Bridges to Success: Keystones of Health for Pennsylvania

DHS’ mission is to help all Pennsylvanians live healthy, enriching, and vibrant lives. As part of this work, DHS seeks to use its Medicaid program to offer targeted supports and services to certain Pennsylvanians through Bridges to Success: Keystones of Health for Pennsylvania (Keystones of Health). 

Social determinants of health can be more influential on a person’s health and quality of life than clinical care. DHS hopes to use this program to make health care more accessible, improve quality of care and services, and test new strategies in health care to help people live healthier lives. This program is under development and services and populations are subject to change.

Keystones of Health aims to address the health care needs of Pennsylvanians in four main areas: Reentry Supports, Housing Supports, Food and Nutrition Supports, and Continuous Coverage for Children Under Age Six. 

Submitted Section 1115 demonstration waiver application

The Pennsylvanian Department of Human Services submitted our Section 1115 demonstration waiver application, titled “Bridges to Success: Keystones of Health for Pennsylvania” to the Centers for Medicare & Medicaid Services on January 26, 2024. Below are copies of what was submitted:

1115 Program Administrator RFI - Bridges to Success: Keystones of Health for Pennsylvania

The Department of Human Services has released a new Request for Information (RFI) to assist in determining possible implementation needs for the Commonwealth’s proposed 1115 Demonstration Waiver titled, Bridges to Success: Keystones of Health for Pennsylvania. This RFI will help inform a potential scope of work for private, public, and non-profit organizations that could serve in the future as a Program Administrator for the program. If approved and implemented, Keystones of Health would bring new resources to Pennsylvania’s Medicaid program to address health-related social needs (HRSN) that have a direct impact on health care spending and health outcomes. Responses to the RFI are due August 19, 2024 by 12:00 pm.

The proposed Keystones of Health program seeks to expand tools available to address critical health care needs of Pennsylvanians in four main areas: reentry supports, housing resources, food and nutrition services, and continuous health coverage for children under the age six. This RFI seeks information to assist DHS in implementing the proposed housing and food and nutrition services for beneficiaries. Through this RFI, the Department is seeking knowledge about potential Program Administrator responsibilities and capabilities for administering these HRSN services. The RFI will also inform aspects of DHS’ implementation plan that is currently in development while the Commonwealth collaborates with the Centers for Medicare & Medicaid Services to secure approval. The Department encourages respondents and other interested parties to provide feedback by responding to the RFI.

Section 1115 of the Social Security Act gives the federal government the ability to waive certain federal rules that govern Medicaid to allow states to design and evaluate new state pilot projects that promote the general goals of the Medicaid program, helping people live healthier lives. Section 1115 waivers are a major pathway for state innovation in the Medicaid program that many states have leveraged. If approved and the necessary state funds are appropriated, it would allow DHS to introduce innovative programs and services that address health-related social needs that can improve health and quality of life for Pennsylvanians who access health care through Medicaid. 

Submit feedback to DHS’ Request for Information.

Non-Discrimination and Accessibility Information

DHS complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, gender, gender identity or expression, or sexual orientation.

DHS does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, gender, gender identity or expression, or sexual orientation.

DHS provides free aids and services to people with disabilities to communicate effectively with us, such as:  

  • Qualified sign language interpreters 
  • Written information in other formats (large print, audio, accessible electronic formats, other formats) 

DHS provides free language services to people whose primary language is not English, such as:  

  • Qualified interpreters 
  • Information written in other languages 

If you need these services, contact DHS at: 

  • Telephone: 1-866-872-8969 — choose Option #1 for English, Option #2 for Spanish, Option #3 for Vietnamese, Option #4 for Cambodian, Option #5 for Russian, Option #6 for Mandarin Chinese, or Option #7 for a sign language interpreter and leave a detailed voice mail message.
  • TDD/TTY – PA Relay 711 — give the operator the 1-866-872-8969 phone number to call, choose Option #7 for a sign language interpreter, and leave a detailed voice mail message.
  • E-mail: MA-Interpreter@pa.gov

Keystones of Health Overview:

DHS’ goal and vision for the waiver is to address Pennsylvania’s Medicaid participants’ health-related social needs with interventions that are both lifesaving and cost saving.

