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19397 |
Prepared by the North Dakota
Legislative Council staff for the Budget Committee on Government Services September 2000 |
DEPARTMENT OF HUMAN SERVICES - TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) AND MEDICAL ASSISTANCE EXPENDITURES
TOTAL TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND MEDICAID EXPENDITURES
For the period July 1999 through July 2000, TANF and medical assistance (Medicaid) expenditures have totaled $367.7 million, $15.5 million more than the original appropriation estimate for this time period of $352.2 million. These expenditures include those relating to the intergovernmental transfer program authorized under Senate Bill No. 2168. Excluding the intergovernmental transfer program expenditures, actual expenditures have totaled $330.9 million, $9.1 million less than the original appropriation estimate of $340 million
Appendix A is a schedule providing the detail of TANF and Medicaid appropriations and expenditures.
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES
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 was 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 July 2000 actual TANF expenditures were $12.2 million, $200,000, or 1.9 percent, less than estimated expenditures of $12.4 million.
Appendix B provides charts comparing actual caseloads and average monthly payments to projections for the 1999-2001 biennium. The number of cases has been more than estimated while the average monthly payment has been less than estimated. Representatives of the department have reported that the average monthly payment has been less than estimated due primarily to the recipient families' earned income being more than projected.
The department has been spending the general fund moneys at a faster rate than the federal or special funds in order to meet the state's maintenance-of-effort requirement to assure that the state will have access to the total federal funds available.
MEDICAL ASSISTANCE
Appropriation
The 1999 Legislative Assembly appropriated $679.3 million, $196.3 million of which is from the general fund for medical assistance grants for the 1999-2001 biennium.
Expenditures to Date
Actual Medicaid expenditures through July 2000 were $355.5 million, $15.7 million more than the original appropriation estimate of $339.8 million. Excluding the $36.8 million of expenditures related to the intergovernmental transfer program, actual expenditures have totaled $318.7 million, $8.9 million less than the original appropriation estimate of $327.6 million. Of the $8.9 million savings, $2.5 million is from the general fund.
Major expenditure variances among service areas through July 2000 include:
| Service | Expenditure Variance Under (Over) Estimate | Percentage Variance Under (Over) |
| Nursing home care | $7,290,948 | 5.93 |
| Drugs (net) | ($5,383,661) | (21.71) |
| Outpatient hospital | $3,436,929 | 20.66 |
| Inpatient hospital | $1,683,522 | 5.47 |
Major reasons for these variances include:
- Nursing home care - The number of recipients has been approximately four percent less than anticipated and the cost per recipient has been approximately two percent less than projected.
- Drugs (net) - The number of recipients has been approximately seven percent greater than anticipated and the cost per recipient has been nearly 13.5 percent more than estimated.
- Outpatient hospital - Although expenditures have been less than estimated, the department anticipates making additional payments upon completion of cost settlements. Blue Cross Blue Shield reviews actual costs of medical providers for the services provided and, based on these reviews, payments are adjusted to reflect the actual cost of the services.
- Inpatient hospital - The number of recipients of inpatient hospital services has been seven percent less than estimated; however, the cost per recipient is approximately two percent more than projected.
In February 2000 the department reprojected community-based developmental disabilities services expenditures, and in May 2000 reprojected other medical assistance-related expenditures. The revised projections, excluding the intergovernmental transfer program, totaled $658.8 million, $8.9 million less than the original appropriation estimate of $667.1 million.
Comparing the department's July 2000 estimate of biennial expenditures to the original appropriation, excluding the intergovernmental transfer program, the department projects that total biennial costs based on actual expenses through July 2000 and the department's revised estimates for the remainder of the biennium will be $9.2 million less than appropriated, $3 million of which is from the general fund.
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