Healthy PA Archives - Page 2 of 7 - Safety-Net Association of Pennsylvania

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

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.
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.

PA Safety Net Admin2015-01-06T06:00:19+00:00January 6th, 2015|Health care reform, Healthy PA|Comments Off

PA Addresses Healthy PA Transition Issues

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.

PA Safety Net Admin2014-12-30T06:00:43+00:00December 30th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments: a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.

PA Safety Net Admin2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Medicaid Primary Care Fees to Plummet

Payments to Pennsylvania primary care physicians who serve Medicaid patients will fall 52.4 percent after the first of the year, when the Affordable Care Act’s two-year increase in those payments ends.
The temporary fee increase was included in the Affordable Care Act to encourage more primary care physicians to serve Medicaid patients in anticipation of the significant growth of Medicaid as a result of the reform law’s Medicaid expansion. Under that law, Medicaid primary care fees were raised to the level of Medicare primary care rates for two years. Nation-wide, the average Medicaid primary care fee will fall 42.8 percent.
So far, 15 states plan to use their own money to prevent the dramatic reduction of Medicaid primary care payments. Pennsylvania is not among them.
The cut will be especially damaging to the state’s safety-net hospitals because they serve so many more Medicaid patients than the typical hospital and expect to serve even more such patients when the state’s Medicaid program expands beginning on January 1.
Learn more about the upcoming Medicaid payment cut in the new Urban Institute report Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015?, which you can find here, on the Urban Institute’s web site.

PA Safety Net Admin2014-12-17T06:00:15+00:00December 17th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Access to Primary Care a Medicaid Problem, HHS OIG Says

Many of the primary care providers that participate in Medicaid managed care programs are inaccessible to those plans’ members, according to a new report by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG).
As states’ Medicaid rolls grow and they direct more of their Medicaid beneficiaries into managed care plans, those beneficiaries may be encountering difficulty converting their access to health insurance into access to health care.
According to the OIG report Access to Care: Provider Availability in Medicaid Managed Care,

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

In response to these problems, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) work with states to

… (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed.

Pennsylvania’s safety-net hospitals will need to monitor this situation closely in the coming months as the state’s Medicaid expansion begins, bringing as many as 600,000 new beneficiaries into the program.
See the complete OIG report here.

PA Safety Net Admin2014-12-15T06:00:51+00:00December 15th, 2014|Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Hospitals Worry About Underpayments as Medicaid Expands in PA

The Healthy Pennsylvania Medicaid expansion will bring Medicaid payments that often fall below hospital costs, potentially causing problems for hospitals that serve especially large numbers of new Medicaid beneficiaries.
While hospitals acknowledge that in some cases they will, under the program, start receiving payments for care they otherwise might have provided without any reimbursement at all, they note that the payments they expect from Healthy PA private insurers will fail to cover the cost of the care they provide in many cases.
The problem is especially acute when it comes to payment for outpatient services, which may cover only about 30 percent of the cost of outpatient care.
Because they serve so many Medicaid patients, this situation is likely to pose an especially great challenge for Pennsylvania’s safety-net hospitals.
For a look at the challenges hospitals expect under the Healthy PA Medicaid expansion and the effect it may have on their bottom line, see this Pittsburgh Tribune-Review story.

PA Safety Net Admin2014-12-11T06:00:55+00:00December 11th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

Among the articles in the November newsletter are a piece on how some immigrants currently covered by the state’s General Assistance program may be able to retain their coverage under Healthy Pennsylvania and another on differences in how the state’s Medicaid expansion population will obtain behavioral health services from private option plans participating in that expansion.
Find the November newsletter here.

PA Safety Net Admin2014-12-10T06:00:45+00:00December 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Healthy PA Enrollment Begins

Uninsured Pennsylvanians with an income less than 138 percent of the federal poverty level have begun enrolling in health insurance plans under the state’s Healthy Pennsylvania Medicaid expansion.
The official date on which enrollment began is December 1 in anticipation of the program’s official implementation on January 1. During this period, an estimated 600,000 eligible Pennsylvanians may choose private insurers through which they can receive health care coverage, with their premiums to be paid with federal Medicaid funds.
While the program is expected to begin as scheduled on January 1, it is not clear how long it will last in its current form. Governor-elect Tom Wolf has expressed opposition to the approach taken by the Corbett administration through Healthy Pennsylvania and envisions a more traditional expansion of the state’s Medicaid program. Whether Mr. Wolf will pursue such an approach, and when he might do so, remains unknown.
For a closer look at the Healthy Pennsylvania launch and the immediate future of Medicaid expansion in Pennsylvania, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-12-03T06:00:06+00:00December 3rd, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Full Speed Ahead on Healthy PA Medicaid Expansion

When the federal government approved the Corbett administration’s Healthy Pennsylvania Medicaid proposal at a time when the governor trailed in the polls in his bid for re-election, observers wondered whether Mr. Corbett would continue to implement the program if he lost even if his opponent opposed that implementation.
The answer, apparently, is yes.
Department of Public Welfare Secretary Beverly Mackereth told the Pittsburgh Post-Gazette that the state continues to implement the Healthy Pennsylvania Medicaid expansion and will begin enrolling participants on December 1 in anticipation of the program’s official launch on January 1.
It is doing so despite being asked not to do so by representatives of Governor-elect Tom Wolf, who does not take office until January 20.
Learn more about the circumstances surrounding Medicaid expansion in Pennsylvania in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-11-21T06:00:26+00:00November 21st, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

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