Unmet social needs such as housing instability and homelessness, food insecurity, and lack of social supports create barriers to accessing and utilizing health care services and can directly impact health and the cost of care.

Bridges to Success: Keystones of Health 1115 Presentation

Proposed Services

Under Keystones of Health, services are proposed to be provided in the following areas:

What is an 1115 Demonstration?

Keystones of Health is an 1115 demonstration. These allow states to develop programs in coordination with the federal Centers for Medicare and Medicaid Services (CMS) that provide services and benefits not normally allowed in state Medicaid plans. States use these to design and evaluate new and creative ways to make health care better. DHS' goal for Keystones of Health is to improve health and quality of life for Pennsylvania's Medicaid beneficiaries by helping with health-related social needs, which can improve a person's quality of life and offset the need for more costly, intensive acute care. It will also improve access to care through improved reentry supports following release from correctional facilities and multi-year continuous coverage for children under 6 years of age.

What are Health-Related Social Needs?

Health-related social needs are things that affect people's health and well-being that are not purely medical. These include different social, economic, and environmental factors such as having healthy food to eat or a safe place to live. Health-related social needs are often external to the health care system but play a crucial role in shaping an individual's health status and quality of life.

Who will be part of Keystones of Health?

Bridges to Success: Keystones of Health for Pennsylvania focuses on individuals who need help with their health-related social needs who also have related health conditions. For example:

  • Beneficiaries who are leaving or recently released from correctional facilities with substance use disorder and serious mental illness;
  • Beneficiaries experiencing homelessness
  • Beneficiaries with diet sensitive chronic conditions;
  • Pregnant and post-partum beneficiaries; and,
  • Provide continuous Medicaid coverage for children under six years of age.

The application and topic overviews include more details on populations and eligibility. DHS will update the Keystones of Health application based on public comments and feedback from the Centers for Medicare & Medicaid Services. This means populations and scope may change.

Provide Feedback

DHS' public comment period on the Keystones of Health draft application opened on December 2, 2023 and closed January 2, 2024. During this time, DHS accepted written and verbal comments on the Keystones of Health application. These comments will inform the final application. Full details of how DHS will seek input are available on the Public Input Process page.

The public comment period opened on 12/2/2023 and closed as of 1/2/2024.

Join a public event

DHS is offering the public the opportunity to come to virtual forums to learn more about the Keystones of Health 1115 demonstration and the proposed services. During the forums, the public will be able to ask questions and provide comments. If you are interested in joining the public forums, the information is below:

Public Forum 1

  • Date: Monday, December 11, 2023 - This meeting has already occurred.
  • Time: 12:00-1:00pm
  • This meeting has already occurred.

Public Forum 2

  • Date: Tuesday, December 12, 2023
  • Time: 6:00-7:00pm
  • This meeting has already occurred.

Public Forum 3

  • Date: Friday, December 15, 2023 - This meeting has already occurred.
  • Time: 9:00-10:00am
  • This meeting has already occurred.

Please register to participate virtually. When you register, there will be an option to add the Public Forum to your calendar. Registration is not necessary to join by phone only. Closed captioning will be provided during each public forum. See the Public Input Process for a list of additional meetings including a Keystones of Health presentation and brief comment opportunity.

Resources and Additional Information

Interested in learning more about Bridges to Success: Keystones of Health for Pennsylvania? Consider downloading these resources or subscribing to email updates.

Public Notice

Proposed Federal Section 1115 Demonstration for Medicaid Coverage of Health-Related Social Needs and Continuous Eligibility for Young Children.

Overview, Goals, and Objectives

The Pennsylvania Department of Human Services (Department) is making available for public review and comment the proposed Federal Section 1115 Demonstration application, entitled Bridges to Success: Keystones of Health for Pennsylvania (Keystones of Health), which proposes Medicaid Coverage for Health-Related Social Needs (HRSNs), reentry supports, and multiyear continuous eligibility for young children. 

