Effective December 27, 2020, migrants under the Compact of Free Association (COFA) may be newly eligible for Medicaid if they meet all of the eligibility criteria in their state. COFA migrants are generally citizens of the Marshall Islands, Federated States of Micronesia, and Republic of Palau who are lawfully residing in one of the U.S. states or territories. Under the new eligibility criteria, COFA migrants are now considered qualified non-citizens (QNC) for the purposes of Medicaid eligibility and do not have to wait for five years after receiving their status before qualifying for Medicaid coverage, if otherwise eligible. This policy change does not apply to coverage through separate Children’s Health Insurance Program (CHIP) programs, except for states that have elected to cover children and/or pregnant women in CHIP under the CHIPRA 214 option.

Currently, COFA migrants who apply at the Federally-Facilitated Exchange (FFE) will not be found eligible for Medicaid, as the system does not consider COFA migrants to be QNCs for purposes of Medicaid eligibility. Instead, COFA migrants may be found eligible for Marketplace coverage with advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs), if otherwise eligible. CMS is actively working on system changes to determine correct eligibility for these consumers at the Marketplace, and anticipates a release in early summer 2021.

Until the system changes at the FFE are finalized, CMS recommends that consumers apply directly with their state Medicaid agencies to determine their eligibility for Medicaid. Once consumers receive a determination of eligibility for Medicaid, they should return to the Marketplace to end their QHP coverage with financial assistance if they are found eligible for Medicaid and do not want to pay full cost for their share of the Marketplace coverage. This is because consumers who are enrolled in Medicaid or CHIP that counts as qualifying coverage (also known as minimum essential coverage, or MEC), are not eligible for APTC or CSRs to help pay for the cost of a Marketplace plan premium and covered services. The FFE will not take action on a consumer’s behalf to end their Marketplace coverage if they are found to be Medicaid eligible by their state due to this policy update.

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced commitments from national organizations to support Latino outreach and enrollment efforts during the current Special Enrollment Period (SEP) made available on HealthCare.gov by President Biden due to the COVID-19 Public Health Emergency. As part of the Latino Week of Action April 18 – 24, these organizations and HHS will share information with Latino consumers and use social media to encourage them to enroll in affordable, quality health plans through HealthCare.gov.

“Helping communities take advantage of reduced costs on quality health care coverage is a priority for this Department. In addition to putting our money where our mouth is, we are partnering with key organizations representing the Latino community to engage their knowledge and network to promote enrollment in quality, affordable health insurance coverage during this Special Enrollment Period,” said HHS Secretary Becerra. “To the many Latinos who may have lost health care coverage during the pandemic, I am here to tell you that ‘help is here.’ Health care coverage is more affordable for people and assistance is available if you need help finding a health plan that best meets your needs.”

• To read the HHS press release in Spanish, visit: HHS Press Release Spanish.
• To read the HHS press release in English, visit: HHS Press Release English

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) announced the availability of $2.7 million in funding for entities to deliver employment support services to individuals in recovery from substance use disorder (SUD) seeking to enter the workforce.

“A key component to an individual’s sustained recovery is steady, reliable employment,” said DDAP Secretary Jen Smith. “To date, we have significantly expanded access to treatment, and we are starting to shift our focus to the entire continuum of care. These grants will enable organizations to give individuals the necessary tools to succeed after treatment and empower their recovery.”

The grants are part of $55 million in federal funding awarded to Pennsylvania through the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Substance Abuse Prevention and Treatment Block Grant Program COVID-19 Supplemental Awards. The funding spending plan submitted by DDAP is currently pending approval by SAMHSA. More information will be shared about this funding and supporting projects as it becomes available.

Eligible applicants can find the grant application and project summary on the DDAP website here. Five to eight grants will be awarded up to $400,000 for a wide variety of eligible items, including:

• Vocational assessments;
• Resume writing;
• Interviewing skills;
• Job placement; and
• Transportation assistance related to employment.

