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Archive for August 2018

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the July/August 2018 edition of its newsletter. Included in this edition are articles about: proposed changes in Medicaid-covered behavioral health services for children; the launch in southeastern Pennsylvania of Community HealthChoices, the state’s program of managed long-term services and supports for the dually eligible Medicare/Medicaid population; Community HealthChoices’ person-centered services plans; and changes in how individuals will seek health insurance for 2019 through the federal health insurance marketplace. Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy

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 … Read More

Posted in 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.

Posted in 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 … Read More

Posted in 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 … Read More

Posted in 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: incorrect fee-for-service payments from MCOs, where the MCO paid providers for improper claims, such as claims for … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid
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