The purpose of this demonstration is to further the objectives of Medicaid to expand access to care, improve health outcomes, drive innovation, and engage partners and communities through targeted, time-limited interventions to address HRSNs.

The goals of this demonstration are to:

  1. Address Pennsylvania's Medicaid beneficiaries' HRSNs, such as food and housing, to improve health outcomes and quality of life with interventions that are both lifesaving and cost saving.
  2. Provide HRSN services to support beneficiaries, especially those experiencing life transitions, to reduce avoidable hospitalizations and medical utilization and increase recommended or preventive care.
  3. Reduce churn and gaps in coverage for children enrolled in Medicaid.
  4. Expand Medicaid coverage to improve services to beneficiaries as they prepare to leave incarceration and provide continued support as beneficiaries transition back into the community.

Under Keystones of Health, services are proposed to be provided in the following areas:

  • Reentry from correctional facilities:  Improve transitions to the community for beneficiaries reentering society from correctional facilities. The available services, which will require a legislative amendment, will focus on improving transitions to community-based health care and social services with a particular emphasis on those with significant health care needs such as serious mental illness and substance use disorder. The demonstration will also provide continuous eligibility for 12 months after release.
  • Housing supports: Add new Medicaid services to help beneficiaries without stable housing find and keep a place to live. Having stable housing makes it easier to find and use health care. These services will focus on beneficiaries with behavioral health issues and chronic conditions where health outcomes are greatly impacted by improved consistency of care and medication access.
  • Food and nutrition supports: Provide food and nutrition services to specific Medicaid populations facing food insecurity, including pregnant beneficiaries and beneficiaries with diet-sensitive conditions. Services would include direct food support such as medically-tailored meals or groceries with a goal of also connecting eligible beneficiaries to long-term food assistance, like the Supplemental Nutrition Assistance Program (SNAP).
  • Multi-year continuous coverage for children under 6 years of age:  Provide continuous Medicaid coverage for children from birth or older but under 6 years of age to reduce gaps in coverage that interrupt access to essential health care services, such as preventive care. This proposal provides eligibility from birth, or when a child first receives Medicaid, through the last day of the month in which they turn 6 years of age. This proposal will make it easier for children to get the important early childhood health care they need.

The 1115 Demonstration application is available at dhs.pa.gov/Keystones-of-Health. In addition, copies of the application are available upon written request to: 

Department of Human Services
Office of Medical Assistance Programs
c/o Regulations Coordinator
P.O. Box 2675, Harrisburg, PA 17120

Eligible Beneficiaries and Proposed Services

The services provided under Keystones of Health will be in addition to the services provided through the Medicaid State Plan Most services will be provided through Pennsylvania's managed care programs, collectively known as HealthChoices, which provide physical and behavioral health care, as well as LTSS, through managed care organizations (MCOs). Managed care enrollment is mandatory for most Medicaid populations. Beneficiaries receiving services in the fee-for-service (FFS) delivery system, including those who are in FFS as they transition to managed care, will also be able to access HRSN services.

This demonstration affects all eligibility groups under the State Plan (Table 1) through the provision of additional services.

Eligibility GroupFederal CitationsIncome Level (% of FPL)
Children aged 18 and under42 CFR §435.118Up to 341%
Pregnant women42 CFR §435.116Up to 215%
Parents and care takers of children under 2142 CFR §435.116Up to 133%
Adults ages 19-6442 CFR §435.119Up to 133%
Individuals who are aged (65 and older), blind, or disabled42 CFR §435.121-435.138Varies by program
Medical assistance for workers with disabilities1902(a)(10)(A) (ii)(XVI) and 1905(v)(2)Up to 250%
Individuals receiving long-term care or home and community based services42 CFR §435.725, 435.733, 435.832Up to 300%

Table 1: Existing Medicaid eligibility groups affected by the demonstration

The demonstration will not restrict any existing eligibility, rather it will expand the eligibility of justice-involved individuals. This demonstration will provide coverage and limited benefits for incarcerated adults who are preparing for release and meet criteria for being high risk as defined in the table below. Eligibility will be determined through existing State Plan processes and eligibility criteria, and only include those who would be otherwise eligible if not incarcerated.

