New Medicaid Feature Aims to Reduce Nursing Home Enrollments in Pa.

Pennsylvania has unveiled a new Medicaid feature designed to reduce the number of nursing home enrollees in years to come.

Under the Community HealthChoices initiative, insurers will be paid to manage Medicaid’s long-term care services with a financial incentive meant to prioritize in-home care for enrollees.

The state is rolling out the program in 14 southwestern counties on Jan. 1, with a wider launch planned for the Philadelphia area in 2019 and the remaining 48 counties across central and northern Pennsylvania in 2020, the Associated Press reported.


About 80,000 people, many of whom qualify for both Medicare and Medicaid, are eligible to participate in the first round of the program, the Pittsburgh Post Gazette reported.

The big driver behind the change is cost. One year of nursing home care costs about $62,000 per person, while similar in-home care costs around half that amount, state officials told AP.

“Long term, you are expecting to see savings because you are going to be seeing more people getting services in a less expensive environment, which also happens to be where people want to get their services, at their home,” Teresa Miller, Democratic Gov. Tom Wolf’s acting human services secretary, told AP.


The move would dampen the growth of the state’s growing Medicaid-covered nursing home population, which currently numbers more than 50,000. Though the feature may not prompt many people to move out of nursing homes in the state, it could let more seniors stay at home for longer.

The initiative has run into some pushback from some groups representing home health agencies and nursing homes, both of which worry about glitches in a new payment system and coordinating with insurers, reported AP.

And nursing homes could still be the cheaper option for someone who has multiple chronic health care needs, according to the Pennsylvania Health Care Association (PHCA), an advocacy group that represents long-term care providers in the state.

“No one who does not need the around-the-clock skilled care and services provided in a nursing facility should be forced to reside in a nursing facility merely because other options do not exist,” PHCA President and CEO W. Russell McDaid told Skilled Nursing News. “However, unless a Medicaid-eligible person needs significantly less care and can be safely cared for in their home, Medicaid-funded care in a nursing facility is the more cost-effective use of Pennsylvania’s tax dollars.”

Written by Tim Regan

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