Illustrative Calculation of State Phased-down Monthly Contribution for 2006
Item | Illustrative Value | Source | |
(i) | Gross per capita Medicaid expenditures for prescription drugs for 2003 for full-benefit dual eligibles not receiving drug coverage through a comprehensive Medicaid managed care plan, excluding drugs not covered by Part D | $2,000 | CY MSIS data |
(ii) | Aggregate State rebate receipts in calendar year 2003 | $100,000,000 | CMS-64 |
(iii) | Gross State Medicaid expenditures for prescription drugs in calendar year 2003 | $500,000,000 | CMS-64 |
(iv) | Rebate adjustment factor | 0.2000 | (2) ÷ (3) |
(v) | Adjusted 2003 gross per capita Medicaid expenditures for prescription drugs for full-benefit dual eligibles not in comprehensive managed care plans | $1,600 | (1) * [1 - (4)] |
(vi) | Estimated actuarial value of prescription drug benefits under comprehensive capitated managed care plans for full-benefit dual eligibles for 2003 | $1,500 | To be Determined |
(vii) | Average number of full-benefit dual eligibles in 2003 who did not receive covered outpatient drugs through comprehensive Medicaid managed care plans | 90,000 | CY MSIS data |
(viii) | Average number of full-benefit dual eligibles in 2003 who received covered outpatient drugs through comprehensive Medicaid managed care plans | 10,000 | CY MSIS data |
(ix) | Base year State Medicaid per capita expenditures for covered Part D drugs for full-benefit dual eligible individuals (weighted average of (5) and (6)) | $1,590 | [(7) * (5) + (8) * (6)] ÷ [(7) + (8)] |
(x) | 100 minus Federal Medical Assistance Percentage (FMAP) applicable to month of State contribution (as a proportion) | 0.4000 | FEDERAL REGISTER |
(xi) | Applicable growth factor (cumulative increase from 2003 through 2006) | 50.0% | NHE projections |
(xii) | Number of full-benefit dual eligibles for the month | 120,000 | State submitted data |
(xiii) | Phased-down State reduction factor for the month | 0.9000 | specified in statute |
(xiv) | Phased-down State contribution for the month | $8,586,000 | 1 / 12 * (9) * (10) * [1 + (11)] * (12) * (13) |
42 C.F.R. §423.910