State notifying 100,000 Medicaid consumers of upcoming changes
Some 100,000 southwestern Pennsylvania residents eligible for Medicaid-funded long-term care services are about to receive their first notices of a major state shift affecting them in January 2018.
The Pennsylvania Department of Human Services this week began mailing flyers to aged and disabled residents of 14 counties who will be the first in the state transferred into the new Community HealthChoices managed care program.
Under the Wolf administration initiative, those who qualify for government-funded services because of their health and income limitations will be expected to choose one of three state-contracted managed care organizations to coordinate their health and long-term care services.
The MCOs will replace more limited service coordination that needy individuals have received through Area Agencies on Aging or other government contractors.
State officials maintain that the current system of spending some $6 billion in Medicaid funds on nursing homes, home assistance and other long-term care services results in excessive
institutional care.
They suggest a managed care system will provide financial incentives leading to more preventive health services that avoid unnecessary hospitalizations and more home assistance that reduces nursing home use.
The service coordinators Medicaid beneficiaries now use for long-term care help — such as arranging aides who visit homes — have no role in planning and awareness of doctors’ visits and other medical-related care that often is paid by Medicare.
Community HealthChoices is designed to provide more comprehensive management of all those government-funded services.
“The data is pretty disturbing about how many preventable hospitalizations are out there from lack of coordination,” said Jennifer Burnett, deputy secretary of the state’s Office of Long-Term Living.
However, she acknowledged that the state has a large task in educating consumers about the looming changes. Affected individuals are not supposed to take any immediate action, but a follow-up mailing next month will inform them about when and how to choose an MCO.
Some 20 public information sessions also are anticipated in September and October in the counties affected on Jan. 1. That will be followed by a broader state rollout that ultimately affects about 400,000 Pennsylvanians.
Medicaid beneficiaries satisfied with their current services can keep them for at least 180 days after Jan. 1 with no changes in coordination or providers. After that, coordination will be taken over by one of three health insurance-related MCOs that won state contracts — UPMC Community HealthChoices, PA Health & Wellness and AmeriHealth Caritas.
The three are arranging their own networks of home care agencies, nursing homes, adult day services and other providers they will be working with.
In many cases, providers are likely to work with multiple MCOs after negotiating rates separately for what the insurer will pay them.
The MCOs will receive a fixed monthly rate from the state to organize and provide care for each consumer — in six different rate categories based on the individual’s health status — rather than follow the existing fee-for-service system.
Called a “capitated” payment system, an increasing number of states have adopted the model for longterm care in an effort to better manage costs.
Ms. Burnett said the state’s primary goal with Community HealthChoices is to better serve consumers, but considering the increase in the state’s elderly population in the coming years, “we’re hoping we can flatten the cost curve and serve more people in the community.”
Consumers seeking more information about the program in the 14 counties initially affected — Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland — can call 1-833-735-4416 during normal office hours for more information.