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.
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:
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.
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.
Nearly 80,000 low-income Pennsylvanians insured through the state’s General Assistance program will need to switch to private option Medicaid plans once the Healthy Pennsylvania Medicaid expansion takes effect next year.
These individuals – generally, adults whose income is less than 44 percent of the federal poverty level but who have no children and meet other limited criteria – can begin enrolling in private option insurance plans on December 1 and will need to be enrolled by January 1, 2015, when the General Assistance program ends. Because of their extremely low income, these participants will not be required to pay insurance premiums.
Learn more about the end of General Assistance and the state’s plans for continuing to serve this population in this article on the web site of public radio station WITF.
In a letter to the editor of the York Daily Record, Pennsylvania Department of Welfare Secretary Beverly Mackereth has outlined the rationale for the Corbett administration’s “Healthy Pennsylvania” health care reform plan and its approach to expanding access to Medicaid services.
In the letter, Secretary Mackereth stresses the importance of a program tailored to Pennsylvania and describes the thinking behind the state’s approach to benefit packages, encouraging enrollees to engage in healthy behaviors, Medicaid premiums, and the use of private health insurance instead of the general expansion of Medicaid many other states are employing.
See Secretary Mackereth’s letter to the York Daily Record here.
While the federal government has approved the Corbett administration’s proposal to expand Medicaid eligibility in Pennsylvania and serve the newly eligible through private insurance plans, it did not rule on a key component of the administration’s Healthy Pennsylvania proposal: reducing benefits for some Medicaid recipients.
Instead, any changes in the state’s Medicaid benefits must still be negotiated with the federal government and remain subject to federal approval.
For a closer look at the state’s Medicaid expansion plan and its implications, see this report in the “State House Sound Bites” section of the web site of public radio station WITF.
Pennsylvania’s request for federal approval of its Medicaid expansion plan has been approved by the federal government.
The plan, part of the Corbett administration’s “Healthy Pennsylvania” health care reform proposal, calls for an expanded population of Pennsylvanians who are newly eligible for Medicaid to obtain subsidized coverage through the private health insurance market – managed care organizations approved by the state to serve the new Medicaid expansion population.
The letter of approval from Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner to Pennsylvania Department of Public Welfare Secretary Beverly Mackereth notes that
…the state aims to modify Pennsylvania’s Medicaid program and expand access to coverage to adults in Pennsylvania with incomes through 133 percent of the federal poverty level (FPL) beginning January 1, 2015.
The terms of the demonstration have been incorporated into the accompanying Special Terms and Conditions (STCs) and waiver authorities for the demonstration approval. The approved demonstration authorizes the state to charge premiums to newly eligible individuals up to 133 percent of FPL with access to health care coverage through managed care health plans. Specifically, beginning in January 2016 of the demonstration, the state may charge monthly premiums in an amount not to exceed 2 percent of household income for certain adults with incomes above 100 percent of the FPL.
Beneficiaries subject to a premium as authorized by the demonstration will not be charged copayments (with the exception of an $8 copayment for non- emergency use of the emergency room, which the state may authorize within the Medicaid state plan). Individuals failing to pay the monthly premiums for three consecutive months may be disenrolled from coverage, and may re-enroll without a waiting period. The Commonwealth is not imposing premiums on individuals with incomes at or below 100 percent of the FPL.
The Healthy Pennsylvania demonstration includes an incentive program that is intended to improve the use of preventive services and other healthy behaviors. Enrollees who complete specified healthy behaviors during the first year of enrollment in the demonstration shall have their premium obligations reduced in their second year. For each subsequent year, enrollees will have the opportunity to complete healthy behaviors to reduce their amount of financial obligations.
We have provided authority for the state to not offer non-emergency medical transportation (NEMT) during the first year of the demonstration. This authority will sunset on December 31,2015, and the state will provide NEMT to these beneficiaries beginning in year 2 of the demonstration. The changes in the Pennsylvania demonstration are consistent with those in other demonstrations.
The Commonwealth will deliver services to the newly eligible population through contracts with managed care organizations. Individuals covered will have the choice of an approved health plan in their region. Medicaid managed care rules continue to apply under the demonstration although as stipulated in the demonstration the Commonwealth may rely on state or federal commercial standards when those standards are at least as robust as the Medicaid standards.
Benefits provided to individuals eligible under the expansion will be consistent with federal statutory requirements effectuated through amendments to the Commonwealth’s state plan, rather than the approved demonstration. The expansion population, including those who are subject to this demonstration and those who are medically frail and covered outside of this demonstration, will receive the full complement of health services required under the law. Medically frail individuals will receive coverage from the state through a “high risk” benefit plan.
CMS and the state have been in active consultation on the state plan amendments needed to effectuate this change and have reached agreement on the overall benefits approach, pending final submission of documents by the state consistent with the agreement that has been reached.
In addition, outside this demonstration, the state aims to encourage employment through incentives for job training and work-related activities, including access to Healthy Pennsylvania Career Coaches, for Healthy Pennsylvania beneficiaries who choose to participate in the state’s Encouraging Employment program. Health coverage provided by the Medicaid program and this demonstration will not be affected by this state initiative.
The complete approval letter and a second document describing the special terms and conditions the federal government has attached to the waiver approval can be found here, on the Healthy Pennsylvania web site.
The Pennsylvania Health Law Project has published its latest newsletter.
Among the articles are stories about the preservation of the state’s Medical Assistance for Workers with Disabilities Program (MAWD); new funding for home- and community-based services for people with disabilities; a clarification of Children’s Health Insurance Program (CHIP) benefits; and more.
Find the newsletter here.
A Pennsylvania program to help the elderly remain in their own homes instead of moving into nursing homes is struggling with backlogs.
The state’s Aging Waiver Program is a Medicaid program that enables those who meet certain medical and financial criteria to receive assistance in their own homes from nurses and home health aides rather than go into a nursing home.
Currently the program serves more than 32,000 people – nearly twice as many as it did six years ago – but applications are taking as long as two months to process. The biggest challenge is verifying financial eligibility, but the state recently added staff to help address the backlog.
Learn more about Pennsylvania’s Aging Waiver Program in this Pittsburgh Tribune-Review article.