Starting April 17, the Pennsylvania Department of Human Services (DHS) DHS will decide who qualifies for the Children’s Health Insurance Program and process all new applications and renewals. The current 130,000 CHIP families—and all new enrollees—must go through DHS instead of their CHIP health insurance plan to determine eligibility.

The transition of eligibility processing and determinations from the CHIP plans to caseworkers in local DHS County Assistance Offices (CAO) is on the heels of the unwinding process of Medicaid continuous coverage that began on April 1st.

CAOs, which already have full workloads with the unprecedented task of Medicaid unwinding, will now be responsible for processing CHIP applications and renewals.

And while the CHIP eligibility transition had been in the works long before the COVID-19 pandemic, the state ultimately was able to determine its timing.

Check out CHIP changes webpage for more details about how this change will impact CHIP families.

  Information about the most recent Rural Communities Opioid Response Program grantee cohorts is now available on the Rural Health Information Hub at the following links:

• RCORP – Behavioral Healthcare Support Grantee Directory: 2022 Cohort
• RCORP – Implementation IV Grantee Directory: 2022 Cohort
• RCORP – Medication Assisted Treatment Access Grantee Directory: 2022 Cohort
• RCORP – Psychostimulant Support II Grantee Directory: 2022 Cohort

 The Centers for Medicare & Medicaid Services recently published payment policy updates to Medicare Advantage (also known as Medicare Part C) and Medicare Prescription Drug Program (also known as Medicare Part D) for the calendar year 2024. The updates include a payment increase of 3.32% compared to 2023, Star Rating updates, and finalized growth rates for Medicare Advantage, as well as alignment of Medicare Advantage, plans with the Internal Classification of Diseases (ICD)-10 system which has been in place since 2015 for many other payors in the U.S. The updates also include policies addressing Puerto Rico payment rates, prior authorization practices, access to behavioral health services, and marketing of Medicare Advantage plans. Part D updates for 2024 include the elimination of cost-sharing in catastrophic phase coverage, expanding the low-income subsidy program, eliminating deductibles for certain adult vaccines and insulin products, and limiting a month’s supply of covered insulin products to $35 per month. Medicare Advantage has continued to grow faster in rural areas, with enrollment growing 13.4 percent between 2021 and 2022 in rural and 7.9 percent in urban counties.

In response to a change in the way the Census Bureau defines rural and urban areas, the Centers for Medicare & Medicaid Services (CMS) released an interim process for determining locations of new Rural Health Clinics. For now, CMS will use the 2010 and 2020 Census urban criteria when determining rural location, and locations meeting either standard will be eligible.  The 2010 criteria defined two types of urban areas: 1) urbanized areas with a population of 50,000 or more; and 2) urban clusters with at least 2,500 but fewer than 50,000 people. So under the 2010 criteria, a rural location is one that is not in an urbanized area but might be in an urban cluster. Under the 2020 criteria, the Census Bureau no longer subdivides urban areas by population size so all developed areas are simply called urban areas – and housing density, not population, is the primary determining factor. The population is still considered at the lower end: the minimum population for an urban area designation increased from 2,500 people to 5,000 people or at least 2,000 housing units. The Federal Office of Rural Health Policy is housed in a different agency (HRSA) under the U.S. Department of Health & Human Services and uses different measures to define rural for its grant programs.  Learn more details about eligibility for FORHP grants on the HRSA website.