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The Centers for Medicare and Medicaid Services approved the Healthy Pennsylvania plan Thursday. This handout lays out, from the state's perspective, what it will look like. More here: http://www.witf.org/news/2014/08/7-questions-and-answers-about-healthy-pennsylvania.php
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Institute Prescription Drug Monitoring Program
Promote Good Public Health
Support Older Pennsylvanians &
Persons with Disabilities
Advance Telemedicine
Promote Access to Primary Health Care
Get All Kids Insured
Reform PAs Medical Liability System
Reform Pennsylvanias Medicaid Program
Healthy Pennsylvania Plan
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HPA Chronology
ACA passed in 2010. US
Supreme Court ruling
in 2012
April 2, 2013 Gov. met with
Secretary Sebelius on PA specific solution
Sept. 16, 2013 Governor launched Healthy
Pennsylvania
Dec. 2013 Jan. 2014 DPW held 7 Public
hearings across state & 2 webinars; 1,000 attendees & 170 live
testimonies
Feb. 19, 2014, Healthy
Pennsylvania waiver officially
submitted to CMS.
May 8, 2014, DPW released
Request for Application for
private coverage to insurers
June 10, 2014, DPW received bids from nine PA health care
insurers
August 28, 2014 Pennsylvania
and CMS reach agreement on
Healthy Pennsylvania
This is a Pennsylvania-specific plan to reform Medicaid, protect taxpayers, and increase access to quality, affordable health care.
Pennsylvania is the first state in the country to have a sweeping common sense, state-based Medicaid reform plan approved by the federal government.
Increases access to coverage for more than 600,000 eligible Pennsylvanians
Enrollment to begin on December 1, 2014 with an implementation for coverage effective on January 1, 2015
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Key Facts
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A Pennsylvania-specific Plan
Medical Assistance (Vulnerable Pennsylvanians)
Low income parents/ caretaker relatives with incomes up to 133% FPL
Children
Medically frail
Individuals with disabilities
Seniors
Private Coverage Option (January 1, 2015)
Childless adults
Adult parents/caretaker relatives
Incomes up to 133% FPL
Working poor
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Healthy Pennsylvania
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Medicaid Reforms
Reduce # of plans: 14 plans to Low Risk & High Risk Benefit Changes: Limit # of visits & limit types of benefits provided based on commercial standards and needs of individual
Eligibility Changes: Move categories of people from Medical Assistance to private coverage
Private Coverage
Create new private commercial products to increase access to coverage for more than 600,000 eligible Pennsylvanians: Plan similar to employer-sponsored coverage
Healthy Pennsylvania
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Personal Responsibility Employment: PA first state allowed to offer incentivized employment program
to reduce cost sharing. Participants will be assigned a HPA Career Coach and enrolled in Job Gateway.
Healthy Behaviors: Healthy behaviors to allow reductions in health care cost sharing
Healthy Pennsylvania
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Cost Sharing Premiums:
1. First state allowed to require a premium of 2% of household income for individuals with incomes greater than 100%FPL, starts in Year 2
2. One of only a few states allowed to dis-enroll individuals for failure to pay premiums for 90 days
Co-Payments:
1. $8 co-pay for non-emergency use of ER
2. Provider can refuse service for failure to make co-pay for those above 100% FPL
Healthy Pennsylvania
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Reformed Medicaid Currently eligible aged 21-64 and medically frail up
to 133% FPL
Private Coverage Option Adults 21-64 with incomes
up to 133% FPL, not on Medicaid
Benefits Reduce # of benefit plans from 14 to low risk & high risk Low risk/high risk benefits aligned with recipient needs Private commercial product with essential health benefits Encouraging Employment Incentivized employment and job training Cost Sharing Copayments in Year 1 of Healthy PA Copayments in Years 2-5 of Healthy PA Premium of 2% of household income for individuals over 100% FPL Disenrollment for failure to pay premiums after 90 Days $8 copayment for non-emergency use of the ER Provider can refuse service for failure to make copayment for those above 100% FPL Healthy Behaviors Healthy behaviors can reduce cost sharing
Healthy PA Private Coverage Across the State
Region 1: United Healthcare, UPMC, Gateway Health, Vista Region 2: UPMC, Gateway Health, Vista, Keystone Health Plan West/Highmark Region 3: Geisinger Health Plan, United Healthcare, Vista Region 4: United Healthcare, Aetna Better Health, UPMC, Vista, Keystone Health Plan West/Highmark, Gateway Health Region 5: United Healthcare, UPMC, Gateway Health,Vista Region 6: Geisinger Health Plan, United Healthcare, Gateway Health, Vista, Capital Blue Cross
Region 7: Geisinger Health Plan, United Healthcare, UPMC, Gateway Health, Vista, Capital Blue Cross Region 8: United Healthcare, Aetna Better Health, Health Partners, Gateway Health, Vista Region 9: United Healthcare, Aetna Better Health, Gateway Health, Vista, Capital Blue Cross
The Healthy Pennsylvania Private Coverage Option will begin providing coverage on Jan. 1, 2015.
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Healthy Pennsylvania Taxpayer Savings
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FY 14-15 FY 15-16 ACA $218,954,121 $331,046,519 Administrative Costs $39,751,000 $38,091,000 Healthy PA (savings) ($125,405,377) ($616,396,847) Total in First 2 Years $133,299,744 ($247,259,328) Cumulative Total by Year 8 = $4.5 Billion
Healthy Pennsylvania PlanHPA ChronologyKey FactsA Pennsylvania-specific PlanHealthy PennsylvaniaHealthy PennsylvaniaHealthy PennsylvaniaHealthy PennsylvaniaHealthy PA Private Coverage Across the StateHealthy Pennsylvania Taxpayer Savings