HEALTHY PA ENROLLMENT BEGINS DECEMBER 1st!

On August 28th, the Centers for Medicare and Medicaid Services (CMS) announced their approval of Governor Corbett’s Medicaid Expansion alternative, Healthy Pennsylvania. The "Coverage Gap" that prevented more than 300,000 low-income Pennsylvanians from getting help paying for coverage in 2014 is now closed. From now on, individuals and families with incomes below 138% of the federal poverty level will be eligible for health insurance through Medicaid Expansion.
WHO QUALIFIES FOR HEALTHY PA MEDICAID EXPANSION COVERAGE?

Single people with yearly incomes below $16,105
Families of 2 with yearly incomes below $21,707
Families of 3 with yearly incomes below $27,310
Families of 4 with yearly incomes below $32,913
Families of 5 with yearly incomes below $38,516
Families of 6 with yearly incomes below $44,119
Families of 7 with yearly incomes below $49,721
Families of 8 with yearly incomes below $55,324

There is no longer an "asset test" for this newly-eligible 
group, and you don't have to fall into certain categories to 
be eligible, like with traditional Medicaid. 

HOW CAN I ENROLL IN HEALTHY PA MEDICAID EXPANSION COVERAGE?

You can apply with help (in person or over the phone) from a Navigator or Certified Application Counselor by calling any of the following organizations:

Pennsylvania Health Access Network: 1-877-570-3642
Pennsylvania Benefits Center: 1-855-486-9331
Consumer Health Coalition: 412-456-1877
Pennsylvania Mental Health Consumers Association:
1-855-274-5626
Mental Health America Westmoreland County:
1-855-274-5626

Find an enrollment assister near you, using this map: http://pahealthaccess.org/GetHelp.

You can apply directly, through the state's Department of Human Services (formerly DPW) by:
Enrollment begins December 1st, 2014 and continues
year-round. If you apply after January 1st, the date of your application will become your coverage effective date.
WHAT BENEFITS ARE COVERED UNDER HEALTHY PA MEDICAID EXPANSION?

Healthy PA Medicaid Expansion coverage will be offered by private health insurance companies ("PCO's"). All plans will cover:
  • Doctor and Specialist Visits
  • Prescriptions
  • Preventive care
  • Mental and Behavioral Care
  • Hospitalization
  • Maternity and Reproductive Care
  • Rehabilitative Services
  • Vision and Dental 
There will not be any premiums for Healthy PA Medicaid Expansion coverage in 2015. Plans do not have deductibles, but some have small co-pays for certain services.

There are 9 planned Healthy PA coverage regions in Pennsylvaniawith 2 to 3 different plan options in each region. You can choose your insurance company, and providers within their network.












  • Region 1: United Healthcare, UPMC, Gateway Health, Vista
  • Region 2: UPMC, Gateway Health, Vista
  • Region 3: Geisinger Health Plan, United Healthcare, Vista
  • Region 4: United Healthcare, Aetna Better Health, UPMC, Vista, Gateway Health
  • Region 5: United Healthcare, UPMC, Gateway Health, Vista
  • Region 6: Geisinger Health Plan, United Healthcare, Gateway Health, Vista, Capital Blue Cross
  • Region 7: Geisinger Health Plan, United Healthcare, UPMC, Gateway Health, Vista, Capital Blue Cross
  • Region 8: United Healthcare, Aetna Better Health, Health Partners, Gateway Health, Vista
  • Region 9: United Healthcare, Aetna Better Health, Gateway Health, Vista, Capital Blue Cross
HOW DOES HEALTHY PA AFFECT PEOPLE THAT ALREADY HAD MEDICAID COVERAGE?

As a condition of expanding health care for some, Governor Corbett is trying to take it away from others by pushing through drastic and dangerous cuts in benefits for current enrollees that are scheduled to take effect January 1st, 2015. 

All adult Medicaid enrollees would see their benefits change, and be moved from their current plan into either a "High Risk" or "Low Risk" benefits plan, both of which cover less than current Medicaid plans. 

Don't let Governor Corbett take away benefits from the most vulnerable Pennsylvanians! Sign and share our petition to protect benefits today.

WHO WILL GET WHAT COVERAGE?
The following groups of people that had Medicaid before Expansion will receive the “Healthy Plus” high-risk plan:
  • Adult Medicaid recipients who are receiving Medical Assistance in an SSI-related category, including: Healthy Horizons, Nursing Home MA, Home and Community Based Services, and Medical Assistance for Workers with Disabilities;
  • Medicaid recipients who are: over age 65, pregnant, or “medically frail.” To qualify as "medically frail," an individual must have: a mentally disabling disorder (must be one of 7 specified diagnoses), a chronic substance abuse disorder, a permanent physical disability that significantly impairs functioning, an intellectual disability, autism spectrum disorder requiring institutional level care, a disability based on Social Security disability criteria, or a serious and complex medical condition (one of an enumerated list of about 10 conditions);
  • Medicaid recipients who: live in a long-term care or intermediate care facility or be enrolled in hospice or who have 2+ inpatient admissions in 12 months and 3 or more ER visits in 6 months and 4 or more prescriptions per month.
The rest of current Medicaid enrollees (all current adult Medicaid parents or caregivers, or former foster care children) who: do not qualify for the Healthy Plus high-risk plan or who do not complete Pennsylvania’s proposed new health screening questionnaire will receive the "Healthy" low-risk plan. 

[Information provided by Community Legal Servicesan independent 501(c)(3) organization that provides free legal services, in civil matters, to low-income Philadelphians].