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SNAPShots

PA Senate to Move on Medicaid Expansion

Pennsylvania state Senate leaders plan to bring a vote to expand the state’s Medicaid program to the Senate floor this week.
The bill, according to Senate leaders, will include conditions that will make it more palatable to more conservative Republicans and the governor.  Democrats are already thought to support Medicaid expansion.
While the bill is considered likely to enjoy solid support in the Senate, it is not clear whether the state House is as interested in Medicaid expansion as envisioned under the federal Affordable Care Act.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about the Senate bill, who is behind it, and what the bill says in this Centre Daily Times article.

2013-06-24T06:00:32+00:00June 24th, 2013|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off on PA Senate to Move on Medicaid Expansion

Will Medicaid Coverage Mean Access?

With many states preparing to expand their Medicaid programs and enroll unprecedented numbers of new people, it is not clear whether Medicaid coverage will lead to access to care.
That concern arises in the wake of a survey that found that only 43 percent of physicians accept Medicaid patients.  Other providers, moreover, may not be up to filling the gap:  the same survey found that only 20 percent of physician assistants and nurse practitioners serve Medicaid patients.
Thus, while more people than ever will have health insurance once the Medicaid expansion component of the Affordable Care Act takes effect, it is not clear whether those who find themselves newly insured will have reasonable access to medical services.
While the Affordable Care Act attempts to anticipate this challenge by raising the traditionally low fees that Medicare pays primary care physicians to the same level as those paid by Medicare for the next two years, it is not clear whether this new policy is working and if will have a lasting impact after the two-year experiment ends.
This could become a major challenge for Pennsylvania’s safety-net hospitals if the state eventually chooses to expand its Medicaid program.  To date, the state has chosen not to expand the program but has been discussing the possibility of doing so with federal officials.  The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about the survey and its implications in this Healthcare Finance News reportDoctor listening to patient.

2013-05-08T06:00:00+00:00May 8th, 2013|Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off on Will Medicaid Coverage Mean Access?

Medicaid Expansion Would Boost PA Economy and Pay for Itself, Report Says

A new study suggests that expanding Medicaid eligibility in Pennsylvania would create as many as 39,000 new jobs over the next seven years and generate enough new revenue to pay the state’s share of the expansion’s costs.
Or so says a new study by RAND Health.
According to the study, Medicaid expansion under the terms established by the Affordable Care Act would reduce Pennsylvania’s uninsured rate from the current 12.7 percent to 4.8 percent in 2016, spur $20 billion in economic growth by 2020, and generate more new tax revenue than the state would need to spend to pay its share of expansion’s cost once the federal share of expansion drops from 100 percent to 90 percent.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about the RAND Health report, and find a link to the study, in this Central Penn Business Journal article.

2013-04-01T06:00:54+00:00April 1st, 2013|Health care reform, Pennsylvania Medicaid policy|Comments Off on Medicaid Expansion Would Boost PA Economy and Pay for Itself, Report Says

Feds Offer New Carrot to Promote Medicaid Expansion

In their desire to persuade states to expand their Medicaid programs as called for in the Affordable Care Act, federal officials are now suggesting that states could use new federal Medicaid funds to enable Medicaid-eligible people to purchase private insurance.
Even though this was not envisioned in the  health reform law, the prospect of making greater use of the private sector appears to be appealing to many Republican governors who have otherwise been reluctant to commit their states to expanding their Medicaid programs.
Pennsylvania has no current plans to expand Medicaid eligibility, although there appears to be growing interest in doing so throughout the state.  Expansion would add approximately 500,000 people to the state’s Medicaid rolls, many of whom would be served by safety-net hospitals.  The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the commonwealth.
Read more about how this idea came about, why many states find it appealing, how it would work, and what the potential challenges are in this New York Times article.

