Governor Corbett’s Version of Medicaid Expansion Approved
CMS Removes Most Harmful Elements, but Concerns Remain about State Bureaucracy, Future Benefit Cuts
On August 28th, the Centers for Medicare and Medicaid Services (CMS) announced their approval of Governor Corbett’s Medicaid Expansion alternative, Healthy Pennsylvania. The final proposal is markedly different from the original plan submitted by Pennsylvania’s Department of Public Welfare (DPW), with some of the most harmful elements like punitive lockout periods and tying premiums to a new, bureaucratic work search requirement removed.
The modified version of Healthy PA leaves Pennsylvania’s current Medicaid program mostly intact, and will extend health care coverage to more than half-a-million Pennsylvanians. Beginning January 1st, 2015, individuals and families with incomes below 138% of the federal poverty level will be eligible to enroll in health insurance offered by private Medicaid Managed Care companies in a new system run by the Commonwealth.
While the approval of Healthy PA marks a major step forward in covering all Pennsylvanians, serious concerns remain about several key aspects of the final proposal:
Under the agreement, DPW has the authority to require low-income Pennsylvanians living between 100 and 138% of the poverty level to pay 2% of their monthly income for coverage starting in 2016. A significant body of research shows that imposing premiums on low-income people leads to poor health outcomes, unmet health needs and loss of coverage.
NEW MEDICAID MANAGED CARE SYSTEM
Rather than cover newly eligible Pennsylvanians through the private plans in the federal Marketplace or through Pennsylvania’s current Medicaid Managed Care system, Healthy PA intends to establish an entirely new, distinct MCO system that will operate independently from but need to interact with existing structures. Pennsylvania has long struggled to seamlessly link health systems, which often results in individuals getting “lost in the system” or experiencing delays and disruptions in their coverage.
POTENTIAL FOR FUTURE BENEFIT CUTS
While CMS did not approve significant benefit cuts to the existing Medicaid program under the Healthy PA waiver agreement, they also did not rule them out. Negotiations will continue between PA’s DPW and CMS on changing the scope of benefits for Pennsylvania’s current Medicaid program.
This chart developed by Community Legal Services and the Pennsylvania Health Law Project contrasts current Medicaid benefits with the high and low-risk benefit packages the Corbett Administration is seeking to implement (and move current Medicaid enrollees into based on their score on a 20-question health survey still under development at DPW).
Most current Medicaid recipients would be placed into the most restrictive “low-risk” plan. Some Medicaid recipients with disabilities or other special health care needs would be placed in the “high-risk” plan. The 500,000+ newly eligible people under expansion would be enrolled in private insurance and receive the Essential Health Benefits package.