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

Medicaid “Pay Bump” Worked, New Study Suggests

A federally mandated increase in Medicaid payments for primary care services appears to have achieved its goal of improving access to care for Medicaid recipients – especially in Pennsylvania.
The increase, part of the Affordable Care Act, called for raising payments for Medicaid primary care services to the same level as Medicare payments in the hope that such an increase would lead more primary care providers to serve Medicaid patients, thereby improving access to primary care services for those patients. Historically, primary care providers have been reluctant to serve Medicaid patients, citing low pay as their reason for avoiding such patients.
That Medicaid pay increase – often referred to as the “Medicaid pay bump” – was mandated for two years and expired at the end of 2014. One of the reasons policy-makers resisted extending it was the lack of proof that it achieved its goal of improving access. Now, a new study in the New England Journal of Medicine provides the first broad look at the program’s impact – and the first proof of its success.
In the study, researchers selected ten states and measured the availability and waiting times for primary care appointments for two limited periods of time. They found that

…The availability of primary care appointments in the Medicaid group increased by 7.7 percentage points, from 58.7% to 66.4%, between the two time periods. The states with the largest increases in availability tended to be those with the largest increases in reimbursements, with an estimated increase of 1.25 percentage points in availability per 10% increase in Medicaid reimbursements.

Among the ten states evaluated in the study was Pennsylvania, where the benefits of the Medicaid pay bump were especially noteworthy: while the availability of appointments rose eight percent overall in the states that were part of the study, appointment availability rose 13 percent in Pennsylvania.
One possible reason: the Medicaid pay bump doubled Medicaid primary care fees.
The study’s conclusion?

Our study provides early evidence that increased Medicaid reimbursement to primary care providers, as mandated in the ACA, was associated with improved appointment availability for Medicaid enrollees among participating providers without generating longer waiting times.

Learn more about the study from this Allentown Morning Call article or find the New England Journal of Medicine article here.

PA Safety Net Admin2015-01-27T06:00:28+00:00January 27th, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Millions Live in ACA Coverage Gap

Nearly four million people who were supposed to be helped to health insurance through the Affordable Care Act remain uninsured today because they earn too much to qualify for Medicaid and not enough to qualify for the reform law’s health insurance subsidies.
When the law was passed in 2010, it was supposed to provide Medicaid coverage for those earning up to 138 percent of the federal poverty level and offer subsidies to other low-income earners. But when the Supreme Court made the reform law’s mandatory Medicaid expansion optional for states and some states chose not to expand their Medicaid programs, nearly four million people found themselves wedged between eligibility for Medicaid and eligibility for subsidies, with no help forthcoming.
Among the four million, more than half work at least part-time and two-thirds reside in a household with at least one wage-earner. Most work for small companies that are not required to provide health insurance for their employees and many earn the minimum wage. Many are single adults.
The coverage gap has been a problem in Pennsylvania, which until recently did not expand its Medicaid program. As a result, many people who fell into this gap turned to the state’s safety-net hospitals when they needed care but had no health insurance.
The Washington Post has taken a look at the challenges these low-income and often medically vulnerable people face living in states that have chosen not expanded their Medicaid programs. See its report here.

PA Safety Net Admin2015-01-26T06:00:19+00:00January 26th, 2015|Affordable Care Act, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

The Challenges Facing Pennsylvania’s Safety-Net Hospitals

With the arrival of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The second of those four papers describes the major health care and health policy challenges safety-net hospitals face. Those challenges include:

the distinct patients safety-net hospitals serve
inadequate payments for Medicaid services
the large numbers of uninsured and underinsured patients safety-net hospitals serve
threats to vital state Medicaid supplemental payments, such as Medicaid disproportionate share payments (Medicaid DSH
continuing change and reform in the health care system, including the delivery of care and how safety-net hospitals are paid for their services

The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
Find both SNAP papers here.

PA Safety Net Admin2015-01-23T06:00:07+00:00January 23rd, 2015|Safety-Net Association of Pennsylvania|Comments Off

Healthy Pennsylvania Medicaid Benefits Posted

The Pennsylvania Department of Human Services has published materials describing Medicaid benefits under the state’s Healthy Pennsylvania Medicaid expansion.
A Medical Assistance Bulletin (#99-15-02) describing the “Interim Healthy Benefit Plan” can be found here and tables comparing the benefits packages under the “Healthy” (low risk), “Healthy Plus” (high risk), and Private Coverage Option plans (PCO) can be found here.

