Medicaid Budget for Fiscal Year 2013-2014

Source: Pennsylvania Health Law

Governor Corbett and the General Assembly reached agreement on the state budget but failed to reach any agreement on the Governor’s proposed state pension changes, transportation funding, or liquor store privatization plan. The $28.375 billion General Fund budget is an increase of 2.3% over the previous year. The final Fiscal Year 2013-2014 budget for the Medicaid program is most note-worthy for what it does not contain: Medicaid expansion (as discussed previously). None of the line-item appropriations and initiatives that are contained in the final Medicaid budget approach the scale of the Medicaid expansion, which would have expanded Medicaid to nearly a half million additional uninsured adults in Pennsylvania.

Unlike in recent years, this budget does not cut eligibility or reduce the services available to Medicaid consumers. It funds the Department of Public Welfare (DPW) at $10.96 billion, an increase of 3.1% over the past fiscal year. The overall budget for the Medicaid program is $20.2 billion, which includes $6.5 billion in state General Funds, $2.6 billion in “other” state funds, and $11.1 billion in federal funds.
The final Medicaid budget contains reauthorization of the statewide hospital assessment, a 2% rate increase for nursing facilities, and a 2% increase in the capitation rates for Medicaid managed care organizations. It also contains an 8% increase in funding for the Medical Assistance Transportation Program.
Specific highlights of the final FY 2013-2014 Medicaid budget include:

  • Human Services Block Grant: The budget expands the Human Services Block Grant program, through which counties receive flexibility in spending their county-based human services funds, from 20 to 30 counties. The Governor had proposed expanding this program statewide.
  • Intellectual Disability (ID) Waiver Funding: The budget provides additional funds to reduce waiting lists for the Consolidated and Person/Family Directed Supports (PFDS) Waivers. DPW officials estimate the additional funding will allow them to serve 380 individuals currently on an ID waiver waiting list. They also estimate the funding will be sufficient to provide waiver services to an additional 118 individuals with autism spectrum disorders.
  • Funding for Individuals with Physical Disabilities: The budget provides additional funds to serve approximately 1680 more people through waivers for individuals with physical disabilities. It is not clear at this time whether this increased funding will result in people being able to enroll into the COMMCARE or the OBRA waivers again (these programs currently have an enrollment moratorium). There is a 13% increase in funding for the Attendant Care waiver and Act 150 pro-gram, but DPW officials did clarify that this increased funding would not be used to reduce the waiting list for Act 150 services. The state-funded Act 150 program is for adults with physical dis-abilities who do not qualify for the Attendant Care Waiver because they don’t meet the level of care or financial eligibility requirements.
  • In-Home Services for Older Adults: The budget included an increase in fund-ing for the Aging Waiver program which provides in-home services to individuals age 60 and older who are determined to meet the nursing home level of care. The increased funding allows for an ad-ditional 1550 older adults to be served under this program.
  • “Fair Share” Premiums for Families with Disabled Children: The final budget includes a new premium for the families of children with disabilities (PH-95 category) with incomes above $100,000 per year. Department officials, however, do not believe implementing this premium is per-mitted under the federal maintenance of effort protections in place until 2019 for children.