Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs.

Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs.

This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings of $6394 a year, mostly because of fewer hospitalizations.

As a Medicaid expansion state, Pennsylvania and the safety-net hospitals that serve its low-income communities have contributed to this encouraging trend.

Learn more about how Medicaid expansion is improving the health of low-income people with diabetes and lowering health care spending in this California Healthline report or go here to see the Health Affairs study “Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medications” on which that report is based.

Filed under: Affordable Care Act, Pennsylvania safety-net hospitals

PA Outlines Implementation of Association Health Plans

In a letter to the U.S. Secretary of Health and Human Services and Secretary of Labor, the Pennsylvania Insurance Department has outlined how it plans to implement at the state level the recent federal regulation governing association health plans.

In the letter, state Insurance Commissioner Jessica Altman notes ambiguities in the federal regulation and describes how the state Insurance Department intends to address those ambiguities and other aspects of the federal regulation that she believes are unclear.

See the Insurance Department’s news release on this issue here and read Commissioner Altman’s letter here.

Filed under: Uncategorized

PA Looking at Social Determinants of Health

One of the emerging trends in health care is a greater focus on what are called the “social determinants of health” – factors and conditions  in individuals’ lives that may affect both their health and their ability to obtain the medical services they need to stay healthy or recover when they are sick or injured.

Pennsylvania’s Department of Human Services, which runs the state’s Medicaid program, has increased its focus on the social determinants of health as it looks to Medicaid providers and Medicaid managed care plans to do more than provide medical services:  it wants them to join with others in addressing the social determinants of health of the communities they serve.

Recently, Pennsylvania Department of Human Services deputy executive secretary Leesa Allen, former director of the state’s Medicaid program, participated in a panel discussion to talk about the social determinants of health and how the state is approaching this issue.  Go here to listen to that conversation, which was broadcast by WITF, a Harrisburg-based public radio station.

Filed under: Pennsylvania Medicaid

Battle Over Medicaid Work Requirements Not Over

The Secretary of Health and Human Services is not accepting a recent federal court ruling as the final word on Medicaid work requirements.

Although the court ruled against a federally approved plan to permit the state of Kentucky to implement a work requirement for some able-bodied Medicaid recipients, HHS Secretary Alex Azar insists that his department will continue to support work requirements for Medicaid beneficiaries.

Azar told a Heritage Foundation audience that

We suffered one blow in district court in litigation, but we are undeterred.  We’re proceeding forward…We’re fully committed to work requirements and community participation in the Medicaid program…we will continue to litigate, we will continue to approve plans, we will continue to work with states.  We are moving forward.

Twice in the past two years, proposals to impose a work requirement on Pennsylvania Medicaid recipients failed in the state legislature.  The issue is likely to arise again.

Learn more about the ruling against Kentucky’s Medicaid work requirement, which was approved by HHS, and the federal government’s determination to enable states to impose such requirements in this Washington Post article.

Filed under: Federal Medicaid issues, Pennsylvania Medicaid

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers.

This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs.

The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers.  The two biggest risks, the GAO concluded, were:

  1. incorrect fee-for-service payments from MCOs, where the MCO paid providers for improper claims, such as claims for services not provided; and
  2. inaccurate state payments to MCOs resulting from using data that are not accurate or including costs that should be excluded in setting payment rates.

The GAO traces some of these problems to a delay in the Centers for Medicare & Medicaid Services’ planned Medicaid managed care guidance to states; limited implementation of new auditing practices CMS introduced in 2016; and CMS’s failure to account for overpayments to providers when it reviews state capitation rates for Medicaid managed care plans.

To address these shortcomings, the GAO report recommends that CMS:

  1. expedite issuing planned guidance on Medicaid managed care program integrity;
  2. address impediments to managed care audits; and
  3. ensure states account for overpayments in setting future MCO payments.

The vast majority of Pennsylvania’s non-long-term care Medicaid spending is through Medicaid managed care.

Learn more about the study – why it was undertaken, how it was conducted, what it found, and what it recommended – by going here to see the GAO report Medicaid Managed Care:  Improvements Needed to Better Oversee Payment Risks.


Filed under: Federal Medicaid issues, Pennsylvania Medicaid

Former PA Gubernatorial Candidate Lands at CMS

Paul Mango, who earlier this year ran unsuccessfully for the Republican nomination for governor of Pennsylvania, has joined the Centers for Medicare & Medicaid Services as chief principal deputy administrator and chief of staff.

Mango previously worked as a health care consultant for more than 25 years, including for the McKinsey & Company consulting firm.  Among his past Pennsylvania clients were hospitals and insurers.

Filed under: Uncategorized

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs.

According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible.

Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it.

Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion.

Learn more about the studies, their results, and their significance by going here to see the Health Affairs report “No Association Found Between The Medicaid Primary Care Fee Bump And Physician-Reported Participation In Medicaid and here for the study “Physicians’ Participation In Medicaid Increased Only Slightly Following Expansion.”

Filed under: Affordable Care Act, Federal Medicaid issues

CMS: Not Done With Medicaid Work Requirements

Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients.

Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C.

The Washington Examiner reports that at that event, Verma said that

We are looking at what the court said.  We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals.

CMS currently has applications from eight states to establish new Medicaid work requirements.  While Pennsylvania is not among them, some members of the state’s General Assembly unsuccessful advocated such a requirement last year and continue calling for the introduction of a work requirement in the state’s Medicaid program.

Learn more about the legal obstacles Medicaid work requirements have encountered and how CMS views those obstacles in this Washington Examiner article.


Filed under: Uncategorized

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the June 2018 edition of its monthly newsletter.

Included in this edition are articles about:

  • Changes in Pennsylvania Medicaid’s medical transportation program governing non-emergency transportation.
  • The renewal of the state’s hospital tax and an increase in that tax.
  • Challenges surrounding the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports, in southwestern Pennsylvania.
  • Information about the launch of Community HealthChoices in southeastern Pennsylvania.
  • A provision in a recent bill modifying the state’s human services code that calls for the Department of Human Services to develop a new, outcomes-based program for hospitals and Medicaid managed care plans that will be oriented toward preventing potentially avoidable medical events.

Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.


Filed under: long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

HHS Chief Says 340B Changes are Coming

Health care providers and drug manufacturers should expect changes in the section 340B prescription drug discount program in the near future.

That was the message conveyed by Health and Human Services Secretary Alex Azar during a recent conference held by the 340B Coalition.

The 340B program, which provides discounts on the prescription drugs dispensed on an outpatient basis by eligible providers to their low-income patients, has become increasing controversial in recent years as it has expanded and pharmaceutical companies have objected to the discounts they must provide.

Among the changes Azar suggested are coming are greater accountability among participating hospitals for how they use the savings they derive from the discounts and a narrowing of the difference between the prices hospitals pay for the drugs and their average sales price, which Azar said is currently too great.  CMS recently imposed a 28 percent reduction of Medicare payments to participating providers for drugs dispensed to 340B-qualified patients.

To qualify for participation in the program, providers must serve especially high proportions of low-income patients.  All Pennsylvania safety-net hospitals participate in the program.

Learn more about Secretary Azar’s comments from this Healthcare Dive article.

Filed under: 340b, Uncategorized

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2012 Safety-Net Association of Pennsylvania