The plan, titled Healthy Pennsylvania, is said to focus on:
getting kids insured, promoting access to primary health care - particularly in rural and underserved areas of the state, and creating a coordinated long term care and support system for older Pennsylvanians and persons with disabilities. Healthy Pennsylvania includes common sense reforms to the Medicaid program and a pathway to increase access to health care for uninsured Pennsylvanians. These reforms include aligning benefits with national standards proposed by the Department of Health and Human Services, reasonable premiums, individual responsibility, work search and job training supports.Specifically, documents from the Administration point to the following changes:
- Pennsylvania proposes "simplifying the existing 14 adult benefit packages into two commercial-like alternative benefit packages." Adult benefits packages will be consistent with national standards for coverage. Children's packages will not change. Medicaid benefits will be aligned with health care benefits available on the commercial market.
- According to the newly released Healthy Pennsylvania document, "the Medicaid cost sharing structure does not provide positive incentives for healthy choices or personal responsibility." Healthy Pennsylvania proposes eliminating Medicaid copays except for a $10 copay for "inappropriate" ER visits to encourage more visits to family doctors.
- Monthly premiums will be set at no more than $25 for an individual and $35 for a household, with premium contributions beginning when participants reach 50% of the Federal Poverty Level ($5,745 for an individual and $7,555 for a household). Eligibility will remain until participants reach 133% of the Federal Poverty Level ($15,282 individual, $20,628 household).
- Premiums can be reduced when applicants participate in health and wellness appointments and when they "actively engage in job search and training programs." Participants (with limited exceptions) will be expected to take part in work search and job training through PA CareerLink(R) if they are unemployed and working-age.
- Pennsylvania proposes a private option insurance program through the federal health insurance exchanges for individuals earning below 133% of the Federal Poverty Level but who are not otherwise eligible for Medicaid. Through this option, parents and children could receive coverage under the same Qualified Health Plan. "Medically frail" individuals could continue on Medicaid.
- Individuals under this program would be expected to pay income-based monthly premiums, could qualify to have their premiums reduced by participating in health and wellness appointments, and will actively engage in job search and training programs.
- Under this proposal, Pennsylvania will develop public financing strategies that include competitive and value-based purchasing. Specifically, Healthy Pennsylvania proposes bringing together stakeholders to focus "on the quality of care provided rather than how much is provided" to improve patient outcomes.
- A federal State Innovation Model Design Grant will be used to test payment models, to evaluate results and determine best practices, and to engage stakeholders in developing alternative models.
- Healthy Pennsylvania is based on the continuance of "at a minimum, the federal participation levels set forth in the ACA... . If the federal funding is not provided at the levels and time periods as set forth in the ACA, Pennsylvania will notify participants in the private option that the coverage will no longer be funded through the commonwealth."
- This proposal calls for a continued emphasis on reducing waste, fraud, and abuse through predictive modeling, audits, policy changes, and actions on credible allegations of fraud and abuse.
- Reauthorizing the Children's Health Insurance Program (CHIP) by December 31, 2013, while eliminating the current 6 month waiting period for children to enroll.
- Continuing efforts to redesign services so that older Pennsylvanians can receive home and community based care, including the convening of a Long Term Care Commission.
- Hosting a Healthy Pennsylvania Summit in Spring 2014 to expand preventative health best practices.
- Enhancing prescription drug monitoring programs.
Public comments can be sent to RA-PWHealthyPA@pa.gov or sent to:
PA Dept. of Public Welfare
c/o Healthy PA
625 Forster St. Suite 333
Harrisburg, PA 17120