One State’s Medicaid Managed Care Formulary Operations: A Look at Pennsylvania, 2001-2002 This report examines formulary implementation under mandatory Medicaid managed care in Pennsylvania between 2001 and 2002. It looks at one state during a yearlong period; formulary operations are likely to vary across states and programs and over time.…
- state & global data
- view as grid
- view as list
Updated as of December 12, 2012 Establishing the Exchange On December 12, 2012, Governor Tom Corbett (R) notified federal officials that Pennsylvania would default to a federally-facilitated health insurance exchange.1 Prior to the announcement, the Pennsylvania Insurance Department had taken the lead with exchange planning. The Insurance Department, released an…
This state report explains how the ACA expands coverage in Pennsylvania, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Pennsylvania are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, the report quantifies how many uninsured people fall into the “coverage gap,” meaning they will be ineligible for financial assistance in the Marketplace or for Medicaid in their state despite having an income below the federal poverty level.
This fact sheet describes Pennsylvania’s approved 1115 waiver demonstration, Healthy PA, which will implement the ACA’s Medicaid expansion.
This brief focuses on Section 1115 Medicaid demonstration waivers related to implementation of the ACA Medicaid expansion (eligible for ACA enhanced matching funds) or other coverage (not eligible for ACA enhanced matching funds). To date, the Centers for Medicare and Medicaid Services (CMS) has approved waivers to implement the Medicaid expansion in five states: Arkansas, Iowa, Michigan, Pennsylvania and most recently Indiana. In addition, Pennsylvania has a waiver proposal. In addition, New Hampshire has a proposal pending with CMS, and Governors in both Tennessee and Utah have been negotiating plans with CMS, but these plans also need to be approved by the state legislature.
The Affordable Care Act (ACA) went into full effect on January 1, 2014, ushering in health insurance reforms and new health coverage options in Pennsylvania and elsewhere across the country. Pennsylvania is experiencing changes to its health care delivery system as the state expands Medicaid, provides new coverage options through the federal health insurance marketplace, streamlines application and enrollment processes for coverage programs, and implements new health care delivery system and payment reforms. This fact sheet provides an overview of population health, health coverage, and the health care delivery system in Pennsylvania in the era of health reform.
This report is based on based on focus group discussions with parents with moderate incomes enrolled in private coverage (employer sponsored or Marketplace) who had children in public coverage (primarily CHIP) or children with private coverage. This report is based on 14 focus group discussions conducted by the Kaiser Family Foundation and John Snow, Inc. in six cities during February and March 2015. Sites included Birmingham, AL, Chicago, IL, Denver, CO, Philadelphia, PA, and Tampa, FL. Each of these states operate separate CHIP programs. An additional 4 focus groups were conducted in Los Angeles, CA (two in English and two in Spanish). The purpose of the groups was to gain insight into what low and middle-income families value in their children’s coverage, their experiences with CHIP and private insurance, and on parents’ perspectives on the future of CHIP. The information gathered can help inform policy questions such as would private coverage (either employer sponsored coverage or Marketplace) or Medicaid work for children who currently are enrolled in CHIP?