Pennsylvania safety-net hospitals Archives - Page 16 of 20 - Safety-Net Association of Pennsylvania

Safety-Net Hospitals Hurt More by Readmissions Reduction Program

Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study.
According to the study,

Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.

Because they care for so many more low-income patients than the typical hospital, Pennsylvania’s safety-net hospitals are especially vulnerable to the Medicare hospital readmissions reduction program’s financial penalties.
The study, “The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations,” was published recently in Health Services Research and can be found here.

PA Safety Net Admin2014-01-22T06:00:20+00:00January 22nd, 2014|Affordable Care Act|Comments Off

Providers Receive Expanded Authority to Extend Presumptive Medicaid Eligibility

While hospitals and providers in 33 states have long enjoyed the ability to extend presumptive eligibility for Medicaid to children or pregnant women, that authority is now being extended in some states to any adults whose income appears likely to fall below 138 percent of the federal poverty level.
The extension of this authority comes via the Affordable Care Act, which also offers states the option of expanding Medicaid eligibility for their residents. Individual states decide whether to extend this authority, which is typically wielded by hospitals, schools, clinics, other providers of care to the Medicaid and CHIP population, Head Start programs, and others.
This policy could benefit many Pennsylvania safety-net hospitals because they serve much higher proportions of low-income patients than the average hospital. Currently, 52 acute-care hospitals in the state are authorized to determine presumptive eligibility.
To learn more about changes in extending presumptive eligibility to low-income patients, see the policy brief “Hospital Presumptive Eligibility” from the Robert Wood Johnson Foundation and the publication Health Affairs.

PA Safety Net Admin2014-01-16T12:31:52+00:00January 16th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Concern About Churn

State government and health insurers are worried about a process called “churning” – people moving back and forth between Medicaid and private insurers as their income changes. With more people now qualified for Medicaid, observers believe that as many as nine million people may move back and forth between Medicaid and private insurance in 2014.
In the past, people whose income rose enough to lose their Medicaid eligibility often could not afford private insurance and joined the ranks of the uninsured. Now, some will be eligible for subsidies that may enable them to purchase health insurance on their own. People who move back and forth between insurers, however, may be at risk of gaps in coverage and loss of continuity of care.
Churn may be especially prevalent in the lower-income communities served by Pennsylvania’s safety-net hospitals.
How does churn work and what are the states doing to anticipate and address it? Learn more in this Washington Post article.

PA Safety Net Admin2014-01-08T06:00:58+00:00January 8th, 2014|Affordable Care Act|Comments Off

Enough Docs to Go Around?

With nine million people expected to enroll in Medicaid in the coming year, questions are arising about whether there will be enough physicians to serve them.
Across the country there has long been a shortage of physicians, and especially specialists, willing to serve Medicaid patients because of how poorly most state Medicaid programs pay those doctors. Now, with more people than ever expected to become insured by Medicaid, it is not clear whether the existing physician pool will be able to serve them very effectively.
The Affordable Care Act anticipated this problem and included a two-year increase in Medicaid payments to physicians, a move designed to raise Medicaid rates to the same level as those paid by Medicare. But states have been slow to make these payments, which were expected to begin last January, and physicians recognize that this will only be a temporary raise. As a result, fewer physicians than expected have agreed to serve Medicaid patients.
Whether this might pose a problem for Pennsylvania and its safety-net hospitals could depend on whether Governor Tom Corbett’s “Healthy Pennsylvania” proposal is fully implemented and the state expands Medicaid enrollment through the private health insurance market. One of the selling points of the Healthy Pennsylvania proposal has been that working through private insurers, rather than Medicaid managed care organizations or the state itself, should result in better payments for health care providers, thereby making those providers more willing to serve Medicaid patients.
See this New York Times article for a look at these and other questions related to the upcoming Medicaid expansion and the ability of the medical community to meet an unprecedented demand for care.

