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

Feds Find Temporary Way to Overcome Medicaid Enrollment Problem

The problems plaguing the beleaguered healthcare.gov web site continue to make it difficult for people to find new health insurance, but a new approach devised by the federal government will make it easier for Medicaid applicants to overcome this problem.
While the Centers for Medicare & Medicaid Services (CMS) was having trouble sending completed Medicaid and CHIP applications to the states, it continued sending them basic data from Medicaid and CHIP applications on a weekly basis primarily to help them gauge possible interest in Medicaid enrollment. Now, it is telling states they can use this limited data to enroll such individuals in their Medicaid programs without complete applications.
This process is expected to facilitate enrollment in states that have chosen to expand eligibility for their Medicaid programs. To date, Medicaid enrollment has been one of the brightest aspects of the troubled launch of the Affordable Care Act’s insurance expansion. While Pennsylvania is not expanding its Medicaid program at this time, the process could facilitate the enrollment of so-called woodwork applicants: people who are already eligible for Medicaid and never enrolled but have been drawn to do so by all of the attention the Medicaid expansion and Affordable Care Act have received.
To learn more about the CMS workaround to this problem, read this Kaiser Health News report or read the letter CMS sent to state Medicaid directors describing how this process will work.

PA Safety Net Admin2013-12-05T06:00:58+00:00December 5th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Enough Docs to Go Around?

With nine million people expected to enroll in Medicaid in the coming year, questions are arising about whether there will be enough physicians to serve them.
Across the country there has long been a shortage of physicians, and especially specialists, willing to serve Medicaid patients because of how poorly most state Medicaid programs pay those doctors. Now, with more people than ever expected to become insured by Medicaid, it is not clear whether the existing physician pool will be able to serve them very effectively.
The Affordable Care Act anticipated this problem and included a two-year increase in Medicaid payments to physicians, a move designed to raise Medicaid rates to the same level as those paid by Medicare. But states have been slow to make these payments, which were expected to begin last January, and physicians recognize that this will only be a temporary raise. As a result, fewer physicians than expected have agreed to serve Medicaid patients.
Whether this might pose a problem for Pennsylvania and its safety-net hospitals could depend on whether Governor Tom Corbett’s “Healthy Pennsylvania” proposal is fully implemented and the state expands Medicaid enrollment through the private health insurance market. One of the selling points of the Healthy Pennsylvania proposal has been that working through private insurers, rather than Medicaid managed care organizations or the state itself, should result in better payments for health care providers, thereby making those providers more willing to serve Medicaid patients.
See this New York Times article for a look at these and other questions related to the upcoming Medicaid expansion and the ability of the medical community to meet an unprecedented demand for care.

PA Safety Net Admin2013-12-03T06:00:13+00:00December 3rd, 2013|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Enrolling Homeless in Medicaid Poses Challenges, Offers Hope

Enrolling the homeless in Medicaid poses numerous logistical challenges for government, providers, and caregivers but also offers the prospect of improving the lives of those who gain access to care.
Many low-income, homeless adults will be eligible for Medicaid for the first time in states that expand Medicaid eligibility under the Affordable Care Act, but enrolling them in the program can be difficult: they can be hard to find, hard to convince to apply, and hard to enroll because they lack such basics as a mailing address and telephone number.
Yet bringing health care to such individuals could greatly improve their lives and perhaps help address their homelessness by ending the financial stresses that resulted in homelessness or improving their health to the point where they qualify for housing services.
While Pennsylvania still has not expanded its Medicaid program, it now appears to be on a cautious path toward doing so in the near future. If it does, enrolling the homeless in Medicaid also offers the prospect of the state’s safety-net hospitals receiving Medicaid reimbursement for the care they provide to such patients, typically through their emergency departments.
Learn more about the challenges of enrolling the homeless and Medicaid and the benefits of Medicaid eligibility for the homeless in this New York Times article.

PA Safety Net Admin2013-11-26T06:00:25+00:00November 26th, 2013|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Safety-Net Hospitals Bear Brunt of Medicare Penalties

Hospitals that serve the largest proportion of low-income patients are suffering the greatest financial penalties under Medicare’s value-based purchasing program.
Collectively, hospitals that serve the most low-income patients are seeing their Medicare payments reduced 0.09 percent during year two of the Medicare program while hospitals that serve the fewest low-income patients have seen their Medicare payments rise 0.06 percent, according to a new study by a Harvard School of Public Health professor.
Medicare’s value-based purchasing program, mandated by the Affordable Care Act, bases penalties and bonuses on 24 quality measures.
In Pennsylvania, 45 percent of the state’s hospitals received bonuses while 53 percent were penalized; both figures are the same as the national averages. The average bonus for Pennsylvania hospitals was 0.24 percent – the national average – while the average penalty was 0.20 percent, slightly lower than the national average of 0.26 percent.
The author of the study suspects that the performance of safety-net hospitals may be suffering from the manner in which their patients are responding to the patient satisfaction survey that is one of the determining factors in evaluating hospital performance.
For a closer look at the study and its findings, see this Kaiser Health News report.

