Pennsylvania safety-net hospitals Archives - Page 17 of 20 - Safety-Net Association of Pennsylvania

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

Medicaid Expansion to Ease Hospitals’ Uncompensated Care But Not in PA

Hospitals in states that expand their Medicaid programs under provisions of the Affordable Care Act should see a reduction in their uncompensated care once people begin applying for Medicaid benefits.
That will not be happening in Pennsylvania, however, because the state is not expanding eligibility for its Medicaid program.
In states that do expand their programs, hospitals will continue to lose money serving Medicaid patients because Medicaid payments seldom cover the cost of the services hospitals provide. Demand for Medicaid services will grow in these states, moreover, as more people become eligible for benefits and some who have not had regular access to care for years begin to use their new benefits to address long-standing medical problems.
Recent published reports suggest that the Corbett administration is working on an expansion plan, to be negotiated with the federal government, and that this plan may be revealed to the public this fall.
Michigan became the most recent state to decide to take advantage of the Affordable Care Act and expand its Medicaid program. For a look at how Medicaid expansion will affect hospitals in that state, see this Detroit Free Press article .

PA Safety Net Admin2013-09-04T13:40:02+00:00September 4th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Insurance Subsidies Will Be Common

Nearly half of all individuals and families expected to turn to health insurance exchanges for insurance policies under the Affordable Care Act will be entitled to federal subsidies to help pay their premiums.
Those subsidies will average more than $5500 per family and cover two-thirds of a premium’s overall cost.
These subsidies will be critical for Pennsylvania’s safety-net hospitals, which currently find themselves providing significant amounts of uncompensated care to low-income but working individuals and families that cannot afford health insurance today.
These were among the findings of a recent Kaiser Family Foundation analysis. Read more about the analysis and the future that awaits individuals and families in the new individual health insurance market in this CQ HealthBeat article presented by the Commonwealth Fund.

PA Safety Net Admin2013-08-22T06:00:31+00:00August 22nd, 2013|Affordable Care Act|Comments Off

Tackling Medicaid “Super-Users”

All Pennsylvania safety-net hospitals have them: a relatively small number of Medicaid patients who are constantly in need of care.
Five percent of all Medicaid beneficiaries account for more than half of all Medicaid expenditures. The challenges such patients pose are legitimate: many have multiple chronic conditions.
How best to serve these patients? The Center for Medicaid and CHIP Services has been looking into this problem and the Center for Medicare and Medicaid Innovation and the Robert Wood Johnson Foundation have been underwriting demonstration programs designed to find better ways to care for these patients.
Read more about the problem and these models, and find a direct link to a Center for Medicaid and CHIP Services advisory bulletin on the subject, here on the Fierce Healthcare web site.

PA Safety Net Admin2013-08-01T06:00:23+00:00August 1st, 2013|Uncategorized|Comments Off

SNAP Comments on Observation Rate Proposal

The Safety-Net Association of Pennsylvania has submitted a formal comment letter to the state’s Department of Public Welfare in response to the department’s expressed interest in establishing an observation rate in the state’s Medical Assistance fee-for-service program.
DPW expressed this interest in a June 29 Pennsylvania Bulletin notice.
SNAP supports the creation of an observation rate, and in its letter it outlines how it believes DPW should go about developing a rate that is fair to hospitals.
Safety-net hospitals have a special interest in this issue because observation rate candidates enter hospitals through their emergency rooms and safety-net hospitals typically have among the busiest emergency rooms in the communities they serve.
Read SNAP’s observation rate comment letter here .

PA Safety Net Admin2013-07-23T16:12:30+00:00July 23rd, 2013|Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

DSH Delay Bill Picks Up Co-Sponsors

A bill that would delay implementation of Medicaid disproportionate share (Medicaid DSH) and Medicare DSH payment cuts for two years now has 46 co-sponsors in the U.S. House of Representatives.
H.R. 1920, the DSH Reduction Relief Act of 2103, would delay for two years the DSH cuts mandated by the Affordable Care Act.
The rationale underlying the proposal is that between some states choosing not to expand their Medicaid programs as the reform law envisioned and the delay in imposing the mandate for businesses to help their employees with health insurance, the expected rise in the rate of insurance will be slower than expected and hospitals that care for especially large numbers of low-income patients will have a greater need for DSH revenue than originally anticipated.
Because they serve so many more low-income patients than the typical acute-care hospital and Pennsylvania is not among the states planning to expand eligibility for Medicaid, the state’s safety-net hospitals are especially interested in this issue and have conveyed their support for the bill both to Congress and to the administration.
Read more about the proposed DSH delay bill and its prospects for passage in this CQ HealthBeat article presented by the Commonwealth Fund.

PA Safety Net Admin2013-07-19T06:00:20+00:00July 19th, 2013|Health care reform|Comments Off

Low-Income Patients Prefer Hospital ERs

Even when they have health insurance, many low-income patients prefer receiving care in hospital emergency rooms rather than private physician offices or clinics.
According to a new study published in the journal Health Affairs, low-income patients cite convenience, cost, and quality as reasons for their preference.
These findings emerge at a time when government and insurers are working hard to find ways to reduce overuse of costly hospital emergency room services.
Emergency room overuse is especially a problem for many of Pennsylvania’s safety-net hospitals, which often have among the busiest emergency facilities in the regions they serve.
Read more about the new study in this report from the Robert Wood Johnson Foundation and find the study itself here, on the Health Affairs web site.

PA Safety Net Admin2013-07-16T06:00:59+00:00July 16th, 2013|Uncategorized|Comments Off

Closer Scrutiny Needed for Medicaid Managed Care?

With Medicaid expansion about to begin in many states and managed care expected to be a major tool in that expansion, advocates are suggesting that states need to do a better job of monitoring the performance of the managed care plans that serve their Medicaid population.
Currently, according to advocates, different states monitor their Medicaid managed care plans for different aspects of their performance and some states do a better job than others. With relatively few federal standards, state-to-state comparisons either are difficult or impossible.
Thirty-six states and the District of Columbia have at least some Medicaid patients enrolled in managed care plans, and together, those plans receive about one out of every four dollars that the states and the federal government spend on Medicaid.
With nearly all of the state’s Medicaid recipients now in managed care plans, this issue is of special interest to Pennsylvania’s safety-net hospitals.
Read more about the issue, the challenges, and why this issue is now receiving attention in this Kaiser Health News report .

PA Safety Net Admin2013-07-10T06:00:18+00:00July 10th, 2013|Pennsylvania Medicaid policy|Comments Off

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