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Institute Prescription Drug Monitoring Program

Promote Good Public Health

Support Older Pennsylvanians &

Persons with Disabilities

Advance Telemedicine

Promote Access to Primary Health Care

Get All Kids Insured

Reform PAs Medical Liability System

Reform Pennsylvanias Medicaid Program

Healthy Pennsylvania Plan

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HPA Chronology

ACA passed in 2010. US

Supreme Court ruling

in 2012

April 2, 2013 Gov. met with

Secretary Sebelius on PA specific solution

Sept. 16, 2013 Governor launched Healthy

Pennsylvania

Dec. 2013 Jan. 2014 DPW held 7 Public

hearings across state & 2 webinars; 1,000 attendees & 170 live

testimonies

Feb. 19, 2014, Healthy

Pennsylvania waiver officially

submitted to CMS.

May 8, 2014, DPW released

Request for Application for

private coverage to insurers

June 10, 2014, DPW received bids from nine PA health care

insurers

August 28, 2014 Pennsylvania

and CMS reach agreement on

Healthy Pennsylvania

This is a Pennsylvania-specific plan to reform Medicaid, protect taxpayers, and increase access to quality, affordable health care.

Pennsylvania is the first state in the country to have a sweeping common sense, state-based Medicaid reform plan approved by the federal government.

Increases access to coverage for more than 600,000 eligible Pennsylvanians

Enrollment to begin on December 1, 2014 with an implementation for coverage effective on January 1, 2015

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Key Facts

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A Pennsylvania-specific Plan

Medical Assistance (Vulnerable Pennsylvanians)

Low income parents/ caretaker relatives with incomes up to 133% FPL

Children

Medically frail

Individuals with disabilities

Seniors

Private Coverage Option (January 1, 2015)

Childless adults

Adult parents/caretaker relatives

Incomes up to 133% FPL

Working poor

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Healthy Pennsylvania

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Medicaid Reforms

Reduce # of plans: 14 plans to Low Risk & High Risk Benefit Changes: Limit # of visits & limit types of benefits provided based on commercial standards and needs of individual

Eligibility Changes: Move categories of people from Medical Assistance to private coverage

Private Coverage

Create new private commercial products to increase access to coverage for more than 600,000 eligible Pennsylvanians: Plan similar to employer-sponsored coverage

Healthy Pennsylvania

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Personal Responsibility Employment: PA first state allowed to offer incentivized employment program

to reduce cost sharing. Participants will be assigned a HPA Career Coach and enrolled in Job Gateway.

Healthy Behaviors: Healthy behaviors to allow reductions in health care cost sharing

Healthy Pennsylvania

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Cost Sharing Premiums:

1. First state allowed to require a premium of 2% of household income for individuals with incomes greater than 100%FPL, starts in Year 2

2. One of only a few states allowed to dis-enroll individuals for failure to pay premiums for 90 days

Co-Payments:

1. $8 co-pay for non-emergency use of ER

2. Provider can refuse service for failure to make co-pay for those above 100% FPL

Healthy Pennsylvania

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Reformed Medicaid Currently eligible aged 21-64 and medically frail up

to 133% FPL

Private Coverage Option Adults 21-64 with incomes

up to 133% FPL, not on Medicaid

Benefits Reduce # of benefit plans from 14 to low risk & high risk Low risk/high risk benefits aligned with recipient needs Private commercial product with essential health benefits Encouraging Employment Incentivized employment and job training Cost Sharing Copayments in Year 1 of Healthy PA Copayments in Years 2-5 of Healthy PA Premium of 2% of household income for individuals over 100% FPL Disenrollment for failure to pay premiums after 90 Days $8 copayment for non-emergency use of the ER Provider can refuse service for failure to make copayment for those above 100% FPL Healthy Behaviors Healthy behaviors can reduce cost sharing

Healthy PA Private Coverage Across the State

Region 1: United Healthcare, UPMC, Gateway Health, Vista Region 2: UPMC, Gateway Health, Vista, Keystone Health Plan West/Highmark Region 3: Geisinger Health Plan, United Healthcare, Vista Region 4: United Healthcare, Aetna Better Health, UPMC, Vista, Keystone Health Plan West/Highmark, Gateway Health Region 5: United Healthcare, UPMC, Gateway Health,Vista Region 6: Geisinger Health Plan, United Healthcare, Gateway Health, Vista, Capital Blue Cross

Region 7: Geisinger Health Plan, United Healthcare, UPMC, Gateway Health, Vista, Capital Blue Cross Region 8: United Healthcare, Aetna Better Health, Health Partners, Gateway Health, Vista Region 9: United Healthcare, Aetna Better Health, Gateway Health, Vista, Capital Blue Cross

The Healthy Pennsylvania Private Coverage Option will begin providing coverage on Jan. 1, 2015.

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Healthy Pennsylvania Taxpayer Savings

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FY 14-15 FY 15-16 ACA $218,954,121 $331,046,519 Administrative Costs $39,751,000 $38,091,000 Healthy PA (savings) ($125,405,377) ($616,396,847) Total in First 2 Years $133,299,744 ($247,259,328) Cumulative Total by Year 8 = $4.5 Billion

Healthy Pennsylvania PlanHPA ChronologyKey FactsA Pennsylvania-specific PlanHealthy PennsylvaniaHealthy PennsylvaniaHealthy PennsylvaniaHealthy PennsylvaniaHealthy PA Private Coverage Across the StateHealthy Pennsylvania Taxpayer Savings