PA Safety Net Admin2013-11-22T06:00:26+00:00November 22nd, 2013|Affordable Care Act, Health care reform|Comments Off

400,000 Fall Into PA Insurance Gap

400,000 Pennsylvanians currently fall into a gap between eligibility for the state’s Medicaid program and qualifying for health insurance subsidies through the state’s health insurance marketplace.
Under the Affordable Care Act, states were to expand eligibility for their Medicaid programs while the federal government would provide partial subsidies for low-income people who remained ineligible for Medicaid but were unlikely to be able to afford health insurance without such assistance.
But when the Supreme Court made Medicaid expansion optional for states, many people fell into a new insurance gap that was not anticipated when the 2010 reform law was written. Approximately half of the 50 states have expanded their Medicaid programs as the law expected, but in the half that did not, millions remain in this gap, earning too much money to qualify for Medicaid but not enough to be able to afford health insurance.
Among those millions are 400,000 Pennsylvanians because the commonwealth has not decided to move forward and expand its Medicaid program. Currently, state officials are exploring such expansion through a new “Healthy Pennsylvania” initiative and are negotiating possible terms for expansion with the federal government.
Learn more about Pennsylvania’s insurance gap, who is in it, why it exists, and why it is a candidate to disappear sometime in the future in this Philadelphia Inquirer article.

PA Safety Net Admin2013-11-20T06:00:19+00:00November 20th, 2013|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off

Some States Face Double Loss: No Medicaid Expansion Plus DSH Cut

When passed in 2010, the Affordable Care Act called for significant cuts in future Medicare disproportionate share hospital payments (Medicare DSH) based on the expectation that hospitals would have far fewer of the uninsured patients such payments helped subsidize. They would have fewer uninsured patients because of the reform law’s Medicaid expansion provisions and enhanced access to affordable health insurance.
But then the Supreme Court made Medicaid expansion optional instead of mandatory for states.
Today, 25 states have chosen either not to expand their Medicaid programs or have not decided what to do, but their hospitals still face the prospect of a future loss of Medicare DSH revenue without the full expected decline in the number of uninsured patients they serve.
Pennsylvania is one of those states that has not yet expanded its Medicaid program, although state officials are currently negotiating a possible expansion with the federal government; the Safety-Net Association of Pennsylvania (SNAP) supports such an expansion. In the meantime, the state’s safety-net hospitals continue to face the prospect of a future loss of Medicare DSH revenue.
The loss of such revenue would threaten any provider, but safety-net hospitals appear to be especially at risk, as the New York Times reports in the article “Cuts in Hospital Subsidies Threaten Safety-Net Care.” Learn about the challenges some hospitals and their low-income patients face as they await the loss of some Medicare DSH revenue without the expected increase in Medicaid patients in this Times article.

PA Safety Net Admin2013-11-15T06:00:52+00:00November 15th, 2013|Uncategorized|Comments Off

PA Facing Loss of Federal Medicaid Funds

Pennsylvania stands to lose $325 million in federal Medicaid matching funds next year.
The reduction comes as a result of a decline in the state’s federal medical assistance percentage (FMAP) of 1.7 percentage points that takes effect as of October 1, 2014.
Department of Public Welfare Secretary Beverly Mackereth is asking federal officials to review their calculation of the state’s matching rate.
Read about the anticipated loss of federal Medicaid funds and how it might affect recipient benefits and provider payments in this Philadelphia Inquirer article.

PA Safety Net Admin2013-11-14T06:00:15+00:00November 14th, 2013|Uncategorized|Comments Off

ACA Drives Rise in Medicaid Enrollment

While some aspects of implementation of the Affordable Care Act continue to struggle with technical problems, one aspect is moving ahead effectively: enrollment in Medicaid is on the rise.
More than 400,000 newly eligible people in just ten states have enrolled in Medicaid since October 1. The ten states are among the 25 that have decided to expand their Medicaid programs in accordance with provisions of the federal health care reform law. Other states either have chosen not to expand their programs or are still undecided about expansion.
Pennsylvania is one of the states that has not expanded its Medicaid program but state officials are currently negotiating a possible expansion with the federal government. The Safety-Net Association of Pennsylvania supports such an expansion.
The Congressional Budget Office projects that nine million people will join the Medicaid ranks through Affordable Care Act expansion provisions in the coming year.
For more about the increase in Medicaid enrollment and how it is being accomplished despite some of the reform law’s early technical problems, see this Washington Post article.

PA Safety Net Admin2013-11-13T06:00:03+00:00November 13th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

CMS Offers Guidance on Medicare “Two-Midnight Rule”

The Centers for Medicare & Medicaid Services (CMS) has published an FAQ to give providers guidance on the application of its so-called two-midnight rule governing when certain medical situations qualify for patient admission and when they should be classified as Medicare outpatient observation status. See that FAQ here.

PA Safety Net Admin2013-11-07T11:22:05+00:00November 7th, 2013|Uncategorized|Comments Off

PA Ambulatory Surgery Centers Grow in Numbers, Profitability

The number of ambulatory surgery centers in Pennsylvania grew in FY 2012, and along with that growth in numbers came a growth in profitability.
According to a new report by the Pennsylvania Health Care Cost Containment Council (PHC4), providers added 10 new facilities in FY 2012, raising the number to 281, and the average operating margin of the facilities rose from 24.94 percent to 25.83 percent.
For the latest data on ambulatory surgery centers in Pennsylvania, where they are, who they serve, how many procedures they perform, and who is paying for those procedures, find a PHC4 news release and the agency’s latest report here.

PA Safety Net Admin2013-11-04T06:00:00+00:00November 4th, 2013|Uncategorized|Comments Off

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