Healthcare (Medicaid)

in committee · Pennsylvania · House Jan 6, 2026

HB 1628: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for pregnancy-related and postpartum medical assistance.

HB 1628 extends Pennsylvania's medical assistance program to cover pregnancy-related care and postpartum support for up to 12 additional months after childbirth or pregnancy loss (such as miscarriage). It directly affects pregnant and postpartum women who are currently receiving medical assistance, have income below 215% of the federal poverty level, and are not otherwise eligible for ongoing assistance. The bill requires the state to seek federal approval for this extension via a waiver under the Social Security Act, and if federal approval is denied, it mandates a report to the legislature within 180 days detailing how to revise the application for future approval. This change aims to improve access to healthcare during a critical period following pregnancy.

Topics ✓ HealthcareSupports HealthcareExtends medical assistance coverage for pregnancy/postpartum care by 12 months, expanding access to healthcare services for eligible women.95% confidence

Sub-Topics Medicaid Women's Health

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in committee · Pennsylvania · Senate Dec 5, 2025

SB 1112: An Act providing for access to contraceptives; imposing duties on the Insurance Department and the Department of Human Services; providing for severability; and imposing penalties.

SB 1112, the "Contraceptive Access for All Act," requires most health insurance plans in Pennsylvania - including Medicaid managed care plans and private health insurance - to cover all FDA-approved contraceptives without cost-sharing (like deductibles or copays). It specifically mandates coverage for prescription contraceptives, emergency contraception (like levonorgestrel), and over-the-counter oral contraceptives, and prohibits insurers from requiring prior authorization or step therapy for these items. The law applies to standard health insurance policies but excludes limited policies like dental, vision, or workers' compensation plans. It directly affects health insurers and managed care plans by requiring them to provide this coverage at no additional cost to enrollees.

Topics ✓ HealthcareSupports HealthcareMandates full insurance coverage for contraceptives without cost-sharing, expanding access to essential reproductive healthcare services per bill's explicit requirements.95% confidence

Sub-Topics Insurance Medicaid Women's Health

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in committee · Pennsylvania · House Feb 12, 2025

HB 595: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for behavioral health and physical health services integration.

HB 595 requires Pennsylvania's Medicaid program to integrate mental health, addiction, and physical health services into a single managed care system for all eligible residents. The bill mandates that the state contract with managed care organizations to provide comprehensive, community-based care addressing both behavioral and physical health needs, while also addressing social factors affecting health. It requires the state to seek federal waiver approval by October 1, 2025, to implement this integration, including mandatory enrollment for all Medicaid-eligible individuals in the new system. This change aims to improve care coordination and create a more efficient health care delivery model.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid integration of mental/physical health services and community-based care, advancing comprehensive coverage and addressing social health factors.95% confidence

Sub-Topics Medicaid Mental Health Substance Abuse

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in committee · Pennsylvania · House Apr 4, 2025

HB 1128: An Act establishing the Medicaid Care Transition Program; and imposing duties on the Department of Human Services.

HB 1128 establishes Pennsylvania's Medicaid Care Transition Program to address delays in moving Medicaid patients from emergency departments to appropriate follow-up care. It directly affects Medicaid patients stuck in emergency settings, hospitals, and "responsible entities" (like county Medicaid managed care plans) that must create dedicated care transition units. Key provisions require responsible entities to: contact hospitals within 24 hours for placement, seek out-of-network options if in-network care isn't available quickly, and notify the Department of Human Services after 48 hours if placement fails. The Department then intervenes to resolve barriers like clinical issues, payment problems, or coordination with other agencies. The law aims to reduce emergency department overcrowding and ensure timely access to necessary postacute care for Medicaid enrollees.

Topics ✓ HealthcareSupports HealthcareEstablishes Medicaid Care Transition Program to reduce ER delays and improve patient access to follow-up care - directly strengthens healthcare coordination and access for Medicaid patients.90% confidence

Sub-Topics Hospitals Medicaid

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passed · Pennsylvania · House Jan 30, 2026

HB 348: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in departmental powers and duties as to licensing, providing for notice of legal representation for medical assistance.

HB 348 amends Pennsylvania's Human Services Code to require the state human services department to notify medical assistance applicants about their right to legal representation during application or eligibility reviews. This change directly affects individuals applying for medical assistance programs (like Medicaid) and the department responsible for processing these applications. The key provision mandates that applicants receive written notice detailing their option to seek legal help, which the department must provide before finalizing eligibility decisions. The bill focuses on improving transparency in the application process without altering eligibility criteria or benefit amounts.

Topics ✓ HealthcareSupports HealthcareRequires notice of legal representation rights for medical assistance applicants, protecting access to healthcare coverage and applicant rights during eligibility reviews.95% confidence

Sub-Topics Medicaid

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in committee · Pennsylvania · House Mar 11, 2025

HB 857: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for emergency transportation services.

