Affordable Care Act

Healthy PA v.2 (a.k.a. Pennsylvania’s Medicaid 1115 Demonstration Proposal)

In mid-September Governor Corbett released a concept paper, Healthy Pennsylvania, outlining his proposed plan to reform the Medicaid program in Pennsylvania. This twelve-page document was a predecessor to a more formal document known as a Medicaid Section 1115 Demonstration Waiver. In order for the Governor to implement his Healthy Pennsylvania plan he must seek and get approval from CMS for the 1115 demonstration waiver. 

Today Governor Corbett published the Commonwealth’s draft proposal for a Medicaid Section 1115 Demonstration Waiver. 1115 waivers allow states to be flexible within their Medicaid programs through a demonstration project; however, goals of demonstration project must be congruent to the goals of the Medicaid program overall.  

Governor Corbett is using the 1115 waiver as a mechanism to reform the Medicaid program in Pennsylvania. Even though the Governor’s proposal calls for expanding Medicaid eligibility to individuals with incomes up to 133% of the federal poverty level, his plan should not be confused with traditional Medicaid expansion. The plan would go into effect beginning 2015 and would last for five years prior to renewal. Corbett’s plan involves several controversial provisions including:

  • Providing premium assistance to newly eligible and some currently eligible Medicaid enrollees to purchase health insurance through the private market or new Health Insurance Marketplace rather than providing Medicaid through traditional Medicaid Managed Care Organizations currently operating in the state
  • Imposing a work search requirement on individuals who are eligible for Medicaid
  • Requiring individuals to pay a monthly cost-share on a sliding scale basis. Individuals with incomes as low as 51% of the federal poverty level (less than $6000/year) would be required to pay 
  • Requiring a $10 co-payment for inappropriate emergency room use
  • Consolidating the existing Medicaid benefit plans in the state into two Alternative Benefit Plans that will mirror “commercial-like” coverage (benefits are generally not as comprehensive as those provided through traditional Medicaid, especially for behavioral health services)

Since the proposal was released earlier today, I am still making my way through its details. The state is required to hold a 30 day notice and comment period as well as host public hearings. There will be six public hearings as well as two webinars in which individuals can voice their opinion about the proposal. I encourage everyone take the time to read the proposal and attend a public hearing