All applications must be submitted via email to RA-DAGrantsMgmt@pa.gov by 12:00PM on Monday, May 17, 2021. Applications will be competitively reviewed and scored based upon the applicant’s adherence to the funding announcement guidelines, and timely submission to DDAP. Additionally, awarding of the funds is contingent upon the approval of DDAP’s funding spending plan by SAMHSA.

Questions regarding the grants and the application process should be forwarded to RA-DAGrantsMgmt@pa.gov.

Throughout the Wolf Administration’s second term, DDAP is placing a heavy focus on reducing stigma associated with substance use disorder, intensifying primary prevention efforts, strengthening treatment systems, and empowering sustained recovery. The aim of these efforts, laid out in DDAP’s 2019-2022 State Plan, will be to positively influence the knowledge and behavior around the topic of addiction.

For more information about the work the Wolf Administration is doing to combat the opioid crisis, visit pa.gov/opioids.

Kathy Masisak, 68, doesn’t want to live in a community without robust medical care. But her local hospital in rural McKean County has been downsizing for years, and she said it’s affecting her family.

“They took a maternity ward away last year, and my granddaughter had to go to Olean — which is 35, 40 minutes away — in an emergency situation to deliver that baby,” Masisak said. “I was panicking the whole time going over there to see her.”

Masisak lives in Lewis Run, a borough seven miles south of Bradford, where the Bradford Regional Medical Center is about to lose even more services, including departments for acute care and surgery.

The COVID-19 era has created a paradox for hospitals. Even as medical needs related to the pandemic have grown — with so much focus on health care — other, less-essential hospital services were put under stress due to declining use. Hospitals across the country have been feeling the financial pain, but it’s hitting rural America especially hard.

‘Death by a thousand cuts’

Anne Hardy, 57, was the director of Bradford’s emergency department before retiring from three decades of service. She remembers the hospital’s heyday.

“We had a lot of young doctors, surgeons, medical guys, all starting their career,” said Hardy, who saw wide-ranging and robust options for patients. “I was impressed with the amount of young people in practice and what they were doing.”

But as more people moved away, and recruiting medical professionals got more difficult, cuts came faster. Bradford Regional merged with Olean General Hospital across the New York stateline in 2018. The following year, the OB-GYN department was cut.

And then, the pandemic hit.

“I’ll tell you, COVID killed us,” Hardy said. “I mean, we were seeing like 52 patients a day, averaging, and then COVID came and our volumes dropped in half. And that just really hurt the bottom line for so many hospitals.”

Starting in May, the hospital in Bradford will be left with just 10 inpatient beds.

Hardy, who retired in December, said the dwindling of services has been “like a death by a thousand cuts.”

Rural hospitals across the country have been facing struggles like this for years. Low patient volumes due to population loss plagues providers financially. According to a study by the University of North Carolina, since 2010, more than 130 rural hospitals have closed in the U.S.

A 2015 report on Pennsylvania found that 14% of people in the state live in medically underserved areas, including a significant portion of McKean County. In recent years, whole hospitals have closed in rural counties including Lawrence and Northumberland, with 10 others in danger of the same fate.

Jeff Zewe, President and CEO of Upper Allegheny Health System, which runs Bradford’s hospital, said the cuts boil down to basic supply and demand.

“Ten beds is a good fit,” Zewe said. “We’re just trying to get smarter and more efficient.”

Zewe also acknowledged the effects of the pandemic, which caused the health system to lose about $23 million in revenue last year.

“We lost a lot of revenue from shutting down those services that you can’t get back. So it certainly expedited things and pushed the need to do it sooner,” he said. “We needed to make an adjustment anyway.”

‘Big detriment’

Many in the community don’t see it that way.

State Rep. Martin Causer (R-McKean) said his phone has been ringing off of the hook with complaints.

“It’s hard to believe that we’re actually discussing this in the middle of a pandemic, when we’re talking about medical hospital resources, and making sure that we have resources to take care of patients,” he said.

