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February 2017 eNews
Health Law PA News

Click here for the February 2017 Health Law PA News.
  • Latest ACA Repeal Efforts Target Drastic Changes to Medicaid Funding
  • States Encouraged to Support Dual Eligibles’ Access to DME and Supplies
  • Hospitals Required to Give Medicare Patients Notice of Their Observation Status
  • PA LINK’s Person-Centered Counselors Offer  Variety of Services
  • Federal Poverty Level Guidelines Published

Washington Proposals to Block Grant Medicaid Should Alarm Pennsylvania’s Elected Officials

Our February edition of Health Law PA News reports on the efforts of the Trump Administration and Republican leaders in Congress to fundamentally change the structure and financing of Medicaid.  They are proposing what many refer to as a block grant program.  This means the federal government would give a set amount of money to each state for Medicaid; it would be up to the states to spend it however they like. Pennsylvania will not benefit from this so called “flexibility.”

Our colleagues at the Kaiser Family Foundation and Community Legal Services have written excellent analyses about the implications of capping federal Medicaid funds.  Simply put, Medicaid block grants make future federal budget projections look good at the expense of state budgets.  

Block grants (and per capita caps) offer the federal government an easy and quick mechanism for reducing its contribution to state Medicaid than the current cost-sharing arrangement.  There’s no magic in how Congress reduces spending under a block grant mechanism.  It just says it will do so, and leaves the hard and painful decisions to others—like Pennsylvania policymakers!  

How will Pennsylvania officials act when Washington forces them—via Medicaid block granting—to provide the same amount of health care with fewer dollars?  Raising taxes has been an anathema to state lawmakers, and there are no easy ways to trim a Medicaid program that already operates with low administrative costs and low provider reimbursement levels. 

Facing federal funding reductions, Pennsylvania would likely cut eligibility, benefits, and reimbursement to providers.  These cuts would put populations that disproportionately rely on Medicaid at risk including low-income children, the elderly and individuals with disabilities.

Capping and reducing federal financing for Medicaid will shift costs to states.  Perhaps Pennsylvania officials will find a way to reduce Medicaid spending without causing problems; problems like when, in 2011-12, thousands of children lost their Medicaid coverage and angrily complained to members of the General Assembly.  If they can’t, though, state officials will have to budget with less from the federal government, make the hard choices and face the brunt of the blame.

Laval Miller-Wilson

Executive Director


The Importance of Medicaid for Adults with Disabilities

This story is one in a series PHLP has compiled profiling Pennsylvanians who rely on Medicaid. Read the entire profile here.

Susan and Grant both have disabilities, and depend on Medicaid and Medicare to get the health care they need.  Medicaid covers the in-home supports that Grant needs to stay out of a nursing home and in his own home with Susan. 

Grant suffers from a number of health problems, including traumatic brain injury, heart failure, diabetes, and esophageal cancer. He is treated by a team of nearly three dozen doctors and takes over 50 medications.  Susan has health problems too. She suffers from epilepsy, sleep apnea, spinal cord damage, and a heart condition that increases her risk of stroke.  They get by on Social Security Disability benefits alone.  Medicaid covers the Medicare cost-sharing and deductibles that they would not be able to otherwise afford (doctor’s visits and Grant’s wheelchair, for example).

Medicaid also covers the items that Medicare doesn’t, like suppositories, adult diapers, and liquid nutrition.  Although navigating the two insurances has presented challenges over the years, they are extremely grateful for Medicaid.

Grant has been able to avoid a nursing home and stay in his home because of Medicaid long term care supports.  Through a “waiver” program that provides in-home services and supports, Medicaid covers 40 hours a week of personal care assistance.  It also covered a home modification to make Grant’s bathroom accessible and a special hospital bed he needed because of his size.  And it covers the regular service and repair of a wheelchair lift that enables Grant to get out of his house to attend his medical appointments and participate as fully as possible in life activities. Grant and Susan are thankful that they receive this help through Medicaid so that, despite their disabilities, they can continue living with one another and in the house that they love.


