Pennsylvania Medicaid Archives - Page 14 of 20 - Safety-Net Association of Pennsylvania

PA Contacts Medicaid Recipients About Benefits

The Pennsylvania Department of Public Welfare is in the process of sending letters to all current adult Medicaid recipients in the state advising them of changes in their Medicaid benefits to take effect on January 1 as a result of the state’s Healthy Pennsylvania Medicaid expansion.
The Pennsylvania Health Law Project has published an explanation of the situation, including sample copies of the letters the state is sending, information about the different benefit packages available to Medicaid recipients, and advice on how recipients who believe they have more serious medical problems can apply for a benefits package better suited to their needs.
Find the Pennsylvania Health Law Project notice here.

PA Safety Net Admin2014-11-10T09:05:50+00:00November 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

MACPAC Not Yet Sold on Continuing Medicaid Primary Care Pay Increase

The independent federal agency that advises Congress on Medicaid and the Children’s Health Insurance Program is not ready to endorse continuing the Affordable Care Act’s two-year increase in Medicaid primary care fees as a means of encouraging more doctors to serve Medicaid patients.
At its October 30-31 public meeting in Washington, D.C., the staff of the Medicaid and Children’s Health Insurance Program Payment and Access Commission (MACPAC) reported that it has begun looking into the effectiveness of the temporary pay increase in persuading more doctors to care for Medicaid recipients. Among its preliminary findings are that

The payment increase had at best, a modest effect on provider participation according to states and MCOs
Most states reported that the provision had no effect on the use of primary care services

Consequently, MACPAC did not offer any recommendations on this issue at the public meeting and intends to continue studying the impact of enhanced Medicaid primary care fees on physician willingness to serve Medicaid patients.
For the two years ending on December 31, 2014, the federal government has paid for 100 percent of the fee increases. Some states have already decided to continue making the enhanced payments at their own expense, some will make enhanced payments but not necessarily at the level authorized by the Affordable Care Act, and some intend to restore the payments to their previous levels.
Pennsylvania plans to return its Medicaid primary care fee-for-service rates to their 2012 level.
The MACPAC presentation on Medicaid primary care physician payments can be found here.

PA Safety Net Admin2014-11-04T06:00:10+00:00November 4th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

To Increase or Not to Increase? That is the Question

To induce more primary care providers to serve Medicaid patients at a time when Medicaid enrollment was about to increase significantly nation-wide, the Affordable Care Act raised Medicaid primary care reimbursement to the same level as Medicare rates for 2013 and 2014, with the federal government to pick up the tab for 100 percent of the increase in state spending for these services.
With that two-year increase coming to an end, states now must decide whether to continue the increase and pay for it themselves or let their Medicaid primary care rates return to their old levels.
According to a survey taken by the Kaiser Family Foundation, 15 states will continue the increases either in part or in full; 24 do not plan to continue the increases; and 12 still have not decided.
Some states that are continuing the increases in some form also are changing the types of primary care providers that will receive the enhanced Medicaid payments.
Pennsylvania is among the 24 states not planning to continue the rate increase.
For a closer look at the issue, including a map that illustrates each state’s intentions, see the Kaiser Family Foundation report “The ACA Primary Care Increase: State Plans for SFY 2015” here, on the foundation’s web site.

PA Safety Net Admin2014-11-03T06:00:34+00:00November 3rd, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

PA Closing in on Classification Criteria for New Medicaid Recipients

Among the features of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program is the consolidation of 14 current adult benefits packages into just two packages: the “Healthy” package for new recipients considered low-risk patients and the “Healthy Plus” package for those who are considered high-risk patients, or medically frail.
But ever since the Corbett administration unveiled its Medicaid expansion plan last fall, the question of how new recipients would be evaluated to determine which benefit package they will receive has remained unanswered.
Now, the Pennsylvania Department of Public Welfare (DPW) appears to be getting closer to providing a clear answer.
Recently, DPW’s Medical Assistance Advisory Committee (MAAC) circulated three working documents that present the state’s latest thinking on the classification process.
The first document presents an overview of the latest version of state’s screening tool, including what the tool is, how it defines “medically frail,” and how it will be used. It also notes that use of the tool is not mandatory.
This next document offers additional information about how the state envisions defining “medically frail.”
And this third document is a draft of the screening tool itself, the health care needs questionnaire.
Pennsylvania’s Medicaid expansion is scheduled to take effect on January 1, 2015, but people who think they may be eligible may begin enrolling on December 1 through the state’s enrollment web site or at any state county assistance office.

PA Safety Net Admin2014-10-31T06:00:57+00:00October 31st, 2014|Healthy PA|Comments Off

Some PA Women Could Lose State Medical Benefits

The expiration of a state health program could leave about 90,000 low-income Pennsylvania women without the free family planning and women’s health benefits they currently receive.
A program called SelectPlan for Women offers limited health benefits to low-income women between the ages of 18 and 44 who are otherwise ineligible for Medicaid. While there has been no formal announcement of the program’s termination, women’s health advocates have informally been told that such a termination is possible at the end of the year.
If the program expires, some of the women it currently covers will be eligible for Medicaid under the state’s Medicaid expansion to take effect on January 1 while others should be eligible for at least some subsidization of insurance premiums on the federal health insurance exchange.
The SelectPlan for Women, however, has no limits on visits, no co-pays, and no premiums.
Learn more about SelectPlan for Women, what it does, and why it may soon disappear in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-10-30T06:00:59+00:00October 30th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Medicaid Directors Weigh in On Managed Care Regulation

