Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania, Social Determinants of Health, Uncategorized

Pennsylvania Lawmakers Move Forward with Medicaid Work Requirements

On April 16th the Pennsylvania House of Representatives voted to pass House Bill 2138 providing work requirements as a condition of receiving Medical Assistance (Pennsylvania’s Medicaid program). This bill is one of several currently making their way through the Pennsylvania legislature that would detrimentally affect low-income families and children, cost the state hundreds of millions of dollars to implement, and generally serve no valid public interest other than to deter individuals who need life saving benefits from getting them.

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House Bill 2138 mandates that Medical Assistance enrollees must work 20 hours per week or complete twelve “job training program-related activities” per month in order to maintain the benefit. Individuals who fail to comply with this requirement will lose their eligibility for three months initially, then six months, and then nine months. Individuals who are 19 years and older must verify compliance with the work requirements on a biannual basis and by request from the State. Furthermore, the State can delay enrollment if the individual is found to have failed to comply with these requirements.

Certain populations are exempt from the work requirements including: full-time high school students; individuals receiving temporary or long-term disability benefits; individuals under 18 years of age and 65 and over; pregnant women; individuals receiving Supplemental Security Income (SSI); primary caregivers for dependents six years of age or younger; and primary caregivers for individuals who are permanently disabled or in hospice care. Additionally, individuals who are experiencing a crisis, serious medical condition, or temporary condition that prevents the enrollee from actively seeking employment, including domestic violence and substance use disorder, are exempt.

The process in which individuals seeking exemption must participate in, including paperwork and verification requirements, is unclear based on the bill alone; however, the current Secretary of Human Services, Teresa Miller, reported that it would cost $650 million and an additional 300 staff members to enact these changes in her department. Now that the bill has passed the House, it moves on to the Pennsylvania Senate for a vote.

Policy experts find that work requirements harm families and individuals who are already working the most. Moreover, work requirements rarely lead to additional employment, but often lead to disenrollment, stripping vulnerable individuals of critical benefits and services. One study found, “four to five years after such requirements were implemented, about 70 percent of the welfare recipients who went off welfare because of work requirements had no income, or had income at or below 50 percent of the poverty line.”

Since the Centers for Medicare and Medicaid Services (CMS) changed its policy on work requirements in January 2018, Kentucky, Arkansas, and Indiana have had Medicaid waivers approved that include work requirements. Pennsylvania is among several other states in the process of establishing a pathway for work requirements.

It is critical that Pennsylvania residents and residents of other states seeking to implement these changes reach out to their elected officials urging them to stop their assault on poor families. The Pennsylvania Health Access Network has an easy form to find your State Senator and submit a letter urging her or him to vote NO on work requirements.

*This article was cross-posted on http://www.helpmlp.org.

Affordable Care Act, Health Policy, Medicaid, Philadelphia

Healthy or Unhealthy PA? Advocates Weigh in on Gov. Corbett’s Plan to Reform Medicaid in Pennsylvania

Governor Corbett’s Healthy PA proposal to reform the Medicaid system in Pennsylvania through a Medicaid 1115 Demonstration Waiver has been met with harsh criticism by many and for good reason.  Healthy PA (known fondly by some as Unhealthy PA) would disrupt the current cost-efficient Medicaid program in Pennsylvania by enrolling newly eligible individuals and many currently existing Medicaid beneficiaries into private health insurance plans.

So, why is this a problem? A couple of reasons:

  1. Historically, private health insurance plans do a poor job of providing coverage for specific types of illnesses. For example, the lack of private coverage for mental health and substance use disorders called for the enactment of federal legislation known as the Mental Health Parity and Addiction Equity Act.
  2. Private health insurance companies spend much more money on administrative costs and profits than Medicaid. This means that administering the Medicaid program through the private  insurance industry will mean less bang for the tax payers’ buck.

Additionally, Governor Corbett’s plan includes many controversial provisions that are likely to face close scrutiny by the federal government:

  1. A monthly premium for individuals making as little as 50% of the federal poverty level (less than $6,000/year).
  2. Work search requirements (no other state in the United States has such a provision). As a side note this would apply to certain individuals who meet “medically frail” criteria, but that are otherwise “able bodied.”
  3. A $10 co-payment for “non-emergent” emergency use.
  4. Harsh punitive measures that would disqualify households from Medicaid if the fail to pay their monthly premiums.
  5. Benefit limits that would substantially reduce scope of coverage that is currently offered through Medicaid.

