1. Pennsylvania Health Law Project May 2011 How the Pennsylvania Budget Could Impact Your Access to Care

2. Budget Process Overview Mar. 8, 2011: Governor Corbett released proposed budget March: Appropriations Hearings Passage of General Appropriations Bill July 1, 2011: Final budget must be passed

3. Budget Snapshot The Challenge $4.1B deficit Enhanced ARRA funding ends June 30, 2011 Governor’s Proposed Budget ($27.3B) Corbett’s Commitment: No revenue enhancements or tax increases Reflects Priorities Public Welfare vs. Education Budget Surplus

4. Department of Public Welfare (DPW) Increase in State Funding ($11.2B proposed) Maintenance of Effort Requirements Federal Medical Assistance Percentage MA Spending Expected to Increase: $5.2B (from $3.5B) More complex medical problems Increased drug and technology costs Higher service utilization Current Medicaid Beneficiaries: 2.2 million (1 out of 6) Projected Increase in Enrollment: 4 to 5 percent

5. DPW - Proposed Changes Benefit Limits Dental Benefit ($25M reduction) Prescription Drug Benefit ($28M reduction) Pharmacy Utilization Management Prior authorization of certain drugs Utilization management for certain controlled substances Managed Care Funding Rate increase ($965M increase) Performance incentives ($26M increase) Hospital Supplemental Payments ($150M reduction)

6. Long-Term Living Cost-Containment Initiatives Nursing Home Care Smart Purchasing ($22.9M saving) Program Integrity ($5.4M saving) Rebalancing Long-Term Living System ($18.2M saving) Waiver Programs Aging Waiver: No projected growth No Assisted Living Waiver Other Options Available Community First Choice? Spend-down to Waiver?

7. Rebalancing the Long-Term Living System "Savings generated through the implementation of a variety of home and community-based services reforms, including improved service coordination, revised reimbursement rates and reporting requirements, and expanded consumer-directed care.”

8. Services to Persons with Disabilities & Attendant Care CSPPPD waivers: $27M net decrease Attendant Care (Waiver and Act 150 Program): $36M reduction (state and federal funding) PENNCARE appropriation: 240 additional Act 150 slots Sufficient funding to continue programs Continue managing CSPPPD waivers and Act 150 Program to attrition Savings assumed from a “variety of HCBS reforms”

9. Other Long-Term Care Programs PACE/Net: $50M increase Living Independence for the Elderly (LIFE) $29M increase Program grew 58% from 2008 to 2010 OLTL proposing rate adjustment effective 7/1/11 Eliminates Human Services Development Fund

10. Office of Mental Health and Substance Abuse Services Maintains HealthChoices Carve-Out Special Pharmaceutical Benefits Program: $1.3M increase Maintains county respite funding for children receiving behavioral health services Does not add “psychiatric rehabilitation” as a covered service No funding for Department of Drug & Alcohol Services

11. OMHSAS Cost-Containment Initiatives Eliminates Pay-for-Performance Incentive Payments ($19M saved) Caps Reinvestment Dollars ($20M saved) Privatizes Forensic Units ($3M saved) Shifts Act 152 Drug & Alcohol Treatment Funding to Behavioral Health Managed Care Organizations ($1.5M saved) More Prudent Use of Behavioral Health Rehabilitative Services ($10M saved) Reduced Lengths of Stay for Children in Residential Treatment Facilities ($10M saved)

12. Intellectual Disability Services Bureau of Autism Services Adult Autism Waiver (300 slots) Adult Community Autism Program (180 slots) Office of Developmental Programs (ODP) will take greater control over: Distributing waiver slots Reviewing Individualized Service Plans Continue funding for transitioning persons out of ICF-MRs into smaller group homes funded under Consolidated Waiver ODP will review 1-2 person group homes $7.5M increase to fund the changing needs of current P/FDS and Consolidated Waiver recipients

13. Person/Family-Directed Services (P/ FDS) & Consolidated Waiver Programs Waivers managed to attrition. Exceptions: 50 people currently in state centers 35 people in State Psychiatric Hospitals who also have intellectual disabilities 7 people in the MH system who also have intellectual disabilities 16,845 Pennsylvanians on county waiting lists. Includes: 3,051 on Emergency Waiting List 8,150 on Critical Waiting List 5,644 on Planning Waiting List

