Fiscal Note & Local Impact Statement
127 th General Assembly of Ohio
|
STATE FUND |
FY 2008 |
FY 2009 |
FUTURE YEARS |
|
General Revenue Fund –
Medicaid managed care |
|||
|
Revenues |
Possible increase of
approximately 60% of the increase in expenditures |
Possible increase of
approximately 60% of the increase in expenditures |
|
|
Expenditures |
- 0 - |
Increase, potentially in
the tens of millions |
Increase, potentially in
the tens of millions |
|
General Revenue Fund –
health insurance for employees and dependents |
|||
|
Revenues |
- 0 - |
- 0 - |
- 0 - |
|
Expenditures |
Increase |
Increase, potentially in |
Increase, potentially in |
|
Other State Funds – health
insurance for employees and dependents |
|||
|
Revenues |
- 0 - |
- 0 - |
- 0 - |
|
Expenditures |
Increase |
Increase, potentially in |
Increase, potentially in |
Note: The state
fiscal year is July 1 through June 30.
For example, FY 2007 is July 1, 2006 – June 30, 2007.
·
The
bill would increase costs to Medicaid managed care of providing coverage for an
estimated 1,141 autistic children. The
cost per child cannot be estimated due to lack of detail about what is required
of health insuring corporations, but one illustration of potential cost per
child puts the cost at $50,000 per year.
The federal government would match approximately 60% of any increase in
Medicaid spending if federal rules allow the federal matching rate to apply.
·
The
bill would increase costs to the state of providing health benefits to an estimated
37 dependents of state employees. The
cost per child cannot be estimated due to a lack of detail about what is
required of public employee benefit plans, but one illustration of potential
cost per child puts it at $50,000 per year.
The GRF would pay the cost of coverage for approximately half the
children, with various state funds providing the rest.
|
LOCAL
GOVERNMENT |
FY 2008 |
FY 2009 |
FUTURE YEARS |
|||
|
Counties, municipalities,
townships |
||||||
|
Revenues |
- 0 - |
- 0 - |
- 0 - |
|||
|
Expenditures |
Increase, potentially in
the millions |
Increase, potentially in
the millions |
Increase, potentially in
the millions |
|||
|
School districts |
||||||
|
Revenues |
- 0 - |
- 0 - |
- 0 - |
|||
|
Expenditures |
Increase, potentially in
the millions |
Increase, potentially in
the millions |
Increase, potentially in
the millions |
|||
Note: For most local governments, the fiscal year is the calendar year. The school district fiscal year is July 1 through June 30.
·
The
bill would increase costs to counties, municipalities, and townships statewide
of providing health benefits to an estimated 120 dependents of employees. The cost per child cannot be estimated due
to a lack of detail about what is required of public employee benefit plans, but
one illustration of potential cost per child puts it at $50,000 per year.
·
The
bill would increase costs to school districts statewide of providing health
benefits to an estimated 152 dependents of employees. The cost per child cannot be estimated due to a lack of detail
about what is required of public employee benefit plans, but one illustration
of potential cost per child puts it at $50,000 per year.
|
|
H.B. 170 would prohibit
health insuring corporation (HIC) contracts, certain policies of sickness and
accident insurance, public employee benefit plans, and multiple employer
welfare arrangements from excluding coverage for the diagnosis and treatment of
autism. And it defines any violation of
this prohibition to be an unfair and deceptive practice in the business of
insurance. The bill defines autism to
be "autistic disorder" as defined by the Diagnostic and
Statistical Manual of Mental Disorders, 4th edition, published by the
American Psychiatric Association. The
bill does not specify who may diagnose or treat the condition.
Background
LSC staff have not been able
to obtain a precise count of the number of children in Ohio with autism. Some authorities, for example Dr. James
Mulick, professor of pediatrics and psychology at The Ohio State University,
cite a national figure of approximately one child in 166 having autism.[1] A U.S. Government Accountability Office
(GAO) report entitled Federal Autism Activities dated July 2006 cites
various estimates of prevalence of the condition (that are generally consistent
with Dr. Mulick's figure). Among those
estimates are two national surveys cited by the U.S. Centers for Disease
Control and Prevention from 2006 that found figures of 5.5 per 1,000 children
to 5.7 per 1,000 children (page seven of the GAO report). The estimates below assume that 5.7 per
1,000 Ohio children have the condition.
Ohio Department of Health
data indicate that there were 741,215 live births in Ohio between 2002 and
2006. The web site
statehealthfacts.org, an affiliate of the Kaiser Family Foundation, reports
that 62% of Ohio children between the ages of 0 and 18 are insured through an
employer-based health plan, and that another 27% are insured through
Medicaid. The estimates below assume
that the children insured through an employer are covered by governmental plans
in proportion to the overall employment of Ohioans reported by the U.S. Bureau
of Labor Statistics (BLS). That is, BLS
data for May 2007 indicate that 1.4% of the Ohio nonfarm workforce was employed
by state government (not including those employed by an educational
institution), 4.6% were employed by local government (not including those
employed by an educational institution), and 5.8% were employed in local
government education. Using the figures
above, the number of children with autism that are covered by a state health
plan are estimated to be approximately 37, the number that are covered by a
health plan sponsored by a county, municipality, or township is estimated to be
approximately 120, and the number covered by a school district-sponsored health
plan is estimated to be approximately 152.
The statehealthfact.org data indicate more directly that Medicaid covers
approximately 1,141 children with autism.
Fiscal effects
The bill may increase the
costs to state and local governments to provide health benefits to employees
and their dependents. Diagnosis and
treatment of autism may already be fully or partially covered in some
governmental health plans. To the
extent that they are provided currently, the cost estimates below should be
reduced.
The fact that the bill does
not specify who may diagnose or treat a child with autism makes estimating the
cost per child impossible. We might
assume that the condition must be diagnosed and treated by a qualified professional,
but the bill does not specify that coverage must be provided only in such
cases.
Regarding treatment of
autism, Dr. Mulick (in the press release cited above) states that there is no
cure for autism. He reports that the
only therapy that has been shown to have a long-term positive effect on autism
is Early Intensive Behavioral Intervention, a labor-intensive process. It involves one-on-one behavioral treatment
with a child for up to 40 hours per week for several years. If we assume that treatment is provided by a
qualified professional charging an hourly rate of $100, and that treatment
averages 500 hours per year per child, the cost per child would be $50,000
annually.
It should be emphasized that
LSC cannot estimate the cost of the bill due to lack of detail about what is
required of insurers and public employee benefit plans. But the following may provide some
indication of the possible magnitude of costs, given the illustrated cost per
child of $50,000 per year. Given all
the assumptions made above, the cost to the state to cover 37 autistic children[2]
would be $1.8 million per year. The
cost to the Medicaid program's managed care program to cover 1,141 children
would be roughly $57 million, of which the federal government would pay
approximately 60%. Because the cost
would depend on increases in managed care rates, which are currently being
finalized for calendar year 2008, the cost would be delayed until FY 2009. The cost to counties, municipalities, and
townships statewide would be approximately $6 million, and the cost to school
districts would be approximately $7.6 million.
LSC fiscal staff: Ross Miller, Senior Economist
[1] This figure is cited in a press release issued by the Research Communications office of The Ohio State University. The press release is dated August 20, 2007.
[2] This is based on the 741,215 live births in Ohio during the five years from 2002 to 2006. This implicitly assumes that treatment lasts five years for the average child.