Affordable Care Act, Health Disparities, Health Equity, Health Justice, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania

PA HB 2138 Heads to the Senate

Pennsylvania House Bill 2138 which would allow for work requirements in Medicaid has successfully been voted out of the Health Committee and will come to a full vote by the Senate. It is critical that PA residents contact their state senator now to urge him or her to vote NO on HB 2138.

This bill will unnecessarily punish families and children living in poverty at the administrative expense of taxpayers. Check out our past blog to remind yourself of how the law would work.

The Urban Institute did a comprehensive review of the literature on work requirements in public assistance programs and found that the evidence shows these programs fail to meet their stated goals at the detriment of individuals losing life-saving benefits.

Summary of Work Requirements in TANF, SNAP, and Housing Assistance Programs as of December 2017

This article was cross-posted at http://www.helpmlp.org

Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania, Social Determinants of Health, Uncategorized

Pennsylvania Lawmakers Move Forward with Medicaid Work Requirements

On April 16th the Pennsylvania House of Representatives voted to pass House Bill 2138 providing work requirements as a condition of receiving Medical Assistance (Pennsylvania’s Medicaid program). This bill is one of several currently making their way through the Pennsylvania legislature that would detrimentally affect low-income families and children, cost the state hundreds of millions of dollars to implement, and generally serve no valid public interest other than to deter individuals who need life saving benefits from getting them.

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House Bill 2138 mandates that Medical Assistance enrollees must work 20 hours per week or complete twelve “job training program-related activities” per month in order to maintain the benefit. Individuals who fail to comply with this requirement will lose their eligibility for three months initially, then six months, and then nine months. Individuals who are 19 years and older must verify compliance with the work requirements on a biannual basis and by request from the State. Furthermore, the State can delay enrollment if the individual is found to have failed to comply with these requirements.

Certain populations are exempt from the work requirements including: full-time high school students; individuals receiving temporary or long-term disability benefits; individuals under 18 years of age and 65 and over; pregnant women; individuals receiving Supplemental Security Income (SSI); primary caregivers for dependents six years of age or younger; and primary caregivers for individuals who are permanently disabled or in hospice care. Additionally, individuals who are experiencing a crisis, serious medical condition, or temporary condition that prevents the enrollee from actively seeking employment, including domestic violence and substance use disorder, are exempt.

The process in which individuals seeking exemption must participate in, including paperwork and verification requirements, is unclear based on the bill alone; however, the current Secretary of Human Services, Teresa Miller, reported that it would cost $650 million and an additional 300 staff members to enact these changes in her department. Now that the bill has passed the House, it moves on to the Pennsylvania Senate for a vote.

Policy experts find that work requirements harm families and individuals who are already working the most. Moreover, work requirements rarely lead to additional employment, but often lead to disenrollment, stripping vulnerable individuals of critical benefits and services. One study found, “four to five years after such requirements were implemented, about 70 percent of the welfare recipients who went off welfare because of work requirements had no income, or had income at or below 50 percent of the poverty line.”

Since the Centers for Medicare and Medicaid Services (CMS) changed its policy on work requirements in January 2018, Kentucky, Arkansas, and Indiana have had Medicaid waivers approved that include work requirements. Pennsylvania is among several other states in the process of establishing a pathway for work requirements.

It is critical that Pennsylvania residents and residents of other states seeking to implement these changes reach out to their elected officials urging them to stop their assault on poor families. The Pennsylvania Health Access Network has an easy form to find your State Senator and submit a letter urging her or him to vote NO on work requirements.

*This article was cross-posted on http://www.helpmlp.org.

Affordable Care Act, Health Policy, Medicaid, Philadelphia

Healthy or Unhealthy PA? Advocates Weigh in on Gov. Corbett’s Plan to Reform Medicaid in Pennsylvania

Governor Corbett’s Healthy PA proposal to reform the Medicaid system in Pennsylvania through a Medicaid 1115 Demonstration Waiver has been met with harsh criticism by many and for good reason.  Healthy PA (known fondly by some as Unhealthy PA) would disrupt the current cost-efficient Medicaid program in Pennsylvania by enrolling newly eligible individuals and many currently existing Medicaid beneficiaries into private health insurance plans.

So, why is this a problem? A couple of reasons:

  1. Historically, private health insurance plans do a poor job of providing coverage for specific types of illnesses. For example, the lack of private coverage for mental health and substance use disorders called for the enactment of federal legislation known as the Mental Health Parity and Addiction Equity Act.
  2. Private health insurance companies spend much more money on administrative costs and profits than Medicaid. This means that administering the Medicaid program through the private  insurance industry will mean less bang for the tax payers’ buck.