Causer started a petition asking the health system to reconsider its move. More than 4,600 people signed it. In the letter to Upper Allegheny Health System leaders, he noted the move will have greater impact on low-income residents:

“Local residents understand that the proposed changes disproportionately affect people who are poor or have limited means of transportation,” he said. “Quite frankly, if one of your board members or I need health care services, we have the means to get ourselves to where we need to access services … that cannot be said for all residents of McKean County.”

The pushback over the downsizing is about more than lost medical services. The hospital is the third-largest employer in the county. Lifelong Bradford resident Sandra Hudspith said the decision is a “big detriment.”

“It isn’t just health care,” Hudspith said. “It is the welfare of our whole community. It is essential that we keep our health care system here or everything’s, I think, going to go down the tubes.”

But outside onlookers say these cuts may be necessary and could help small, rural hospitals avoid a worse fate.

“I would say, conversely, that having a hospital that has changed its capacity — gone down to 10 beds or 12 beds or whatever it might be — and is moving some services to the larger health system, is actually one way to make sure that that hospital can stay there in that facility,” said Lisa Davis, the director of the Pennsylvania Office of Rural Health, “because it then becomes more financially viable to keep it there.”

Upper Allegheny Health System said there will be layoffs resulting from the consolidation of services. A spokesperson said the numbers of jobs impacted “are looking very minimal.”

The intensive care unit at Bradford Regional Medical Center closed on April 1. Going forward, the health system said it will provide transportation for patients traveling between Bradford and Olean in New York.

A question lingering Anne Hardy’s mind is whether cuts to the hospital will create a vicious cycle, pushing more people to move away. At least in her case, the answer is ‘yes.’ She’s decided to leave the area when her husband joins her in retirement — a flight rooted in access to health care.

“As much as I love my little hospital, I don’t even know what the future holds for it. And I’ve got to go where the services will be there for me when I need them,” Hardy said. “The problem is, as small hospitals go away, there goes your community. Do you want to move to a community that doesn’t have a hospital?”

Listen to the broadcast here.

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Min Xian produced this story as part of the America Amplified initiative, using community engagement to inform and strengthen local, regional, and national journalism. America Amplified is a public media initiative funded by the Corporation for Public Broadcasting. Keystone Crossroads and WPSU are part of the America Amplified network. Reporter Min Xian is following stories that community members identify as deserving of more coverage in McKean County, Pennsylvania.

The country is reckoning with the many largely structural and systemic factors that contribute to poor maternal outcomes for women and birthing people, especially those of color. However, with the ever increasing threat of COVID-19, most do not understand how this also exacerbates the intersecting oppressions and brutal hardships Black women face. The truth is in the facts and they are grave: Black women are three times more likely to experience a pregnancy-related death than white women.

The Pennsylvania Department of Human Services (DHS) and Pennsylvania Department of Health (DOH) are working to ensure that all women have the rights, respect, and resources for a healthy pregnancy and births. We are joining with Black Mamas Matter to observe Black Maternal Health Week (#BMHW2021) and support their mission of improving outcomes for black mothers and their babies.

Black Maternal Health Statistics

• The U.S. has an infant mortality rate of 5.8 per 1000 live births in 2017, with an infant mortality rate among  Black infants of 10.8 deaths per 1,000 live births in 2018, almost twice as high.
• Black mothers are more likely to suffer from PMADs (Perinatal Mood and Anxiety Disorders) like postpartum depression, in silence and without clinical help.
• Only about 66% of Black infants are breastfed compared to more than 82% of white and Latinx moms.
• Hospitals in areas with higher percentages of Black residents were less likely to provide adequate breastfeeding information and support to new mothers.
• Black women disproportionately lack necessary reproductive health care—including contraception, abortion, STI screenings, and reproductive cancer screenings. This leaves them vulnerable to many risk factors around pregnancy. Recent improvements in maternal and infant health across the 20th century are due, in part, to expanded contraceptive access and use.
• Research indicates that 22% of Black women receive lower quality of care than white women and are subject to discrimination in the healthcare field.
• People from some racial and ethnic minority groups are more likely to be uninsured than non-Hispanic whites.

