PA Safety Net Admin, Author at Safety-Net Association of Pennsylvania

Study Finds Surprise in Sources of Medicaid, CHIP Growth

While enrollment in Medicaid and CHIP has been greatest among low-income families working full-time for small businesses, growth in Medicaid and CHIP enrollment among low-income families employed full-time by big businesses has been rising faster in recent years.

According to a new study published in the journal Health Affairs, Medicaid and CHIP enrollment among low-income families employed full-time by large companies rose from 45 percent to 69 percent between 2008 and 2016. The driving force behind this growing reliance on public insurance appears to be the shift of health insurance costs from companies to employees: employee share of health insurance premiums rose 57 percent during that same period, leaving many families unable to afford even employer-subsidized health insurance.

Learn more about the growing Medicaid and CHIP participation rates among different economic groups in the Health Affairs report “Growth Of Public Coverage Among Working Families In The Private Sector.”

PA Safety Net Admin2019-07-09T06:00:56+00:00July 9th, 2019|Uncategorized|Comments Off

CMS Outlines New Medicaid Program Integrity Activities

The federal government will introduce a number of initiatives to combat Medicaid waste, fraud, and abuse in the coming months.

In an article on the Centers for Medicare & Medicaid Services’ blog, CMS administrator Seema Verma outlined her agency’s major Medicaid program integrity efforts of the past year, including:

Oversight of state Medicaid claiming and program integrity
Disallowing unallowable claims of federal funding
Increased audits and oversight
Data sharing and partnerships
Education, technical assistance, and collaboration
Reducing improper payments

Initiatives to be introduced in the coming months include (as described in the blog post):

A proposed comprehensive update to Medicaid’s fiscal accountability regulations, to increase states’ accountability for supplemental payments. The update includes additional state reporting, clearer financial definitions, and stronger federal guidance to ensure that states use supplemental payments properly.
A proposed regulation to further strengthen the integrity of the Medicaid eligibility determination process, including enhanced requirements around verification, monitoring changes in beneficiary circumstances, and eligibility redetermination.
Additional guidance on the Medicaid Managed Care Final Rule from 2016 to further state implementation and compliance with program integrity safeguards, such as reporting overpayments and possible fraud.
Release of improvements to the Medicaid and CHIP Scorecard—a dashboard of program measures that increases public transparency about the programs’ administration and outcomes. The improvements include two program integrity measures to enhance transparency and continue to provide states with performance measures related to their Medicaid programs. Examples of such program integrity measures may include measures based on state initiation of collaborative investigations with their UPIC, state participation in the HFPP at any level, and performance data derived from improper payment drivers.
Conduct provider screening on behalf of states for Medicaid-only providers to improve efficiency and coordination across Medicare and Medicaid, reduce state and provider burden, and address one of the biggest sources of error as measured by PERM.
Medicaid provider education through Targeted Probe and Educate—which identifies providers who have high error rates and educates them on billing requirements—to reduce aberrant billing, as well as education provided through Comparative Billing Reports—which show providers their billing patterns compared to their peers.
Audit state claiming of federal matching dollars to address areas that have been identified as high-risk by GAO and OIG, as well as other behavior previously found detrimental to the Medicaid program.

Learn more in the CMS blog article “Medicaid Program Integrity: A Shared and Urgent Responsibility.”

PA Safety Net Admin2019-07-03T10:21:53+00:00July 3rd, 2019|Federal Medicaid issues|Comments Off

DHS Secretary Says No to Medicaid Work Requirements

Pennsylvania will not seek federal permission to create a Medicaid work requirement, Department of Human Services Secretary Teresa Miller told a joint hearing of the State Senate Republican Policy Committee and Health and Human Services Committee this week.

Miller conveyed what a news release described as

…the Wolf Administration’s firm opposition to work requirements for Medicaid recipients and the administration’s work to expand access to education and training programs and services to support employment for people served by DHS’ programs.

