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PA Prepares to Establish Health Insurance Exchange (Just in Case)

Saying he wants to “protect 382,000 Pennsylvanians from potentially losing subsidies that help them afford health care coverage” if the Supreme Court rules that Affordable Care Act health insurance subsidies are available only to individuals who purchase insurance on state-operated insurance exchanges and not the federal exchange, Pennsylvania Governor Tom Wolf has informed the U.S. Department of Health and Human Services Secretary Sylvia Burwell that his state intends “implement a State-based Marketplace for Pennsylvanians to shop for health insurance coverage.”
Governor Wolf notified the HHS Secretary of his decision in a May 1 letter.  The letter does not commit the state to developing its own exchange; it only declares the state’s intention to develop such an exchange if the Supreme Court rules against the Obama administration in the King v. Burwell case in June.
Go here to see the letter and an announcement of the Wolf administration’s intentions.

2015-05-04T06:00:28+00:00May 4th, 2015|Health care reform|Comments Off on PA Prepares to Establish Health Insurance Exchange (Just in Case)

More That 400,000 Sign Up For Health Insurance in PA

Through early February, 430,000 Pennsylvanians have enrolled in health insurance plans through the federal health insurance marketplace.
Of that number, 81 percent qualified for at least some financial assistance with their premiums.  Through December, more than two-thirds obtained insurance for no more than $100.
To learn more about how Pennsylvanians are using the federal exchange to purchase health insurance, see this Central Penn Business Journal article.
 

2015-02-09T06:00:51+00:00February 9th, 2015|Affordable Care Act, Health care reform|Comments Off on More That 400,000 Sign Up For Health Insurance in PA

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.

2015-01-07T06:00:32+00:00January 7th, 2015|Affordable Care Act, Health care reform, Healthy PA|Comments Off on 180,000 Pennsylvanians Turn to Exchange for Health Insurance

100,000 Apply for Medical Assistance

As 2014 ended, Pennsylvania had received 100,000 applications for Medicaid coverage under the state’s Healthy Pennsylvania Medicaid expansion program.
Health Benefits Claim FormState 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.

2015-01-06T06:00:19+00:00January 6th, 2015|Health care reform, Healthy PA|Comments Off on 100,000 Apply for Medical Assistance

PA Wins Innovation Planning Grant

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.
Group of healthcare workers

2014-12-24T06:00:48+00:00December 24th, 2014|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off on PA Wins Innovation Planning Grant

Pennsylvania Health Law Project’s October Newsletter

The Pennsylvania Health Law Project has released its October newsletter.
It includes articles about Healthy Pennsylvania’s Medicaid expansion and its impact on behavioral health benefits; about letters the state is sending to current Medicaid recipients about changes in their benefits; and about letters from the federal government to those enrolled in federal marketplace plans reminding them that they need to renew their health insurance.
The newsletter also features an article about how the state will address those currently enrolled in federal marketplace plans who will become eligible for Medicaid on January 1.
Find the Pennsylvania Health Law Project’s newsletter here.

2014-11-13T06:00:55+00:00November 13th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off on Pennsylvania Health Law Project’s October Newsletter

Increased Utilization by New Medicaid Patients Levels Off, Study Finds

Spikes in hospital emergency room and inpatient admissions attributed to patients who have recently obtained Medicaid coverage eventually taper off, according to a new study.
According to the study Increased Service Use Following Medicaid Expansion is Mostly Temporary:  Evidence From California’s Low Income Health Program, dramatic increases in ER use and hospitalizations among those newly insured by Medicaid eventually level off and should not especially tax either hospital capacity or state Medicaid budgets.
The study, performed by the UCLA Center for Health Policy Research, found that after pent-up demand for care among those who previously had limited access to services was satisfied, utilization dropped by more than two-thirds and then remained relatively constant.  Outpatient utilization remains generally stable, the study found.
These findings may be a glimpse into Pennsylvania’s future and what its hospitals will face when the state eventually expands its Medicaid program.
For further information about the study and its implications for hospitals and state Medicaid budgets, see this Kaiser Health News report.  To see the UCLA study itself, go here.

2014-10-16T11:53:50+00:00October 16th, 2014|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off on Increased Utilization by New Medicaid Patients Levels Off, Study Finds

Insurers Struggle to Find Providers to Participate in Healthy PA Medicaid Expansion

The insurers selected to participate in Pennsylvania’s Healthy PA Medicaid expansion program are having a hard time persuading hospitals and doctors to join their provider networks.
Citing low Medicaid reimbursement rates, providers have been reluctant to work with the chosen insurers.
The state selected nine insurers to offer Medicaid coverage to approximately 600,000 new recipients beginning on January 1, but now, one of those insurers has withdrawn from the program and another is considering reducing the geographic region it intends to serve.
Originally, the Corbett administration said it hoped to have at least three insurance options in each of the nine regions created for the Medicaid expansion program.  Now, it appears that two carriers per region is a more realistic expectation.
Read more about the challenges insurers are encountering in lining up participating providers, and how that problem could affect the overall Medicaid expansion effort, in this Pittsburgh Tribune-Review article.

2014-10-10T06:00:53+00:00October 10th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off on Insurers Struggle to Find Providers to Participate in Healthy PA Medicaid Expansion

Enrolling in PA’s Medicaid Expansion Program

On December 1, Pennsylvanians who believes they may be eligible for Medicaid under the state’s expanded eligibility criteria – part of the Healthy Pennsylvania program – can begin submitting applications for coverage, which will begin on January 1.
People can apply in four ways:

  • the state’s online application process – at https://www.compass.state.pa.us/
  • the healthcare.gov site
  • a dedicated call center set up by the Affordable Care Act – 866-550-4355
  • a paper application at any county assistance office
Health Benefits Claim Form
2014-10-02T06:00:05+00:00October 2nd, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off on Enrolling in PA’s Medicaid Expansion Program

Unanswered Questions About PA Medicaid Expansion

With only 60 days until approximately 600,000 newly eligible Pennsylvanians can begin enrolling in the state’s Medicaid program on December 1, the state still has not clarified some aspects of its Healthy Pennsylvania Medicaid expansion program.
The newly eligible, for example, will be classified into high-risk or low-risk health plans – but the criteria for making those classification decisions remain unknown.
Also unknown is exactly what benefits the newly eligible will be entitled to receive.
In addition, the state is thought to be in negotiations with federal officials about reducing the benefits that the 2.2 million Pennsylvanians already eligible for Medicaid may receive.
For a closer look at these and other issues that remain to be addressed before Pennsylvania expands its Medicaid program on January 1, see this Philadelphia Inquirer article.

2014-09-30T06:00:49+00:00September 30th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off on Unanswered Questions About PA Medicaid Expansion
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