The Department of Human Services (DHS) has published two reports required by the Centers for Medicare and Medicaid Services on Pennsylvania’s Medicaid unwinding. The first report is a point-in-time baseline report with pending data. The second report is a monthly snapshot of data. Both reports are for the entire Medicaid population. A third document called the Continuous Eligibility Unwinding Plan explains how DHS will process all Medicaid and CHIP renewals. The May 2023 monthly report shows 247,827 total beneficiaries for whom a renewal was initiated during the reporting period with 254,287 due for renewal. Of those renewed and retained, 10,584 were renewed on an ex parte basis, 90,297 were renewed using a pre-populated form, 29,120 were transferred to Pennie, 24,144 individuals were terminated for procedural reasons and 100,142 renewals were not completed. To view these reports, visit the PA DHS Federal Unwinding Reports webpage.

Differences in the Merit-based Incentive Payment System (MIPS) Performance of Clinicians in Metropolitan and Nonmetropolitan Counties in 2018

Mina Shrestha, PhD; Lili Xu, MS; Hari Sharma, PhD; Fred Ullrich, BA; A. Clinton MacKinney, MD; Keith Mueller, PhD

The Merit-based Incentive Payment System (MIPS) is a pay-for-performance system for clinicians under the Medicare Quality Payment Program designed to reward clinicians providing higher quality of care and lower costs. This study compared clinicians’ MIPS performance in 2018 based on their practice location, size, and minority population proportion.

Key Findings:

• The overall performance in the MIPS program was comparable for metropolitan and nonmetropolitan clinicians. However, a smaller proportion of nonmetropolitan clinicians were likely to receive exceptional performance payments.
• Most of the clinicians receiving reduced payments were in solo practice in both metropolitan and nonmetropolitan areas.
• Clinicians serving a high proportion of minorities were less likely to get exceptional performance payments but were also less likely to have their payments reduced under MIPS.

Nonmetropolitan clinicians had a lower total risk-adjusted Medicare Spending Per Beneficiary than metropolitan clinicians indicating that nonmetropolitan clinicians have lower Medicare spending for similar beneficiaries.

Pennsylvania ranks 22nd overall in child well-being, according to the 2023 KIDS COUNT® Data Book, a 50-state report of recent household data developed by the Annie E. Casey Foundation analyzing how children and families are faring. When looking specifically at economic well-being, the state ranks 22nd, while it ranks 20th in health.

The health domain looks at the percentage of children who lack health insurance, child and teen death rates, the percentage of low birth-weight babies and obesity among 10–17-year-olds. The Data Book reports that Pennsylvania’s rate of uninsured children is 4% and approximately 126,000 children cannot access affordable, quality health care coverage through Medicaid and the Children’s Health Insurance Program. In addition, Pennsylvania is ranked 23rd for the percentage of low birth-weight babies.

Pennsylvania families who rely on Medicaid for coverage for themselves and their children may have recently noticed a significant change: the Medicaid redetermination process that began April 1st through which DHS determines whether enrollees still qualify. This change comes about with the end of the public health emergency. During this unwinding process, it is imperative that children no longer eligible be connected to CHIP to avoid gaps in coverage and to ensure that children who remain eligible for Medicaid keep their coverage without experiencing inappropriate terminations or disruptions that often affect children more than the adult population.

The Data Book also reports that too many parents cannot secure child care compatible with work schedules and commutes. The Data Book reports that in 2020—21, 12% of children birth to age 5 in Pennsylvania lived in families in which someone quit, changed, or refused a job because of problems with child care. And women are five to eight times more likely than men to experience negative employment consequences related to caregiving.

Even if parents can find an opening for child care near their home, they often can’t pay for it. Pennsylvania’s average annual cost of center-based child care for a toddler was $11,346, or 10% of the median income for a married couple and 35% of a single mother’s income in the state.

The U.S. Census Bureau has released the 2022 Detailed National, State, and County Population Estimates, the final set of detailed population estimates for this vintage. The data as of July 1, 2022, provides estimates at the national, state, and county levels for population by age, sex, race, and Hispanic origin.

Highlights from this release include:

• The population cohorts aged 75 to 79 and 70 to 74 were the fastest-growing, with those aged 75 to 79 far exceeding other growing cohorts.
• For every 10 non-Hispanic White individuals lost in Pennsylvania from 2020 to 2022, the state roughly gained 8 persons of color.
• The most substantial growth occurred in the Hispanic or Latino, multiracial*, and Asian* populations.

*Refers to non-Hispanic individuals.

To read more, visit: https://pasdc.hbg.psu.edu/Data/Research-Briefs.

CMS has released new estimates on diabetes prevalence and an accompanying infographic to describe the latest data and known disparities among Medicare enrollees with diabetes.

Diabetes is a condition of particular concern to many minority and underserved communities. The number of people in the U.S. with diabetes increased from almost 29 million in 2012 to more than 37 million in 2019. The new CMS diabetes prevalence infographic highlights existing health disparities as well as prevention resources to address the epidemic. The infographic also spotlights how the increased prevalence of non-gestational diabetes among minority populations has led to additional health complications. Finally, the infographic includes information on the increased impact that diabetes has on Medicare enrollees and the disparities that are observed among various subpopulations in the Medicare community.

In addition to the infographic, CMS has released the Medicare Current Beneficiary Survey (MCBS) Public Use File on diabetes prevalence and self-management among Medicare beneficiaries living in the community in 2020. This file presents estimates on diabetes prevalence, diabetes-related health issues, and diabetes knowledge and self-management by a variety of beneficiary characteristics including race/ethnicity, income, and primary language spoken at home.

You can find more information and access the Public Use File and supporting documentation here.

For more information on health equity, visit https://go.cms.gov/omh for the latest updates on resources, data, and more equity work, sign up for our listserv.

  The nonprofit Commonwealth Fund includes considerations for rural areas in this report that breaks down factors affecting licensed providers, clinical supporters, community care workers, and frontline workers.

  Researchers interviewed primary care physicians in rural Pennsylvania to get their views on barriers to care, including cost and insurance, geographic dispersion, and provider shortages/burnout.

This study from the Southwest Rural Health Research Center is a companion piece to the Healthy People 2030 initiative with a focus on the health priorities of rural people.

The Government Accountability Office discusses challenges rural communities face related to healthcare access, such as limited healthcare providers, travel distance and transportation issues, insurance coverage, and access to broadband.

Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway.  Sign up to receive alerts when new publications become available. 

 Among new policy briefs posted by the Rural Health Research & Policy Centers:  COVID-19 pandemic impact on Rural Health Clinic’s operations, and a look at barriers to rural obstetric training for family physicians.