Pennsylvania Medicaid policy Archives - Page 25 of 43 - Safety-Net Association of Pennsylvania

To Increase or Not to Increase? That is the Question

To induce more primary care providers to serve Medicaid patients at a time when Medicaid enrollment was about to increase significantly nation-wide, the Affordable Care Act raised Medicaid primary care reimbursement to the same level as Medicare rates for 2013 and 2014, with the federal government to pick up the tab for 100 percent of the increase in state spending for these services.
With that two-year increase coming to an end, states now must decide whether to continue the increase and pay for it themselves or let their Medicaid primary care rates return to their old levels.
According to a survey taken by the Kaiser Family Foundation, 15 states will continue the increases either in part or in full; 24 do not plan to continue the increases; and 12 still have not decided.
Some states that are continuing the increases in some form also are changing the types of primary care providers that will receive the enhanced Medicaid payments.
Pennsylvania is among the 24 states not planning to continue the rate increase.
For a closer look at the issue, including a map that illustrates each state’s intentions, see the Kaiser Family Foundation report “The ACA Primary Care Increase: State Plans for SFY 2015” here, on the foundation’s web site.

PA Safety Net Admin2014-11-03T06:00:34+00:00November 3rd, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-10-30T06:00:59+00:00October 30th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Medicaid Directors Weigh in On Managed Care Regulation

The nation’s state Medicaid directors have offered their perspectives to the federal government on how to modernize and regulate state Medicaid managed care programs.
In a paper entitled “Medicaid Managed Care Modernization: Advancing Quality Improvement,” the National Association of Medicaid Directors urges the Centers for Medicare Services (CMS) to work with the states to develop quality reporting measures that are both useful and not overly burdensome.
The association also asks CMS to leave decisions about accrediting requirements for state Medicaid managed care programs in state hands and not to establish a national quality rating system for Medicaid managed care plans.
The regulation of Medicaid managed care plans is especially important to Pennsylvania safety-net hospitals because they care for so many Medicaid patients and managed care has become the primary means through which the state’s Medicaid program serves those patients.
Learn more about Medicaid directors’ recommendations for improving and regulating state Medicaid managed care programs in this National Association of Medicaid Directors correspondence with the Center for Medicaid and CHIP Services.

PA Safety Net Admin2014-10-27T06:00:19+00:00October 27th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-10-24T06:00:48+00:00October 24th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-10-16T11:53:50+00:00October 16th, 2014|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-10-10T06:00:53+00:00October 10th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its September newsletter. Included in this edition is a story on federal approval of Pennsylvania’s Medicaid expansion proposal, an FAQ on how the approved plan will work, and a chart detailing key differences between what the state proposed and what the federal government ultimately approved.
Find the newsletter here.

PA Safety Net Admin2014-10-07T06:00:17+00:00October 7th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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

PA Safety Net Admin2014-10-02T06:00:05+00:00October 2nd, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

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.

PA Safety Net Admin2014-09-30T06:00:49+00:00September 30th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

GAO Questions Cost of Private Market Medicaid Expansion

Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs.
Or so says the U.S. Government Accountability Office (GAO).
Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded its traditional Medicaid program.
The GAO said that the U.S. Department of Health and Human Services (HHS) did not perform a budget-neutrality calculation, which would have revealed the increased cost, instead accepting the state’s alternative methodology for determining cost-effectiveness.
Arkansas officials rejected the GAO’s conclusions, asserting that newly eligible Medicaid recipients would have been unable to find providers willing to serve them under a traditional Medicaid expansion.
GAO concluded that CMS may be approving waivers that are not budget-neutral. CMS disagreed with this conclusion.
The GAO letter, written before HHS granted Pennsylvania its Medicaid waiver, specifically mentions Pennsylvania as another state seeking to expand its Medicaid program through the purchase of private insurance for newly eligible Medicaid recipients.
Learn more about the GAO analysis, why it was undertaken, and what it found by reading the GAO letter to the two members of Congress who requested the analysis.

PA Safety Net Admin2014-09-16T06:00:21+00:00September 16th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

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