health care reform Archives - Safety-Net Association of Pennsylvania

400,000 Fall Into PA Insurance Gap

400,000 Pennsylvanians currently fall into a gap between eligibility for the state’s Medicaid program and qualifying for health insurance subsidies through the state’s health insurance marketplace.
Under the Affordable Care Act, states were to expand eligibility for their Medicaid programs while the federal government would provide partial subsidies for low-income people who remained ineligible for Medicaid but were unlikely to be able to afford health insurance without such assistance.
But when the Supreme Court made Medicaid expansion optional for states, many people fell into a new insurance gap that was not anticipated when the 2010 reform law was written. Approximately half of the 50 states have expanded their Medicaid programs as the law expected, but in the half that did not, millions remain in this gap, earning too much money to qualify for Medicaid but not enough to be able to afford health insurance.
Among those millions are 400,000 Pennsylvanians because the commonwealth has not decided to move forward and expand its Medicaid program. Currently, state officials are exploring such expansion through a new “Healthy Pennsylvania” initiative and are negotiating possible terms for expansion with the federal government.
Learn more about Pennsylvania’s insurance gap, who is in it, why it exists, and why it is a candidate to disappear sometime in the future in this Philadelphia Inquirer article.

PA Safety Net Admin2013-11-20T06:00:19+00:00November 20th, 2013|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off

ACA Drives Rise in Medicaid Enrollment

While some aspects of implementation of the Affordable Care Act continue to struggle with technical problems, one aspect is moving ahead effectively: enrollment in Medicaid is on the rise.
More than 400,000 newly eligible people in just ten states have enrolled in Medicaid since October 1. The ten states are among the 25 that have decided to expand their Medicaid programs in accordance with provisions of the federal health care reform law. Other states either have chosen not to expand their programs or are still undecided about expansion.
Pennsylvania is one of the states that has not expanded its Medicaid program but state officials are currently negotiating a possible expansion with the federal government. The Safety-Net Association of Pennsylvania supports such an expansion.
The Congressional Budget Office projects that nine million people will join the Medicaid ranks through Affordable Care Act expansion provisions in the coming year.
For more about the increase in Medicaid enrollment and how it is being accomplished despite some of the reform law’s early technical problems, see this Washington Post article.

PA Safety Net Admin2013-11-13T06:00:03+00:00November 13th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Millions to Fall Into Coverage Gap

More than five million adult Americans will fall into the Affordable Care Act’s Supreme Court-created coverage gap in states that have chosen not to expand their Medicaid programs.
In those 26 states, adults whom the reform law intended to be covered by Medicaid will still earn too much money to qualify for Medicaid yet also will fall below the income level needed to qualify for Affordable Care Act health insurance subsidies.
This gap was created when the Supreme Court made the reform law-mandated Medicaid expansion optional for individual states, and so far, 26 states have chosen not to expand their Medicaid programs. The result, according to a new issue brief from the Kaiser Commission on Medicaid and the Uninsured, is that 5.2 million low-income adults whom the law intended to enroll in Medicaid will remain uninsured.
More than 280,000 of these people reside in Pennsylvania, which has not yet expanded its Medicaid program. Many will continue to be served by the state’s private safety-net hospitals, which will not be paid for the care they provide.
To learn more about these people and why they will remain uninsured, read the study “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Find the study here, on the web site of the Kaiser Family Foundation.

PA Safety Net Admin2013-10-16T10:08:33+00:00October 16th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Gap in Reform Law Could Leave Many Low-Income People Uninsured

When the Supreme Court gave states discretion over whether to expand their Medicaid programs under the Affordable Care Act, it unintentionally created a gap in potential coverage options for many low-income people that may leave many of those people without affordable health insurance.
According to a new report from the Commonwealth Fund, the 2010 reform law anticipated that everyone with incomes below 133 percent of the federal poverty level would be covered by Medicaid. Individuals and families with incomes between 133 percent and 399 percent of the federal poverty level could use new federal subsidies to help purchase private health insurance.
In states that are not expanding their Medicaid programs, people with incomes between 133 percent and 399 percent of the federal poverty level will still be able to take advantage of federal premium subsidies. People with incomes less than 133 percent of the federal poverty level but who do not qualify for their state’s Medicaid program – qualification criteria vary from state to state – will not be eligible for the same subsidies as many who earn more than them because the reform law assumed that all such individuals would be covered by Medicaid.
According to the Commonwealth Fund, this unanticipated gap in the reform law means that as many as 42 percent of people who suffer from periodic or chronic lack of insurance and who live in states that are not expanding their Medicaid programs will not benefit in any way from Affordable Care Act insurance reforms.
Pennsylvania is one of the states in which this problem will occur because the state is not expanding its Medicaid program. It almost certainly will require Pennsylvania’s safety-net hospitals to provide more uncompensated care than originally expected when the reform law was enacted.
Read more about the unintended consequences of the Supreme Court’s decision and the choice by some states not to expand their Medicaid programs in In States’ Hands: How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans, a new report from the Commonwealth Fund.

PA Safety Net Admin2013-09-09T06:00:22+00:00September 9th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Congressman Calls for Delay on DSH Cuts

Cuts in Medicare DSH and Medicaid DSH payments, scheduled to be take effect beginning in FY 2014, would be delayed for two years under a new bill proposed in Congress.
Under the DSH Reduction Relief Act of 2013, Affordable Care Act-mandated cuts in Medicare disproportionate share payments (Medicare DSH) and Medicaid disproportionate share payments (Medicaid DSH) would not begin until FY 2016, instead of in FY 2014, as the reform law requires.
The bill was proposed by Representative John Lewis (D-GA).
Read more about The DSH Reduction Relief Act in this article from Becker’s Hospital Review.

