Health Reform: PA Developments

Pennsylvania Developments

Aspects of Health Care Reform that significantly impact access to care for Pennsylvanians include:

Healthy Pennsylvania

PHLP recently submitted comments to the federal government on behalf of the Consumer Subcommittee in response to Governor Corbett’s Healthy Pennsylvania Demonstration Application.  The Consumers requested that the federal government approve Healthy PA only after addressing the elements of the proposal that would harm existing and future Medicaid consumers. Click here to read the comments.  

PHLP Series on the Benefits of Medicaid Expansion

In 2013, PHLP published a state-specific series on the benefits of Medicaid expansion. Each report focuses on how expanding Medicaid can improve a(n) individual’s and family’s quality of life, help someone to manage their medical conditions, and for many, increase their potential to contribute to society. Please see the articles below to learn more.

Health Insurance Exchanges

  • Under the Affordable Care Act, Health Insurance Exchanges will be both a marketplace that will allow individuals and small businesses to choose insurance coverage and an enrollment entry point once the choice is made.  States will have a fair amount of flexibility in designing their Exchanges, in creating governance for the Exchanges and in designing the online enrollment forms.  Pennsylvania has an extensive amount of work to do to have an Exchange ready for federal review by January of 2013, starting with whether to operate a state Exchange or to defer to the federally run Exchange.  For more information, visit our Exchange resource page.

PA Fair Care

  • An insurance program for uninsured adults with pre-existing conditions, PA Fair Care is administered by the state and funded by the Affordable Care Act. Designed as a bridge program until 2014, PA Fair Care is intended to provide affordable insurance (premiums are $283 per month) for individuals with significant health needs.
  • Funding for PA Fair Care is limited to $160 million, which the PA Insurance Department estimates will cover 6,000 people. Applicants are enrolled on a first-come, first-served basis.
  • Click here for the PA Fair Care website and information on how to apply.  Click here for commentary by PHLP and others on PA Fair Care outreach.
  • Update: On July 1, 2013, Pennsylvania’s Fair Care program ended and became the Pre-Existing Condition Insurance Plan (PCIP) run by the federal government until new, individual coverage under the Affordable Care Act begins January 1, 2014. PHLP has created a fact sheet to help consumers explain these changes to their providers.

Early Medicaid Expansion

  • Pennsylvania has the opportunity under Health Care Reform to modestly expand its Medicaid program and at the same time reduce its state funding for the Medicaid program. By expanding its Medicaid category for the very poor, Pennsylvania could immediately draw down federal matching funds for expenditures that are now entirely state-funded. For commentary by PHLP and others, view the Medicaid Expansion Resolution.

Hospital Accountability

  • Health Care Reform redefines the charitable obligations of non-profit hospitals, requiring transparency in charity care, limitations on charges, and regular community health needs assessments. Click here for more information on these requirements. Click here for a news article on new charity care rules, and here for a trifold brochure on Charity Care in Pennsylvania.

Patients’ Bill of Rights

  • Many of the Affordable Care Act provisions that protect health insurance consumers took effect on September 23, 2010. Among other things, these provisions require insurance companies to cover children with pre-existing conditions, prohibit insurers from arbitrarily rescinding coverage, and eliminate lifetime coverage limits. Click here , and here for more information on consumer protections in the Affordable Care Act.

Children Transitioning from CHIP to Medicaid

  • Under the Affordable Care Act, children ages 6 to 19 with family income between 100 and 133% of the federal poverty level will be eligible for Medicaid effective January 1, 2014. Children now enrolled in CHIP will transition to Medicaid and will need assistance in maintaining their health care providers, their care plans and their medical home. PHLP along with Community Legal Services, the Pennsylvania Chapter of the American Academy of Pediatrics, Pennsylvania Partnerships for Children and Public Citizens for Children and Youth have made a set of recommendations to assure a smooth transition for children moving from CHIP to Medicaid.



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