Additionally, Governor Corbett’s plan includes many controversial provisions that are likely to face close scrutiny by the federal government:

  1. A monthly premium for individuals making as little as 50% of the federal poverty level (less than $6,000/year).
  2. Work search requirements (no other state in the United States has such a provision). As a side note this would apply to certain individuals who meet “medically frail” criteria, but that are otherwise “able bodied.”
  3. A $10 co-payment for “non-emergent” emergency use.
  4. Harsh punitive measures that would disqualify households from Medicaid if the fail to pay their monthly premiums.
  5. Benefit limits that would substantially reduce scope of coverage that is currently offered through Medicaid.

Perhaps, most importantly, the plan is not set to go into effect until January 1, 2015 (assuming it would get approval by the federal government by this time) meaning hundreds of thousands of Pennsylvanians will fall into a “coverage gap” qualifying for neither Medicaid or a tax subsidy through the health insurance marketplace.  These individuals will have no source of meaningful health coverage for the entire year.  Not to mention, delaying expansion until 2015 will cost the Commonwealth 2.5 billion dollars of potential funding.

Advocates representing many different groups and organizations have voiced their opinion on the plan.  Not all of the testimonies provided and comments submitted were adamantly opposed to the plan, but many were. The following is a list of organizations’ comments and/or testimony on the plan:

  1. Community Legal Services of Philadelphia
  2. Project HOME
  3. Public Citizens for Children and Youth
  4. Disability Rights Network of Pennsylvania
  5. Hospital and Healthsystem Association of PA (HAP) 
  6. Delaware Valley Healthcare Council of HAP
  7. Safety Net Association Pennsylvania
  8. Community Behavioral Health of Philadelphia (CBH)
  9. Pennsylvania Association of County Drug and Alcohol Administrators
  10. Pennsylvania Association of County Administrators for Mental Health and Developmental Services
  11.  The Alliance of Community Service Providers (Testimony January 3rd)
  12. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (DBHIDS)
  13. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (Appendix A- Questions to PA DPW on the plan)
  14. The Philadelphia Coalition
  15. Pennsylvania Budget & Policy Center
  16. Todd Keefer, York County resident
  17. Center for Advocacy for the Rights and Interests of  the Elderly (CARIE)
  18. Pennsylvania Partnerships for Children (PPC) 
  19. Rehabilitation and Community Providers Association (RCPA)
  20. The ARC 
  21. Pennsylvania Homecare Association
  22. Public Interest Law Center of Philadelphia (testimony of staff attorney, Benjamin Geffen, on January 3rd)
  23. A coalition of organizations representing individuals with disabilities
  24. Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC)
  25. Juvenile Law Center (JLC)
  26. Pennsylvania Association of Medical Assistance Manged Care Organizations
  27. Women’s Law Project
  28. Greater Philadelphia Chamber of Commerce
  29. Joanne Grossi, Health and Human Services (HHS) Region III (House Democratic Policy Committee Meeting: January 8, 2014)
  30. Joan Alker, Center for Children and Families, Georgetown University (House Democratic Policy Committee)
  31. Jim Willshier, Pennsylvania Association of Community Health Centers (House Democratic Policy Committee)
  32. Sol B. Vazquez-Otero, Disability Rights Network of Pennsylvania (House Democratic Policy Committee)
  33. Jacob Bowling, Mental Health Association of Southeastern PA (House Democratic Policy Committee)

    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commowealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commonwealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
Affordable Care Act

Healthy PA v.2 (a.k.a. Pennsylvania’s Medicaid 1115 Demonstration Proposal)

In mid-September Governor Corbett released a concept paper, Healthy Pennsylvania, outlining his proposed plan to reform the Medicaid program in Pennsylvania. This twelve-page document was a predecessor to a more formal document known as a Medicaid Section 1115 Demonstration Waiver. In order for the Governor to implement his Healthy Pennsylvania plan he must seek and get approval from CMS for the 1115 demonstration waiver. 

Today Governor Corbett published the Commonwealth’s draft proposal for a Medicaid Section 1115 Demonstration Waiver. 1115 waivers allow states to be flexible within their Medicaid programs through a demonstration project; however, goals of demonstration project must be congruent to the goals of the Medicaid program overall.  

Governor Corbett is using the 1115 waiver as a mechanism to reform the Medicaid program in Pennsylvania. Even though the Governor’s proposal calls for expanding Medicaid eligibility to individuals with incomes up to 133% of the federal poverty level, his plan should not be confused with traditional Medicaid expansion. The plan would go into effect beginning 2015 and would last for five years prior to renewal. Corbett’s plan involves several controversial provisions including:

  • Providing premium assistance to newly eligible and some currently eligible Medicaid enrollees to purchase health insurance through the private market or new Health Insurance Marketplace rather than providing Medicaid through traditional Medicaid Managed Care Organizations currently operating in the state
  • Imposing a work search requirement on individuals who are eligible for Medicaid
  • Requiring individuals to pay a monthly cost-share on a sliding scale basis. Individuals with incomes as low as 51% of the federal poverty level (less than $6000/year) would be required to pay 
  • Requiring a $10 co-payment for inappropriate emergency room use
  • Consolidating the existing Medicaid benefit plans in the state into two Alternative Benefit Plans that will mirror “commercial-like” coverage (benefits are generally not as comprehensive as those provided through traditional Medicaid, especially for behavioral health services)

