Changes in Medicaid Fee Schedule
The Pennsylvania Department of Public Welfare has announced changes in its Medical Assistance fee schedule. Those changes, published in the January 18 edition of the Pennsylvania Bulletin, can be found here.
Providers Receive Expanded Authority to Extend Presumptive Medicaid Eligibility
While hospitals and providers in 33 states have long enjoyed the ability to extend presumptive eligibility for Medicaid to children or pregnant women, that authority is now being extended in some states to any adults whose income appears likely to fall below 138 percent of the federal poverty level.
The extension of this authority comes via the Affordable Care Act, which also offers states the option of expanding Medicaid eligibility for their residents. Individual states decide whether to extend this authority, which is typically wielded by hospitals, schools, clinics, other providers of care to the Medicaid and CHIP population, Head Start programs, and others.
This policy could benefit many Pennsylvania safety-net hospitals because they serve much higher proportions of low-income patients than the average hospital. Currently, 52 acute-care hospitals in the state are authorized to determine presumptive eligibility.
To learn more about changes in extending presumptive eligibility to low-income patients, see the policy brief “Hospital Presumptive Eligibility” from the Robert Wood Johnson Foundation and the publication Health Affairs.
SNAP Comments on Proposed Medicaid Waiver
The Safety-Net Association of Pennsylvania has submitted extensive comments to the Pennsylvania Department of Public Welfare regarding the state’s application for a section 1115 Medicaid waiver needed to enable the state to expand its Medicaid program through private market insurers.
The highlights of SNAP’s comments include its call for extending retroactive eligibility to those who obtain Medicaid coverage through the private market; easing proposed limits on benefits and penalties for non-payment of premiums; retaining the current supplemental Medicaid payments qualified hospitals receive; and pursuing greater investment in the health care infrastructure of communities with especially high proportions of low-income patients.
See SNAP’s complete written submission here.
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SNAP Testifies About Healthy Pennsylvania
The Safety-Net Association of Pennsylvania (SNAP) has weighed in on Governor Corbett’s Healthy Pennsylvania health care reform and insurance expansion proposal.
Testifying at a January 9 public hearing in Harrisburg, SNAP president Michael Chirieleison expressed general support for the Healthy Pennsylvania proposal and addressed four aspects of it that safety-net hospitals would like to see improved:
- extension of retroactive eligibility to the Medicaid expansion population;
- including inpatient services provided to that same population as “Medicaid days” for the purpose of determining eligibility for supplemental Medicaid payments and other government programs;
- reconsideration of proposed benefit limits and suspension of eligibility for non-payment of premiums; and
- the addition of a Delivery System Reform Incentive Program or a similar program to support the development of health care infrastructure in communities with large numbers of low-income Pennsylvanians.
Read SNAP’s testimony here.
Healthy PA Road Show Visits Philadelphia
The process of taking public input on Governor Corbett’s Healthy Pennsylvania Medicaid expansion and health care reform proposal continued last Friday with a hearing in Philadelphia.
Among those who testified before Department of Public Welfare Secretary Beverly Mackereth and other state officials were representatives of Project Home, the Cover the Commonwealth Campaign, the Disability Rights Network of Pennsylvania, the Health Federation of Philadelphia, the Pennsylvania Health Care Association, Jefferson Health System, and Mercy Health System, the newest member of the Safety-Net Association of Pennsylvania (SNAP).
Read more about the hearing and the testimony offered in this Philadelphia Business Journal report.
The hearing was the third of six schedule sessions. Hearings already have been held in Erie and Pittsburgh; a hearing is scheduled for today, January 6, in Scranton; and hearings also will be held on January 7 in Altoona and January 9 in Harrisburg. SNAP president Michael Chirieleison will testify in Harrisburg and SNAP also will submit extensive written comments about the Healthy Pennsylvania proposal.
