DPW Overview & Healthy PA Presented by: Secretary Beverly Mackereth

1. DPW Overview& Healthy PAPresented by: Secretary Beverly Mackereth 1

2. DPW Quick Facts DPW is the largest Human Services Agency in the Country: • Staff complement as of July 2014: • 15,617 full-time filled complement • 96 part-time • 845 wage • 134 annuitants • Total DPW budget for FY 2014-15: $31.5 Billion • $11.2 billion in state (general fund) • $17.6 billion in federal • $ 3.0 billion in other funds • DPW is 39% of the General Fund Budget • Approximately 22.7% (2.89 million) of all Pennsylvanians were enrolled in a DPW benefit program as of May 31, 2014 • (Based on the US Census Bureau 2012 Pennsylvania population estimate of 12,763,536). Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 2

3. DPW Quick Facts • Facilities Operated by DPW: • 94 County Assistance Offices • 6 Youth Development Centers/Youth Forestry Camps that served around 777 children in FY 2013-14 • 5 State Centers for Persons with Intellectual Disabilities that were serving 996 individuals as of June 30, 2014 • 7 State Mental Health Hospitals that were serving 1,522 individuals as of July 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 3

4. Program Office Service Delivery • Other • DPW Central Office • DPW Regional Offices • 29 Intermediate Units OLTL OIM OMAP • 94 CAOs • 500 School Districts ODP OMHSAS OCDEL OA OCYF • 42 CCIS • 52 Area Agencies on Aging • 67 County/Joinders • ~100 Service Coordination Organizations • 67,000 Providers • 10 Managed Care Organizations 4

5. Office of Administration (OA) Hearings and Appeals • Conducts administrative hearings on appeals received from recipients and DPW funded agencies services Program Integrity • Detects and deters fraud waste and abuse in the Medicaid program and administers third party recoveries in the Medicaid program Financial Operations • Organizes and conducts audits, guides procurement process, evaluates RFP’s, and executes and monitors contracts Human Services Licensing • Licenses, inspects, and regulates more than 8,500 out-of-home care settings. Human Resources • Administers DPW’s HR systems including labor relations, employee training, recruitment, classification, and placement Information Systems • Supports all information technology needs for Departments of Welfare, Aging and Insurance AdministrativeServices • Services include: forms and publications, printing, automotive fleet operations, guardianship programs, facilities and property management, and emergency operations Equal Opportunity • Ensures nondiscrimination and equal opportunity in all activities • The Bureau of Human Services Licensing ensures safe living conditions for over 100,000 adults and children with mental illnesses, intellectual disabilities, physical disabilities, and behavioral and/or cognitive disorders. 5 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

6. Office of Child Development and Early Learning (OCDEL) Subsidy Services • Child Care Works Certification Services • Child Care Certification Early Intervention Services • Early Intervention Infant/Toddler • Early Intervention Preschool Early Learning Services • Keystone STARS • Keystone Babies • Pennsylvania Pre-K Counts • Full Day Kindergarten • Head Start State Supplemental Assistance Program • Early Head Start • Parent-Child Home Program • Nurse-Family Partnership • Children’s Trust Fund • As of December 2013, nearly 112,423 children were provided monthly subsidies through Child Care Works. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 6

7. Office of Children, Youth and Families (OCYF) Juvenile Justice Services • Youth Development Centers • Youth Forestry Camps • County Juvenile Probation Offices • Private Agency Delinquency Services • Foster Family Service • Community Residential Service and Group Home Service • Supervised Independent Living Service • Residential Service • Secure Residential Service • Emergency Shelter Service Placement AdultEducation • Homemaker/Caretaker Service • Life Skills Education Protective Services • Protective Services (Child Abuse) • Protective Services (General) • Counseling/Intervention Services Adoption • Adoption Services • Adoption Assistance Administration & Oversight • Information and Referral Services • Service Planning Day Services • Day Care Service • Day Treatment Service • From Sept. 30, 2009 to March 31, 2014, out-of-home placements of children have decreased by 19% in PA. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 7