Perhaps, most importantly, the plan is not set to go into effect until January 1, 2015 (assuming it would get approval by the federal government by this time) meaning hundreds of thousands of Pennsylvanians will fall into a “coverage gap” qualifying for neither Medicaid or a tax subsidy through the health insurance marketplace.  These individuals will have no source of meaningful health coverage for the entire year.  Not to mention, delaying expansion until 2015 will cost the Commonwealth 2.5 billion dollars of potential funding.

Advocates representing many different groups and organizations have voiced their opinion on the plan.  Not all of the testimonies provided and comments submitted were adamantly opposed to the plan, but many were. The following is a list of organizations’ comments and/or testimony on the plan:

  1. Community Legal Services of Philadelphia
  2. Project HOME
  3. Public Citizens for Children and Youth
  4. Disability Rights Network of Pennsylvania
  5. Hospital and Healthsystem Association of PA (HAP) 
  6. Delaware Valley Healthcare Council of HAP
  7. Safety Net Association Pennsylvania
  8. Community Behavioral Health of Philadelphia (CBH)
  9. Pennsylvania Association of County Drug and Alcohol Administrators
  10. Pennsylvania Association of County Administrators for Mental Health and Developmental Services
  11.  The Alliance of Community Service Providers (Testimony January 3rd)
  12. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (DBHIDS)
  13. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (Appendix A- Questions to PA DPW on the plan)
  14. The Philadelphia Coalition
  15. Pennsylvania Budget & Policy Center
  16. Todd Keefer, York County resident
  17. Center for Advocacy for the Rights and Interests of  the Elderly (CARIE)
  18. Pennsylvania Partnerships for Children (PPC) 
  19. Rehabilitation and Community Providers Association (RCPA)
  20. The ARC 
  21. Pennsylvania Homecare Association
  22. Public Interest Law Center of Philadelphia (testimony of staff attorney, Benjamin Geffen, on January 3rd)
  23. A coalition of organizations representing individuals with disabilities
  24. Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC)
  25. Juvenile Law Center (JLC)
  26. Pennsylvania Association of Medical Assistance Manged Care Organizations
  27. Women’s Law Project
  28. Greater Philadelphia Chamber of Commerce
  29. Joanne Grossi, Health and Human Services (HHS) Region III (House Democratic Policy Committee Meeting: January 8, 2014)
  30. Joan Alker, Center for Children and Families, Georgetown University (House Democratic Policy Committee)
  31. Jim Willshier, Pennsylvania Association of Community Health Centers (House Democratic Policy Committee)
  32. Sol B. Vazquez-Otero, Disability Rights Network of Pennsylvania (House Democratic Policy Committee)
  33. Jacob Bowling, Mental Health Association of Southeastern PA (House Democratic Policy Committee)

    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commowealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commonwealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
Affordable Care Act, Essential Health Benefits, Health Policy

The time is now for final rules re: mental health parity

The time is now for final rules re: mental health parity

This NY Times article illustrates the need for final rulemaking from the federal government on the issue of mental health parity.  While the Affordable Care Act strengthens existing parity laws by mandating substance use and mental health services be covered under the Essential Health Benefits provision, defining and enforcing parity has proven to be a challenge.

Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania

Medicaid Expansion in Pennsylvania: Is it still possible?

budget letter photoToday, Pennsylvania Governor, Tom Corbett, announced his 2013-2014 proposed budget. During his budget address he announced that without further flexibility and reform from the federal government, expanding Medicaid in Pennsylvania would be, “financially unsustainable for Pennsylvania taxpayers”.  Governor Corbett’s announcement came a day after Republican Ohio Governor, John Kasich, announced that he would be expanding Medicaid in his state. Governor Kasich is the fifth Republican governor to do so.

While today’s announcement is certainly not good news for public health advocates, Corbett’s announcement did not entirely eliminate the possibility of expansion. In addition to his statement on the matter, Corbett sent a letter to HHS Secretary Sebelius identifying his concerns.

Corbett’s 2013-2014 proposed budget materials can be found here.

Affordable Care Act, Health Insurance Exchange, Health Policy, Health Reform, Pennsylvania

Pennsylvania State-Operated Health Insurance Exchange- Not Happening

PA Will Miss Health Insurance Exchange Deadline

On Wednesday, October 17, Pennsylvania Health Insurance Commissioner, Michael Consedine stated that the Commonwealth will not be meeting its November 16th deadline to submit an Exchange Blueprint to the Health and Human Services (HHS) Department. Because of this, the State will not be able to establish its own state-based exchange but must instead either default to a Federally Facilitated Exchange (FFE) or partner with the federal government to establish a Partnership FFE.