance reflected above.
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