Pennsylvania Medicaid Archives - Page 16 of 19 - Safety-Net Association of Pennsylvania

Shifting PA Medicaid to a PDL

Pennsylvania’s planned shift to a preferred drug list for its Medicaid program is the subject of a new analysis of the projected impact of such a change.

Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program. That PDL would apply to both the fee for service and managed care Medicaid programs.

During this year’s budget proceedings, Pennsylvania’s Human Services Code was amended to require an analysis of “the projected cost to the medical assistance managed care organization [sic] and the projected supplemental rebates that could be obtained” by moving to a PDL.

That analysis has now been completed. It concluded that the state

…will save $85 million annual through implementation of a Statewide PDL. The Statewide PDL will allow the Department [of Human Services] to receive an additional $261 million in pharmacy rebates, which will more than offset the estimated increase to managed care organization (MCO) expenditures of $176 million, considering their additional costs and loss of market share rebates.

The analysis commissioned by DHS is now available. To learn more about the implications of a state-wide PDL for the state, for Medicaid managed care organization, and for Medicaid beneficiaries, read “Fiscal Impact Analysis of Medical Assistance Program Uniform Statewide Preferred Drug List, 2019 Report.”

The PDL will take effect on January 1, 2020 and has been posted on a DHS web site here.

PA Safety Net Admin2019-10-09T06:00:03+00:00October 9th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

New in Medicaid Medical Transportation: Uber and Lyft

State Medicaid programs focused on ensuring that beneficiaries keep their doctor appointments are increasingly looking to ride-sharing services to supplement the providers already participating in their medical transportation programs.

Today, Lyft is working with approximately 35 state Medicaid programs while Uber, at least so far, participates only in Arizona’s program.

While ride-sharing is not going to replace other medical transportation programs – for one thing, most Uber and Lyft cars are not equipped to serve individuals with serious disabilities – they can help supplement services that today typically require patients to reserve rides days ahead of time and then share van rides with other patients.

To facilitate the use of ride-sharing services, several state governments have eased regulations that require people who drive Medicaid beneficiaries to undergo first-aid training and drug testing.

While ride-sharing is not yet a formal part of Pennsylvania’s Medical Assistance Transportation Program, pilot programs using such services are currently under way in Allegheny County and Philadelphia.

Learn more about how ride-sharing is moving into the Medicaid medical transportation industry in the Kaiser Health News article “Uber And Lyft Ride-Sharing Services Hitch Onto Medicaid.”

PA Safety Net Admin2019-10-08T06:00:17+00:00October 8th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

SNAP Asks PA Delegation to Support Another Medicaid DSH Cut Delay

In a letter to members of Pennsylvania’s congressional delegation, SNAP has asked those members to support another two-year delay of Medicaid disproportionate share (Medicaid DSH) cuts mandated by the Affordable Care Act.

In the message, SNAP notes the important role Medicaid DSH payments play in helping private safety-net hospitals care for the many uninsured patients who continue to turn to them for care.

If the cut is not delayed, Pennsylvania will see its Medicaid DSH allotment from the federal government fall 40 percent in FY 2020 and 80 percent annually from FY 2021 through FY 2025.

See SNAP’s message to PA delegation members here.

PA Safety Net Admin2019-10-04T06:00:52+00:00October 4th, 2019|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

SNAP Thanks PA Delegation for Supporting Short-Term Medicaid DSH Cut Delay

SNAP has written to members of Pennsylvania’s congressional delegation to thank them for voting for a temporary delay of Medicaid disproportionate share (Medicaid DSH) cuts mandated by the Affordable Care Act.

The Medicaid DSH delay was included in a continuing resolution that Congress passed to fund the federal government temporarily while legislators continue to negotiate an FY 2020 federal budget. The continuing resolution and the Medicaid DSH cut delay run through November 21.

Medicaid DSH cuts mandated by the Affordable Care Act have already been delayed several times by Congress, but if not delayed again, Pennsylvania will see its federal Medicaid DSH allotment fall 40 percent in FY 2020 and 80 percent a year from FY 2021 through FY 2025.

See SNAP’s thank you note to Pennsylvania’s congressional delegation here.

PA Safety Net Admin2019-10-03T06:00:35+00:00October 3rd, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

CMS Adopts Methodology for Medicaid DSH Cuts

Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services.

But it is not clear when that new methodology may actually be used.

Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans. While this has been the case, the decline in the number of uninsured has not been as great as expected. For this reason, Congress has on several occasions delayed the required Medicaid DSH cut.

That cut is now scheduled to take effect next week, on October 1, but a continuing resolution to fund the federal government, passed last week by the House and now under consideration by the Senate, would delay that cut again – at least until November 22.

Should the cut be implemented, Pennsylvania would lose 40 percent of its Medicaid DSH allotment from the federal government in FY alone and that cut would rise to 80 percent a year from FY 2021 through FY 2025. Pennsylvania safety-net hospitals view Medicaid DSH as an important part of their effort to care for the uninsured and underinsured residents of the low-income communities in which they are located.

