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.
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.
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.
As 2014 ended, Pennsylvania had received 100,000 applications for Medicaid coverage under the state’s Healthy Pennsylvania Medicaid expansion program.
State officials estimate that approximately 600,000 adult Pennsylvanians are newly eligible for Medicaid under the program. The 100,000 figure represents applications, not individuals; some applications are for families of varying size. It is not yet known how many of the applicants are currently uninsured.
The state began accepting applications on December 1 for coverage to begin on January 1. There is no deadline for applying.
Learn more about the applications the state is receiving in this Pittsburgh Post-Gazette article.
The temporary increase in Medicaid provider fees for primary care services ended yesterday, leaving observers to wonder whether it will affect access to care for the nation’s growing Medicaid population.
The increase, mandated by the Affordable Care Act, raised Medicaid primary care rates to the same level as Medicare payments in the hope that more primary care providers would begin serving Medicaid patients in anticipation of significant growth in the Medicaid population. Now that the two-year increase has ended, it is unclear whether providers who began serving Medicaid patients because of the increase will remain Medicaid providers and those who accepted more Medicaid patients will continue doing so.
Because of the relatively short duration of the increase, little research has been completed to determine whether the raise made a difference in access, but some states believe it did: a number will use their own money to continue the raises, which during the two-year experiment were paid entirely by the federal government.
Pennsylvania is not among the states that will continue paying the enhanced Medicaid fees for primary care services.
Kaiser Health News has taken a look at this issue and the potential implications of the end of the Medicaid pay raise; see its report here.
A commentary in the New England Journal of Medicine by noted Medicaid expert and advocate Sara Rosenbaum examines the issues of access to Medicaid services, the effect of adequate (or inadequate) Medicaid reimbursement on that access, and the role the federal government and public policy can play in enhancing access to care for low-income Medicaid recipients.
Find that commentary here.
The Pennsylvania Department of Human Services (DHS – formerly the Department of Public Welfare) has issued a memo to Medical Assistance stakeholders addressing two issues involving implementation of the state’s Healthy Pennsylvania Medicaid expansion that have been brought to its attention.
The first issue is that individuals who enrolled in Medicaid in December were not assigned to a behavioral health managed care organization.
The second addresses screening of individuals who currently qualify for Medicaid under the General Assistance category who have behavioral health needs and who likely qualify for the “Healthy Plus” Medicaid benefits plan beginning in 2015.
See the state’s message to stakeholders outlining what these issues are about and how it plans to address them in this memo from the state’s Office of Mental Health and Substance Abuse Services.
The Affordable Care Act-mandated increase in Medicaid payments for primary care services ends on December 31.
While some states believe this increase improved access to care for their Medicaid population and will continue the increase using their own money, Pennsylvania will not, and a new Medical Assistance Bulletin informs primary care providers in the state that the fee-for-service rates they are paid will return to their previous level on January 1.
See the Medical Assistance Bulletin notice here.
The Pennsylvania Health Law Project has updated its Medical Assistance eligibility manual.
Written in plain English for a general readership, the manual describes the various ways individuals may qualify for Medical Assistance (Medicaid) in Pennsylvania and how they can go about applying for benefits.
Find the updated manual here.
Pennsylvania is among 21 states that will receive State Innovation Models Initiative Model Design Awards from the federal Center for Medicare and Medicaid Innovation.
The award of $3 million will be used to
…engage a diverse group of stakeholders, including public and commercial payers, providers and consumers, to develop a State Health Care Innovation Plan.
The purpose of the state innovation models program is to support
…states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation. The Innovation Center is interested in testing innovative payment and service delivery models that have the potential to lower costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while maintaining or improving quality of care for program beneficiaries.
The grant funds were awarded on a competitive basis, with funding decisions based on an initial round of state innovation model planning. Michael Chirieleison, president of the Safety-Net Association of Pennsylvania (SNAP), served on the committee that developed the commonwealth’s state innovation model proposal.
Learn more about the federal State Innovation Models Initiative here.
