New agreement proposes to cap MCO profits to ensure taxpayer dollars benefit Pennsylvanians

A new profit-sharing agreement between Pennsylvania and its Medical Assistance physical health (PH) managed care organizations (MCOs) has been proposed to ensure taxpayer dollars benefit vulnerable citizens, Governor Tom Wolf announced. 

Under the proposed agreement, which would take effect in 2023, PH-MCOs will be capped at annual profits of 3 % and be required to invest additional profits in approved initiatives and projects aimed at benefiting individual health and well-being. 

“At a time when managed care organizations are seeing incredible returns, it is only right that excess dollars be funneled back into helping the very people those organizations serve,” Wolf said. “This agreement is a responsible use of public money and will put a cap on annual profits to allow the wealth to be shared among those who need it most.” 

MCOs will be able to maintain 3 % profit annually under the proposed profit-sharing agreement. Each MCO will have an opportunity to submit proposals to retain these profits to be used to support initiatives in line with the goals of the Department of Human Services (DHS).  

These goals include achieving health equity, employment supports, food security, housing, and programs focused on community development. The DHS’ Office of Medical Assistance Programs will approve and track each proposal’s measurable goals. All or a portion of the profits may be recouped by DHS should approved programs fail to meet their goals. 

“Managed care organizations are important partners in our work to help Medical Assistance recipients access the care and services necessary to achieve the health and quality of life they deserve,” Acting Secretary Meg Snead said. “This profit-sharing agreement will allow us to ensure that taxpayer resources for this program can be used to further invest in the program’s mission or be returned to offset program costs.” 

MCOs work with the DHS to negotiate and establish rates paid on a monthly basis based on how many members they have. To ensure the program remains financially solvent while allowing for profit of 2-3 %, capitation rates are developed. 

Over the last three years, an overall increase in the physical health program’s profits have exceeded 3 %. As this trend is expected to continue, an opportunity exists to require investments by the PH-MCOs in the Medical Assistance population. The excess profit would be spent on people the funding is intended to benefit. 

More than three million Pennsylvanians are covered by the Medical Assistance program. This profit-sharing agreement is intended to leverage Medical Assistance to ensure taxpayer money aids lower income and vulnerable Pennsylvanians.

6 tips for calming your morning chaos: A Loving Journey

One of the questions I get asked the most is “How do you not pull your hair out getting three kids ready to go to three different schools on three different buses every morning?”

Sometimes I have the help from my husband. But some days, he is at work, and then it’s all on me. Here’s how to give yourself fewer things to worry about in the morning:

1. The night before, prepare food

Before you and your kids go to sleep, there is something that must be in order for a smooth morning: lunch. Pack your kids’ lunches the night before and keep them in the fridge overnight so they can grab them and go in the morning. For breakfast, sometimes I have my kids pick out what they want to eat in the morning. Having breakfast ready in containers the night before saves time, though.

2. Go to sleep

Making sure all the kids get ready for school on time begins the night before. I make sure my kids get the amount of sleep the Sleep Foundation recommends for kids their age. This enables them to not only get up on time to get to school, but also to do their best in school. Special needs children may need extra sleep, so ask your pediatrician what kind of schedule your child should be on.

3. Wake up

Throughout the school year, each of my kids has an alarm clock set for the same time. The clocks make noise and change visually when the alarms go off. I have the alarms set for the same times each day to maintain a schedule and create a sense of predictability for my kids. They know that once the alarm goes off, it’s time to get up.

Their alarm clocks are not set over the weekends, though. They decide when to get up—that way they feel a little more in control of their free time. Target and Walmart have some great and inexpensive alarm clocks for kids of all ages.

4. Get ready

When I know the morning will be busy, sometimes I have outfits sitting out and ready for my kids the night before, but other times I let them decide what to wear to school. If your child has trouble making decisions about clothes, laying them out for the day or for the week may be a good idea.

Check retail stores for weekly clothes organizers for your closet. For my special needs twins, I have labeled their dresser drawers according to what clothing items are in them to make getting ready easier. I also have labels in the bathroom to remind them to brush their teeth and hair and to wash their hands.

5. Locate shoes

Where are everybody’s shoes? I’m sure you can relate to this morning stressor. I make sure my boys put their shoes in the same place every night. In a shoe tray or in a box by the door or right in front of their dresser, shoes go there every night. That way they can find their shoes quickly in the morning.

Use the same approach for backpacks and have them lined up and ready to go for the day. My boys’ backpacks are packed with paperwork and homework the night before and then hung by the front door so they can find them easily.

6. Find time for yourself

I may get up at 5:30 a.m. every morning to have a little me time before my kids get up for the morning, to enjoy my coffee in the quiet. I make sure all medications are ready and lined up. Then boys get up at 6 a.m. and, with the easy steps I have described here, are ready to go to school by 7:30 a.m.

We still have meltdowns before school, but they are few and far between. Usually, we are all ready to get one kid on one bus at a time. By 8:30 a.m. all the kids are off to school. Then mommy has some time to get some things done, like writing this article.

Remember: Identify what you can structure and what attempts to structure will only frustrate you, and give your child a choice and some control over their day. It will help them become a little more independent and confident as the days go by.

Enjoy a stress-free start to your morning!

For more ideas for your morning, visit Parenting.com and WebMD.com.

Trish Schaeffer is a mom of three boys—two with special needs—and a blogger for Central Penn Parent. Follow her at www.centralpennparent.com/A-Loving-Journey. You can follow Trish on Twitter @Alovingjourney and on her Facebook group A Loving Journey-Parents of special needs kids.