In her testimony, Miller explained that

Our goal is always to set policy and implement programs that empower Pennsylvanians to live fulfilling lives, support themselves and their families, contribute to our local economies, and build stronger communities. This is not about opposition to work. We want all people to achieve a better quality of life and not be caught in an intergenerational cycle of poverty. The Wolf Administration is not simply opposed to a work requirement; we are committed to increasing opportunities for meaningful work and providing the whole-person supports we contend are needed.

A Medicaid work requirement could affect the Medicaid eligibility of patients served by Pennsylvania’s safety-net hospitals.

Learn more about Secretary Miller’s testimony in this Department of Human Services news release.

PA Safety Net Admin2019-06-14T06:00:07+00:00June 14th, 2019|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Change Coming to PA’s Medicaid Transportation Program

Pennsylvania’s Medicaid transportation program will soon be undergoing major change.

By law, states must provide free non-emergency medical transportation for their Medicaid recipients. The Pennsylvania Medical Assistance Transportation Program has fulfilled that mandate for the past 35 years, with county governments shouldering primary responsibility for providing or arranging for the transportation for their Medicaid-covered residents.

Under a plan adopted by the Pennsylvania Department of Human Services, which administers the state’s Medicaid program, that would change, with the state currently reviewing proposals from private vendors that would serve as brokers and assume this responsibility for large sections of the state: the eastern, central, and western parts of Pennsylvania.

Changing the program in this manner would enable Pennsylvania to change the classification of medical transportation from an administrative cost to a service cost, which would drawn down more federal Medicaid matching funds and save the state about $10 million a year.

Learn more about what the state is doing, why it is doing it, and why some people believe the new approach may be more expensive and less effective in the Philadelphia Inquirer article “As changes come to Pa. Medicaid transportation program, counties fear bumps in road.”

PA Safety Net Admin2019-06-13T06:00:53+00:00June 13th, 2019|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Opioid Prescriptions Down in PA

Pennsylvania doctors are writing fewer prescriptions for opioids, according to a new analysis by the American Medical Association.

According to the AMA, prescriptions for opioids declined 40 percent in the state between 2013 and 2018 – one of the largest declines in the country.

In a news release, the Pennsylvania Medical Society attributed the decline in part to physician education and in part to the state’s prescription drug monitoring programs.

Learn more from the Central Pennsylvania Business Journal article “Pa. physicians writing fewer opioid prescriptions” and from a news release from the Pennsylvania Medical Society.

PA Safety Net Admin2019-06-11T06:00:52+00:00June 11th, 2019|Uncategorized|Comments Off

PA May Take Over Insurance Exchange

Pennsylvania may soon assume responsibility for providing a health insurance exchange for its residents.

When the Affordable Care Act was adopted in 2010, states were given the option of establishing their own marketplaces for health insurance offered under the reform law or having their citizens use a federal exchange established for the same purpose. Pennsylvania chose to have its residents use the federal exchange, but now, a law changing that is making its way through the state legislature.

Harrisburg, PA capital building House Bill 3, with more than 80 sponsors from both parties, would direct the state to establish its own health insurance exchange and establish a Pennsylvania Health Insurance Exchange Fund to pay for it.

After years of ceding this responsibility to the federal government, some state lawmakers now believe the state can run its own exchange more efficiently and save money by operating the exchange for less than it currently pays the federal government for use of the federal exchange. The bill’s sponsors also believe that taking over the exchange will enable the state to seek a federal reinsurance waiver that should reduce health insurance premiums five to ten percent in Pennsylvania.

House Bill 3 will be considered by the House Insurance Committee.

Learn more about what members of the House seek in the WITF radio article “Plan for Pennsylvania to take over health insurance marketplace gaining ground”; read a co-sponsor memo to state House members asking them to co-sponsor the bill; and read House Bill 3 itself.

PA Safety Net Admin2019-06-10T06:00:10+00:00June 10th, 2019|Affordable Care Act|Comments Off

Legislature to Examine Mental Health Provider Shortage

Pennsylvania’s apparent shortage of mental health providers will be the subject of study by the Pennsylvania Joint State Government Commission, a bipartisan arm of the state’s General Assembly.