PA Safety Net Admin2013-12-03T06:00:13+00:00December 3rd, 2013|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Enrolling Homeless in Medicaid Poses Challenges, Offers Hope

Enrolling the homeless in Medicaid poses numerous logistical challenges for government, providers, and caregivers but also offers the prospect of improving the lives of those who gain access to care.
Many low-income, homeless adults will be eligible for Medicaid for the first time in states that expand Medicaid eligibility under the Affordable Care Act, but enrolling them in the program can be difficult: they can be hard to find, hard to convince to apply, and hard to enroll because they lack such basics as a mailing address and telephone number.
Yet bringing health care to such individuals could greatly improve their lives and perhaps help address their homelessness by ending the financial stresses that resulted in homelessness or improving their health to the point where they qualify for housing services.
While Pennsylvania still has not expanded its Medicaid program, it now appears to be on a cautious path toward doing so in the near future. If it does, enrolling the homeless in Medicaid also offers the prospect of the state’s safety-net hospitals receiving Medicaid reimbursement for the care they provide to such patients, typically through their emergency departments.
Learn more about the challenges of enrolling the homeless and Medicaid and the benefits of Medicaid eligibility for the homeless in this New York Times article.

PA Safety Net Admin2013-11-26T06:00:25+00:00November 26th, 2013|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Millions to Fall Into Coverage Gap

More than five million adult Americans will fall into the Affordable Care Act’s Supreme Court-created coverage gap in states that have chosen not to expand their Medicaid programs.
In those 26 states, adults whom the reform law intended to be covered by Medicaid will still earn too much money to qualify for Medicaid yet also will fall below the income level needed to qualify for Affordable Care Act health insurance subsidies.
This gap was created when the Supreme Court made the reform law-mandated Medicaid expansion optional for individual states, and so far, 26 states have chosen not to expand their Medicaid programs. The result, according to a new issue brief from the Kaiser Commission on Medicaid and the Uninsured, is that 5.2 million low-income adults whom the law intended to enroll in Medicaid will remain uninsured.
More than 280,000 of these people reside in Pennsylvania, which has not yet expanded its Medicaid program. Many will continue to be served by the state’s private safety-net hospitals, which will not be paid for the care they provide.
To learn more about these people and why they will remain uninsured, read the study “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Find the study here, on the web site of the Kaiser Family Foundation.

PA Safety Net Admin2013-10-16T10:08:33+00:00October 16th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

DPW Reaches Out to Stakeholders Over Tobacco $ Loss

Pennsylvania Department of Public Welfare Secretary Beverly Mackereth has sent the following message to health care providers and other stakeholders that will be affected by the state’s loss of $180 million in national tobacco settlement money as a result of a recent arbitrary decision.

October 2, 2013

I am reaching out to you, our valued stakeholder, to provide you with information about the potential impact of the recent tobacco master settlement agreement (MSA) decision. Please understand this legal action and the potential next steps are in no way a reflection of the quality of your work or actions as a partner with the Department of Public Welfare (DPW). This decision stems back to circumstances that occurred in 2003.

As you may be aware, the Pennsylvania Attorney General’s office recently notified the Governor’s Budget Office that the state’s annual share of the tobacco MSA will be reduced by an estimated $180 million, or 60 percent of the state’s base tobacco payment, as a result of a decision by an arbitration panel to address claims from 2003.

While this decision has immediate impacts to Pennsylvania’s health and human services programs, the Corbett Administration is committed to maintaining direct services and mandatory healthcare programs. I would like to reassure you that we are working diligently to ensure services will continue without interruption for all Pennsylvanians.

The reduction will occur in the state’s April 2014 MSA payment, which supports spending in the current fiscal year. This has forced the state to freeze discretionary funding from the MSA. As of now the only DPW program affected will be uncompensated care payments to hospitals.

Please be assured, this course of action was not arrived at lightly. Immediate action is necessary in the face of such a dramatic decrease in revenues due to the MSA decision. Moving forward, the Attorney General’s Office is preparing an appeal of the decision.

The attached press release provides additional information regarding this issue. I appreciate your time and understanding as we work together on this issue.

Sincerely,
Beverly Mackereth, Secretary
Department of Public Welfare

The loss of uncompensated care payments will pose a major challenge to the state’s safety-net hospitals, which are the primary providers of care to the uninsured in Pennsylvania and the primary recipients of these funds.
Go here for the press release cited above.

