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Medicaid Expansion in PA: What Happens Now?

Pennsylvania Governor Tom Corbett’s Healthy Pennsylvania program calls for the state to expand its Medicaid program on January 1 through a private insurance market option in which people choose private insurance plans through which to receive the Medicaid benefits for which they are newly eligible.
But Pennsylvania Governor-elect Tom Wolf wants to expand the state’s traditional Medicaid program and not employ the private insurance market coverage.
Governor Corbett will still be in office when his program is set to take effect on January 1, 2015.  Mr. Wolf will not take the oath of office until January 20.
The Philadelphia Inquirer takes a look at how Pennsylvania’s private insurance market option came about and what may happen next.  See its story here.

2014-11-14T06:00:22+00:00November 14th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off on Medicaid Expansion in PA: What Happens Now?

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

PA Contacts Medicaid Recipients About Benefits

The Pennsylvania Department of Public Welfare is in the process of sending letters to all current adult Medicaid recipients in the state advising them of changes in their Medicaid benefits to take effect on January 1 as a result of the state’s Healthy Pennsylvania Medicaid expansion.
The Pennsylvania Health Law Project has published an explanation of the situation, including sample copies of the letters the state is sending, information about the different benefit packages available to Medicaid recipients, and advice on how recipients who believe they have more serious medical problems can apply for a benefits package better suited to their needs.
Find the Pennsylvania Health Law Project notice here.

2014-11-10T09:05:50+00:00November 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off on PA Contacts Medicaid Recipients About Benefits

PA Makes Healthy PA Implementation Official

The Pennsylvania Department of Public Welfare (DPW) has published an official notice in the state’s Medical Assistance Bulletin announcing the implementation of the Healthy Pennsylvania Medicaid expansion program on January 1, 2015.
The notice provides background information about the plan, how it will work, and how it will differ from the state’s current Medicaid program.  It also presents the final word on how the state will define “medically frail” for determining which benefits package participants will receive, outlines how the program’s health screening of applicants will work, and explains enrollees’ cost-sharing responsibilities.
The Bulletin notes that the state will issue a separate announcement to providers with more information about the scope of benefits to be provided, how the program will employ private insurers to serve the state’s Medicaid population, and when training will be offered to familiarize providers on how to work with the new program.
Find the Bulletin here.

2014-11-05T06:00:17+00:00November 5th, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Makes Healthy PA Implementation Official

PA Closing in on Classification Criteria for New Medicaid Recipients

Among the features of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program is the consolidation of 14 current adult benefits packages into just two packages:  the “Healthy” package for new recipients considered low-risk patients and the “Healthy Plus” package for those who are considered high-risk patients, or medically frail.
But ever since the Corbett administration unveiled its Medicaid expansion plan last fall, the question of how new recipients would be evaluated to determine which benefit package they will receive has remained unanswered.
Now, the Pennsylvania Department of Public Welfare (DPW) appears to be getting closer to providing a clear answer.
Recently, DPW’s Medical Assistance Advisory Committee (MAAC) circulated three working documents that present the state’s latest thinking on the classification process.
The first document presents an overview of the latest version of state’s screening tool, including what the tool is, how it defines “medically frail,” and how it will be used.  It also notes that use of the tool is not mandatory.
This next document offers additional information about how the state envisions defining “medically frail.”
And this third document is a draft of the screening tool itself, the health care needs questionnaire.
Pennsylvania’s Medicaid expansion is scheduled to take effect on January 1, 2015, but people who think they may be eligible may begin enrolling on December 1 through the state’s enrollment web site or at any state county assistance office.

2014-10-31T06:00:57+00:00October 31st, 2014|Healthy PA|Comments Off on PA Closing in on Classification Criteria for New Medicaid Recipients

Some PA Women Could Lose State Medical Benefits

The expiration of a state health program could leave about 90,000 low-income Pennsylvania women without the free family planning and women’s health benefits they currently receive.
A program called SelectPlan for Women offers limited health benefits to low-income women between the ages of 18 and 44 who are otherwise ineligible for Medicaid.  While there has been no formal announcement of the program’s termination, women’s health advocates have informally been told that such a termination is possible at the end of the year.
If the program expires, some of the women it currently covers will be eligible for Medicaid under the state’s Medicaid expansion to take effect on January 1 while others should be eligible for at least some subsidization of insurance premiums on the federal health insurance exchange.
The SelectPlan for Women, however, has no limits on visits, no co-pays, and no premiums.
Learn more about SelectPlan for Women, what it does, and why it may soon disappear in this Pittsburgh Post-Gazette article.

2014-10-30T06:00:59+00:00October 30th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off on Some PA Women Could Lose State Medical Benefits

State Releases Information on Primary Care Loan Repayment Program

Part of Governor Corbett’s Healthy Pennsylvania health care reform plan, introduced in the fall of 2013, was a program to help primary care providers pay off their education loans in exchange for a commitment to provide care in facilities that serve predominantly underserved communities and low-income patients.
Now, the state has released further information about the program, including what kinds of providers are eligible for assistance, how they may apply to participate, and how the facilities in which they work can be certified for eligibility.  Also available are application materials.
The deadline for primary care providers to apply is December 4.
Find a fact sheet about the program here and more information about the application process here.

2014-10-29T06:00:19+00:00October 29th, 2014|Healthy PA|Comments Off on State Releases Information on Primary Care Loan Repayment Program

New Video Explains PA Medicaid Expansion

The Pennsylvania Department of Public Welfare has posted a new presentation video on its Healthy Pennsylvania Medicaid expansion program.  The video outlines how the program works, who is eligible to participate, what the benefits are, and more.  It offers useful information for hospital employees and other Pennsylvania health care providers who will soon see an influx of as many as 600,000 new Medicaid recipients in the state.
Find the video here, on the state’s Healthy PA web site.

2014-10-24T06:00:48+00:00October 24th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off on New Video Explains PA Medicaid Expansion

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
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