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

Healthy PA • 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 IMPROVING ACCESS • 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 of 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 Pennsylvania Access – Affordability - Quality

Healthy PA ENSURING 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 Pennsylvania Access – Affordability - Quality

Healthy PA PROVIDING AFFORDABILITY • 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 Pennsylvania Access – Affordability - Quality

PA Medicaid Overview • Approximately $21.9 billion in total funds spent annually on Expenditures 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 • 2.2 million individuals enrolled into Medical Assistance • 17.9% of Pennsylvanians receive Medical Assistance Medical • 7.8% increase in MA enrollment in the past three years Assistance 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 Healthy Pennsylvania Access – Affordability - Quality

PA Medicaid Overview – Mandatory Medicaid Services • Ambulance • Medical Supplies and Equipment • Birthing Center Services • Non-Emergency Medical Transportation (MATP) • Certified Registered Nurse • Nurse Midwife Services Practitioner (CRNP) • Nursing Facility Services for >21 • EPSDT Screens, • Outpatient Hospital - Short Procedure • Family Planning Services Unit • Federally Qualified Health Centers • Outpatient Hospital Services - Clinic (includes Rehabilitation) (FQHC)/Rural Health Clinics (RHC) • Outpatient Hospital Services - • Home Health Services Emergency Room Services • Inpatient Hospital • Outpatient Psychiatric Partial • Inpatient Hospital - Drug & Alcohol Hospitalization Services • Physician Services • Inpatient Hospital – Psychiatric • X-Ray • Inpatient Hospital – Rehabilitation • Laboratory Service Healthy Pennsylvania Access – Affordability - Quality

PA Medicaid Overview – Optional Pennsylvania Services • Ambulatory Surgical Center • Other Rehabilitative Services • Audiologist Services • Outpatient Clinic Services - Drug & Alcohol • Behavioral Health Rehabilitation Services • Outpatient Clinic Services - Independent • Case Management – MA Medical Clinic/Surgical Center • Case Management – Targeted, • Outpatient Clinic Services – Psychiatric • Chiropractor • LIFE Services • Dentist Services • Personal Care • Eyeglasses • Pharmaceuticals - Non-Family Planning • Funeral Director Services • Podiatrist Services • Hearing Aids • Private Duty Nursing • Home and Community Based Waivers • Psychologist Services • Hospice • Renal Dialysis • Intermediate Care of Other Related Conditions • Residential Treatment Facility Services • Intermediate Care of the Intellectually • Social Worker Services Disabled • Therapy – Occupational, Physical and Speech • Optometrist Services Healthy Pennsylvania Access – Affordability - Quality

PA Medicaid Overview – Eligibility Levels by Income PA MEDICAL ASSISTANCE and CHIP INCOME LIMITS FOR 2013 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 Pregnant MAWD, Children Childless General Categorically Medically Elderly and Children w omen & Free BCCTP, (Ages 6 to Adults Assistance Needy Needy Disabled (Ages 1 to 5) Children CHIP Subsidized 19) under age 1 CHIP at 75% 9 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 more information, visit www.insurance.pa.gov For information on health insurance options in PA, visit www.pahealthoptions.com Healthy Pennsylvania Access – Affordability - Quality