Pennsylvania Medicaid Archives - Page 15 of 21 - Safety-Net Association of Pennsylvania

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

GAO Questions State Medicaid Financing

States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).
According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources. Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.
Pennsylvania uses such funding mechanisms, including its gross receipts tax on Medicaid managed care organizations and state-wide and Philadelphia hospital assessments.
Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures. In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.
Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.

PA Safety Net Admin2014-07-31T06:00:42+00:00July 31st, 2014|Pennsylvania Medicaid policy|Comments Off

PA Reverses “MAWD” Elimination

The Corbett administration has reversed an earlier decision and decided to retain Pennsylvania’s Medical Assistance for Workers With Disabilities program, frequently referred to as “MAWD.”
MAWD provides low-cost health insurance to Pennsylvanians with disabilities who do not otherwise qualify for Medical Assistance because they work and have earnings.
The program, which serves about 34,000 people, costs the state $7 million a year. A Department of Public Welfare spokesman said preserving the program is consistent with the Corbett administration’s Healthy Pennsylvania initiative.
Learn more about MAWD here and about the decision to retain it in this Insurance Net News article.

PA Safety Net Admin2014-07-29T06:00:28+00:00July 29th, 2014|Healthy PA, Pennsylvania Medicaid laws and regulations|Comments Off

SNAP Warns of Challenges Ahead

As Pennsylvania lawmakers contemplate the state’s FY 2015 budget, the Safety-Net Association of Pennsylvania has issued a new position paper reminding those officials of the challenges the state’s private safety-net hospitals face in the current environment and the need for adequate, stable funding as they tackle those challenges.
Among those challenges are low-income patients with distinct needs, major cuts in federal Medicare payments that especially target safety-net hospitals, and powerful economic forces marshaled by government, insurers, and others that seek to compel hospitals to deliver care in different ways, be paid differently for their efforts, align their incentives differently with other providers, and invest heavily in information technology.
Pennsylvania’s safety-net hospitals are prepared to do all these things, but to achieve such progress, they need financial stability and predictability: they need to know that their Medical Assistance funding will not be at risk as the state experiences various budget challenges.
Read SNAP’s perspective on these issues in its new position paper, “Pennsylvania’s Safety-Net Hospitals: The Need for Stable and Predictable Funding Amid Increasing Challenges,” which can be found here, on SNAP’s web site.

PA Safety Net Admin2014-06-30T06:00:31+00:00June 30th, 2014|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

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