The nation’s state Medicaid directors have offered their perspectives to the federal government on how to modernize and regulate state Medicaid managed care programs.
In a paper entitled “Medicaid Managed Care Modernization: Advancing Quality Improvement,” the National Association of Medicaid Directors urges the Centers for Medicare Services (CMS) to work with the states to develop quality reporting measures that are both useful and not overly burdensome.
The association also asks CMS to leave decisions about accrediting requirements for state Medicaid managed care programs in state hands and not to establish a national quality rating system for Medicaid managed care plans.
The regulation of Medicaid managed care plans is especially important to Pennsylvania safety-net hospitals because they care for so many Medicaid patients and managed care has become the primary means through which the state’s Medicaid program serves those patients.
Learn more about Medicaid directors’ recommendations for improving and regulating state Medicaid managed care programs in this National Association of Medicaid Directors correspondence with the Center for Medicaid and CHIP Services.

PA Safety Net Admin2014-10-27T06:00:19+00:00October 27th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Introducing…The Pennsylvania Department of Human Services

The Pennsylvania Department of Public Welfare is no more.
The state executive branch agency whose Office of Medical Assistance Programs has overseen Pennsylvania’s Medicaid program since its inception has officially been renamed the Department of Human Services.
The legislation requiring the name change takes effect in November and the department will phase-in its new name over time.
Read the press release from the governor’s office announcing the name change here.

PA Safety Net Admin2014-09-25T06:00:40+00:00September 25th, 2014|Uncategorized|Comments Off

GAO Questions Cost of Private Market Medicaid Expansion

Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs.
Or so says the U.S. Government Accountability Office (GAO).
Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded its traditional Medicaid program.
The GAO said that the U.S. Department of Health and Human Services (HHS) did not perform a budget-neutrality calculation, which would have revealed the increased cost, instead accepting the state’s alternative methodology for determining cost-effectiveness.
Arkansas officials rejected the GAO’s conclusions, asserting that newly eligible Medicaid recipients would have been unable to find providers willing to serve them under a traditional Medicaid expansion.
GAO concluded that CMS may be approving waivers that are not budget-neutral. CMS disagreed with this conclusion.
The GAO letter, written before HHS granted Pennsylvania its Medicaid waiver, specifically mentions Pennsylvania as another state seeking to expand its Medicaid program through the purchase of private insurance for newly eligible Medicaid recipients.
Learn more about the GAO analysis, why it was undertaken, and what it found by reading the GAO letter to the two members of Congress who requested the analysis.

PA Safety Net Admin2014-09-16T06:00:21+00:00September 16th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Aging Waiver Program Struggles With Backlog

A Pennsylvania program to help the elderly remain in their own homes instead of moving into nursing homes is struggling with backlogs.
The state’s Aging Waiver Program is a Medicaid program that enables those who meet certain medical and financial criteria to receive assistance in their own homes from nurses and home health aides rather than go into a nursing home.
Currently the program serves more than 32,000 people – nearly twice as many as it did six years ago – but applications are taking as long as two months to process. The biggest challenge is verifying financial eligibility, but the state recently added staff to help address the backlog.
Learn more about Pennsylvania’s Aging Waiver Program in this Pittsburgh Tribune-Review article.

PA Safety Net Admin2014-08-11T06:00:49+00:00August 11th, 2014|Pennsylvania Medicaid policy|Comments Off

IOM Releases Graduate Medical Education Report

‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”
So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.
The IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education. It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.
In the report, the IOM proposes six goals for improving GME financing.

Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. 
Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal 1. 
Provide transparency and accountability of GME programs, with respect to the stewardship of public funding and the achievement of GME goals. 
Clarify and strengthen public policy planning and oversight of GME with respect to the use of public funds and the achievement of goals for the investment of those funds. 
Ensure rational, efficient, and effective use of public funds for GME in order to maximize the value of this public investment. 
Mitigate unwanted and unintended negative effects of planned transitions in GME funding methods.

To fulfill these goals, the report offers three specific recommendations:

Investing strategically: Maintain Medicare GME funding at its current level, but modernize payment methods to reward performance, ensure accountability, and incentivize innovation in the content and financing of GME. The current Medicare GME payment system should be phased out. 
Building an infrastructure to facilitate strategic investment: Establish a two-part governance infrastructure for federal GME financing. A GME Policy Council in the Office of the Secretary of the Department of Health and Human Services should oversee policy development and decision making. A GME Center within the Centers for Medicare & Medicaid Services should function as an operations center with the capacity to administer payment reforms and manage demonstrations of new payment models. 
Establishing a two-part Medicare GME fund: Allocate Medicare GME funds to two distinct subsidiary funds—a GME Operational Fund to finance ongoing residency training activities and a Transformation Fund to finance development of new programs, infrastructure, performance methods, payment demonstrations, and other priorities identified by the GME Policy Council.

Graduate medical education is an important issue for the Pennsylvania safety-net hospitals that also are teaching hospitals. The state’s Medicaid program is an important source of medical education funding for these hospitals as well.
To learn more about why the study was undertaken, what problems it sought to address, what the IOM learned, and what it proposed, follow this link to the IOM’s web site and the complete report as well as a report summary.

PA Safety Net Admin2014-08-01T06:00:22+00:00August 1st, 2014|Pennsylvania Medicaid policy|Comments Off

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