PA Safety Net Admin2015-01-22T06:00:53+00:00January 22nd, 2015|Healthy PA, Meetings and notices, Pennsylvania Medicaid laws and regulations|Comments Off

Problems Reported in Healthy PA Medicaid Enrollment

It appears some people may be having trouble taking advantage of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion.
The Pittsburgh Post-Gazette reports that there is a backlog in processing applications, some people who are eligible to participate are getting rejected for coverage, and some who need drug and alcohol treatment services have been placed in plans that do not provide such coverage.
The state has acknowledged the problem with drug and alcohol coverage but notes that processing applications can take up to 45 days. So far, the state estimates that 150,000 Pennsylvania households have applied for Medicaid coverage since the enrollment period started on December 1.
To learn more about the challenges Pennsylvania’s Medicaid expansion is encountering, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2015-01-16T06:00:04+00:00January 16th, 2015|Healthy PA, Pennsylvania Medicaid policy|Comments Off

What is SNAP?

With the arrival of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The first paper, “What is SNAP?”, is an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
See “What is SNAP?” here, on the association’s web site.

PA Safety Net Admin2015-01-15T06:00:06+00:00January 15th, 2015|Safety-Net Association of Pennsylvania|Comments Off

Will High Court Help Pave the Way to Higher Medicaid Payments?

In a case that could have nation-wide implications for health care providers, the U.S. Supreme Court will hear an appeal of a lower court decision that ordered the state of Idaho to raise Medicaid payments to providers serving the developmentally disabled because the state’s payments were too low.
While litigants in some states have used the courts in recent years to seek redress for what they believed were inadequate Medicaid payments, Supreme Court action on that matter could have national implications: if the court supports the state of Idaho’s appeal of the order to raise fees it could limit the use of litigation in the future as a means of increasing payments and improving access to care for the Medicaid population. If, on the other hand, the court rejects the Idaho appeal, it could potentially open the door to more such litigation, especially in states with Medicaid payments that do not even cover the cost of services providers deliver.
The outcome of this case will be of special interest to Pennsylvania’s safety-net hospitals because the state still underpays hospitals for much of the care they provide to their Medicaid patients.
To learn more about the Idaho case, similar litigation elsewhere, and the implications of the case about to go before the Supreme Court, see this Kaiser Health News report.

PA Safety Net Admin2015-01-14T06:00:35+00:00January 14th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

New Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has released its latest newsletter.
The December edition includes articles about Medicaid benefits under Healthy Pennsylvania; the eligibility criteria for Medicaid; the continuation of the state’s General Assistance program for selected immigrants; and the process for some Pennsylvanians currently insured through the federal insurance marketplace to shift to Medicaid coverage instead.
Find the newsletter here.

PA Safety Net Admin2015-01-12T06:00:58+00:00January 12th, 2015|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Low-Income Patients Struggle With Diabetes Management

Low-income diabetics are more likely than others to struggle to manage their condition – even if they have health insurance.
According to a new study published in JAMA Internal Medicine, “Increasing access to care may be insufficient to improve the health of patients with diabetes mellitus and unmet basic needs.” The study defines those unmet needs as food insecurity, cost-related medication underuse, housing instability, and energy insecurity.
The study, “Material Needs Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources,” found that difficulty affording food led to more outpatient physician visits; trouble paying for medicine and underuse of medicine for that reason led to more emergency room visits and hospitalizations; and all of the material insecurities contributed to increased health care costs.
The study was based on observation of 400 patients served by community health centers in Massachusetts. It found that 19 percent of those patients had trouble affording food, 28 percent had difficulty paying for medicine, 11 percent struggled to pay for someplace to live, and 14 percent had a hard time paying their utility bills. Overall, nearly half had trouble managing their diabetes.
The study’s supports SNAP’s contention that low-income patients – patients served in disproportionate numbers by Pennsylvania’s safety-net hospitals – are fundamentally more challenging to treat than others and often lack the community and social supports needed to address their medical needs effectively.
Learn more about the study and its implications in this U.S. News & World Report article or find the study itself here, on the web site of JAMA Internal Medicine.

PA Safety Net Admin2015-01-08T06:00:45+00:00January 8th, 2015|Uncategorized|Comments Off

180,000 Pennsylvanians Turn to Exchange for Health Insurance

The federal government estimates that approximately 180,000 low- and moderate-income Pennsylvanians who earn too much to qualify for Medicaid have applied for health insurance through the federal health insurance exchange.
Nearly 80 percent of them are expected to qualify for some federal subsidies to help pay their premiums. 95,000 are first-time applicants.
Last year, 320,000 Pennsylvanians applied for insurance through the federal exchange. About 60 percent did not have health insurance before doing so.
As a result, it appears as if more than 300,000 of the approximately 1.4 million Pennsylvanians who were uninsured at the time the Affordable Care Act’s insurance expansions took effect either now have such coverage or will soon have it. This figure includes those newly eligible for Medicaid under the state’s Healthy Pennsylvania Medicaid expansion program.
Learn more about the various means through which previously uninsured Pennsylvanians are obtaining health insurance in this Harrisburg Patriot-News article.

PA Safety Net Admin2015-01-07T06:00:32+00:00January 7th, 2015|Affordable Care Act, Health care reform, Healthy PA|Comments Off

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