MON Health Care Report: DHS projecting higher Medicaid expenditures in letter to JFC co-chairs

From WisPolitics.com/WisBusiness.com …

— The Department of Health Services is now projecting Medicaid general purpose revenue spending to come in $213.2 million higher than projected when the 2025-27 budget was signed six months ago.

In a letter to the co-chairs of the Joint Finance Committee, DHS Secretary Kirsten Johnson attributed the projected shortfall to several factors. That includes unanticipated higher costs for prescription drugs, Medicare buy-in programs, and fee-for-service mental health and substance use disorder services.

The state budgeted nearly $9.7 billion in general purpose revenue for Medicaid over the 2025-27 biennium with an overall cost for the program of nearly $36.2 billion with federal funds factored in. The projected $213.2 million GPR shortfall amounts to 2.2% of budgeted costs.

Three months ago, DHS was projecting a $144.1 million GPR shortfall in the program.

The factors Johnson cited last week for the higher-than-expected costs include:

  • $76 million for the higher costs for prescription drugs, buy-in programs, and fee-for-service mental health and substance use disorder services.
  • $45 million due to higher-than-expected enrollment in Family Care, which provides services for older adults and adults with disabilities. Johnson wrote the budget adopted lower enrollment trends than what DHS had recommended. So far this biennium, the trend suggests enrollment will be even higher than what the agency had expected prior to passage of the budget.
  • $59 million for nursing home expenditures and $38 million for Children’s Long Term Supports programs due to higher-than-expected utilization.

Johnson wrote some of those higher costs have been offset by savings elsewhere in the program.

— SHINE Technologies has completed the acquisition of the SPECT nuclear medicine business from Massachusetts-based Lantheus, the Janesville company announced. 

The deal includes a manufacturing facility in Massachusetts as well as the company’s portfolio of diagnostic radiopharmaceuticals, according to details released Friday. 

The SPECT site has been producing a product called TechneLite for 55 years, providing hospitals and imaging centers with the self-contained technetium-99m generator. Tc-99m is a radioactive isotope that’s widely used in diagnostic imaging. Along with the production facility in North Ballerica, Mass., the SPECT portfolio includes various imaging agents that are used in millions of procedures each year. 

SHINE is currently developing its Chrysalis facility in Janesville, which it says will become the largest isotope production facility in the world. The newly acquired SPECT business will use several isotopes that will be made there, including molybdenum-99, a “parent” isotope that decays into the Tc-99m used in imaging. 

Greg Piefer, founder and CEO of SHINE, says the nuclear medicine supply chain should be “modernized” to keep up with the needs of patients. 

“We’re building that now, bringing new technology to bear across both diagnostic and therapeutic markets,” he said in a statement on the acquisition. “This strengthens the entire isotope supply ecosystem and positions SHINE to deliver the reliability healthcare depends on.” 

The company on Friday also announced Michael Rossi has been tapped to lead the SPECT business as CEO, touting his more than 30 years of experience in the pharmaceutical industry. 

Financial terms of the deal weren’t disclosed. 

See the release below. 

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