Eligibility GroupProgram or Policy Change

Incarcerated individuals who are preparing for release and meet one or more of the following criteria for high risk:

  • Have one or more substance use disorders
  • Have serious mental illness
  • Eligible for Medicaid funded 1915(c) home and community based services administered by the Office of Long Term Living or Office of Developmental Programs upon release
  • With one or more chronic health conditions
  • Are pregnant or in the 12-month post-partum period
Coverage and limited benefits 90 calendar days prior to release

Individuals following release from correctional settings and meet one or more of the following criteria for high risk:

  • Have one or more substance use disorders
  • Have serious mental illness
  • Eligible for Medicaid funded 1915(c) home and community based services administered by the Office of Long Term Living or Office of Developmental Programs
  • With one or more chronic health conditions
  • Are pregnant or in the 12-month post-partum period
Continued reentry supports following release as described in Table 3

Table 2: Expansion eligibility groups requested under the demonstration

DHS seeks to provide continuous 12-month enrollment for beneficiaries following reentry from correctional settings, regardless of changes in circumstances that would otherwise cause a loss of eligibility. This continuous 12-month enrollment applies to beneficiaries identified in Table 2 following release. This change will stabilize coverage, increase access to primary and preventive services, and preserve participants' continuity in access to ongoing care during a time of transition. The continuous eligibility period will begin on the release date and expire 12 months later at the end of the month.

DHS also requests the ability to provide continuous enrollment for children from birth through the end of the month in which their sixth birthday falls, regardless of when they first enroll in Medicaid, and regardless of changes in circumstances that would otherwise cause a loss of eligibility. This demonstration request will end churn among young Medicaid-enrolled children and better address their primary and preventive health care needs. Children must meet the existing eligibility criteria when they first enroll.

Under the demonstration, DHS will not impose any new cost sharing requirements for services. DHS is also seeking to waive all existing cost-sharing requirements in the State Plan for incarcerated beneficiaries prior to release.

Medicaid beneficiaries will qualify for services outlined in this demonstration based upon their medical need for services and an identified social need. For reentry supports, incarceration qualifies as the social need. Additional screening during case management will connect the individual to the most appropriate services. For Food and Housing Supports, DHS will develop a new core HRSN assessment tool based on existing assessments in use within Pennsylvania.

PopulationServices
Incarcerated individuals who are preparing for release and have one or more substance use disorders
  • Case management
  • Medication Assisted Treatment (MAT)
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports

     

    Benefit does not include:
  • Routine medical care provided while in custody
  • Full State Plan benefit package while in custody
Individuals following release from correctional settings who have one or more substance use disorders
  • Case management
  • Housing and tenancy supports
  • Note: MAT will be provided under the State Plan, not the demonstration authority
  • Other HRSN supports as indicated in the following tables for beneficiaries with substance use disorders
Incarcerated individuals who are preparing for release and have serious mental illness
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports

     

    Benefit does not include:
  • Routine medical care provided while in custody
  • Full State Plan benefit package while in custody
Individuals following release from correctional settings who have serious mental illness
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports
  • Other HRSN supports as indicated in the following tables for beneficiaries with serious mental illness
Incarcerated individuals who are preparing for release and will be eligible for Medicaid funded 1915(c) home and community based services administered by the Office of Long Term Living or Office of Developmental Programs upon release
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports

     

    Benefit does not include:
  • Routine medical care provided while in custody
  • Full State Plan benefit package while in custody
Individuals following release from correctional settings who are eligible for home and community based services
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports
Incarcerated individuals who are preparing for release with one or more chronic health conditions
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports

     

    Benefit does not include:
  • Routine medical care provided while in custody
  • Full State Plan benefit package while in custody
Individuals following release from correctional settings who have one or more chronic health conditions
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports
  • Other HRSN supports as indicated in the following tables Table 4, Table 5 for beneficiaries with
Incarcerated individuals who are preparing for release who are pregnant or in the 12-month post-partum period
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports

