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SNAPShots

DPW Says Fiscal Office Understates Cost of Medicaid Expansion

The Pennsylvania Department of Public Welfare has released a letter it sent to the state’s Independent Fiscal Office (IFO) rejecting many of the assumptions underlying the latter’s analysis of the cost of expanding Medicaid eligibility in the state and stating that as a result of these incorrect assumptions, the IFO has significantly understated the cost of Medicaid expansion in Pennsylvania.
According to the letter sent by acting DPW secretary Beverly Mackereth to IFO director Matthew Knittel, the IFO inaccurately characterizes the baseline year during which to account for potential costs and savings; incorrectly maintains that upfront costs – including hiring 2000 new workers at higher salaries than the IFO projects – will be less than savings; and overstates savings associated with increased federal matching funds for General Assistance recipients.
DPW also maintains in the letter that the IFO incorrectly assumes that new enrollment will take place gradually instead of  fairly quickly once expansion begins; underestimates the number of new “woodwork” enrollees – individuals already eligible for Medicaid who will enroll in the program because of all the attention the eligibility expansion will receive; and prematurely assumes continued income from the gross receipts tax on Medicaid managed care organizations before the federal government has had an opportunity to decide whether the state will be permitted to continue levying that tax.
Read about the letter in this Philadelphia Business Journal article or download the letter itself here.

2013-05-22T06:00:40+00:00May 22nd, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Uncategorized|Comments Off on DPW Says Fiscal Office Understates Cost of Medicaid Expansion

New DPW Secretary Testifies Before Senate

Acting Department of Public Welfare Secretary Beverly Mackereth appeared before the Senate Appropriations Committee this week for the first time to present and defend her department’s proposed FY 2014 – including its Medicaid budget.
Mackereth, herself a former member of the state House, also responded to committee members who questioned Governor Corbett’s decision not to expand Medicaid eligibility in the state, as provided for in the federal Affordable Care Act.
She also promised more dialogue with the General Assembly in the future.
Read more about Ms. Mackereth’s budget testimony before the Senate Appropriations Committee in this Allentown Morning Call article

State Budget


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2013-03-08T06:00:05+00:00March 8th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget|Comments Off on New DPW Secretary Testifies Before Senate

The Proposed FY 2014 State Budget: Part 7 of 7

Department of Health

Pennsylvania Governor Tom Corbett recently unveiled his proposed state FY 2014 budget.  The day he did, members of the Safety-Net Association of Pennsylvania (SNAP) immediately received a comprehensive memHarrisburg, PA capital buildingo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over a seven-day period, SNAP has presented in this space the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.   In this final installment, SNAP takes a look at what that budget proposes for the state’s Department of Health.
The Department of Health’s budget calls for a number of spending cuts.  Among them, it calls for the complete elimination of funding associated with its diabetes, poison control centers, Tourette Syndrome, epilepsy support services, lupus, trauma coordination, ALS support services, and biotech research programs.  Together, this accounts for a $6.3 million cut in Health Department funding.
On the other hand, the department’s proposed budget includes $4 million in grants to clinics to improve access to primary care in medically underserved areas and $1 million in new money to support 24 additional loan repayment grants to enhance the recruitment of doctors to medically underserved areas.
 

2013-02-20T06:00:51+00:00February 20th, 2013|Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget|Comments Off on The Proposed FY 2014 State Budget: Part 7 of 7

The Proposed FY 2014 State Budget: Part 6 of 7

The Children’s Health Insurance Program

Pennsylvania Governor Tom Corbett recently unveiled his proposed state FY 2014 budget.  The day he did, members of the Safety-Net Association of Pennsylvania (SNAP) immediately received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over a seven-day period, SNAP presents in this space the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.   Today, SNAP takes a look at what the proposed budget says about the Children’s Health Insurance Program.
The governor’s proposed FY 2014 budget includes $24 million in new money for the Children’s Health Insurance Program (CHIP).  This additional funding will support the addition of more than 9300 children to the program.
Tomorrow:  Department of Health
Safety-Net Association of Pennsylvania logo