Learn more about Black Maternal Health Week and Black Mamas Matter at blackmamasmatter.org

Reform Plan

Last year, the Wolf Administration unveiled a plan that addresses comprehensive health reforms focusing on both physical and behavioral health and promoting affordability, accessibility and value in health care. The plan includes three main components:

1. Interagency Health Reform Council (IHRC) The council will be composed of commonwealth agencies involved in health and the governor’s office. The initial goal will be to develop recommendations by December 30 to find efficiencies in the health care system by thinking about how to align programs where feasible, including the joint purchasing of medications, aligning value-based purchasing models, and using data across state agencies to promote evidence-based decisions.
2. Regional Accountable Health Councils (RAHCs) RAHCs will be required to collectively develop regional transformation plans – built on community needs assessments – to reduce disparities, address social determinants of health, and align value-based purchasing arrangements.
3. Health Value Commission The Health Value Commission would be established through legislation, and would be charged with keeping all payors and providers accountable for health care cost growth, to provide the long-term affordability and sustainability of our health care system, and to promote whole-person care.

Read more about the Health Reform Plan.

DHS Health Equity Initiatives

Health equity is the attainment of the highest level of health for all people. Studies in Pennsylvania have shown that there is more than ten percent difference in access to well child visits between black infants and white infants. Furthermore, the life expectancy of a baby born in Pennsylvania is strongly tied to zip code. A newborn in certain census tracts of North Philadelphia has a life expectancy of 63 years, when just a couple miles to the south newborns are expected to live to 86. In the U.S., it has been estimated that the combined cost of health disparities and subsequent deaths due to inequitable care is $1.24 trillion dollars. Health shouldn’t be predetermined by the color of your skin, the language that you speak, the country that you were born in, the zip code that you live in, the religion that you practice, or your sexual orientation, gender, or gender identity. As such, DHS has:

• Created the new Equity Incentive Program, starting in 2020, which incentivizes Physical Health Managed Care Organizations (MCOs) to achieve national benchmarks for Black members. The total eligible pool of incentives was $26 million in 2020. The Equity Incentive contained two quality measures in 2020, Timeliness of Prenatal Care (HEDIS®) and Well Child Visits (HEDIS®) and will grow to include measures for racial disparities in chronic condition management in 2021.
• Required Physical Health, Behavioral Health, and Community Health Choices MCOs to achieve or be working towards the National Committee for Quality Assurance (NCQA) Distinction in Multicultural Health Care. The first MCO in the country to achieve the distinction is from Pennsylvania, and almost all Physical Health MCOs have now achieved the distinction.
• Created a new Maternity Care Bundled Payment (a type of value-based purchasing), that will reward providers that reduce racial inequities and achieve national benchmarks in physical health, behavioral health, social determinants of health, and health equity. This bundled payment aims to close racial disparities that lead to a 3:1 maternal mortality inequity between Black and White women.

Launched the Regional Accountable Health Councils (RAHCs). RAHCs—comprised of payors, providers, and community-based organizations— will address health equity as a top priority and will use a collaborative regional approach to focus on communities with a high burden of disease called Health Equity Zones (HEZs). The RAHCs will work to identify the root causes of such disparities and will establish policies and interventions to reduce these disparities. View the RAHCs regions and membership.

Visit the DHS Health Innovations site and view the PA Health Equity Analysis Tool (HEAT)

What is the Emergency Broadband Benefit (EBB) Program?

The Federal Communications Commission (FCC) recently established the Emergency Broadband Benefit (EBB) program.  The EBB uses $3.2 billion in federal funding Congress approved in December 2020. The EBB gives qualifying households money to buy internet service or equipment to use the internet if they are eligible. The COVID-19 pandemic has shown the important role that affordable broadband plays in education, employment, health and other purposes as people are now relying on broadband access to the internet more than ever.

