The Pennsylvania Health Law Project has published the March 2013 edition of Health Law PA News, its monthly newsletter.Features this month include articles about the governor’s proposed FY 2014, prospects for Medicaid expansion, coming Affordable Care Act changes, the final expansion of HealthChoices, and more.
Find a link to the complete newsletter here
, on the web site of the Pennsylvania Health Law Project.
Still rejecting expansion of the state’s Medicaid program as envisioned under the Affordable Care Act, Pennsylvania Tom Corbett has indicated that he may be interested in following the lead of a few other states in attempting to use federal Medicaid expansion money to purchase private health insurance for newly eligible Medicaid recipients.
This news comes in the aftermath of the governor’s Washington, D.C. visit with Health and Human Services Secretary Kathleen Sebelius during which the two officials discussed the governor’s reluctance to incur the future cost increases that he believes the state will face under Medicaid expansion.
Recently, the governors of Arkansas, Ohio, and several other states have expressed interest in purchasing private insurance for new Medicaid recipients instead of expanding their states’ traditional Medicaid programs.
Read more about Governor Corbett’s meeting with Secretary Sebelius and the possibility that the state’s closed door to the question of Medicaid expansion is now slightly ajar in this Philadelphia Inquirer article.
A new study suggests that expanding Medicaid eligibility in Pennsylvania would create as many as 39,000 new jobs over the next seven years and generate enough new revenue to pay the state’s share of the expansion’s costs.
Or so says a new study by RAND Health.
According to the study, Medicaid expansion under the terms established by the Affordable Care Act would reduce Pennsylvania’s uninsured rate from the current 12.7 percent to 4.8 percent in 2016, spur $20 billion in economic growth by 2020, and generate more new tax revenue than the state would need to spend to pay its share of expansion’s cost once the federal share of expansion drops from 100 percent to 90 percent.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about the RAND Health report, and find a link to the study, in this Central Penn Business Journal article.
In their desire to persuade states to expand their Medicaid programs as called for in the Affordable Care Act, federal officials are now suggesting that states could use new federal Medicaid funds to enable Medicaid-eligible people to purchase private insurance.
Even though this was not envisioned in the health reform law, the prospect of making greater use of the private sector appears to be appealing to many Republican governors who have otherwise been reluctant to commit their states to expanding their Medicaid programs.
Pennsylvania has no current plans to expand Medicaid eligibility, although there appears to be growing interest in doing so throughout the state. Expansion would add approximately 500,000 people to the state’s Medicaid rolls, many of whom would be served by safety-net hospitals. The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the commonwealth.
Read more about how this idea came about, why many states find it appealing, how it would work, and what the potential challenges are in this New York Times article.
Immigrants to the U.S. – legal and not – pose a special challenge in the health care environment of the future.
Legal immigrants will not be able to benefit from many of the Affordable Care Act’s provisions until they have resided in the U.S. for five years while undocumented residents will not benefit from the reform law’s Medicaid expansion at all. Meanwhile, many of these individuals will continue to turn to health care providers, and especially to hospitals, when they are sick or injured.
But is this is a problem? And if it is, how great a problem is it? How many such individuals are there?
The Robert Wood Johnson Foundation has attempted to answer that question in a new report titled “State Estimates of the Low-Income Uninsured Not Eligible for the ACA Medicaid Expansion.” Among the report’s findings, it notes that
Safety-net health care providers are likely to continue to be key providers for this population after health reform, and the need for safety-net care will not be spread evenly across states. The capacity of safety-net providers to fill this gap will need to be assessed. While all states will need to develop strategies for meeting the health care needs of these adults, the challenges will be particularly difficult for safety-net providers in states with large numbers of immigrants who will not be eligible for Medicaid.
According to the report, about two percent of Pennsylvania’s non-elderly adults are unauthorized or recent legal immigrants; three percent of the state’s low-income, non-elderly adults are unauthorized or recent legal immigrants; and six percent of the state’s low-income, uninsured, non-elderly adults are unauthorized or recent legal immigrants.
Many of these individuals will undoubtedly turn to Pennsylvania’s safety-net hospitals for medical services.
Find the report here
.
The Philadelphia Inquirer has published an editorial calling on Pennsylvania Governor Tom Corbett to expand eligibility for the state’s Medical Assistance program as envisioned in the Affordable Care Act.
Read that editorial here
.
States are free to reduce payments to providers to keep down their Medicaid costs, the Obama administration has told a court considering a challenge to a 10 percent cut in provider payments by California’s Medicaid program.
The administration weighed in on this subject in a legal brief submitted in a court case that will decide whether California can reduce its Medicaid payments to providers.
If California’s defense of its Medicaid payment cuts proves successful, it could provide a blueprint for other states to reduce payments at a time when most states are preparing for a significant expansion of their Medicaid rolls. Many states are already concerned about the potential for rising Medicaid costs while others have opted out of Medicaid expansion or are still undecided, typically citing the potential for growing costs as the primary reason for their reluctance to expand their Medicaid programs as envisioned under the Affordable Care Act.
Any movement toward reducing Medicaid payments to providers would be extremely harmful to Pennsylvania’s safety-net hospitals, which already suffer from inadequate payments that fail to cover the cost of the care they provide to the state’s 2.1 million Medicaid recipients.
To learn more about the California case and its potential implications elsewhere, see this New York Times article
.
Expanding Medicaid as called for in the Affordable Care Act would extend health insurance to nearly 700,000 currently uninsured Pennsylvanians and create more than 41,000 new jobs in the state in 2016 according to a new report.
Medicaid expansion also would result in $3.3 billion in new health care spending in Pennsylvania and generate $5.1 billion in new economic activity in 2016.
These are among the conclusions presented ind “Pennsylvania’s Economy Will Benefit From Expanding Medicaid,” a new report issued jointly by the Pennsylvania Health Access Network and the national advocacy group Families USA.
Learn more about the report and its analysis and find a link to the entire report here, on the web site of the Pennsylvania Health Access Network.
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:
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
Pennsylvania Governor Tom Corbett has at least temporarily closed the door to the Medicaid expansion envisioned in the Affordable Care Act.
On the same day that he presented his proposed state budget for the 2014 fiscal year, Mr. Corbett wrote to U.S. Health and Human Services Secretary Kathleen Sebelius, explaining that
At this time, and without serious reforms, it would be financially unsustainable for Pennsylvania taxpayers, and I cannot recommend a dramatic Medicaid expansion.
See Governor Corbett’s letter to Secretary Sebelius here.
At the same time, however, the governor did not rule out the possibility of a change of heart sometime in the future. His proposed budget document explains that
At this time, analysis continues on the financial sustainability related to potential expansion of the Medicaid program. The Department of Public Welfare continues to have a dialogue with the U.S. Department of Health and Human Services (HHS) in an effort to obtain clarification and answers on a number of issues, including whether essential reforms of the Medicaid program can be accomplished to improve the health of our citizens and the effectiveness of the program. The department is currently reviewing the recently released proposed regulations on eligibility and benefits from HHS. While due diligence continues, no decision has been made at this time.
The administration intends to engage in an informed dialogue with the public and the legislature on whether expansion of the Medicaid program is prudent, affordable and the right choice for the commonwealth. When a final decision is made, it will be done in consultation with the Legislature and it may require modifications to be made and accounted for in the budget.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.