2013-02-19T06:00:46+00:00February 19th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget|Comments Off on The Proposed FY 2014 State Budget: Part 6 of 7

The Proposed FY 2014 State Budget: Part 5 of 7

Other Medical Assistance Issues

Pennsylvania Governor Tom Corbett recently unveiled his proposed state FY 2014 budget.  When he did, members of the Safety-Net Association of Pennsylvania (SNAP) immediately received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over a seven-day period, SNAP presents in this space the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.   Today, SNAP takes a look at what the proposed budget says about Medical Assistance issues not addressed in parts one through four of this series.
The proposed budget calls for a number of other changes in Medical Assistance spending, including:

  • New spending of $55.9 million in total funds for what has been labeled a “public-private collaboration project” under the outpatient budget that is offset by a $28.5 million savings within the same budget line.
  • Savings in the inpatient, outpatient, and capitation (managed care/HealthChoices) budget lines associated with “audit enhancements.”
  • Savings associated with the state outsourcing its third-party liability functions, including payment recovery.
  • A doubling of state spending on information technology to bring Pennsylvania’s Medical Assistance eligibility systems and technology up to the requirements of the Affordable Care Act.
  • An increase of $27 million for mental health services and $3.2 million for state mental health services block grant funding
  • A savings of more than $8 million associated with instituting premiums for so-called loophole children who participate in the state’s PH-95 program for selected Pennsylvanians with autism.

Tomorrow:  The Children’s Health Insurance Program (CHIP)
Financial graphs
 

2013-02-18T06:00:10+00:00February 18th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off on The Proposed FY 2014 State Budget: Part 5 of 7

The Proposed FY 2014 State Budget: Part 4 of 7

Medical Assistance Supplemental Payments

Last Tuesday, Pennsylvania Governor Tom Corbett unveiled his proposed state FY 2014 budget.  Later that day, members of the Safety-Net Association of Pennsylvania (SNAP) received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over a seven-day period, SNAP presents in this space the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.   Today, SNAP takes a look at what the proposed budget says about Medical Assistance supplemental payments.
Governor Corbett has proposed no change in the state’s spending on OB/NICU, burn center, and trauma center payments.  Because of the reduction in the state’s federal medical assistance percentage (FMAP, or the rate at which the federal government matches state Medicaid spending), total payments to hospitals in each of these programs stands to decline 1.7 percent.
The total amount available for tobacco uncompensated care payments is slated for a 3.3 percent decrease, from $56.5 million to $54.7 million.  This reflects two factors:  a 1.7 percent decrease in money available from the tobacco settlement fund and the state’s reduced FMAP rate.
While total funding for physician practice plans is slated for an 18.9 percent decrease, this appears to reflect a decision to remove from this category one hospital that was added to the group last year.  This would mean funding for physician practice plans would remain the same – as it would for academic medical center disproportionate share hospital payments (DSH).
Critical access hospital payments have been targeted for a $500,000 cut in state funds.
Inpatient DSH, outpatient DSH, medical education, and Community Access Fund payments do not have their own line-items in the proposed budget and therefore cannot be specifically identified in that budget.  Traditionally, however, when an administration is contemplating changes in these payments, it indicates so in the programmatic revision commentary section of the budget document.  In the case of these four payments that are so vital to so many Pennsylvania safety-net hospitals, they were not mentioned in the programmatic revision commentary.
Next Monday:  Other Medical Assistance Issues
Financial paperwork
 

The Proposed FY 2014 State Budget: Part 3 of 7

Hospital Assessment Revenue

Last Tuesday, Pennsylvania Governor Tom Corbett unveiled his proposed state FY 2014 budget.  Later that day, members of the Safety-Net Association of Pennsylvania (SNAP) received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over a seven-day period, SNAP presents in this space the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.   Today, SNAP takes a look at what the proposed budget says about revenue from the state-wide and Philadelphia hospital assessments.
The proposed budget assumes $633 million in revenue from the state-wide hospital assessment and another $148 million from the Philadelphia hospital assessment.  While the revenue anticipated from the Philadelphia assessment appears to be in line with prior years’ collections, the revenue associated with the state-wide assessment appear to be greater than in the past.  It is unclear whether this apparent increase reflects the state’s intention either to increase its share of assessment revenue or to raise the assessment rate.
Tomorrow:  Medical Assistance Supplemental Payments
Harrisburg, PA capital building

