By Rebecca Adams, CQ HealthBeat Associate Editor
September 16, 2013 -- Pennsylvanians on Medicaid would pay premiums of up to $35 per month and adults would get their Medicaid benefits through the new federal marketplace, under an expansion proposal Republican Gov. Tom Corbett announced last week.
Corbett also asked federal officials to allow him to require that as a condition of getting Medicaid benefits, unemployed adults must search for work and sign up for job opening announcements. The state currently requires people receiving unemployment compensation to enroll in its career program, which also provides job training resources online or in person.
The expansion is part of a broad health care policy plan Corbett recently released. Some of the provisions will require a Medicaid waiver. If approved, Medicaid recipients would be paying a monthly premium for the first time. The premium amounts would be on a sliding scale, ranging from nothing to up to $35 per month for families, depending on the recipient's income.
Under Corbett's plan, adults would get their coverage through the new health law exchanges while children's coverage would not change, including those children whose parents did not qualify for Medicaid who would continue to be covered through the Children's Health Insurance Program.
"We are encouraged by Pennsylvania's commitment to helping cover more of the state's uninsured population," said a spokeswoman for the Centers for Medicare and Medicaid Services (CMS). "As we have done with other states, we are eager to work with Pennsylvania to provide the best options that work for Pennsylvanians ... HHS is committed to supporting state flexibility and working with states to design Medicaid programs that work for them."
State officials who briefed reporters by phone did not give a specific timetable for the launch of the revised Medicaid program.
"We don't know how long it'll take to get this up and running," said Public Welfare Secretary Beverly D. Mackereth. In an example of how the program would work, she said that if the expansion took effect in 2015, the state would get two years of full federal funding. That suggested that the state might not be able to get the program operating in time to take advantage of at least part of the first year of full federal financing in 2014.
"I have been urging Governor Corbett for nearly a year to expand Medicaid in Pennsylvania because it's the right thing economically and morally for our Commonwealth," said Rep. Allyson Schwartz, D-Pa., who is running for governor against Corbett. "Instead he has chosen a path of politically motivated delays and inaction hurting nearly 500,000 working Pennsylvanians who need affordable coverage and now won't be eligible under his proposal at the earliest until January of 2015."
Adults would not have to pay co-payments for visits to their primary care doctor but would face a $10 co-pay for emergency room visits that were deemed inappropriate because they were for non-urgent problems that could have been handled by a primary care doctor instead.
The Pennsylvania plan to use Medicaid dollars to buy coverage on the exchange is similar to a proposal Arkansas officials submitted to CMS officials in August. A consultant who has advised Arkansas on the design of its plan said recently that state officials are hoping to get approval of that plan as early as Oct. 1.
"Arkansas is very far along in discussions with CMS," said Deborah Bachrach, a partner in Manatt, Phelps & Phillips. "CMS has been extremely responsive and we've been working through all the issues that come up when you integrate public and private coverage issues. One by one, those issues are being resolved in a way that's workable for Arkansas. We are moving aggressively and Arkansas is looking toward an October approval, which shows CMS' commitment to working with states."
Officials in other states that have expressed interest in the approach being pursued in Arkansas and Pennsylvania, include Iowa, Ohio, Tennessee and potentially Virginia.
Earlier this year, Corbett refused to recommend an expansion, but has been talking with CMS officials for months.
The plan "works to ensure that every child has access to healthcare coverage and that every Pennsylvanian has access to a family doctor or healthcare provider," Corbett said in a statement. "It's a Pennsylvania-based plan that is based on common-sense reforms, creates real healthcare choices, reduces government bureaucracy and provides a pathway to independence for all Pennsylvanians."
State officials said they felt good about the chances that federal officials who have been briefed on the concepts of the plan will approve it.
"We believe it can be approved, and approved in short course," Todd Shamash, the governor's deputy chief of staff, told reporters, adding, "We think all of this, including the work search, is acceptable."
Shamash also said that the state legislature does not have to approve the Medicaid plan.
The governor noted that the current Medicaid program has 14 separate benefit packages for beneficiaries that his office said "far exceed national standards for coverage and are cost prohibitive for taxpayers." Those packages would be replaced with plans that offer the 10 essential health benefits required by the health care law (PL 111-148, PL 111-152).
The state envisions having two sets of benefit packages—one for the chronically ill and another less robust package for people who are healthier.
"We're paying for a lot of things right now that people don't use and don't need," said Mackereth.
Benefits for children and people with disabilities are not expected to change, said materials provided by the governor's office.
The proposal also would ask the legislature to eliminate a six-month waiting period in the Children's Health Insurance Program. The governor wants to ensure all children in the state have coverage.
Corbett also wants to tackle the issue of long-term care by creating a commission to recommend strategies to improve the coordination of care for that population.
