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

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