Learn more about the new regulation governing the future allotments of Medicaid DSH money to the states and the prospects for Medicaid DSH allocation cuts being made anytime soon in the Healthcare Dive article “CMS finalizes Medicaid DSH cuts, but Congress could still delay” and see the regulation itself here.

PA Safety Net Admin2019-09-25T10:59:52+00:00September 25th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals|Comments Off

SNAP Takes Position on State Medicaid Funding After Hahnemann Closure

Pennsylvania’s Medicaid resources should follow now-closed Hahnemann University Hospital’s Medicaid patients as those patients turn to new providers, the Safety-Net Association of Pennsylvania declared in a position statement issued this week.

Safety-Net Association of Pennsylvania logo According to SNAP,

…the best way to protect access to care and prevent additional financial strain on Philadelphia hospitals is to ensure that all state resources reallocated in the wake of Hahnemann University Hospital’s closure follow the displaced patients.

In preparation for addressing this challenge, SNAP performed a data-based analysis of where Medicaid patients turned for care upon the closing of St. Joseph’s Hospital, like Hahnemann a high-volume Medicaid provider and located in the same community as Hahnemann, in 2016. This analysis identified where patients went when St. Joseph’s closed and in its position statement, SNAP urges state policy-makers to perform similar analyses and ensure that state Medicaid resources, especially supplemental payments made to hospitals that serve especially large numbers of Medicaid patients, be distributed to the hospitals that actually serve displaced Hahnemann patients. Such an approach, SNAP maintains, is the best way to ensure the future of the health care safety net in Philadelphia.

Learn more in the SNAP position statement “Protecting Philadelphia’s Health Care Safety Net From the Financial Implications of the Closing of Hahnemann University Hospital.”

PA Safety Net Admin2019-09-18T13:24:14+00:00September 18th, 2019|Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

PA Senate to Take Up Medicaid Work Requirement

Undeterred by past defeats, members of PA’s state senate are again attempting to advance Medicaid work requirement legislation.

This time, the proposal to impose a Medicaid work requirement will add new flexibility to such a requirement, offering exemptions for individuals deemed “medically frail” and enabling individuals who do volunteer work, attend college, or who are actively looking for work to continue qualifying for Medicaid benefits.

Harrisburg, PA capital building The proposal will be considered by the Senate Health and Human Services Committee.

The legislature has passed two Medicaid work requirement bills in the past but Governor Tom Wolf has vetoed them.

Learn more about this latest effort to establish a Medicaid work requirement in Pennsylvania in the PA Post article “Wolf, Republicans resume tug-of-war over Medicaid work requirements.”

PA Safety Net Admin2019-09-17T06:00:13+00:00September 17th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

PA Slams Brakes on Medicaid Transportation Program Overhaul

The plan to introduce major changes in Pennsylvania’s free medical transportation program for the Medicaid population has temporarily been halted.

As envisioned by the state, the current program, in which individual counties contract independently with transportation providers to serve their residents on Medicaid, was to be replaced by a regional approach in which the state contracts with three vendors to serve all of Pennsylvania. Objections by members of the state legislature and county officials, however, led to legislation that requires the Department of Human Services, Department of Transportation, and Department of Aging to study the implications of such a change for patients and taxpayers and to report their preliminary findings to the legislature in September.

Learn more about Pennsylvania’s Medical Assistance Transportation Program, how it works now, how the state sought to change it, and what to expect in the near future in the Philadelphia Inquirer article “Overhaul of PA’s medical transport program on hold after counties raise concerns.”

PA Safety Net Admin2019-08-06T06:00:31+00:00August 6th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Uninsured ED and Inpatient Visits Down Since ACA

Uninsured hospital admissions and emergency department visits are down since passage of the Affordable Care Act.

And Medicaid-covered admissions and ER visits are up, according to a new analysis.

Hospital building The report, published on the JAMA Network Open, found that ER visits by uninsured patients fell from 16 percent to eight percent between 2006 and 2016, with most of this decline after 2014, while uninsured discharges fell from six percent to four percent.

The rate of uninsured ER visits declined, moreover, at a time when overall ER visits continued to rise.

While the Affordable Care Act is likely the cause of most of these changes, other contributing factors include the emergence of urgent care facilities, telemedicine, and free-standing ERs as well as new payment models and rules.

The study’s findings are especially good news for Pennsylvania safety-net hospitals because they care for so many more low-income patients than other hospitals and have benefited from the Affordable Care Act’s expansion of access to insurance, whether through Medicaid expansion or the private health insurance market.

Learn more in the JAMA Network Open article “US Emergency Department Visits and Hospital Discharges Among Uninsured Patients Before and After Implementation of the Affordable Care Act.”