Archive for Pennsylvania Medical Assistance


Hepatitis C Treatment Challenges PA’s Medicaid Program

The cost of treating Medicaid patients who suffer from hepatitis C is posing a challenge to Pennsylvania’s Medicaid program.

As new, more expensive, but more effective hepatitis C drugs reach the market, the state’s costs for treating Medicaid patients with the disease have doubled since 2013.

Meanwhile, the state continues to consider at what point in the progression of their hepatitis C Medicaid patients should be offered the most expensive drugs.
Current guidelines are evolving both in the state and nationally, with medical authorities and federal regulators weighing in with their views. Recently, an advisory committee to the Pennsylvania Department of Human Services offered its own recommendations for criteria for prescribing the most expensive drugs.

Learn more about the issue, the cost of treatment, and current Pennsylvania Medicaid policy on when hepatitis C patients must be offered the most expensive drugs and how that policy might be changing in this Pittsburgh Post-Gazette article.…

PA Re-bids Medicaid Managed Care Contracts

The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program.

The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January.

The new contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years.   Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes.

With a projected value of about $17 billion, the RFP is expected to attract interest from national organizations that have not necessarily served Pennsylvania’s Medicaid population in the past.

To learn more about the state’s HealthChoices plans, see this news release from the Department of Human Services and this Philadelphia Inquirer article. Find the RFP itself here.…

439,000 Added to PA Medicaid Rolls

150,000 Pennsylvanians have enrolled in Medicaid since the Wolf administration officially launched its HealthChoices expansion on April 27.

Added to the 289,000 who enrolled during the Corbett administration’s Healthy Pennsylvania program, that means about 439,000 Pennsylvanians have obtained Medicaid coverage since the state expanded its Medicaid program as authorized by the 2010 federal health care reform law.

To learn more about the latest Medicaid enrollments, their financial impact on the state, and how the HealthChoices expansion works, see this Wolf administration news release.…

PA Governor Seeks to Improve Services for Elderly

Pennsylvania seniors would have improved access to home- and community-based care services under a new proposal announced by Governor Tom Wolf.

Under the proposal, Pennsylvania would:

  • make home- and community-based long-term-care services available to 5500 more Pennsylvania seniors;
  • phase in Medicaid managed long-term care;
  • improve long-term living waiver enrollment and the service plan development process;
  • make greater use of home modifications;
  • implement an online home care registry; and
  • ensure that seniors have choices about where they age.

The Wolf administration envisions achieving this through a combination of budget, legislative, and executive actions.

To learn more about the new governor’s plans for long-term care for the elderly, see its news release on the subject here.…

“Super-Utilizers” Costing Health Care System, Report Shows

“Super-utilizers” – people who visit hospital emergency rooms often and are admitted to hospital beds with unusual frequency – are costing the health care system enormous amounts of money.

According to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4), super-utilizers – people admitted to Pennsylvania acute-care hospitals 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 federal Medicare inpatient spending ($545 million). In all, 18 percent of Medicaid hospital admissions in Pennsylvania in FY 2014 and 10 percent of Medicare admissions were for super-utilizers.

PHC4 identified the three leading reasons for these admissions as heart failure, septicemia, and mental health disorders.

Learn more about super-utilizers and their impact on hospital admissions and health care spending in the PHC4 report, which can be found here.…