1. >www.dpw.state.pa.us > Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare DPW Overview & Healthy PA Presented by: Secretary Beverly Mackereth 1

2. >www.dpw.state.pa.us > DPW is the largest Human Services Agency in the Country: Staff complement as of July 2014: 15,617 full-time filled complement 96 part-time 845 wage 134 annuitants Total DPW budget for FY 2014-15: $31.5 Billion $11.2 billion in state (general fund) $17.6 billion in federal $ 3.0 billion in other funds DPW is 39% of the General Fund Budget Approximately 22.7% (2.89 million) of all Pennsylvanians were enrolled in a DPW benefit program as of May 31, 2014 (Based on the US Census Bureau 2012 Pennsylvania population estimate of 12,763,536). DPW Quick Facts 2 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

3. >www.dpw.state.pa.us > Facilities Operated by DPW: 94 County Assistance Offices 6 Youth Development Centers/Youth Forestry Camps that served around 777 children in FY 2013-14 5 State Centers for Persons with Intellectual Disabilities that were serving 996 individuals as of June 30, 2014 7 State Mental Health Hospitals that were serving 1,522 individuals as of July 2014 3 DPW Quick Facts Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

4. >www.dpw.state.pa.us > Program Office Service Delivery 67 County/Joinders 52 Area Agencies on Aging ~100 Service Coordination Organizations 10 Managed Care Organizations 94 CAOs 42 CCIS 500 School Districts 29 Intermediate Units Other DPW Central Office 67,000 Providers DPW Regional Offices OIM OLTL OMAP OMHSAS ODP OCYF OCDEL OA 4

5. >www.dpw.state.pa.us > Conducts administrative hearings on appeals received from recipients and DPW funded agencies services Hearings and Appeals Detects and deters fraud waste and abuse in the Medicaid program and administers third party recoveries in the Medicaid program Program Integrity Organizes and conducts audits, guides procurement process, evaluates RFP’s, and executes and monitors contracts Financial Operations Administers DPW’s HR systems including labor relations, employee training, recruitment, classification, and placement Human Resources Supports all information technology needs for Departments of Welfare, Aging and Insurance Information Systems Ensures nondiscrimination and equal opportunity in all activities Equal Opportunity Services include: forms and publications, printing, automotive fleet operations, guardianship programs, facilities and property management, and emergency operations Administrative Services The Bureau of Human Services Licensing ensures safe living conditions for over 100,000 adults and children with mental illnesses, intellectual disabilities, physical disabilities, and behavioral and/or cognitive disorders. Office of Administration (OA) 5 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare Licenses, inspects, and regulates more than 8,500 out-of-home care settings. Human Services Licensing

6. >www.dpw.state.pa.us > Child Care Certification Certification Services Keystone STARS Keystone Babies Pennsylvania Pre-K Counts Full Day Kindergarten Head Start State Supplemental Assistance Program Early Head Start Parent-Child Home Program Nurse-Family Partnership Children’s Trust Fund Early Learning Services Early Intervention Infant/Toddler Early Intervention Preschool Early Intervention Services Child Care Works Subsidy Services As of December 2013, nearly 112,423 children were provided monthly subsidies through Child Care Works. 6 Office of Child Development and Early Learning (OCDEL) Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

7. >www.dpw.state.pa.us > Youth Development Centers Youth Forestry Camps County Juvenile Probation Offices Private Agency Delinquency Services Juvenile Justice Services Foster Family Service Community Residential Service and Group Home Service Supervised Independent Living Service Residential Service Secure Residential Service Emergency Shelter Service Placement Homemaker/Caretaker Service Life Skills Education Adult Education Protective Services (Child Abuse) Protective Services (General) Counseling/Intervention Services Protective Services Adoption Services Adoption Assistance Adoption Day Care Service Day Treatment Service Day Services Information and Referral Services Service Planning Administration & Oversight From Sept. 30, 2009 to March 31, 2014, out-of-home placements of children have decreased by 19% in PA. Office of Children, Youth and Families (OCYF) 7 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

8. >www.dpw.state.pa.us > HealthChoices Behavioral Health (HC-BH) Program Fee-for-Service Behavioral Health Services Initiative (BHSI) Base Act 152 Behavioral Health & Substance Abuse Services CHIPP Integration Programs State Hospitals and Restoration Center Other Initiatives State Facilities Special Pharmacy Benefits Program for Mental Health (SPBP-MH) Pharmacy 1,952,895 of MA covered Pennsylvanians were covered by HealthChoices Behavioral Health as of March 2014. Office of Mental Health and Substance Abuse Services (OMHSAS) 8 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

9. >www.dpw.state.pa.us > Consolidated Waiver P/FDS Waiver Base Services Intellectual Disabilities: HCBS Adult Autism Waiver (AAW) Adult Community Autism Program (ACAP) Autism: HCBS State Centers Private Facilities Intermediate Care Facilities Office of Developmental Programs (ODP) 9 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare Over 28,000 individuals were served by ODP waivers as of May 2014.

