Archive for February 2015
Even though the rate at which non-Medicaid recipients inappropriately use hospital emergency rooms exceeds the rate of inappropriate use among Medicaid patients, a number of states are launching efforts to reduce ER overuse among their Medicaid recipients. Medicaid patients currently use – as distinguished from inappropriately use – hospital ERs at twice the rate of privately insured patients, typically for a number of reasons: they are less healthy than insured patients; they have a more difficult time finding primary care physicians who will treat them; and they have jobs that prevent them from going to doctors during ordinary office hours. To address overuse, states are trying a number of approaches. Nearly half of the states are imposing or increasing Medicaid … Read More
Health insurance plans that do not include hospital benefits fail to meet employers’ obligations under the Affordable Care Act and will leave companies that provide such insurance vulnerable to fines of $3000 a year for every worker covered by such a plan, the Centers for Medicare & Medicaid Services (CMS) announced last week. But in recognition that some employers had arranged such coverage well in advance, the federal government is permitting companies that committed to such plans by November 4 to use them for the next year, after which they must be replaced. In addition, employees who seek to compensate for that shortcoming in their coverage by purchasing supplemental insurance will be eligible for tax credits based on their income. … Read More
Nearly 472,000 Pennsylvanians enrolled in health insurance during the Affordable Care Act’s open enrollment period, which ended on February 15. Some were new enrollees and some were automatically renewed; a breakdown is not yet available. For a closer look at Pennsylvanians obtaining health insurance during the open enrollment period and the national picture, see this Central Penn Business Journal article.
“Super-utilizers” – people who visit hospital emergency rooms often and are admitted to hospital beds with unusual frequency – are costing the health care system millions of dollars a year. According to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4), super-utilizers – people admitted to the hospital at least five times in a year – while just three percent of hospital patients in FY 2014, accounted for 17 percent of the state’s Medicaid expenditures for inpatient care ($216 million) and 14 percent of Medicare inpatient expenditures ($545 million). In all, 18 percent of Medicaid hospital admissions in Pennsylvania in FY 2014 were for super-utilizers. PHC4 identified the three leading reasons for these admissions as heart failure, … Read More
Along with the Wolf administration’s decision to exit the Healthy Pennsylvania Medicaid expansion in favor of a more conventional approach comes a new web site dedicated to that expansion: HealthChoices PA. The new HealthChoices PA site features sections that describe the program and address the immediate implications of the state’s shift from Healthy Pennsylvania to HealthChoices PA. It also offers an FAQ, resources for consumers and providers, and a gateway for applicants. The address of the new site is http://www.healthchoicespa.com. Find it here.
With the inauguration of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff. The fourth of those papers, released this week, addresses the importance of innovation in addressing the challenges safety-net hospitals face in leading the way to serving Pennsylvania’s growing Medicaid population. The paper describes the new demands being made of hospitals by insurers, government, and others; tools through which to pursue innovation; the goals of future innovation; and the role that SNAP and safety-net hospitals must play in that innovation. The first paper, “What is SNAP?”, was an introduction … Read More
Pennsylvania Governor Tom Wolf has taken the first step to short-circuit the state’s Healthy Pennsylvania Medicaid expansion in favor of a more traditional approach to Medicaid expansion. In a news release issued yesterday, the Wolf administration announced that it will withdraw Pennsylvania’s request for a second tier of medical benefits for Medicaid recipients because it intends to change the state’s program to offer the same benefits to all participants. This will be the first step toward building the state’s Affordable Care Act-authorized Medicaid expansion around the state’s HealthChoices-oriented structure instead of the private market insurance plans favored by Mr. Wolf’s predecessor, former Governor Tom Corbett. Learn more about the new administration’s first step toward changing the state’s Medicaid expansion effort … Read More
Through early February, 430,000 Pennsylvanians have enrolled in health insurance plans through the federal health insurance marketplace. Of that number, 81 percent qualified for at least some financial assistance with their premiums. Through December, more than two-thirds obtained insurance for no more than $100. To learn more about how Pennsylvanians are using the federal exchange to purchase health insurance, see this Central Penn Business Journal article.
The Pennsylvania Health Law Project has released its January 2015 newsletter. Among the articles in it are pieces on the launch of the Healthy Pennsylvania Medicaid expansion; an update on the temporary extension of the state’s Select Plan for Women; information on how Medicaid recipients who believe they need the state’s new Medicaid “Healthy Plus” benefits package can seek that enhanced coverage; and news on who should consider shifting from a health insurance plan purchased on the federal marketplace to Medicaid. Find the newsletter here.