Since the proposal was released earlier today, I am still making my way through its details. The state is required to hold a 30 day notice and comment period as well as host public hearings. There will be six public hearings as well as two webinars in which individuals can voice their opinion about the proposal. I encourage everyone take the time to read the proposal and attend a public hearing

Affordable Care Act, Health Reform, Medicaid, Pennsylvania

Advocates weigh in on Corbett’s Healthy PA plan

Pennsylvania is moving forward with seeking approval by the federal government for its Healthy PA plan to reform the Medicaid system and expand Medicaid eligibility in the Commonwealth. The Pennsylvania Department of Public Welfare accepted comments on the plan in its current form as a concept paper.

When he announced the Healthy PA plan in mid-September, Governor Corbett made it clear that he did not view it as Medicaid expansion, but instead, Medicaid reform.  The plan proposes to consolidate the existing Medicaid benefit packages in the state into two alternative benefit plans mirroring commercial-like coverage.  While the plan does call for an expansion of Medicaid eligibility for individuals up to 138% of the federal poverty level, new Medicaid beneficiaries would be enrolled in private health insurance plans offered through the Marketplace.  The Pennsylvania plan contains other controversial proposals such as requiring a work-search requirement, attaching a monthly premium, and imposing a $10 co-payment for “inappropriate” emergency room usage.

Pennsylvania advocates expressed grave concern about the legality and impact the proposed plan would have on individuals:

In its comments, Community Legal Services (CLS) identifies issues with the plan’s proposal to attach a monthly premium on individuals making as little as 50% of the federal poverty level (less than $6000/year).  Additionally, CLS cites guidance from CMS regarding its position on imposing barriers to eligibility including work-search requirements.

Echoing many of the concerns expressed by CLS, the Consumer Sub-Committee of the Medical Assistance Advisory Committee (MAAC), under its counsel, the PA Health Law Project, expressed concerns with the monthly premium, emergency use co-payment, and work-search requirements of the plan. The Consumer Sub-Committee and the Disability Rights Network also called for clarity regarding the process of defining “medically frail” under the proposed plan. 

The PA Coalition of MCOs’ 12-page list of questions illustrates the considerable need for clarity regarding the plan’s proposals.  The Coalition’s comprehensive list of questions range from inquiring about the state’s timeline to the range of benefits and options that will be available to Medicaid-eligible individuals enrolled in private health insurance plans.

The next procedural step Pennsylvania must take in order to implement an alternative Medicaid expansion plan is seeking CMS approval of a Section 1115 waiver. Once the waiver is drafted, Pennsylvania must hold public hearings and have a formal notice and comment period of at least 30 days.  To date, the only state to receive approval by CMS to implement an alternative Medicaid expansion plan is Arkansas.

Links to other organizations’ submitted comments:

Affordable Care Act, Education, Health Reform, Medicaid, Pennsylvania, Philadelphia, Uncategorized

Affordable Care Act (ACA) Education & Outreach

This weekend I had the opportunity to discuss the Affordable Care Act (ACA) with Pennsylvania Senator Vincent Hughes and Philadelphia Department of Behavioral Health & Intellectual disABILITY Services Commissioner Arthur Evans on Philadelphia radio show Philly Speaks on 100.3 FM. The show gave us a chance to demystify “Obamacare” and what it really means for individuals. A few of the key messages that were expressed include:

  • Getting insurance coverage is essential for many individual and societal reasons.
  • The new Health Insurance Marketplace provides an opportunity for individuals to purchase health insurance on a more “level playing field” than in the past.
  • Through the Marketplace individuals could receive financial assistance to purchase coverage.
  • The Marketplace will screen individuals for public and private health insurance options and financial assistance to purchase insurance.
  • Individuals with behavioral health needs (mental health and substance use challenges) will have an increased opportunity to access services due to the Affordable Care Act’s provisions.
  • Expanding Medicaid in Pennsylvania is a “no brainer” and will be a huge missed opportunity if the state administration does not act soon.
  • Healthcare.gov, localhelp.healthcare.gov, and 1-800-318-2596 are valuable resources for individuals to learn more about their options and places to get in-person assistance.

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Affordable Care Act, Essential Health Benefits, Health Policy

The time is now for final rules re: mental health parity

The time is now for final rules re: mental health parity

This NY Times article illustrates the need for final rulemaking from the federal government on the issue of mental health parity.  While the Affordable Care Act strengthens existing parity laws by mandating substance use and mental health services be covered under the Essential Health Benefits provision, defining and enforcing parity has proven to be a challenge.