Medicaid

An important advocacy priority for HAP continues to be upholding Pennsylvania’s Medicaid program by providing insurance coverage for low-income, non-elderly, working Pennsylvanians and their families. HAP advocates for insurance coverage to improve Pennsylvanians’ access to health care and to reduce the financial burden of caring for the uninsured borne by hospitals and employers.

Medicaid is a jointly funded, federal-state health insurance program for low-income populations. Of the roughly $581.9 billion spent on Medicaid nationally in 2017, the federal share was 63 percent. Each state government’s share varies; in Pennsylvania, it has been 52 percent annually from fiscal year (FY) 2015 through FY 2019 1.

Medicaid Payment Shortfall in Pennsylvania

HAP commissioned the health care economics and consulting firm Dobson DaVanzo & Associates LLC to complete a report about the adequacy of Medicaid program payments to Pennsylvania hospitals. Based upon fiscal year 2016 data, Medicaid paid only 81.1 cents on the dollar of cost, which resulted in a $1.2 billion Medicaid payment shortfall.


Medicaid Eligibility

All states must meet federal minimum requirements, but can opt for broader eligibility. Pennsylvania’s Medicaid program, called Medical Assistance, covers children, pregnant women, parents, seniors, and individuals with disabilities, as well as other adults who are eligible for federally assisted income maintenance payments.2

The Affordable Care Act extended Medicaid eligibility to non-elderly adults with incomes at or below 138 percent of the federal poverty limit. States that choose to participate in this expansion receive enhanced federal matching payments. Pennsylvania opted to expand its Medicaid coverage during 2015. HAP supported this expansion. More than 700,000 Pennsylvanians have benefited from access to coverage as a result.

Medicaid Disproportionate Share Hospital (DSH) Program

The Medicaid Disproportionate Share Hospital (DSH) program provides payments to hospitals that serve a high proportion of Medicaid beneficiaries and uninsured patients. The payments are essential for hospitals to offset their uncompensated care costs from treating low income patients. The amount of federal DSH funds a state can receive is limited by state-specific allotments established by federal law.

Advocacy

HAP advocates with state lawmakers and the Governor to maintain important Medical Assistance supplemental payments in the state budget for critical access hospitals, obstetrics/neonatal units, burn care centers, and trauma centers.

HAP works with the Pennsylvania Congressional delegation to preserve Medicaid DSH payments that provide essential financial assistance to hospitals that care for our state’s most vulnerable populations. A series of payment cuts are scheduled for fiscal years 2020 through 2025, beginning with a $4 billion reduction during 2020. Under a 2017 federal proposed rule methodology, the state's Medicaid DSH allotment would be reduced by approximately $242 million during FY 2020. HAP is engaging with federal lawmakers and working with stakeholders to address detrimental payment cuts that would have a devastating impact on Pennsylvania’s hospitals that provide crucial community services such as trauma and burn care, high-risk neonatal care, and disaster preparedness resources. 

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1 Medicaid’s Federal Medical Assistance Percentage (FMAP), Congressional Research Service, April 25, 2018. See Appendix A, FMAP Rates for Medicaid, By State, p. 13
2 Medical Assistance General Eligibility Requirements. Pennsylvania Department of Human Services. Last accessed 4/1/2019. See also: Pennsylvania Medicaid Program. Published by Benefits.gov. Last accessed: 4/1/2019

 

HAP Contacts

For more information, contact Warren Kampf, senior vice president, advocacy and external affairs; Jeffrey Bechtel, senior vice president, health economics and policy; Laura Stevens Kent, senior vice president, strategic integration; or Jolene Calla, vice president, health care finance & insurance. For media inquiries, contact Rachel Moore, director, media relations.

HAP News

August 03, 2020

New Fact Sheet Supports Efforts to Make Telehealth Flexibilities Permanent

The American Hospital Association (AHA) has released a new fact sheet to support its national effort to urge Congress and the Administration to ensure telehealth flexibilities remain in place after the COVID-19 public health emergency ends and to reimburse virtual services on par with in-person care.

July 21, 2020

New Federal Guidance Affirms Equity in Care During COVID-19

On July 20, the U.S. Department of Health and Human Services (HHS) released a bulletin, Civil Rights Protections Prohibiting  Race, Color and National Origin Discrimination During COVID‐19, aimed at helping to ensure Title VI compliance during the COVID‐19 public health emergency.

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