     

    Benefit does not include:
  • Routine medical care provided while in custody
  • Full State Plan benefit package while in custody
Individuals following release from correctional settings who are pregnant or in the 12-month post-partum period
  • Case management
  • 30-day supply of all prescription medications on release
  • Housing and tenancy supports
  • Other HRSN supports as indicated in tables Table 4, Table 5 for pregnant and post-partum beneficiaries

Table 3: Proposed populations by reentry service

Proposed populations by Housing service

PopulationServices
Individuals experiencing homelessness who also have serious mental illness or substance use disorder
  • Pre-tenancy and transition navigation and case management, including connection to housing specialists
  • One-time transition start-up services (moving costs, initial furnishings)
  • Rental subsidies for up to six months
  • Tenancy sustaining services
Individuals experiencing homelessness who also have a chronic health condition
  • Pre-tenancy and transition navigation and case management, including connection to housing specialists
  • One-time transition start-up services (moving costs, initial furnishings)
  • Rental subsidies for up to six months
  • Tenancy sustaining services
Individuals experiencing homelessness who are pregnant or in the post-partum period
  • Pre-tenancy and transition navigation and case management, including connection to housing specialists
  • One-time transition start-up services (moving costs, initial furnishings)
  • Rental subsidies for up to six months
  • Tenancy sustaining services
Individuals transitioning from corrections facilities who are homeless or at risk of homelessness
  • Pre-tenancy and transition navigation and case management, including connection to housing specialists
  • One-time transition start-up services (moving costs, initial furnishings)
  • Rental subsidies for up to six months
  • Tenancy sustaining services

Table 4: Proposed populations by housing service

Proposed populations by Food and Nutrition service

PopulationServices
Individuals experiencing food insecurity or with a history of food insecurity who are pregnant or in the post-partum period (and their household)
  • Grocery delivery/food boxes for pregnant beneficiaries for six months (includes their children under age 18 who reside in the same household)
  • Ongoing nutrition assistance navigation and application support
Individuals experiencing food insecurity or with a history of food insecurity who have a diet-sensitive condition
  • Medically tailored meals and/or groceries for adults with diet sensitive conditions for six months
  • Ongoing nutrition assistance navigation and application support

Table 5: Proposed populations by food and nutrition service

 

Public Hearing Schedule

The Department will hold three virtual public hearings to receive comments regarding the proposed Demonstration. The Department will also receive comments on the Demonstration application at the Income Maintenance Advisory Council meeting on December 5, 2023, the Medical Assistance Advisory Committee meeting on December 7, 2023, and the Information Sharing and Advisory Committee Hub meeting on December 12, 2023.

The public hearings will be held as follows:

  • December 11, 2023, from 12:00 p.m. to 1:00 p.m.
    This meeting has already occurred.
  • December 12, 2023, from 6:00 p.m. to 7:00 p.m.
    This meeting has already occurred.
  • December 15, 2023, from 9:00 a.m. to 10:00 a.m.
    This meeting has already occurred.

Please register to participate virtually. When you register, there will be an option to add the Public Forum to your calendar. Registration is not necessary to join by phone. Closed captioning will be provided during each public forum.

 

DHS is also consulting existing DHS advisory groups and meeting with additional stakeholders in the public comment period:

Medical Assistance Advisory (MAAC) Managed Care Subcommittee
December 4, 2023, from 11:00 a.m. to 10:00 a.m.
This meeting has already occurred.

Income Maintenance Advisory Committee (IMAC)
December, 5, 2023, from 1:00 p.m. to 4:30 p.m.
 This meeting has already occurred.

MAAC Consumer Subcommittee
December 6, 2023, from 1:00 p.m. to 3:00 p.m.
 This meeting has already occurred.

MAAC
December 7, 2023, from 10:00 a.m. to 12:00 p.m.
 This meeting has already occurred.

Information Sharing and Advisory Committee (ISAC)
December 12, 2023, from 10:30 a.m. to 11:00 a.m.