2013-03-27T06:00:31+00:00March 27th, 2013|Health care reform, Safety-Net Association of Pennsylvania|Comments Off on Feds Offer New Carrot to Promote Medicaid Expansion

Sequestration Could Hit Southeastern PA Hospitals Hard

Hospitals in southeastern Pennsylvania could lose $50 million in patient revenue a year if the scheduled sequestration of federal spending takes effect on March 1.
At that time, all Medicare payments to hospitals would be cut two percent.
In addition, hospitals in that region could lose another $41 million from a comparable cut in National Institutes of Health (NIH) spending.
Safety-net hospitals located in southeastern Pennsylvania would suffer a significant proportion of both of these cuts.  Members of the Safety-Net Association of Pennsylvania (SNAP) located in this region include the Albert Einstein Medical Center, Hahnemann University Hospital, the Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn Presbyterian Medical Center, St. Christopher’s Hospital for Children, The Children’s Hospital of Philadelphia, and Thomas Jefferson University Hospital.
To learn more about how sequestration could affect one group of Pennsylvania safety-net hospitals, see this Philadelphia Inquirer articleFinancial graphs.

2013-02-27T06:00:15+00:00February 27th, 2013|Safety-Net Association of Pennsylvania|Comments Off on Sequestration Could Hit Southeastern PA Hospitals Hard

The Proposed FY 2014 State Budget: Part 5 of 7

Other Medical Assistance Issues

Pennsylvania Governor Tom Corbett recently unveiled his proposed state FY 2014 budget.  When he did, members of the Safety-Net Association of Pennsylvania (SNAP) immediately 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 a seven-day period, SNAP presents in this space 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.   Today, SNAP takes a look at what the proposed budget says about Medical Assistance issues not addressed in parts one through four of this series.
The proposed budget calls for a number of other changes in Medical Assistance spending, including:

  • New spending of $55.9 million in total funds for what has been labeled a “public-private collaboration project” under the outpatient budget that is offset by a $28.5 million savings within the same budget line.
  • Savings in the inpatient, outpatient, and capitation (managed care/HealthChoices) budget lines associated with “audit enhancements.”
  • Savings associated with the state outsourcing its third-party liability functions, including payment recovery.
  • A doubling of state spending on information technology to bring Pennsylvania’s Medical Assistance eligibility systems and technology up to the requirements of the Affordable Care Act.
  • An increase of $27 million for mental health services and $3.2 million for state mental health services block grant funding
  • A savings of more than $8 million associated with instituting premiums for so-called loophole children who participate in the state’s PH-95 program for selected Pennsylvanians with autism.

Tomorrow:  The Children’s Health Insurance Program (CHIP)
Financial graphs
 

2013-02-18T06:00:10+00:00February 18th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off on The Proposed FY 2014 State Budget: Part 5 of 7

The Proposed FY 2014 State Budget: Part 4 of 7

Medical Assistance Supplemental Payments

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 a seven-day period, SNAP presents in this space 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.   Today, SNAP takes a look at what the proposed budget says about Medical Assistance supplemental payments.
Governor Corbett has proposed no change in the state’s spending on OB/NICU, burn center, and trauma center payments.  Because of the reduction in the state’s federal medical assistance percentage (FMAP, or the rate at which the federal government matches state Medicaid spending), total payments to hospitals in each of these programs stands to decline 1.7 percent.
The total amount available for tobacco uncompensated care payments is slated for a 3.3 percent decrease, from $56.5 million to $54.7 million.  This reflects two factors:  a 1.7 percent decrease in money available from the tobacco settlement fund and the state’s reduced FMAP rate.
While total funding for physician practice plans is slated for an 18.9 percent decrease, this appears to reflect a decision to remove from this category one hospital that was added to the group last year.  This would mean funding for physician practice plans would remain the same – as it would for academic medical center disproportionate share hospital payments (DSH).
Critical access hospital payments have been targeted for a $500,000 cut in state funds.
Inpatient DSH, outpatient DSH, medical education, and Community Access Fund payments do not have their own line-items in the proposed budget and therefore cannot be specifically identified in that budget.  Traditionally, however, when an administration is contemplating changes in these payments, it indicates so in the programmatic revision commentary section of the budget document.  In the case of these four payments that are so vital to so many Pennsylvania safety-net hospitals, they were not mentioned in the programmatic revision commentary.
Next Monday:  Other Medical Assistance Issues
Financial paperwork
 