HB 857 amends Pennsylvania's Human Services Code to update reimbursement rates for emergency ambulance services under Medicaid programs. It requires the state to pay ambulance providers the higher of either Medicare's 2023 rates or current Medicaid ambulance fees (as updated in 2023) for services provided to Medicaid enrollees starting January 1, 2024. For services where patients declined transport, new rates based on 2025 Medicare data or updated Medicaid fees will apply beginning July 1, 2025. This directly affects licensed emergency medical services agencies that provide ambulance transport to Medicaid beneficiaries.

Topics ✓ HealthcareSupports HealthcareIncreases Medicaid ambulance reimbursement rates to higher Medicare benchmarks, improving provider payment and access to emergency services for Medicaid enrollees.95% confidence

Sub-Topics Medicaid Medicare

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in committee · Pennsylvania · Senate Apr 9, 2025

SB 594: An Act providing for complex wheelchair quality assurance; and imposing duties on the Department of Human Services and the Insurance Department.

SB 594, the Complex Wheelchair Quality Assurance Act, requires health insurers and government programs (like Medicaid) to cover semiannual maintenance visits ("well-visits") for individuals using complex wheelchairs. These wheelchairs are defined as individually configured devices designed for specific medical needs, requiring specialized adjustments and evaluations. The bill mandates coverage for physical checks, adjustments, and telehealth options for these visits, along with annual notifications to users about their coverage. It also directs the Department of Human Services and Insurance Department to establish implementation rules within two years.

Topics ✓ HealthcareSupports HealthcareMandates insurers/Medicaid coverage for semiannual wheelchair maintenance visits, expanding access to essential medical device care and protecting patient rights for complex wheelchair users.95% confidence

Sub-Topics Medicaid Telehealth

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in committee · Pennsylvania · Senate Jun 24, 2025

SB 888: An Act providing for the use of certain credentialing applications and for credentialing requirements for health insurers; imposing penalties; and conferring powers and imposing duties on the Insurance Department.

This bill, the Health Care Practitioner Credentialing Act, requires Pennsylvania health insurers to accept the CAQH credentialing application or a nationally recognized alternative for health care practitioners seeking to join provider networks. It sets clear timelines: insurers must notify practitioners within 10 business days if an application is incomplete and issue a credentialing decision within 45 business days for complete applications. Insurers failing to comply may face administrative penalties, though the bill does not guarantee practitioners a spot in any insurer's network. The law applies broadly to most health insurers (including Medicaid managed care organizations) but excludes certain coverage types like accident-only or vision insurance.

Topics ✓ HealthcareSupports HealthcareStreamlines insurer credentialing for healthcare practitioners, reducing delays in provider network access and improving patient access to care through mandated timelines and penalties for non-compliance.92% confidence

Sub-Topics Insurance Medicaid Medical Licensing

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signed · Pennsylvania · House Nov 12, 2025

HB 749: An Act amending the act of June 13, 1967 (P.L.31, No.21), entitled "An act to consolidate, editorially revise, and codify the public welfare laws of the Commonwealth," in public assistance, further providing for uniformity in administration of assistance and regulations as to assistance and for copayments for subsidized child care, providing for report on transition to chip-enabled access cards, further providing for reports to General Assembly, for persons eligible for medical assistance and for nonemergency medical transportation services and providing for abrogation of regulatory requirements for payment for outpatient behavioral health services within physical confines of behavioral health clinic facilities and for SNAP benefit reporting; and making a repeal.

HB 749 updates Pennsylvania's public welfare laws to streamline assistance programs and improve service access. It requires copayments for subsidized child care, changes reporting for SNAP benefits, and mandates reports on transitioning to chip-enabled access cards for benefits. The bill removes regulatory barriers for outpatient behavioral health services provided within clinic facilities, allowing services to be billed as part of the clinic visit. It also requires additional reports to the General Assembly regarding medical assistance eligibility and nonemergency medical transportation services.

Topics ✓ HealthcareSupports HealthcareRemoves regulatory barriers for outpatient behavioral health services within clinics, enabling streamlined billing and access to mental health care.90% confidence

Sub-Topics Children's Health Medicaid Primary Care

in committee · Pennsylvania · House Jan 22, 2025

HB 268: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for the medically needy and determination of eligibility.

HB 268 amends Pennsylvania's Human Services Code to require that individuals determined eligible for home- and community-based waiver services must be offered those benefits within 90 days of eligibility determination. The bill directly affects Pennsylvanians applying for medically needy assistance through home-care waiver programs. Its key provision (Section 442.1(d)) establishes a strict 90-day timeline for offering waiver benefits after eligibility is confirmed, aiming to streamline access to community-based care. This is a procedural change to eligibility processing, not a new benefit or funding measure.

Topics ✓ HealthcareSupports HealthcareRequires 90-day timeline for offering home-care waiver benefits, improving patient access to medically needy assistance programs per Section 442.1(d).95% confidence

Sub-Topics Medicaid

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