Healthy Pennsylvania Plan
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1 Healthy Pennsylvania Plan Get All Kids Insured Reform Pennsylvania s Medicaid Program Promote Access to Primary Health Care Reform PA s Medical Liability System Advance Telemedicine Institute Prescription Drug Monitoring Program Support Older Pennsylvanians & Persons with Disabilities Promote Good Public Health 1
2 HPA Chronology ACA passed in US Supreme Court ruling in 2012 Sept. 16, 2013 Governor launched Healthy Pennsylvania Feb. 19, 2014 Healthy Pennsylvania waiver officially submitted to CMS. June 10, 2014 DPW received bids from nine PA health care insurers April 2, 2013 Gov. met with Secretary Sebelius on PA specific solution Dec Jan DPW held seven public hearings across state and two webinars; 1,000 attendees & 170 live testimonies May 8, 2014 DPW released Request for Application for private coverage to insurers August 28, 2014 Pennsylvania and CMS reach agreement on Healthy Pennsylvania 2
3 Key Facts 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,
4 A Pennsylvania-specific Plan Medical Assistance (Vulnerable Pennsylvanians) Low income parents/ caretaker relatives with incomes up to 44% FPL Children Medically frail/individuals with disabilities Private Coverage Option (January 1, 2015) Childless adults Adult parents/caretaker relatives Incomes up to 133% FPL Working poor Seniors 4 4
5 Healthy Pennsylvania 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 employersponsored coverage 5
6 Healthy Pennsylvania 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. 6
7 Healthy Pennsylvania Cost Sharing Premiums: 1. First state allowed to require a premium of 2% of 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 7
8 Benefits/ Healthy Pennsylvania Reduce # of benefit plans from 14 to low risk & high risk Low risk/high risk benefits aligned with essential health benefits and recipient needs Private commercial product with essential health benefits Encouraging Employment Reformed Medicaid Currently eligible aged and medically frail Private Coverage Option Adults with incomes up to 133% FPL 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 income for % FPL in years 2-5 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 8
9 Healthy PA Private Coverage Across the State The Healthy Pennsylvania Private Coverage Option will begin providing coverage on Jan. 1, 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 9
10 Healthy Pennsylvania Taxpayer Savings FY FY 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 10
11 Next Steps Pennsylvania is currently operationalizing the Healthy Pennsylvania plan to increase access to quality, affordable health care for all Pennsylvanians. To learn more about the Healthy PA plan visit Healthy Pennsylvania 11
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