The Proposed FY 2014 State Budget: Part 3 of 7

Hospital Assessment Revenue

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 a seven-day period, SNAP presents in this space 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.   Today, SNAP takes a look at what the proposed budget says about revenue from the state-wide and Philadelphia hospital assessments.
The proposed budget assumes $633 million in revenue from the state-wide hospital assessment and another $148 million from the Philadelphia hospital assessment.  While the revenue anticipated from the Philadelphia assessment appears to be in line with prior years’ collections, the revenue associated with the state-wide assessment appear to be greater than in the past.  It is unclear whether this apparent increase reflects the state’s intention either to increase its share of assessment revenue or to raise the assessment rate.
Tomorrow:  Medical Assistance Supplemental Payments
Harrisburg, PA capital building

2013-02-14T06:00:06+00:00February 14th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off on The Proposed FY 2014 State Budget: Part 3 of 7

The Proposed FY 2014 State Budget: Part 2 of 7

The Major Medical Assistance Spending Categories

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 a seven-day period, SNAP presents in this space 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.   Today, SNAP takes a look at what the proposed budget says about the major Medical Assistance spending categories.
The proposed budget calls for what on the surface appear to be sizeable decreases in state funds available for Medical Assistance inpatient and outpatient funding ­– a decrease of 44.9 percent in inpatient and 31.6 percent in outpatient funding.  What this actually represents, however, is the state’s continued shift toward greater use of managed care through its expanded HealthChoices program, which has been budgeted for a 5.7 percent increase in funding.  Overall, the combined changes in the inpatient, outpatient, and capitation lines of the proposed budget represent a 1.4 percent decrease in the amount of state money available for physical health services.

Click on the accompanying chart to see the proposed changes in the state’s funding allocations for the major categories of Medical Assistance physical health spending from FY 2013 to FY 2014.
Tomorrow:  Hospital Assessment Revenue
 

2013-02-13T06:00:22+00:00February 13th, 2013|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2014 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off on The Proposed FY 2014 State Budget: Part 2 of 7

PA Says No to Medicaid Expansion (For Now)

Pennsylvania Governor Tom Corbett has at least temporarily closed the door to the Medicaid expansion envisioned in the Affordable Care Act.
On the same day that he presented his proposed state budget for the 2014 fiscal year, Mr. Corbett wrote to U.S. Health and Human Services Secretary Kathleen Sebelius, explaining that

At this time, and without serious reforms, it would be financially unsustainable for Pennsylvania taxpayers, and I cannot recommend a dramatic Medicaid expansion.

See Governor Corbett’s letter to Secretary Sebelius here.
At the same time, however, the governor did not rule out the possibility of a change of heart sometime in the future.  His proposed budget document explains that

 At this time, analysis continues on the financial sustainability related to potential expansion of the Medicaid program.  The Department of Public Welfare continues to have a dialogue with the U.S. Department of Health and Human Services (HHS) in an effort to obtain clarification and answers on a number of issues, including whether essential reforms of the Medicaid program can be accomplished to improve the health of our citizens and the effectiveness of the program.  The department is currently reviewing the recently released proposed regulations on eligibility and benefits from HHS.  While due diligence continues, no decision has been made at this time.

 The administration intends to engage in an informed dialogue with the public and the legislature on whether expansion of the Medicaid program is prudent, affordable and the right choice for the commonwealth.  When a final decision is made, it will be done in consultation with the Legislature and it may require modifications to be made and accounted for in the budget.

The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.

2013-02-07T06:00:12+00:00February 7th, 2013|Health care reform, Pennsylvania Medicaid policy, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off on PA Says No to Medicaid Expansion (For Now)
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