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Providers urge Pennsylvania to expand LIFE access, allow provider assessments and boost Medicaid reimbursement
Summary
Provider groups told the committee that streamlining enrollment (including allowing LIFE providers to perform functional eligibility assessments), improving outreach and raising reimbursement toward 60% of the AWAP would expand access and stabilize the LIFE program, which providers said saves the state money.
Representatives of Leading HPA, Life Northwest Pennsylvania, the Lutheran Foundation for Long Term Living and other provider groups told the House Aging & Older Adult Services Committee that streamlining enrollment and modest rate increases would increase access to LIFE (PACE) services and produce net savings for Pennsylvania.
Chuck Quinnen, senior vice president of government affairs for Leading HPA, said the LIFE model reduces hospitalizations and institutional care and urged a minimum reimbursement target of 60% of the amount that would otherwise be paid (AWAP) under Community HealthChoices. "For every individual who receives care through LIFE instead of CHC, the state Medicaid budget saves over $39,000 each year," Quinnen said, adding that the change would require roughly "a little over $19,000,000" in annualized state funding while still generating substantial savings.
Providers pressed for two operational changes to speed access: allowing LIFE organizations to perform the functional eligibility determination (FED) using state-approved training and oversight, and improving information flow so eligible individuals are directly connected to providers rather than relying solely on opt‑in outreach. Rob McQuillan (Life Northwest Pennsylvania) said Pennsylvania’s end-to-end enrollment averages about 34 days and said allowing providers to conduct the FED could shorten assessment time from weeks to days. "By allowing LIFE providers to administer that same objective screening tool and be trained on it, we're cutting it down to 2 visits," McQuillan said.
Dr. Mark Usek (Lutheran Foundation) and others asked the legislature to consider statutory or administrative changes to permit direct outreach and to reduce friction in the enrollment pathway; Usek said in prior cases his organization won 98% of appeals when initial functional assessments were overturned, which he framed as evidence of process breakdowns that access reforms could correct.
On rates, multiple witnesses said Pennsylvania’s LIFE Medicaid reimbursement has fallen substantially over time and is now around 56% of AWAP. Mike, representing the PA Life Providers Alliance, said the program’s share fell from roughly 87% in FY10–11 to about 56% today and urged changes in rate methodology to reflect the LIFE model’s integrated services and institutional risk.
Safeguards and oversight were a recurring theme. Witnesses and the National PACE Association recommended state oversight and automated flags so that if providers’ assessments differ significantly from other state assessments, the state reviews and resolves discrepancies. Liz Perry of the National PACE Association cited national experience where allowing PACE organizations to complete assessments produced faster enrollment and flagged that many states pair provider assessments with review and oversight mechanisms.
Next steps discussed included further data-sharing to support actuarial rate-setting, legislative language or administrative policy to allow provider-conducted assessments subject to state oversight, and specific proposals from providers on guardrails to reduce fraud risk. Committee members asked providers to return with concrete proposals for enrollment safeguards and two-to-three practical checkpoints to balance access and program integrity.