10. >www.dpw.state.pa.us > For Families with Children For the Aged and Disabled Long Term Care Select Plan for Women Medical Assistance Temporary Assistance for Needy Families (TANF) SSI State Supplement Cash Assistance Nutritional support for low- income families Supplemental Nutrition Assistance Program (SNAP) Assistance to low-income families in need of assistance with their heating and cooling bill Low Income Home Energy Assistance Program (LIHEAP) Establishes paternity and support orders and provides medical support and employment services for non-custodial parents Child Support Enforcement A suite of programs that provide job readiness, placement, retention training, and supportive services Employment and Training Programs Provides services to families and children in immediate need of shelter and to those in imminent danger of becoming homeless Homeless Assistance Provides free services to assist clients to resolve civil legal problems Legal Assistance As of July 2014, CAOs helped more than 397,000 households to stay safe and warm in their homes. Office of Income Maintenance (OIM) 10 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

11. >www.dpw.state.pa.us > Managed Care Fee for Service Medical Assistance What is Medical Assistance? Medicaid is an entitlement program jointly funded by the federal and state governments that provides health care coverage to low income children and adults, the elderly, and disabled. The Pennsylvania Medicaid Program is known as Medical Assistance (MA) because it includes both the federal Medicaid Program as well as state funded only programs, i.e., General Assistance and State Blind Pension recipients How are services delivered? Fee for service administered through the federally-approved Medicaid State Plan Mandatory Medicaid managed care program known as HealthChoices administered through a federally-approved 1915(b) waiver Pennsylvania Medicaid Facts 17.8% of Pennsylvanians are currently covered by some form of MA Over 81,000 MA providers 58,136,763 claims processed for FY13 Office of Medical Assistance Programs (OMAP) 11 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

12. >www.dpw.state.pa.us > Attendant Care Waiver Act 150 Attendant Care Independence Waiver COMMCARE Waiver OBRA Waiver Community Service Programs for People with Physical Disabilities (CSPPPD) Aging Waiver Aging MA Nursing Facilities Nursing Facilities AIDS Waiver AIDS Living Independence for the Elderly (LIFE) LIFE Over 47,000 individuals were served by OLTL waivers as of May 2014. 12 Office of Long-Term Living (OLTL) Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

13. >www.dpw.state.pa.us > Our mission is to improve the quality of life for Pennsylvania’s individuals and families. We promote opportunities for independence through services and supports while demonstrating accountability for taxpayer resources. Mission Statement Our vision is to see Pennsylvanians living safe, healthy and independent lives. Vision Statement Strategic Focus Areas Communications AccountabilityBack to Basics 13 Strategic Planning for the Department Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

14. >www.dpw.state.pa.us > DPW Budget Priorities 14 Expanding Services for Older Pennsylvanians and Individuals with Physical Disabilities: Increase of $25.3 million in General and Lottery funds to serve: An additional 1,764 older Pennsylvanians through the Medicaid Home and Community-Based Aging Waiver ($11.6 million); An expansion in the LIFE program ($4.7 million); An additional 1,599 individuals with physical disabilities in community settings ($9 million). Expanding Services for Individuals with Intellectual Disabilities and Autism: Additional $13.1 million to provide home and community-based options for: 700 young adults who are graduating from the special education system to continue to live independently in the community; 400 individuals who are on the emergency waiting list to access crucial services to keep them in their homes and communities; and 100 adults with autism spectrum disorders. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

15. >www.dpw.state.pa.us > DPW Budget Priorities 15 Moving Individuals from Institutional Care to Community-Based Care: An additional $2.8 million to increase community placement for individuals currently in state mental hospitals and state intellectual disability facilities. This enables the transition of clients from state mental hospitals to progressive mental health treatment in home-like settings as well as clients from state intellectual disability facilities to home and community-based settings. Act 150: Funding was allocated to serve individuals currently on the Act 150 waiting list who are determined eligible. Child Care Assistance: Increase of $15 million in federal funds to allow an additional 2,895 children currently waiting for services to receive child care assistance. Child Advocacy Centers: $2 million for the support and expansion of Child Advocacy Centers in Pennsylvania, supporting a recommendation from the Task Force on Child Protection. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

16. >www.dpw.state.pa.us > DPW Budget Priorities 16 Balancing Incentive Program - $94 million ($75m in FY 2014-2015) Enhanced federal funds (2% increase in federal matching funds, or FMAP) on community-based long-term services and supports Available to states that spend less than 50% of their long term supports on community based services The increase in FMAP is time limited and expires September 2015 Requirements to receive the increase include: No wrong door approach Core elements required by CMS and consistency between assessment tools Conflict free Provide utilization and outcome data Application approved by the federal government on June 18, 2014 BIP funding began July 1, 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

17. >www.dpw.state.pa.us > Long-Term Care Commission 17 Commission Responsibilities –Identify and examine the critical issues and trends in Pennsylvania’s long-term care services and supports delivery system –Study existing long-term care resources available for individuals with physical disabilities, older adults, their families and caregivers –Consult with various commonwealth departments and agencies on: Regulations Licensure Financing Other responsibilities relating to long-term care –Review current and proposed state and federal legislation and regulations relating to long-term care –Make written recommendations to the Governor on findings Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