14. ODP Cost-Containment Initiatives Limiting Payment for State-funded Waiver-ineligible Costs ($27.0M saved) Reducing reimbursements to group homes under the Consolidated Waiver Reviewing group home “ineligible” costs Program Integrity ($11.0M saved). Includes: Changing the number of reimbursable “vacancy days” ($9.7M saved) Ensuring the MA Waiver functions as the payer of last resort Placing limits on habilitation services*

15. Department of Health Reduces Department funding by $28M Eliminates funding for: Several disease-specific programs (ex: Lupus, Tourette Syndrome, Epilepsy Support Services) Newborn Hearing Screening Regional Cancer Institutes Rural Cancer Outreach Drug and Alcohol Abuse Prevention and Treatment Level-funded Remains in DOH

16. Department of Insurance Special Programs Maintains funding for CHIP at 2010-11 level: $97.3M Eliminates funding for adultBasic Affordable Care Act High Risk Pool: $41.1M Consumer Assistance Program: $1.4M PA Exchange Grant: $1.0M Health Insurance Premium Review: $1.0M

17. House Bill 1485 Overview $27.3 billion spending plan $500 million surplus remains intact Restores some cuts to public and higher education Basic education aid ($210M restored) Higher education aid ($380M restored)

18. House Bill 1485 The Nitty Gritty $471M of cuts in public welfare spending Addresses DPW administrative errors in handling MA cases ($158M saved) Cost-sharing proposals ($50M saved) Monthly premium for MA for severely disabled children Copays for doctor visits and transportation Increases use of generic drugs Eliminates discretionary spending by DPW

19. House Bill 1485 The Really Nitty Really Gritty Office of Medical Assistance Programs Most hospital supplemental programs ($23M restored) Human Services Development Fund ($20M restored) Hospital inpatient ($44M reduction) Fee-for-service outpatient ($81M reduction) Managed care capitation ($15M reduction) Medical Assistance Transportation ($10M reduction) Office of Long-Term Living Long-term care ($315M reduction) Home and Community-Based Services ($452M restored) Eliminates Attendant Care ($103M) and Services to persons with disabilities ($136M) Breast cancer screening ($1M reduction) Behavioral health ($4M reduction) Autism intervention services ($3M reduction) Mental Health Services ($4M reduction)

20. adultBasic Subsidized insurance for working poor Terminated on 2/28/11 after 9 years in operation 42,000 lost health coverage; 505,000 on waiting list 63% of enrollees were women Funded by the “Blues” and Tobacco Settlement Fund Options Special Care Medicaid

21. Tobacco Settlement Fund: Background Established by Tobacco Settlement Act (Act 77 of 2001) Payments are allocated to designated health related programs Health Insurance for Adults: 30% Health Research: 19% Home and Community-Based Services for Seniors: 13% Tobacco Use Prevention and Cessation Programs: 12% Hospital Uncompensated Care Payments: 10% PACENET: 8% Health Endowment Account: 8% Annual allocation based on payments received in previous year

22. Tobacco Settlement Fund: Corbett’s Proposal “The budget proposes to deposit the Tobacco Master Settlement Agreement directly into the General Fund beginning in 2011-12. Funding previously provided to the Department of Aging for Home and Community- Based Services from the Tobacco Fund is recommended to be appropriated from the Lottery Fund. The Lottery Fund will be offset by a decrease in the Lottery Fund Medical Assistance-Long-Term Care appropriation in the Department of Public Welfare” - Department of Aging’s Budget Narrative (page E7.6)

23. WelFAIR (Fairness, Accountability, Integrity and Responsibility) HB 1297: Drug Testing for Public Assistance (Everett, R- Lycoming) HB 960: Income Eligibility Verification System (Gingerich, R- Lebanon) HB 392: Photo ID (Kauffman, R-Cumberland/Franklin) HB 1251: Strengthen Welfare Fraud Penalties (Toohil, R- Lurzerne) HB 1261: Welfare Benefit Oversight (Quigley, R-Montgomery) HB 1312: Special Allowance Reform (Stephens, R-Montgomery) HB 1254: Prohibiting Tobacco Purchase (Reese, R-Fayette /Westmoreland) HB 1301: Medical Assistance Transportation Reform (Oberlander, R-Clarion/Armstrong)

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