The Pennsylvania Medicaid Program

In Pennsylvania, the Medicaid program is called Medical Assistance, and the Department of Public Welfare (DPW) is responsible for its management.  DPW sets eligibility standards and, through local county assistance offices, conducts eligibility determinations and recertifications.  DPW also establishes medical benefits, provider payments, and the level of beneficiary cost sharing (Pennsylvania Department of Public Welfare 2009).  It also reimburses medical providers and makes payments to health plans.  Budget considerations and laws also shape the Medicaid program in Pennsylvania. Medical Assistance provides health insurance coverage for many low-income people, offers long-term care assistance to individuals who are 65 and older, covers individuals with disabilities, and addresses the gaps in the Medicare program.  Consequently, Medical Assistance is a major source of funding for healthcare institutions.  Through Medicaid, the Commonwealth is the second largest health insurer in Pennsylvania (after Blue Cross/Blue Shield affiliates).  In the average month during 2009, approximately 15 percent of Pennsylvania’s population was enrolled in Medicaid.  Between July 1, 2008, and June 30, 2009 (the state’s fiscal year), Pennsylvania’s total Medicaid expenditures were approximately $16.6 billion.  Of this amount, the state paid $7.5 billion ($5 billion came from the general fund and $2 billion from other sources, such as the Tobacco Fund and taxes on providers).  The federal government paid $8 billion, or 54.8 percent of the total cost of the Medicaid program in Pennsylvania (Pennsylvania Department of Public Welfare 2009).