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

Affordable Care Act, Health Reform, Medicaid, Pennsylvania

Advocates weigh in on Corbett’s Healthy PA plan

Pennsylvania is moving forward with seeking approval by the federal government for its Healthy PA plan to reform the Medicaid system and expand Medicaid eligibility in the Commonwealth. The Pennsylvania Department of Public Welfare accepted comments on the plan in its current form as a concept paper.

When he announced the Healthy PA plan in mid-September, Governor Corbett made it clear that he did not view it as Medicaid expansion, but instead, Medicaid reform.  The plan proposes to consolidate the existing Medicaid benefit packages in the state into two alternative benefit plans mirroring commercial-like coverage.  While the plan does call for an expansion of Medicaid eligibility for individuals up to 138% of the federal poverty level, new Medicaid beneficiaries would be enrolled in private health insurance plans offered through the Marketplace.  The Pennsylvania plan contains other controversial proposals such as requiring a work-search requirement, attaching a monthly premium, and imposing a $10 co-payment for “inappropriate” emergency room usage.

Pennsylvania advocates expressed grave concern about the legality and impact the proposed plan would have on individuals:

In its comments, Community Legal Services (CLS) identifies issues with the plan’s proposal to attach a monthly premium on individuals making as little as 50% of the federal poverty level (less than $6000/year).  Additionally, CLS cites guidance from CMS regarding its position on imposing barriers to eligibility including work-search requirements.

Echoing many of the concerns expressed by CLS, the Consumer Sub-Committee of the Medical Assistance Advisory Committee (MAAC), under its counsel, the PA Health Law Project, expressed concerns with the monthly premium, emergency use co-payment, and work-search requirements of the plan. The Consumer Sub-Committee and the Disability Rights Network also called for clarity regarding the process of defining “medically frail” under the proposed plan. 

The PA Coalition of MCOs’ 12-page list of questions illustrates the considerable need for clarity regarding the plan’s proposals.  The Coalition’s comprehensive list of questions range from inquiring about the state’s timeline to the range of benefits and options that will be available to Medicaid-eligible individuals enrolled in private health insurance plans.

The next procedural step Pennsylvania must take in order to implement an alternative Medicaid expansion plan is seeking CMS approval of a Section 1115 waiver. Once the waiver is drafted, Pennsylvania must hold public hearings and have a formal notice and comment period of at least 30 days.  To date, the only state to receive approval by CMS to implement an alternative Medicaid expansion plan is Arkansas.

Links to other organizations’ submitted comments:

Affordable Care Act, Education, Health Reform, Medicaid, Pennsylvania, Philadelphia, Uncategorized

Affordable Care Act (ACA) Education & Outreach

This weekend I had the opportunity to discuss the Affordable Care Act (ACA) with Pennsylvania Senator Vincent Hughes and Philadelphia Department of Behavioral Health & Intellectual disABILITY Services Commissioner Arthur Evans on Philadelphia radio show Philly Speaks on 100.3 FM. The show gave us a chance to demystify “Obamacare” and what it really means for individuals. A few of the key messages that were expressed include:

  • Getting insurance coverage is essential for many individual and societal reasons.
  • The new Health Insurance Marketplace provides an opportunity for individuals to purchase health insurance on a more “level playing field” than in the past.
  • Through the Marketplace individuals could receive financial assistance to purchase coverage.
  • The Marketplace will screen individuals for public and private health insurance options and financial assistance to purchase insurance.
  • Individuals with behavioral health needs (mental health and substance use challenges) will have an increased opportunity to access services due to the Affordable Care Act’s provisions.
  • Expanding Medicaid in Pennsylvania is a “no brainer” and will be a huge missed opportunity if the state administration does not act soon.
  • Healthcare.gov, localhelp.healthcare.gov, and 1-800-318-2596 are valuable resources for individuals to learn more about their options and places to get in-person assistance.

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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.