Share your own stories about Medicaid’s value and the importance of continued federal funding.  Individuals who are worried about the future of Medicaid are encouraged to call their U.S. Representatives and Senators

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What We're Reading

Repealing Obamacare 'Would Have Devastating Impacts' For Pennsylvania, Harrison Jacobs, Business Insider, February 15, 2017

“Overall, 479,000 Pennsylvanians have gained insurance coverage through the ACA-established individual markets or the law's provision that allows children to stay on their parents' coverage until 26, the Department of Health and Human Services (HHS) reported in December.

In 2015, Pennsylvania joined 31 other states and the District of Columbia in taking advantage of the Medicaid expansion provision in the ACA, which provided states funds to expand Medicaid to any any adult living under 138% of the federal poverty level — an income of $27,821 for a family of three in 2016. Through the expansion, 670,000 people have gained coverage.

All in all, that's more than 1 million Pennsylvanians who could be affected by what happens in Washington.”
Federal Cuts Would Target Civil Legal Aid for Poor, Kate Giammarise, Pittsburgh Post-Gazette, February 27, 2017

"According to several reports, President Donald Trump’s budget proposal could eliminate the Legal Services Corporation, the largest funder of civil legal assistance for low-income Americans. Locally, legal services funds go to the Neighborhood Legal Services Association, Southwestern Pennsylvania Legal Services, Inc. and Laurel Legal Services, Inc. …

Elimination of the Legal Services Corporation would cut $1.4 million from Neighborhood Legal Services, $607,000 from Laurel Legal Services and $416,000 from Southwestern Pennsylvania Legal Services. According to its website, the entire Legal Services Corporation has an annual budget of $375 million.”
GOP Fix to Insurance Markets Could Spike Premiums for Older Customers, Jordan Rau and Julie Appleby, Kaiser Health News, February 22, 2017

“Middle-aged Americans already face the highest premiums in the health care markets for individuals who don’t get coverage from their workplace or the government. Plans are permitted to charge three times as much for a 64-year-old as for a 21-year-old. Last year 3.3 million consumers ages 55 through 64 bought insurance on the marketplaces. That was a quarter of all those covered, more than any other age group tracked by the federal government, data show.

The GOP has not unified behind a single plan, but one proposal last year by House Speaker Paul Ryan (R-Wis.) would let insurers make older people pay five times more than young adults. Another plan offered by Department of Health and Human Services Secretary Tom Price when he was a Georgia congressman would do away entirely with age restrictions and instead give tax credits that increase by age. House Republican leaders embraced a similar concept of tax credits this month.”
Pennsylvania Snapshot of Children’s Coverage, Georgetown Center for Children and Families, February 2017

This fact sheet examines the state of children's health coverage through Medicaid, the Children's Health Insurance Program (CHIP), and the Affordable Care Act (ACA).
The Obamacare Provision That Saved Thousands from Bankruptcy, Sarah Kliff, Vox, February 15, 2017

“The Affordable Care Act is brimming with provisions like these: small parts of the law that are hugely consequential for the people who rely on them. These provisions complicate the matter of repeal and replace, because they all have constituencies that will show up for a lobbying battle in Washington — and their stories could tug at the heartstrings of voters who otherwise support the repeal effort.

The lifetime limits ban is a few paragraphs of a 1,300-page law. It isn’t crucial to making the coverage expansion work in the way that, for example, the individual mandate or insurance subsidies are. But the ban is absolutely crucial to making the Morrisons’ lives work.”
A Deep Dive into 4 GOP Talking Points On Health Care, Julie Rovner, Kaiser Health News, February 14, 2017

“Republican leaders have a lengthy list of talking points about the shortcomings of the health law… Yet a careful analysis of some of the GOP’s talking points show a much more nuanced situation and suggest that the political fights over the law may have contributed to some of its problems.”
Pennsylvania Medicaid Expansion Report, Pennsylvania Department of Human Services, January 27, 2017

Pennsylvania released a 107-page report detailing the positive impact of Medicaid expansion’s on Medicaid enrollment, uninsured rates, the commonwealth’s budget, and the overall economy from January 2015 to December 2015. Utilization of health care services was also analyzed from April 2015 to March 2016. “As of January 20th, 706,281 Pennsylvanians from across every county are enrolled in Medicaid because of expansion.  The commonwealth has seen an increase in providers to serve the additional recipients. There are 4,422 more physicians, 601 more dentists, and 444 more certified registered nurse practitioners in Pennsylvania now compared to prior to when Medicaid expansion took effect in April 2015.”
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