18. >www.dpw.state.pa.us > Long-Term Care Commission 18 Areas of Focus for Work Groups –Prevention –Accessibility –Provision of Service –Quality Outcomes and Measurements Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

19. >www.dpw.state.pa.us > Long-Term Care Commission 19 Held 7 public sessions across the state More than 200 individuals provided input at the public meetings or submitted comments Report due to the Governor no later than December 31, 2014 The Executive Order expires on December 31, 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

20. Healthy PA Overview

21. Healthy Pennsylvania at a Glance 21 Increased health care access for 600,000 Pennsylvanians Improve health outcomes Benefits match health care needs Increased personal responsibility Reformed Medicaid program

22. Introduction This session provides an overview of the Healthy PA Program and the components being introduced in January 2015. Newly Eligible Adult Group Health Screening Healthy Behaviors New Components Low Risk High Risk Simplified Benefit Plan Structure 22

23. 23 Healthy PA Components Simplified Benefit Plan Structure Healthy PA Timeline Overview Topics

24. Healthy PA Newly Eligible 24 Ages 19-64 Income ≤ 133% FPL Not eligible for Medicaid

25. Healthy PA Newly Eligible 25 Ages 19-64 Income ≤ 133% FPL Not eligible for Medicaid Up to approximately $15,500 for an individual and $20,900 for a family of two.

26. Applying for Benefits There is ‘no wrong door’ when applying for health care! COMPASS Paper Application Consumer Service Center 26

27. Health Screening Aligns health care needs to the appropriate benefit package Basic information about a person’s health conditions, similar to what you may provide when first visiting a doctor’s office Completion of the tool is not required for eligibility Questions may be skipped Information is confidential If not completed, individuals will be placed in either the low risk plan or the Private Coverage Option. 27

28. Health Screening Who will need to complete the screening tool? Adults between the ages of 21 through 64 applying for Medicaid or the Private Option Coverage The following individuals will not complete the screening tool: Children up to the age of 21 Adults 65 years of age and older Pregnant woman Individuals on SSI (or in a SSI related eligibility category), Those applying for or receiving MA home and community base (waiver) services Individuals residing in institutional settings (nursing homes, intermediate care facilities) 28

29. Healthy Behaviors 29 Annual Wellness Visit Continue to pay as assigned Providers can deny services if: Individual refuses to pay copay; Current practice is to deny services with refusal to pay copay; and Household income is >100% of the applicable FPL Meet Cost-Sharing Obligations

30. 30 Healthy PA Components Simplified Benefit Plan Structure Healthy PA Timeline Overview Topics

31. New Medicaid Benefit Plans High Risk Adults who have complex health care needs, either medical or behavioral health, including pregnant women Administered by current HealthChoices managed care plans Screened High Includes adults 65 and over Adults who have complex health care needs, either medical or behavioral health, including pregnant women Administered by current HealthChoices managed care plans Screened High Includes adults 65 and over Low Risk Adults, ages 21 through 64, who do not have complex health care needs, either medical or behavioral, and are eligible for Traditional MA. Administered by current HealthChoices managed care plans Not screened high Opted out of how risk plan Adults, ages 21 through 64, who do not have complex health care needs, either medical or behavioral, and are eligible for Traditional MA. Administered by current HealthChoices managed care plans Not screened high Opted out of how risk plan 31 No changes have been made to the children’s benefit plan.

32. Both the high risk and low risk plans meet the federal standards for essential health benefits, mental health and drug & alcohol parity. Benefit Categories Covered Physician services, including primary care Outpatient services Emergency room services and emergency transportation (ambulance) Hospitalization Maternity and newborn care Mental health and substance use disorder services and treatments Lab services, x-rays, imaging (MRI, CT, etc.) Rehabilitation and habilitation services and devices Preventive and wellness services Prescription drugs Dental services 32 High Risk and Low Risk Plans

33. Private Coverage Option 33 Private market health insurance plan for individuals up to 133% of FPL who do not qualify for Medicaid Pennsylvania Enrollment Services will assist in enrolling individuals in a health insurance plan Cost sharing obligations identical to current MA plansCovers cost sharing for in-network services

34. Medically Frail 34 Medical Frail includes individuals who have a: Disabling mental disorder Chronic substance abuse disorder Serious and complex medical condition Physical disability that significantly impairs his or her functioning Intellectual or developmental disability Disability determination designation by the Social Security Administration Individuals who are screened as medically frail will be placed in the Medicaid high risk benefit plan.

35. A Pennsylvania-specific Plan Medical Assistance (Vulnerable Pennsylvanians) Low income parents/ caretaker relatives with incomes up to 44% FPL Children Medically frail/Individuals with disabilities Seniors Private Coverage Option (January 1, 2015) Childless adults Adult parents/caretaker relatives Incomes up to 133% FPL Working poor 35

36. 36 Healthy PA Components Simplified Benefit Package Structure Healthy PA Timeline Overview Topics

37. Implementation Timeline November 2014 December 2014 January 2015 37 Letter sent to recipients changing packages If transitioning to low risk or PCO plan, includes invitation to complete health screening Notices of transition mailed Effective date of new MA and PCO plans PCO enrollment begins