Healthy PA Testimony in Pittsburgh
Thirty people testified at a recent public hearing in Pittsburgh as the Pennsylvania Department of Public Welfare continued its tour of the state seeking input on Governor Corbett’s Healthy Pennsylvania proposal and its Medicaid expansion component.
Among those who testified were both supporters and critics of the plan.
To learn more about the views expressed during the three-hour public hearing, read reports from the Pittsburgh Tribune Review and Pittsburgh Post-Gazette.
Iowa Approval Good Sign for PA?
Last week the federal government granted Iowa permission to expand its Medicaid program by enabling newly eligible residents to purchase state-approved, subsidized private health insurance.
Pennsylvania currently is planning to make a similar request, and Iowa now is the second state to be permitted to move forward in this manner. Arkansas received permission for a similar approach to Medicaid expansion in September.
While there are differences between the approved Arkansas and Iowa programs and the approach embodied in the Corbett administration’s “Healthy Pennsylvania” proposal, the Iowa approval suggests a continued willingness of the federal government to consider private insurance market alternatives to Medicaid expansion.
Learn more about the approved Iowa plan in this Kaiser Health News report.
Delay in Switch From CHIP to Medicaid
The federal government is permitting Pennsylvania to delay shifting children currently enrolled in the state’s Children’s Health Insurance Program (CHIP) into Medicaid.
The state has objected to such a transition, which is mandated by the Affordable Care Act, and is in the process of attempting to negotiate a compromise with federal officials. Those federal officials have agreed to delay the required transition until they have an opportunity to review the state’s new proposal, which should be delivered later this week.
Learn more about this issue in this article in The (Cumberland County) Sentinel.
PA Seeks Federal OK for Medicaid Expansion
The Corbett administration is asking the federal government to authorize the expansion of the state’s Medicaid program to serve another 500,000 people.
Healthy Pennsylvania, the reform plan unveiled by the Corbett administration in September, calls for expanding eligibility for Medicaid as envisioned in the federal Affordable Care Act but providing coverage to newly eligible individuals through private insurers
Under the plan, most newly eligible recipients would select state-subsidized insurance through the federal health insurance marketplace and receive the same benefits as regular commercial customers.
Healthy Pennsylvania also calls for streamlined benefits packages, enrollee premiums, and a work search requirement.
The formal unveiling of the plan is linked to the state’s application to the federal government for a waiver from selected federal Medicaid requirements. While states routinely request such waivers, each waiver is subject to individual scrutiny and negotiation between the state and federal governments after a period of public comment at the state level.
To learn more about the Healthy Pennsylvania proposal, see this Philadelphia Inquirer article. The administration also has published a description of its proposed application for the federal waiver, including information about how interested parties may comment on the proposal, in the Pennsylvania Bulletin; that notice can be found here. The complete draft waiver application can be found here.
Feds Find Temporary Way to Overcome Medicaid Enrollment Problem
The problems plaguing the beleaguered healthcare.gov web site continue to make it difficult for people to find new health insurance, but a new approach devised by the federal government will make it easier for Medicaid applicants to overcome this problem.
While the Centers for Medicare & Medicaid Services (CMS) was having trouble sending completed Medicaid and CHIP applications to the states, it continued sending them basic data from Medicaid and CHIP applications on a weekly basis primarily to help them gauge possible interest in Medicaid enrollment. Now, it is telling states they can use this limited data to enroll such individuals in their Medicaid programs without complete applications.
This process is expected to facilitate enrollment in states that have chosen to expand eligibility for their Medicaid programs. To date, Medicaid enrollment has been one of the brightest aspects of the troubled launch of the Affordable Care Act’s insurance expansion. While Pennsylvania is not expanding its Medicaid program at this time, the process could facilitate the enrollment of so-called woodwork applicants: people who are already eligible for Medicaid and never enrolled but have been drawn to do so by all of the attention the Medicaid expansion and Affordable Care Act have received.
To learn more about the CMS workaround to this problem, read this Kaiser Health News report or read the letter CMS sent to state Medicaid directors describing how this process will work.