8. Office of Mental Health and Substance Abuse Services (OMHSAS) • State • Facilities • State Hospitals and Restoration Center • Other Initiatives • Behavioral • Health & Substance • Abuse Services • HealthChoices Behavioral Health (HC-BH) Program • Fee-for-Service • Behavioral Health Services Initiative (BHSI) • Base • Act 152 • Integration Programs • CHIPP • Pharmacy • Special Pharmacy Benefits Program for Mental Health (SPBP-MH) • 1,952,895 of MA covered Pennsylvanians were covered by HealthChoices Behavioral Health as of March 2014. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 8

9. Office of Developmental Programs (ODP) • Intellectual Disabilities: • HCBS • Consolidated Waiver • P/FDS Waiver • Base Services • Autism: • HCBS • Adult Autism Waiver (AAW) • Adult Community Autism Program (ACAP) • Intermediate Care Facilities • State Centers • Private Facilities • Over 28,000 individuals were served by ODP waivers as of May 2014. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 9

10. Office of Income Maintenance (OIM) • Medical Assistance • For Families with Children • For the Aged and Disabled • Long Term Care • Select Plan for Women • Cash Assistance • Temporary Assistance for Needy Families (TANF) • SSI State Supplement • Supplemental Nutrition Assistance Program (SNAP) • Nutritional support for low-income families • Low Income Home Energy Assistance Program (LIHEAP) • Assistance to low-income families in need of assistance with their heating and cooling bill • Employment and Training Programs • A suite of programs that provide job readiness, placement, retention training, and supportive services • Child Support Enforcement • Establishes paternity and support orders and provides medical support and employment services for non-custodial parents • Homeless • Assistance • Provides services to families and children in immediate need of shelter and to those in imminent danger of becoming homeless • Legal Assistance • Provides free services to assist clients to resolve civil legal problems • As of July 2014, CAOs helped more than 397,000 households to stay safe and warm in their homes. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 10

11. Office of Medical Assistance Programs (OMAP) • Medical • Assistance • Managed Care • Fee for Service • What is Medical Assistance? • Medicaid is an entitlement program jointly funded by the federal and state governments that provides health care coverage to low income children and adults, the elderly, and disabled. The Pennsylvania Medicaid Program is known as Medical Assistance (MA) because it includes both the federal Medicaid Program as well as state funded only programs, i.e., General Assistance and State Blind Pension recipients • How are services delivered? • Fee for service administered through the federally-approved Medicaid State Plan • Mandatory Medicaid managed care program known as HealthChoices administered through a federally-approved 1915(b) waiver • Pennsylvania Medicaid Facts • 17.8% of Pennsylvanians are currently covered by some form of MA • Over 81,000 MA providers • 58,136,763 claims processed for FY13 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 11

12. Office of Long-Term Living (OLTL) AttendantCare • Attendant Care Waiver • Act 150 Community Service Programs for People with Physical Disabilities (CSPPPD) • Independence Waiver • COMMCARE Waiver • OBRA Waiver NursingFacilities • MA Nursing Facilities Aging • Aging Waiver LIFE • Living Independence for the Elderly (LIFE) AIDS • AIDS Waiver • Over 47,000 individuals were served by OLTL waivers as of May 2014. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 12

13. Strategic Planning for the Department • Strategic Focus Areas • Mission Statement • Vision Statement Our mission is to improve the quality of life for Pennsylvania’s individuals and families. We promote opportunities for independence through services and supports while demonstrating accountability for taxpayer resources. Our vision is to see Pennsylvanians living safe, healthy and independent lives. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 13

14. DPW Budget Priorities • Expanding Services for Older Pennsylvanians and Individuals with Physical Disabilities: • Increase of $25.3 million in General and Lottery funds to serve: • An additional 1,764 older Pennsylvanians through the Medicaid Home and Community-Based Aging Waiver ($11.6 million); • An expansion in the LIFE program ($4.7 million); • An additional 1,599 individuals with physical disabilities in community settings ($9 million). • Expanding Services for Individuals with Intellectual Disabilities and Autism: • Additional $13.1 million to provide home and community-based options for: • 700 young adults who are graduating from the special education system to continue to live independently in the community; • 400 individuals who are on the emergency waiting list to access crucial services to keep them in their homes and communities; and • 100 adults with autism spectrum disorders. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 14

