Since January of last year, Pennsylvania’s Medical Assistance program has limited categorically needy adult recipients over the age of 21 to six prescriptions a month.
While Medical Assistance has established a process for seeking exceptions to this limit, the Department of Public Welfare has now published a new MA Bulletin that lists exceptions that will automatically be granted.
Find that list in this
MA Bulletin.
The Pennsylvania Department of Public Welfare (DPW) has updated its Medical Assistance fee-for-service fee schedule for a variety of physician services, podiatrist services, surgical services, and more.
See a complete list of changes here
, in the Pennsylvania Bulletin.
A Pennsylvania judge has concluded that the state violated its own constitution when it ended the adultBasic program without making other provisions to use tobacco settlement funds to help lower-income adults.
The Corbett administration ended adultBasic in 2011 and used money previously designated for that program to support Pennsylvania’s Medicaid program. Commonwealth Court judge Dan Pelligrini declared the laws that ended the program unconstitutional and said the state must use the money for adultBasic or a similar program.
Learn more about the court decision, the circumstances surrounding the challenge to the end of adultBasic, and what might happen next in this York Daily Record article.
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
.
Enrollment in Pennsylvania’s Medical Assistance program declined by 55,000 people during the second half of 2012.
While it is not clear why enrollment dropped so significantly, one theory is that some people who lost their General Assistance cash assistance – a casualty of the state’s FY 2013 budget – did not reapply for Medical Assistance. Others point to the inability of county assistance offices to process applications effectively.
Read more about the drop in Medicaid enrollment in Pennsylvania and its possible causes in this Philadelphia Inquirer 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
The Pennsylvania Department of Public Welfare has published Medical Assistance Bulletins that explain to providers how to pursue their Medicaid electronic health record (EHR) incentive payments for FY 2013.
The bulletin for eligible hospitals can be found here and the bulletin for eligible physicians and other providers can be found here.
The Pennsylvania Health Law Project has published its January 2013 newsletter, which includes articles on the state’s budget process (including a schedule of upcoming budget hearings), the continued expansion of HealthChoices, changes in Medicaid-covered behavioral health and substance abuse services, limits on Medical Assistance benefits, the overall benefits of Medicaid expansion for Pennsylvania, and more.
Go here
to download the Pennsylvania Health Law Project’s Health Law PA News.
Will he or won’t he?
That question is still on the minds of many as Pennsylvania Governor Tom Corbett continues neither to declare that the state will expand its Medicaid program as provided for in the Affordable Care Act nor to confirm the suspicion of most observers that he will choose not to expand the program beyond its current 2.2 million recipients.
As of right now, 12 states appear to be undecided about Medicaid expansion. The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion.
For a closer look at the situation in Pennsylvania, including an account of which interest groups are for expansion and which are not as enthusiastic as one might expect, read this column
from the Central Penn Business Journal.