PA Safety Net Admin2013-05-13T09:36:10+00:00May 13th, 2013|Health care reform|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2013 newsletter.
Targeted to the very population that Pennsylvania’s safety-net hospitals serve, this month’s newsletter includes features on the benefits of Medicaid expansion under the Affordable Care Act, Medicaid eligibility, and the uninsured in Pennsylvania. It also includes links to articles and features relevant to the state’s low-income population and the health care providers who serve them.
See the Pennsylvania Health Law Project’s January 2013 newsletter here .

PA Safety Net Admin2013-01-31T06:00:57+00:00January 31st, 2013|Health care reform, Pennsylvania Medicaid policy|Comments Off

PA Prepares to Boost Medicaid Primary Care Rates

Pennsylvania will soon begin paying primary care providers more for the services they deliver to their Medical Assistance patients.
Under the Affordable Care Act, state Medicaid programs are required to pay primary care providers Medicare-level fees for calendar years 2013 and 2014. This policy was adopted as part of a broader effort to recruit more physicians to serve Medicaid patients at a time when Medicaid enrollment will increase significantly in most states.
Now, the Pennsylvania Department of Public Welfare (DPW) is presenting its plan for how it will go about implementing this federal requirement.
DPW has issued a new Medical Assistance Bulletin titled “Medical Assistance Program Fee for Select Primary Care Services and Physician Attestation Form” that identifies eligible providers and explains how they can go about receiving the enhanced payments. That bulletin can be found here. DPW also has issued an attestation form through which providers can assert their eligibility for the enhanced payments; that form, and directions for completing and submitting it, can be found here.

PA Safety Net Admin2013-01-29T06:00:39+00:00January 29th, 2013|Health care reform, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

States Finding it Hard to Say No to Federal Medicaid Money

While many of the nation’s governors have ideological problems with many aspects of the Affordable Care Act, it appears that more of them are preparing to accept one major facet of the bill with which they particularly disagree: Medicaid expansion.
When the law passed, the mandatory expansion of Medicaid eligibility was one of its most controversial aspects and encountered a great deal of resistance from many governors. When the Supreme Court ruled last year that the mandate was unconstitutional, many governors indicated that they would decline the now-optional Medicaid expansion.
But as the time for implementing the Medicaid expansion draws closer, more governors are concluding that the lure of millions, and even billions, of “free” federal Medicaid matching dollars is too hard to resist.
In addition, some governors are concerned about appearances if they turn down the federal Medicaid money while a clause in the reform act would enable legal immigrants in their state to receive health insurance premium subsidies while other low-income residents remain ineligible for those subsidies and uninsured.
Pennsylvania Governor Tom Corbett has not yet announced his decision on whether the state will expand its Medicaid program but appears to be leaning against such an expansion. The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the commonwealth.
Read about the challenges governors face in refusing the federal Medicaid money in this RealClearPolitics article and about the immigration twist on the issue in this Washington Post report .

PA Safety Net Admin2013-01-28T06:00:29+00:00January 28th, 2013|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

Hearing Promotes Medicaid Expansion in PA

Democratic members of the state Senate Appropriations Committee held a hearing in Philadelphia to promote expansion of the state’s Medicaid (Medical Assistance) program.
Participating legislators took testimony from representatives of a number of organizations that support Medicaid expansion, which is an optional component of the Affordable Care Act.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Governor Corbett has not yet announced his decision on Medicaid expansion but is thought to be leaning against it. The General Assembly members who held the hearing are in the minority party in the state senate.
Read more about the hearing, the issues, and the testimony offered in this Philadelphia Inquirer article.

PA Safety Net Admin2013-01-25T12:06:55+00:00January 25th, 2013|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

GAO Finds Problems With Medicaid DSH Payments

The U.S. Government Accountability Office (GAO) is now reviewing audits of states’ Medicaid disproportionate share payments (Medicaid DSH) to hospitals and is raising questions about states’ compliance with federal requirements for those payments.
Based on its analysis of state Medicaid DSH audits, GAO found that states are making Medicaid DSH payments to hospitals that exceed those hospitals’ uncompensated care costs and are inaccurately calculating those hospital uncompensated care costs. The GAO also found that states are not always targeting their Medicaid DSH payments to the hospitals that provide the most uncompensated care.
States are required to submit audits and data as a condition of receiving Medicaid DSH funds from the federal government. Currently, the Centers for Medicare & Medicaid Services (CMS) is not acting on the information it receives but will begin doing so after a transition period that ends when 2014 audits are completed. In anticipation of that time, GAO is reviewing the information CMS receives for state compliance with six federal standards for Medicaid DSH payments.
This data also may eventually be used to help implement the Medicaid DSH payment reduction mandated under the Affordable Care Act.
According to the report, Pennsylvania did not provide some of the required data, so in several instances in which the document provides specific information about individual state performance, it has nothing about Pennsylvania. It does note, however, that in FY 2007, six hospitals in the state received Medicaid payments greater than their Medicaid costs.
Because Pennsylvania’s safety-net hospitals care for so many uninsured and low-income patients and receive higher Medicaid DSH payments than other hospitals, they are far more dependent on these payments than other hospitals and will need to watch this situation closely in the future.
Learn more about GAO’s examination of Medicaid DSH payments – why it is undertaking this review, what it found, and how its findings may be used in the future – in the report More Transparency of and Accountability for Supplemental Payments are Needed, which can be found here , on GAO’s web site.

PA Safety Net Admin2012-12-28T06:00:33+00:00December 28th, 2012|Health care reform, Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

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