The Pennsylvania Department of Human Services has published materials describing Medicaid benefits under the state’s Healthy Pennsylvania Medicaid expansion.
A Medical Assistance Bulletin (#99-15-02) describing the “Interim Healthy Benefit Plan” can be found here and tables comparing the benefits packages under the “Healthy” (low risk), “Healthy Plus” (high risk), and Private Coverage Option plans (PCO) can be found here.
It appears some people may be having trouble taking advantage of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion.
The Pittsburgh Post-Gazette reports that there is a backlog in processing applications, some people who are eligible to participate are getting rejected for coverage, and some who need drug and alcohol treatment services have been placed in plans that do not provide such coverage.
The state has acknowledged the problem with drug and alcohol coverage but notes that processing applications can take up to 45 days. So far, the state estimates that 150,000 Pennsylvania households have applied for Medicaid coverage since the enrollment period started on December 1.
To learn more about the challenges Pennsylvania’s Medicaid expansion is encountering, see this Pittsburgh Post-Gazette article.
The Pennsylvania Health Law Project has released its latest newsletter.
The December edition includes articles about Medicaid benefits under Healthy Pennsylvania; the eligibility criteria for Medicaid; the continuation of the state’s General Assistance program for selected immigrants; and the process for some Pennsylvanians currently insured through the federal insurance marketplace to shift to Medicaid coverage instead.
Find the newsletter here.
The federal government estimates that approximately 180,000 low- and moderate-income Pennsylvanians who earn too much to qualify for Medicaid have applied for health insurance through the federal health insurance exchange.
Nearly 80 percent of them are expected to qualify for some federal subsidies to help pay their premiums. 95,000 are first-time applicants.
Last year, 320,000 Pennsylvanians applied for insurance through the federal exchange. About 60 percent did not have health insurance before doing so.
As a result, it appears as if more than 300,000 of the approximately 1.4 million Pennsylvanians who were uninsured at the time the Affordable Care Act’s insurance expansions took effect either now have such coverage or will soon have it. This figure includes those newly eligible for Medicaid under the state’s Healthy Pennsylvania Medicaid expansion program.
Learn more about the various means through which previously uninsured Pennsylvanians are obtaining health insurance in this Harrisburg Patriot-News article.
As 2014 ended, Pennsylvania had received 100,000 applications for Medicaid coverage under the state’s Healthy Pennsylvania Medicaid expansion program.
State officials estimate that approximately 600,000 adult Pennsylvanians are newly eligible for Medicaid under the program. The 100,000 figure represents applications, not individuals; some applications are for families of varying size. It is not yet known how many of the applicants are currently uninsured.
The state began accepting applications on December 1 for coverage to begin on January 1. There is no deadline for applying.
Learn more about the applications the state is receiving in this Pittsburgh Post-Gazette article.
The Pennsylvania Department of Human Services (DHS – formerly the Department of Public Welfare) has issued a memo to Medical Assistance stakeholders addressing two issues involving implementation of the state’s Healthy Pennsylvania Medicaid expansion that have been brought to its attention.
The first issue is that individuals who enrolled in Medicaid in December were not assigned to a behavioral health managed care organization.
The second addresses screening of individuals who currently qualify for Medicaid under the General Assistance category who have behavioral health needs and who likely qualify for the “Healthy Plus” Medicaid benefits plan beginning in 2015.
See the state’s message to stakeholders outlining what these issues are about and how it plans to address them in this memo from the state’s Office of Mental Health and Substance Abuse Services.
The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments: a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.
The Healthy Pennsylvania Medicaid expansion will bring Medicaid payments that often fall below hospital costs, potentially causing problems for hospitals that serve especially large numbers of new Medicaid beneficiaries.
While hospitals acknowledge that in some cases they will, under the program, start receiving payments for care they otherwise might have provided without any reimbursement at all, they note that the payments they expect from Healthy PA private insurers will fail to cover the cost of the care they provide in many cases.
The problem is especially acute when it comes to payment for outpatient services, which may cover only about 30 percent of the cost of outpatient care.
Because they serve so many Medicaid patients, this situation is likely to pose an especially great challenge for Pennsylvania’s safety-net hospitals.
For a look at the challenges hospitals expect under the Healthy PA Medicaid expansion and the effect it may have on their bottom line, see this Pittsburgh Tribune-Review story.
Among the articles in the November newsletter are a piece on how some immigrants currently covered by the state’s General Assistance program may be able to retain their coverage under Healthy Pennsylvania and another on differences in how the state’s Medicaid expansion population will obtain behavioral health services from private option plans participating in that expansion.
Find the November newsletter here.
Uninsured Pennsylvanians with an income less than 138 percent of the federal poverty level have begun enrolling in health insurance plans under the state’s Healthy Pennsylvania Medicaid expansion.
The official date on which enrollment began is December 1 in anticipation of the program’s official implementation on January 1. During this period, an estimated 600,000 eligible Pennsylvanians may choose private insurers through which they can receive health care coverage, with their premiums to be paid with federal Medicaid funds.
While the program is expected to begin as scheduled on January 1, it is not clear how long it will last in its current form. Governor-elect Tom Wolf has expressed opposition to the approach taken by the Corbett administration through Healthy Pennsylvania and envisions a more traditional expansion of the state’s Medicaid program. Whether Mr. Wolf will pursue such an approach, and when he might do so, remains unknown.
For a closer look at the Healthy Pennsylvania launch and the immediate future of Medicaid expansion in Pennsylvania, see this Pittsburgh Post-Gazette article.