How Much is the Average EBB Support?

The program will provide eligible households with discounts of up to $50 a month for broadband service. Eligible households can also get a one-time discount of up to $100 on equipment to use the internet. Equipment includes a computer or tablet if they contribute $10-$50 toward the price for the equipment. The benefit is limited to one monthly service discount and one device discount per household. This EBB is in addition to, not in place of, the current Lifeline Program that provides $9.25 a month to support affordable broadband service.

Who is Eligible for the EBB?

The program is open to Lifeline subscribers and households that currently participate in an existing low-income or pandemic relief program offered by a broadband provider. This includes consumers whose income is at or below 135% of the federal poverty guidelines or who receive Medicaid, SNAP, SSI, Federal Housing or Veterans benefits. The EBB also is available to households if they receive free or reduced-price school lunch or school breakfast, federal Pell grants, or experienced a substantial loss of income since Feb. 29, 2020..

When Will the EBB Begin?

While the program has been authorized by the FCC, the start date has not yet been established. The FCC has adopted rules for the program and is identifying eligible providers who will deliver this benefit.

How Can Consumers Apply for the EBB?

At the current time, the program is not yet in operation, although the FCC is required to make it available within 60 days of Feb. 26, 2021. In the meantime, consumers may wish to contact their current wireless, telephone or cable provider to ask if they are planning to participate in this program. For more information about broadband availability, visit the FCC’s website.  The FCC also posted a new consumer FAQ on the EBB. The FAQ provides answers to common questions on benefit eligibility, how the discount will be applied to broadband services costs and program length.

For more information, contact the Pennsylvania Public Utility Commission 1-800-692-7380 or www.puc.pa.gov.  For people with speech or hearing loss, dial 7-1-1 (Telecommunications Relay Service)

Unanimous Vote Creates Rules and Procedures to Move Forward with Round 2 of Program to Support Health Care Providers During the Pandemic

On March 30, 2021, the Federal Communications Commission (FCC) voted to formally adopt a Report and Order and Order on Reconsideration to establish Round 2 of the COVID-19 Telehealth Program, a $249.95 million federal initiative that builds on the $200 million program established as part of the CARES Act.  The FCC’s COVID-19 Telehealth Program supports the efforts of health care providers to continue serving their patients by providing telecommunications services, information services, and connected devices necessary to enable telehealth during the COVID-19 pandemic.  The application window is expected to open within 30 days of release of the Order and the FCC will provide notice in advance of that date.

“Today the FCC announced it is moving forward with Round 2 of its COVID-19 Telehealth Program.  This past year has proven, without a doubt, that telehealth technology is critical to helping address inequities in access to health care services.  And with today’s unanimous approval of the Report and Order, the FCC remains ready to address these challenges head on.

“As part of the Consolidated Appropriations Act of 2021, Congress called on the FCC to increase transparency of the FCC’s COVID-19 Telehealth Program and to establish a clear set of rules and guidelines for evaluating applications.  With today’s action, we have answered that call.  The pandemic has affected communities both large and small throughout the country, from our urban centers to our most rural corners.  Round 2 of this program will mirror this far-reaching impact to better ensure that each state and territory can be approved for funding.  In addition, to facilitate a more equitable funding window, we will set an application deadline so that all applications can be evaluated collectively.  By working together, we can continue to make an impact on the health and well-being of all Americans now and well into the future,” said Acting Chairwoman Jessica Rosenworcel.

In January 2021, as directed by Congress in the Consolidated Appropriations Act, the FCC’s Wireline Competition Bureau sought public input on Round 2.  This Report & Order establishes a clear way to rate applications that takes into consideration objective factors about the health care provider and the area it serves.  Round 2 will also distribute funding to each state, territory, and the District of Columbia and will have an application filing window so all applicants are on equal footing during the review.  Finally, applicants will be able to provide additional information to supplement their applications if necessary.

For more information about the FCC’s COVID-19 Telehealth program, visit https://www.fcc.gov/covid19telehealth.