Full details of how DHS will seek input are available on the Public Input Process page.

 

Public Comment

The Department seeks public input on the proposed 1115 Demonstration application for Medicaid coverage of HRSNs, reentry supports, and multiyear continuous eligibility for young children. The 30-day public comment period will take place from December 2, 2023, through January 2, 2024.

Individuals may submit written comments through:
https://tinyurl.com/KeystonesofHealthComments
by email to: RA-PWMAProgComments@pa.gov
by mail to:
Department of Human Services
Office of Medical Assistance Programs
c/o Regulations Coordinator
P.O. Box 2675, Harrisburg, PA 17120

Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at 1-800-654-5984 (TDD users) or 1-800-654-5988 (voice users).

The Department will consider all comments received by January 2, 2024, in developing the final Demonstration application.

1115 Waiver Estimates of Proposed Annual Enrollment and Annual Aggregate Expenditures and Financial Analysis of Proposed Initiatives.

 
A summary of annual and aggregate projected demonstration enrollment and expenditure data is provided in the tables below. Note that not all Medicaid expenditures are captured in these tables. For example, Commonwealth administrative expenditures and expenditures for populations or services excluded from the 1115 waiver are not included. The expenditure data for these estimates is limited to expenditures that will be considered as part of the 1115 waiver budget neutrality and projected new expenditures where data and estimates are currently available. Demonstration projections are approximations based on assumptions used for the purpose of the waiver planning. Demonstration estimates, including financing and budget neutrality assumptions, will continue to evolve throughout the course of the waiver application process and as new budget data becomes available. The impact of the ending of the PHE may impact these projections.

 DY1 
CY 2025 
DY2 
CY 2026 
DY3 
CY  
2027 
DY4 
CY  
2028 
DY5 
CY 2029 
Five Year Total 
CE 0-6 Expenditures $189M $372.5M $416.5M $431.5M $446.5M $1,856M 
Members Impacted 340,000 415,000 450,000 450,000 450,000 450,000 by DY 5 
CE Reentry Expenditures $0 $13.5M $51M $56.5M $62.5M $183.5M 
Members Impacted   0 7,250 27,700 27,700 27,700 27,700 by  
DY 5 
Reentry Services $0 $47.9M $142.8M $144.7M $146.7M $482.1M 
Members Impacted   0 7,250 27,750 27,750 27,750 90,500 
HRSN Food and Nutrition Supports  $0 $45.1M $72.8M $60.4M $42.2M $220.5M 
Members Impacted   0 15,100 23,900 19,500 13,700 72,200 
HRSN Housing Supports $0 $30.1M $54M $61.9M $56.6M $202.6M 
Members Impacted  0 1,000 1,800 2,100 1,800 6,700 
HRSN Food, Nutrition and Housing Supports Infrastructure Investments*  $12.8 $12.8M $12.8M $12.8M $0 $51.2M 
Reentry Supports Infrastructure Investments* $18.1M $18.1M $18.1M $18.1M $0 $72.4M 
Total Expenditures$219.9M $540.0M $768.0M $785.9M $754.5M $3068.3M 

Table 6 Projected Expenditures and Enrollment for Demonstration Proposals
* Infrastructure support funding by year will be refined based on planning and implementation.

Evaluation and Hypotheses
DHS will test the following research hypotheses through the section 1115 demonstration:

