Archive for September 2014
With only 60 days until approximately 600,000 newly eligible Pennsylvanians can begin enrolling in the state’s Medicaid program on December 1, the state still has not clarified some aspects of its Healthy Pennsylvania Medicaid expansion program. The newly eligible, for example, will be classified into high-risk or low-risk health plans – but the criteria for making those classification decisions remain unknown. Also unknown is exactly what benefits the newly eligible will be entitled to receive. In addition, the state is thought to be in negotiations with federal officials about reducing the benefits that the 2.2 million Pennsylvanians already eligible for Medicaid may receive. For a closer look at these and other issues that remain to be addressed before Pennsylvania expands … Read More
A new report suggests that education is more important to an individual’s overall health than access to health care. According to the Virginia Commonwealth University’s Center on Society and Health, More education means better health – in part because more education brings better jobs, improved access to health insurance, and higher earnings that can help pay for medical expenses and a healthier lifestyle. Conversely, people with less education tend to have more challenges accessing health services – lower rates of health insurance coverage and less money to afford copayments and prescription drugs; they are also more likely to live in low-income neighborhoods with limited access to primary care providers. Improved access to health care may improve overall health but it … Read More
The Pennsylvania Department of Public Welfare is no more. The state executive branch agency whose Office of Medical Assistance Programs has overseen Pennsylvania’s Medicaid program since its inception has officially been renamed the Department of Human Services. The legislation requiring the name change takes effect in November and the department will phase-in its new name over time. Read the press release from the governor’s office announcing the name change here.
The non-partisan federal agency charged with advising Congress, the Department of Health and Human Services, and the states on matters involving Medicaid and the Children’s Health Insurance Program (CHIP) met last week in Washington, D.C. The Medicaid and CHIP Payment and Access Commission (MACPAC) addressed a number of CHIP-related issues during its September 18-19 meetings, including the future of the program, its funding, state experiences with CHIP changes, and consumer protections. MACPAC also looked at a variety of Medicaid issues, including state Medicaid expansions through premium assistance, enrollment so far in 2014, the Centers for Medicare & Medicaid Services’ Medicaid program integrity plan, early experiences of new enrollees, and future reductions in Medicaid disproportionate share payments (Medicaid DSH). CHIP and … Read More
Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs. Or so says the U.S. Government Accountability Office (GAO). Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded … Read More
The Centers for Medicare & Medicaid Services (CMS) has posted more information about its offer to settle hospital appeals of Medicare denials of payments for short hospital stays. The offer, made last week, seeks to help CMS with an 18-month backlog of hundreds of thousands of appeals from acute-care and critical access hospitals. Hospitals willing to drop their appeals are eligible to receive 68 cents on the dollar for the value of the cases in dispute. The offer is available only for cases in which Medicare’s auditors rejected hospital claims for inpatient reimbursement for short hospital stays and then categorized the cases in question as outpatient care. Hospitals that wish to take advantage of the CMS offer must drop their … Read More
Nearly 80,000 low-income Pennsylvanians insured through the state’s General Assistance program will need to switch to private option Medicaid plans once the Healthy Pennsylvania Medicaid expansion takes effect next year. These individuals – generally, adults whose income is less than 44 percent of the federal poverty level but who have no children and meet other limited criteria – can begin enrolling in private option insurance plans on December 1 and will need to be enrolled by January 1, 2015, when the General Assistance program ends. Because of their extremely low income, these participants will not be required to pay insurance premiums. Learn more about the end of General Assistance and the state’s plans for continuing to serve this population in … Read More
Faced with an 18-month backlog of hundreds of thousands of appeals on cases in which auditors say hospitals billed Medicare for inpatient services that should have been billed at outpatient rates, the Centers for Medicare & Medicaid Services (CMS) is offering hospitals a deal: drop your appeals and accept a payment of 68 percent of the amount in dispute. Under the offer, acute-care and critical access hospitals have until October 31 to accept CMS’s terms, and once the paperwork is completed, they should receive their payments within 60 days. Hospitals must be willing to relinquish all of their short stay-related claims; they cannot seek payment for some but continue to appeal others. The offer has both appeal and risk: on … Read More
In a letter to the editor of the York Daily Record, Pennsylvania Department of Welfare Secretary Beverly Mackereth has outlined the rationale for the Corbett administration’s “Healthy Pennsylvania” health care reform plan and its approach to expanding access to Medicaid services. In the letter, Secretary Mackereth stresses the importance of a program tailored to Pennsylvania and describes the thinking behind the state’s approach to benefit packages, encouraging enrollees to engage in healthy behaviors, Medicaid premiums, and the use of private health insurance instead of the general expansion of Medicaid many other states are employing. See Secretary Mackereth’s letter to the York Daily Record here.
Hospitals and charitable groups such as the United Way are exploring the possibility of paying the health insurance premiums of uninsured patients who come through hospital doors. Such an approach would enhance access to care for the uninsured while helping hospitals get paid for care they will be providing regardless of whether the patients in question have health insurance. Such a practice is not entirely new. A United Way organization in Wisconsin raised $2 million to help low-income residents purchase health insurance and hospital groups in New York and Florida are exploring a similar approach. Health insurers oppose the idea, maintaining that hospitals selectively choosing whom to help will skew the pool of insured people toward those with greater health … Read More