2013-02-14T06:00:06+00:00February 14th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off on The Proposed FY 2014 State Budget: Part 3 of 7

The Proposed FY 2014 State Budget: Part 2 of 7

The Major Medical Assistance Spending Categories

Last Tuesday, Pennsylvania Governor Tom Corbett unveiled his proposed state FY 2014 budget.  Later that day, members of the Safety-Net Association of Pennsylvania (SNAP) received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over a seven-day period, SNAP presents in this space the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.   Today, SNAP takes a look at what the proposed budget says about the major Medical Assistance spending categories.
The proposed budget calls for what on the surface appear to be sizeable decreases in state funds available for Medical Assistance inpatient and outpatient funding ­– a decrease of 44.9 percent in inpatient and 31.6 percent in outpatient funding.  What this actually represents, however, is the state’s continued shift toward greater use of managed care through its expanded HealthChoices program, which has been budgeted for a 5.7 percent increase in funding.  Overall, the combined changes in the inpatient, outpatient, and capitation lines of the proposed budget represent a 1.4 percent decrease in the amount of state money available for physical health services.

Click on the accompanying chart to see the proposed changes in the state’s funding allocations for the major categories of Medical Assistance physical health spending from FY 2013 to FY 2014.
Tomorrow:  Hospital Assessment Revenue
 

2013-02-13T06:00:22+00:00February 13th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off on The Proposed FY 2014 State Budget: Part 2 of 7

The Proposed FY 2014 Pennsylvania State Budget: Part 1 of 7

The Big Picture

Last Tuesday, Pennsylvania Governor Tom Corbett unveiled his proposed state FY 2014 budget.  Later that day, members of the Safety-Net Association of Pennsylvania (SNAP) received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over the next seven business days, SNAP will present the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.
The following is a schedule of the remaining six parts of this overview:
Safety-Net Association of Pennsylvania logo
Today:  the big picture underlying the proposed budget.
In this proposed budget, the Department of Public Welfare (DPW) projects a three percent increase in Medical Assistance enrollment and caseload in FY 2014.  Overall, the DPW budget calls for $14.2 billion in total spending on Medical Assistance – a decrease of less than half a percent from the current fiscal year’s available funding.
While some of the proposed changes in the budget are spending decisions, others reflect a reduction in the state’s federal medical assistance percentage, or FMAP (the rate at which the federal government matches state Medicaid spending), which will fall from its current 54.28 percent to an estimated 53.52 percent during FY 2014.  Consequently, in some cases, lower payments would reflect a reduced federal contribution rather than a state decision to reduce those payments.
The major themes of next year’s proposed Medical Assistance budget appear to be a continued state-wide expansion of the HealthChoices Medical Assistance managed care program and expanded access to community-based services for individuals with intellectual disabilities and the elderly.
The budget does not provide for the Medicaid expansion envisioned in the Affordable Care Act.  Governor Corbett has conveyed to the federal government that he will not expand Medicaid eligibility at this time but his document states that such expansion will be the subject of further analysis and public discussion.
Tomorrow:  The Major Medical Assistance Spending Categories
 

Health Law PA News

The Pennsylvania Health Law Project has published its January 2013 newsletter, which includes articles on the state’s budget process (including a schedule of upcoming budget hearings), the continued expansion of HealthChoices, changes in Medicaid-covered behavioral health and substance abuse services, limits on Medical Assistance benefits, the overall benefits of Medicaid expansion for Pennsylvania, and more.
Go here to download the Pennsylvania Health Law Project’s Health Law PA News.

2013-02-08T06:00:35+00:00February 8th, 2013|Meetings and notices, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off on Health Law PA News
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