Healthy PA Healthy Pennsylvania is Governor Corbetts plan to ensure - - PowerPoint PPT Presentation

• Healthy Pennsylvania is Governor Corbett’s plan to

ensure that Pennsylvanians have increased access to quality, affordable health care.

• Builds on Pennsylvania's World Class Health Care

System and is a Pennsylvania solution to improve Medicaid and increase access to health care for PA.

• Focuses on Three Priorities
• Improving Access
• Ensuring Quality
• Providing Affordability

Healthy Pennsylvania Access – Affordability - Quality

Healthy PA

• Get All Kids Insured. Nearly 95% of Pennsylvania’s children have health care
• coverage. Although this is good, we can do better. Healthy PA works to ensure that

all of Pennsylvania’s children have access to quality, affordable health care coverage that best meets their needs.

Specific Initiatives: Elimination of CHIP waiting period; CHIP reauthorization; Expanded CHIP marketing and outreach

• Promote Access to Primary Health Care. Every Pennsylvanian should have timely

access to a family doctor or health care provider. Healthy PA works to increase access to preventive and primary care throughout the state.

Specific Initiatives: Continued support for primary care clinics, primary care residency slots and family medicine focused loan forgiveness

• Enhance Care Delivery Through Technology. Healthy PA will promote greater use
• f health IT, including EHR and telemedicine, to improve care coordination and bring

quality specialty health care services to all Pennsylvanians.

Specific Initiatives: Telemedicine summit and regulatory reforms; Develop internal HIE

Healthy PA

IMPROVING ACCESS Healthy Pennsylvania Access – Affordability - Quality

• Support Older & Disabled Pennsylvanians. Healthy PA seeks to develop a more

effective and coordinated long term care and support system in Pennsylvania by making significant investments and redesigning services to allow, if appropriate, individuals to remain in their homes and communities.

Specific Initiatives: Investment in waiting list, nursing home and home & community-based care initiatives; Convening long term care collaborative

• Promote Good Public Health. Improving the health of Pennsylvania starts in our
• communities. Healthy PA supports public health efforts that engage individuals in

their communities and promote healthy choices.

Specific Initiatives: Convene Healthy Pennsylvania Summit; Support and expand community-based health partnerships

• Combat Prescription Drug Abuse. Under Healthy PA, Pennsylvania will work with

families, providers and communities to alleviate the growing health, financial and public safety concerns attributable to prescription drug abuse.

Specific Initiatives: Create enhanced Prescription Drug Monitoring Program; Expand “Drug Take-Back” program across the state

Healthy PA

ENSURING QUALITY Healthy Pennsylvania Access – Affordability - Quality

• Continue Medical Liability System Reform. Defensive medicine and malpractice

costs continue to place a financial burden on the state’s health care system, but generates little in terms of improved outcomes or better health care.

Specific Initiatives: Enact “Apology Rule”

Healthy PA

PROVIDING AFFORDABILITY Healthy Pennsylvania Access – Affordability - Quality

Expenditures

• Approximately $21.9 billion in total funds spent annually on

Medicaid

• $8.0 billion in state funds
• $11.9 billion in federal funds
• $2.0 billion in other funds
• Total Medicaid spend accounts for 73% of the Department’s

budget and 27% of the entire General fund budget

• Pennsylvania is second highest in the nation with respect to the

percentage of the state’s general fund going towards Medicaid

Pennsylvania Medical Assistance

• 2.2 million individuals enrolled into Medical Assistance
• 17.9% of Pennsylvanians receive Medical Assistance
• 7.8% increase in MA enrollment in the past three years

Providers

• Statewide managed care for physical and behavioral health

services

• Over 68,000 MA providers across the state
• 17,411,352 claims processed annually in Medical Assistance

PA Medicaid Overview

Healthy Pennsylvania Access – Affordability - Quality

• Ambulance
• Birthing Center Services
• Certified Registered Nurse

Practitioner (CRNP)

• EPSDT Screens,
• Family Planning Services
• Federally Qualified Health Centers

(FQHC)/Rural Health Clinics (RHC)

• Home Health Services
• Inpatient Hospital
• Inpatient Hospital - Drug & Alcohol
• Inpatient Hospital – Psychiatric
• Inpatient Hospital – Rehabilitation
• Laboratory Service
• Medical Supplies and Equipment
• Non-Emergency Medical Transportation

(MATP)

• Nurse Midwife Services
• Nursing Facility Services for >21
• Outpatient Hospital - Short Procedure

Unit

• Outpatient Hospital Services - Clinic

(includes Rehabilitation)

• Outpatient Hospital Services -

Emergency Room Services

• Outpatient Psychiatric Partial

Hospitalization Services

• Physician Services
• X-Ray

PA Medicaid Overview – Mandatory Medicaid Services Healthy Pennsylvania Access – Affordability - Quality

• Ambulatory Surgical Center
• Audiologist Services
• Behavioral Health Rehabilitation Services
• Case Management – MA
• Case Management – Targeted,
• Chiropractor
• Dentist Services
• Eyeglasses
• Funeral Director Services
• Hearing Aids
• Home and Community Based Waivers
• Hospice
• Intermediate Care of Other Related

Conditions

• Intermediate Care of the Intellectually

Disabled

• Optometrist Services
• Other Rehabilitative Services
• Outpatient Clinic Services - Drug & Alcohol
• Outpatient Clinic Services - Independent

Medical Clinic/Surgical Center

• Outpatient Clinic Services – Psychiatric
• LIFE Services
• Personal Care
• Pharmaceuticals - Non-Family Planning
• Podiatrist Services
• Private Duty Nursing
• Psychologist Services
• Renal Dialysis
• Residential Treatment Facility Services
• Social Worker Services
• Therapy – Occupational, Physical and Speech

PA Medicaid Overview – Optional Pennsylvania Services Healthy Pennsylvania Access – Affordability - Quality

9

Percent of Federal Poverty

Annual Income

Income Guidelines (FPIG)

for a 4 person household

300% 250% $58,875 200% $47,100 185% $43,568 160% 138% $32,499 133% $31,322 100% $23,550 77% $18,134 50% 47% $11,069 26% $6,123

MAWD, BCCTP, Subsidized CHIP at 75%

PA MEDICAL ASSISTANCE and CHIP INCOME LIMITS FOR 2013

Childless Adults Categorically Needy Medically Needy Elderly and Disabled Children (Ages 6 to 19) Children (Ages 1 to 5) Pregnant w omen & Children under age 1 Free CHIP General Assistance

PA Medicaid Overview – Eligibility Levels by Income Healthy Pennsylvania Access – Affordability - Quality

Healthy PA

PROVIDING AFFORDABILITY

• Reform Pennsylvania’s Medicaid Program. Healthy PA includes a common sense

approach to reforming the Medicaid program in order to provide affordable, quality health care in a fiscally sustainable manner.

Specific Initiatives: Seek federal approval for the following Medicaid Reforms: Adult Benefit Package Redesign, Cost Sharing & Personal Responsibility, and Job Training & Work Search;

• Reinvest Savings to Increase Access for Uninsured. If Pennsylvania is successful

in reforming its Medicaid program, the savings realized can be reinvested and through working with the federal government, we can increase access for the uninsured.

Specific Initiatives: Explore using private option to enroll “newly eligible” uninsured adult Pennsylvanians in private health insurance plans through the federal exchange

Healthy Pennsylvania Access – Affordability - Quality

For information on health insurance

• ptions in PA, visit

www.pahealthoptions.com For more information, visit www.insurance.pa.gov

Healthy Pennsylvania Access – Affordability - Quality