Medicaid

In a bid to build pressure on Gov. Corbett to expand Medicaid next year, Democratic members of the Pennsylvania Senate Appropriations Committee met Thursday in Philadelphia with city health officials, hospital experts, and advocates for the poor. The session in City Hall came less than two weeks before Corbett is to present his budget proposal for fiscal 2014. Were he to opt for Medicaid expansion under the Affordable Care Act, provisions for the rollout starting in October would have to be built into that budget, officials said.

It has helped expand the federal budget deficit, threatened to topple state budgets, and earned the dubious distinction of being one of the nation's fastest-growing entitlement programs, with an annual price tag exceeding $150 billion. Under the circumstances, it is hardly surprising that Medicaid is on the congressional cutting board, with some budget hawks going so far as to suggest dicing it up into 50 separate state programs and ending its status as an "entitlement. " Yet even as they seek to curtail Medicaid's growth, members of Congress are coming face to face with a little-known but politically explosive reality: Most people, including members of Congress, think of Medicaid as part of the welfare system, the part that finances health care for the poor.

A federal judge yesterday ordered Pennsylvania to boost payments to Temple University Hospital by 35 percent for services provided to Medicaid patients, pending an overhaul of the state program. U.S. District Judge John P. Fullam directed state officials to increase Medicaid payments on an interim basis for all bills, retroactive to Jan. 25. But he ruled that the state was not required to make back payments to Temple for millions of dollars that the hospital contends it was underpaid in previous years.

The state wastes millions of dollars every year on erroneous Medicaid payments for residents who are no longer eligible for the benefits, according to a state audit released yesterday. The report by Auditor General Jack Wagner's office found that the Department of Public Welfare, through its county assistance offices, failed to properly determine eligibility for more than 1,600 Medicaid applicants between January 2005 and March 2008, resulting in $3.3 million in improper payments.

PENNSYLVANIA has reached a critical juncture. Following the Supreme Court's ruling to uphold the Affordable Care Act (ACA), or ObamaCare, states can choose to opt out of the law's Medicaid expansion. The decision has been left in the hands of governors and state leaders. Here in Pennsylvania, Gov. Corbett has not yet reached a decision. This is curious because there is really little choice. Why? Opting into the expansion is a great deal for Pennsylvania. By opting into the expanded Medicaid program, the governor has the opportunity to help hundreds of thousands of uninsured, low-income, working Pennsylvania citizens, save our state hundreds of millions of dollars and provide a significant and much-needed boost to our economy, which will provide thousands of new jobs in Pennsylvania.

HARRISBURG - The pressure on Gov. Corbett to expand the state's Medicaid rolls is no longer only geographic; it's now coming from within his own party. First there was Gov. Christie's announcement Tuesday that New Jersey would join other Pennsylvania neighbors - New York, Maryland, and Ohio - by opting in on the Medicaid expansion made available to all states under the Affordable Care Act. Now the heat is coming from some of Corbett's fellow Republicans in the state legislature.

A coalition headed by the American Medical Association reports that too many poor people are receiving inadequate medical coverage. They're right. Nearly 18 percent of the civilian population under 65 have no health insurance. Neither do more than 20 percent of all children in a nation that leads the world in medical technology. Even having a job is no guarantee that better health coverage is obtainable. Children of poor working families are 38 percent less likely to have health coverage than children of the unemployed.

WASHINGTON - The nation's Republican governors, seeking a voice in Congress' forthcoming debt debate, on Tuesday pushed for loosening restrictions on how states spend money on health care for poor and disabled Americans. States, they argued, should be allowed to design their own Medicaid programs and operate them with a lump payment every year from the federal government, and then be held accountable for the results. Outdated or inappropriate federal guidelines now make it more burdensome to provide a health-care safety net that's one of the biggest expenses for cash-strapped states, the governors said.

In 1986, the idea had considerable appeal: Create an HMO-like plan for the poor that would halt costly visits to emergency rooms, increase preventive care and generally bring continuity to a Medicaid system plagued by fragmented services. But today some 80,000 poor Philadelphians enrolled in the three-year-old HealthPass plan are wondering whether they can even fill prescriptions, one of the results of a bitter financing dispute between federal regulators and state officials. Not only are druggists wary - some even briefly stopped filling prescriptions last week - but hospitals, too. Several in the area, already stung by the bankruptcy of a former HealthPass contractor, are said to be weighing withdrawing from the program.