Medicaid. Summary

Hundreds of operational and technical professionals as well as policies engaged in implementing the health care reform law. Some states including Pennsylvania had to prioritize these requirements since simultaneous dealing with all the aspects of implementing the reforms is difficult. Pennsylvania lacks adequate information and federal guidance concerning the various aspects of the Health-Care Reform Law.

Medicaid is the most crucial budget cost not only for Pennsylvania, but also other US states. About one third of the entire budget of Pennsylvania is spent on Medicaid. Pennsylvania had to cut back the state funding for higher education due to the high expenditures associated with Medicaid.

The administration aims to deal with the problems of health care coverage in Pennsylvania through the Governor. Until the state has the flexibility to create a framework that increases cost-effective coverage, it will delay the decision concerning the expansion of Medicaid for adult citizens. The Federal Government needs to pay for all the costs for the recently qualified people on Medicaid according to the Affordable Care Act for first three years of the expansion.

Federal law required the states to adopt the Modified Adjusted-Gross Income (MAGI) approach in determining the eligibility for Medicaid. MAGI rules are a challenge for Pennsylvania health care IT systems. The costs of integrating these changes into the present system are estimated to be not less than 250 million dollars.

DSH adjustment payment provides finances to hospitals, which serve a considerable number of low money income patients or hospitals located in urban areas and have more than 100 beds. States receive a yearly DSH allocation to meet the cost of hospitals which provide care to citizens with low income which are not paid out by other payers like Medicaid, CHIP, Medicare.

The law on health care reform requires the health care department to carry out system changes on their Medicaid Management Information System for both the providers and the claims. Personnel is to enroll every prescribing, referring and ordering providers. This brings considerable change to every state. Pennsylvania has about 67000 rendering providers.



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