On July 1, Pennsylvania Governor Tom Wolf signed into law Act 69 of 2021 formally Senate Bill 156. This Act increases earning eligibility under the Medicaid Assistance for Workers with Disabilities (MAWD) program. Dollars earned over the cap will move contributions into a new category instead of eliminating eligibility and covers workers from 250% of the federal poverty level to 600% or about $75,000.  Workers will pay 7.5% of their income to the MAWD program to cover their healthcare, which is a 2.5% increase from the current 5%. This means, when a worker earns $75,000 annually, they will pay 100% of the average cost of the MAWD program.

Enrollment statewide for Pennsylvania’s Medicaid program has increased by 456,330 people since March 2020 for a total enrollment of 3,330,144 people in June 2021. This represents an almost 15 percent increase. Of these enrollments, 957,812 are enrolled due to Medicaid expansion. Enrollment in the Children’s Health Insurance Program (CHIP) peaked in May 2020 and has steadily decreased as children enrolled in Medical Assistance have increased by 11 percent since the beginning of the public health emergency declaration.

The American Rescue Plan Act (ARPA) temporarily increases the generosity of subsidies available on Marketplace plans for consumers earning up to 400% FPL. It also provides maximum subsidies and cost-sharing reductions to people who have been approved for unemployment for any week during 2021. At present, states using Healthcare.gov whose customers were enrolled in an ACA plan prior to April must return to request the new, higher subsidies. However, starting in September, CMS will automatically begin providing the higher premium tax credits (PTCs) amounts to consumers who have yet to update their information on healthcare.gov. However, CMS will not automatically adjust plans to reflect the larger cost-sharing reductions, so consumers are still encouraged to return to the Marketplace and access the benefits. Pennsylvania’s state-based marketplace, Pennie, has already completed automatic reduction for customers as of July 6, 2021. Pennie customers should have received information from Pennie and their current health insurance plan with the new premium tax credit calculations and lower premiums.

Do you have a patient with a cognitive impairment? Medicare covers a separate visit for a cognitive assessment so you can more thoroughly evaluate cognitive function and help with care planning.

The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam, resulting in a written care plan.

Effective January 1, 2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently covers these services via telehealth.

More Information:

• Visit the Cognitive Assessment webpage
• Watch our video (4:34)
• Visit the National Institute on Aging’s Alzheimer’s and Dementia Resources for Professionals webpage

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On July 21, 2021, the Senate Health, Education, Labor, and Pensions (HELP) Primary Health and Retirement Security Subcommittee held a hearing on year-end data from CDC showing life expectancy dropped 1.5 years from 2019 to 2020. The focus of the hearing was on both COVID-19 and drug overdoses. Senator Susan Collins (R-ME) pointed to the concerning number of drug overdose deaths in Maine, 504 last year alone, which were more than the deaths there from COVID-19.