  1. Addressing unmet HRSN within the Medicaid-eligible population will improve health outcomes and reduce the cost of care.
  2. A focus on health equity improvements for specific populations that have experienced disproportionately poor health outcomes will result in improved health outcomes, increased access to care, and a reduction in the gap between outcomes for populations of focus and those that have historically experienced favorable health outcomes.
  3. HRSN services designed to support individuals experiencing life transitions will result in a reduction in avoidable hospitalizations and medical utilization (e.g., lower emergency department (ED) use, lower avoidable ED visits) and an increase in recommended or preventive care.
  4. Access to pre-release services will result in increased use of recommended and/or preventive care, resulting in positive impacts on health outcomes.
  5. Implementation of pre-release services will result in increased collaboration between stakeholders, identification of medical needs and HRSN prior to release, gradual expansion of access to pre-release services for justice-involved individuals, and improved insights into healthcare delivery for this population.
  6. Expanded housing supports will reduce homelessness, homeless recidivism, and housing instability of individuals.
  7. Improvements in housing stability will improve access to recommended and/or preventive care.
  8. Implementation of nutrition supports will result in increased collaboration between stakeholders, gradual expansion of access to nutrition services for participating individuals, and improved infrastructure for the provision of nutrition support services.
  9. Nutrition support services will result in reductions in food insecurity and improved disease management for participating individuals.
  10. Continuous coverage will reduce churn and gaps in coverage for children enrolled in Medicaid, including for racial and ethnic minority populations that experience disproportionately high rates of churn.
  11. Continuous coverage will reduce the quantity of redeterminations, resulting in lower administrative burden for eligibility workers and associated costs.
  12. Continuous coverage will increase utilization of preventive care services including vaccinations and reduce potentially avoidable services, such as inpatient hospitalizations and non-emergency use of emergency departments.

Waiver authorities

Under the authority of Section 1115(a)(1) of the Act, the following waivers shall enable Pennsylvania to implement this Section 1115 demonstration for five years following approval.

Waiver AuthorityUse for Waiver
1902(a)(1) Statewideness

To enable the state to limit reentry services to state prisons and qualified county correctional facilities.

To allow managed care plans or types of managed care plans only in certain geographic areas.

1902(a)(8) Reasonable PromptnessTo allow the state to create service caps and the potential use of waiting lists for Housing and Food and Nutrition services.
1902(a)(10)(B)
1902(a)(17)
Amount, Duration, and Scope and Comparability
To enable the state to provide a varying amount, duration, and scope of HRSN services to a subset of beneficiaries depending on need, which are not otherwise available to all beneficiaries in the same eligibility group.


To the extent necessary to enable the state to limit housing services and supports under the demonstration to certain targeted groups of participants.
1902(a)(14)
1916 and 1916A
Premiums and Cost Sharing

To enable the state to waive existing cost-sharing requirements in the State Plan for incarcerated beneficiaries prior to release.

To enable the state to waive copays on prescription medications in the 30-day supply of medications provided on release.

Table 7: Pennsylvania waiver authorities for the demonstration
 

Expenditure authorities

The table below lists the expenditure authorities the Commonwealth is seeking to support the demonstration policies.

PolicyUse for Expenditure Authority
Expenditures related to the continuous enrollment of childrenProvide continuous State Plan enrollment for children until the end of the month of their sixth birthday (under six years of age) without regard to whether their income or assets exceed eligibility limits as described in Section II.
Expenditures related to the continuous enrollment of individuals following incarcerationProvide continuous State Plan enrollment for formerly incarcerated beneficiaries for 12-months following release from the correctional setting without regard to whether their income exceeds eligibility limits as described in Section II.
Expenditures Related to Waiver ImplementationExpenditure authority to support demonstration implementation capacity at the community level, including payments to qualified entities for infrastructure and capacity building, as well as for interventions and services that will enable implementation of the demonstration benefits and complement the array of benefits and services authorized through the State Plan and other related authorities.
Expenditures Related to Reentry SupportsExpenditures for certain services rendered to incarcerated beneficiaries 90 calendar days prior to their release, including case management, as appropriate; and community based physical and behavioral health clinical consultation services provided via telehealth or, optionally, in-person as needed. In addition, services will include a 30-day supply of medication for use post-release into the community.
Expenditures Related to Food and Nutrition ServicesExpenditures for food and nutrition services not otherwise covered provided to beneficiaries who meet the qualifying criteria as described in Changes to benefits by population in Section III.
Expenditures Related to Housing ServicesExpenditures for housing services not otherwise covered provided to beneficiaries who meet the qualifying criteria as described in Changes to benefits by population in Section III.

Table 8: Pennsylvania expenditure authorities for the demonstration