Archive for Pennsylvania Medicaid

 

COVID Drives Major Increase in PA Medicaid Enrollment

Medicaid enrollment in Pennsylvania has risen nearly 14 percent in the past year as rising unemployment resulting from COVID-19 drives people to turn to the state for health insurance.

As a result, Pennsylvania has added nearly 400,000 people to its Medicaid rolls in the past year.  Today, 3.2 million Pennsylvanians are enrolled in the state’s program, although among them are approximately 250,000 who would have been dropped from the program except for a federal requirement that the state not drop people from the program in exchange for a major increase in federal aid for the state’s program.

As a result of the increase, the state’s Department of Human Services, which runs its Medicaid program, has asked the legislature for nearly $1 billion in supplemental funding to help finance its services for this expanded enrollment through the rest of the state’s FY 2021 year.

Learn more about the past year’s increase in Medicaid enrollment, who the new enrollees are, and how the state is accommodating them in the Philadelphia Inquirer article “A huge spike in Medicaid enrollment in Pa. shows how devastating the coronavirus has been.”

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Pennsylvania to Introduce Medicaid PDL on January 1

Starting on January 1, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services, which administers the state’s Medicaid program.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon:  the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1.  Here’s why.”

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PA Delays New Long-Term Care Program

The Pennsylvania Department of Human Services will delay for six months the introduction of its Community HealthChoices program in southeastern Pennsylvania.

The program’s implementation in the five-county Philadelphia area, scheduled to begin on July 1, 2018, has been pushed back to January 1, 2019.

Preparations are currently under way to launch Community HealthChoices in 14 southwestern Pennsylvania counties on January 1, 2018.

Community HealthChoices is a new state program of managed long-term services and supports for Pennsylvanians over the age of 55 who are eligible for both Medicare and Medicaid.

Learn more about the program’s delay in southeastern Pennsylvania in this Philadelphia Inquirer article.

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PA Governor Vetoes Medicaid Work Requirement

Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.

 Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.

Pennsylvania Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance.

The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s hospital assessment.

HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements in calendar year 2017, 15 percent in 2018, and 30 percent in 2019. The Hospital Quality Incentive Program seeks to facilitate achieving these goals.

The Pennsylvania Department of Human Services, which administers the state’s Medicaid program, has posted on its web site an explanation of the new program, a presentation on the program, and an FAQ. Find them here.…