The resolution to conduct the study was approved unanimously by the state House, and according to a news release from state representative Jeanne McNeill, who sponsored the resolution,

The study will work to identify factors behind the state shortages, make projections on the number of mental health care providers in Pennsylvania in the future, make recommendations on how to solve the disparity in the number of mental health care providers in rural counties compared to urban and suburban counties and any other solutions needed to stop and reverse the mental health care provider shortage.

Learn more about the mental health provider shortage and the legislature’s search for solutions to that problem in the Central Penn Business Journal article “Panel to study mental health care shortage in PA” and from Representative O’Neill’s news release.

PA Safety Net Admin2019-06-07T06:00:34+00:00June 7th, 2019|Uncategorized|Comments Off

Administration Ramps Up Scrutiny of Immigrants’ Use of Public Benefits

Immigrants’ sponsors could be more likely to be held financially responsible for the cost of public benefits those immigrants receive under a new memorandum issued by the White House.

The requirement itself is not new; the purpose of the memorandum is to encourage federal agencies to enforce existing laws that state that, according to the memorandum,

…when an alien applies for certain means-tested public benefits, the financial resources of the alien’s sponsor must be counted as part of the alien’s financial resources in determining both eligibility for the benefits and the amount of benefits that may be awarded. Financial sponsors who pledge to financially support the sponsored alien in the event the alien applies for or receives public benefits will be expected to fulfill their commitment under law.

Among the means-tested public benefits programs at which this new directive is aimed are Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), and Temporary Assistance for Needy Families (TANF).

While the law already requires agencies to enforce immigrants sponsors’ legal financial responsibilities, the White House memorandum notes that it is not being enforced and directs the federal agencies involved to review and update their enforcement procedures.

Enforcement of this directive could result in fewer people applying for and being found eligible to receive Medicaid. If this occurs, it could be especially harmful to Pennsylvania safety-net hospitals that serve large immigrant communities, potentially leaving them unpaid for care they provide to such patients.

Learn more from the administration’s “Memorandum on Enforcing the Legal Responsibilities of Sponsors of Aliens.”

PA Safety Net Admin2019-06-06T06:00:12+00:00June 6th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Medicaid Expansion Helps Pregnant Women and Their Babies

An intuitive assumption now has evidence to support it: Medicaid expansion has improved the health of pregnant women and their babies.

According to a new study from the Georgetown University Health Policy Institute’s Center for Children and Families,

…states that expand Medicaid improve the health of women of childbearing age: increasing access to preventive care, reducing adverse health outcomes before, during and after pregnancies, and reducing maternal mortality rates.

Better health for women of childbearing age also means better health for their infants. States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than non-expansion states.

The report notes that the number of uninsured women of childbearing age in Pennsylvania fell 49 percent during the three years after Pennsylvania expanded its Medicaid program. Significant numbers of these newly insured women are served by Pennsylvania safety-net hospitals.

Learn more, including specific health benefits enjoyed by pregnant women and their babies, in the Georgetown study “Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies.”

PA Safety Net Admin2019-06-03T16:17:14+00:00June 3rd, 2019|Affordable Care Act, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Medicaid DSH Delay Wins Bipartisan Support

More than 300 members of the U.S. House have joined a letter to House leadership urging a delay in Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH).

The bipartisan letter notes that hospitals that receive Medicaid DSH funds cannot absorb the loss of revenue such a cut would bring. That cut, scheduled to begin in FY 2020, would amount to a $4 billion reduction in nation-wide Medicaid DSH spending in FY 2020 and an $8 billion reduction in each of FY 2021, FY 2022, FY 2023, FY 2024, and FY 2025.

SNAP was actively involved in urging Pennsylvania House members to join the letter. If implemented, the Medicaid DSH cuts would be especially harmful to SNAP members and all Pennsylvania safety-net hospitals – and to the low-income residents of the communities they serve.

See the bipartisan letter seeking a delay of Medicaid DSH cuts here.

PA Safety Net Admin2019-05-24T06:00:46+00:00May 24th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

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