Pennsylvania Medicaid policy Archives - Page 24 of 44 - Safety-Net Association of Pennsylvania

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

Richman to Advise Wolf on Medicaid

Pennsylvania Governor-elect Tom Wolf has appointed former Department of Public Welfare Secretary Estelle Richman to advise him on Medicaid matters during his transition period.
Richman served as secretary of the Department of Public Welfare – now the Department of Human Services – from 2003 to 2009, during the administration of former governor Ed Rendell.
Richman is expected to focus on the expansion of the state’s Medicaid program, authorized under the federal Affordable Care Act and to begin on January 1 as part of Governor Corbett’s Healthy Pennsylvania program. Instead of expanding the state’s traditional Medicaid program, Healthy Pennsylvania will involve those newly eligible for Medicaid choosing from a pool of private insurers selected by the state, with their insurance premiums to be paid with federal Medicaid funds.
Learn more about Ms. Richman and her expected role in the Wolf transition in this Harrisburg Patriot-News article.

PA Safety Net Admin2014-12-01T06:00:24+00:00December 1st, 2014|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

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.

PA Safety Net Admin2014-11-14T06:00:22+00:00November 14th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-11-13T06:00:55+00:00November 13th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-11-10T09:05:50+00:00November 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-11-05T06:00:17+00:00November 5th, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

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