PA Safety Net Admin2013-10-04T06:00:00+00:00October 4th, 2013|Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

CMS Proposes Basic Health Program

The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposal to establish what it is calling a “Basic Health Program” that gives states “the option to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace.”
The program, established in the Affordable Care Act, is designed for people who do not qualify for Medicaid or CHIP and whose incomes are between 133 percent and 200 percent of the federal poverty level. Legal residents who are non-citizens whose incomes are below 133 percent of the federal poverty level also qualify. The federal government is picking up 95 percent of the cost of this program.
A new proposed regulation addresses who is eligible, how enrollment works, enrollee financial responsibilities, the program’s basic benefits, and more.
Such a program could prove beneficial to many low-income residents of communities served by Pennsylvania’s safety-net hospitals.
Read about the new Basic Health Program in this CMS fact sheet, which also includes a link to the entire proposed regulation.

PA Safety Net Admin2013-09-27T06:00:53+00:00September 27th, 2013|Affordable Care Act|Comments Off

CMS Finalizes Medicaid DSH Cuts

The Centers for Medicare & Medicaid Services (CMS) has issued a final Medicaid disproportionate share (Medicaid DSH) regulation that cuts federal spending on Medicaid DSH $500 million in FY 2014 and $600 million in FY 2015.
The Medicaid DSH cuts were mandated by the Affordable Care Act in anticipation of every state expanding its Medicaid program. The reform law’s Medicaid expansion mandate was later made optional by a Supreme Court ruling.
Medicaid DSH cuts will hurt all Pennsylvania safety-net hospitals, and the Safety-Net Association of Pennsylvania (SNAP) has conveyed its opposition to the cuts to CMS and also has asked members of Pennsylvania’s congressional delegation to support current legislation to delay the implementation of both Medicaid DSH and Medicare DSH cuts for two years.
While the Affordable Care Act calls for Medicaid DSH cuts through 2020, the new regulation covers only two years. CMS has indicated that it will review its reduction methodology for future years.
Read more about the Medicaid DSH cut, why it was made, the objections to it, and future Medicaid DSH cuts in this CQ Healthbeat article presented by the Commonwealth Fund.

PA Safety Net Admin2013-09-20T06:00:29+00:00September 20th, 2013|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Gap in Reform Law Could Leave Many Low-Income People Uninsured

When the Supreme Court gave states discretion over whether to expand their Medicaid programs under the Affordable Care Act, it unintentionally created a gap in potential coverage options for many low-income people that may leave many of those people without affordable health insurance.
According to a new report from the Commonwealth Fund, the 2010 reform law anticipated that everyone with incomes below 133 percent of the federal poverty level would be covered by Medicaid. Individuals and families with incomes between 133 percent and 399 percent of the federal poverty level could use new federal subsidies to help purchase private health insurance.
In states that are not expanding their Medicaid programs, people with incomes between 133 percent and 399 percent of the federal poverty level will still be able to take advantage of federal premium subsidies. People with incomes less than 133 percent of the federal poverty level but who do not qualify for their state’s Medicaid program – qualification criteria vary from state to state – will not be eligible for the same subsidies as many who earn more than them because the reform law assumed that all such individuals would be covered by Medicaid.
According to the Commonwealth Fund, this unanticipated gap in the reform law means that as many as 42 percent of people who suffer from periodic or chronic lack of insurance and who live in states that are not expanding their Medicaid programs will not benefit in any way from Affordable Care Act insurance reforms.
Pennsylvania is one of the states in which this problem will occur because the state is not expanding its Medicaid program. It almost certainly will require Pennsylvania’s safety-net hospitals to provide more uncompensated care than originally expected when the reform law was enacted.
Read more about the unintended consequences of the Supreme Court’s decision and the choice by some states not to expand their Medicaid programs in In States’ Hands: How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans, a new report from the Commonwealth Fund.

PA Safety Net Admin2013-09-09T06:00:22+00:00September 9th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

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