15. DPW Budget Priorities Moving Individuals from Institutional Care to Community-Based Care: An additional $2.8 million to increase community placement for individuals currently in state mental hospitals and state intellectual disability facilities. This enables the transition of clients from state mental hospitals to progressive mental health treatment in home-like settings as well as clients from state intellectual disability facilities to home and community-based settings. Act 150: Funding was allocated to serve individuals currently on the Act 150 waiting list who are determined eligible. Child Care Assistance: Increase of $15 million in federal funds to allow an additional 2,895 children currently waiting for services to receive child care assistance. Child Advocacy Centers: $2 million for the support and expansion of Child Advocacy Centers in Pennsylvania, supporting a recommendation from the Task Force on Child Protection. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 15

16. DPW Budget Priorities • Balancing Incentive Program - $94 million ($75m in FY 2014-2015) • Enhanced federal funds (2% increase in federal matching funds, or FMAP) on community-based long-term services and supports • Available to states that spend less than 50% of their long term supports on community based services • The increase in FMAP is time limited and expires September 2015 • Requirements to receive the increase include: • No wrong door approach • Core elements required by CMS and consistency between assessment tools • Conflict free • Provide utilization and outcome data • Application approved by the federal government on June 18, 2014 • BIP funding began July 1, 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare 16

17. Long-Term Care Commission • Commission Responsibilities • Identify and examine the critical issues and trends in Pennsylvania’s long-term care services and supports delivery system • Study existing long-term care resources available for individuals with physical disabilities, older adults, their families and caregivers • Consult with various commonwealth departments and agencies on: • Regulations • Licensure • Financing • Other responsibilities relating to long-term care • Review current and proposed state and federal legislation and regulations relating to long-term care • Make written recommendations to the Governor on findings Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

18. Long-Term Care Commission • Areas of Focus for Work Groups • Prevention • Accessibility • Provision of Service • Quality Outcomes and Measurements Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

19. Long-Term Care Commission • Held 7 public sessions across the state • More than 200 individuals provided input at the public meetings or submitted comments • Report due to the Governor no later than December 31, 2014 • The Executive Order expires on December 31, 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

20. Healthy PAOverview

21. Healthy Pennsylvania at a Glance Increased health care access for 600,000 Pennsylvanians Improve health outcomes Benefits match health care needs Increased personal responsibility Reformed Medicaid program

22. Introduction This session provides an overview of the Healthy PA Program and the components being introduced in January 2015.

23. Overview Topics

24. Healthy PA Newly Eligible

25. Healthy PA Newly Eligible Up to approximately $15,500 for an individual and $20,900 for a family of two.

26. Applying for Benefits Consumer Service Center Paper Application COMPASS There is ‘no wrong door’ when applying for health care!

27. Health Screening

28. Health Screening

29. Healthy Behaviors

30. Overview Topics

31. New Medicaid Benefit Plans Low Risk High Risk • Adults who have complex health care needs, either medical or behavioral health, including pregnant women • Administered by current HealthChoices managed care plans • Screened High • Includes adults 65 and over • Adults, ages 21 through 64, who do not have complex health care needs, either medical or behavioral, and are eligible for Traditional MA. • Administered by current HealthChoices managed care plans • Not screened high • Opted out of how risk plan No changes have been made to the children’s benefit plan.

32. High Risk and Low Risk Plans Both the high risk and low risk plans meet the federal standards for essential health benefits, mental health and drug & alcohol parity.

33. Private Coverage Option

34. Medically Frail Individuals who are screened as medically frail will be placed in the Medicaid high risk benefit plan. • Medical Frail includes individuals who have a: • Disabling mental disorder • Chronic substance abuse disorder • Serious and complex medical condition • Physical disability that significantly impairs his or her functioning • Intellectual or developmental disability • Disability determination designation by the Social Security Administration

35. A Pennsylvania-specific Plan • Medical Assistance (Vulnerable Pennsylvanians) • Low income parents/ caretaker relatives with incomes up to 44% FPL • Children • Medically frail/Individuals with disabilities • Seniors • Private Coverage Option • (January 1, 2015) • Childless adults • Adult parents/caretaker relatives • Incomes up to 133% FPL • Working poor

36. Overview Topics

37. Implementation Timeline • Letter sent to recipients changing packages • If transitioning to low risk or PCO plan, includes invitation to complete health screening • Notices of transition mailed • PCO enrollment begins • Effective date of new MA and PCO plans