Pennsylvania gains approval for alternate Medicaid expansion plan

HHS has approved Pennsylvania's plan to use federal Medicaid expansion funding to launch Healthy Pennsylvania, a program that will promote affordable care and increase access to care for the uninsured, Gov. Tom Corbett (R) announced yesterday.

The Health Pennsylvania initiative will reform the state's current Medicaid program in addition to offering a Healthy PA private coverage option to increase access to care through the commercial insurance market for more than 600,000 state residents. The initiative — which Gov. Corbett unveiled last September — will extend insurance coverage to Pennsylvanians with incomes below 133 percent of the federal poverty level.

Although similar to the Medicaid expansion option included in the Patient Protection and Affordable Care Act, Pennsylvania's initiative will offer people coverage through the private insurance market because that route will involve less bureaucracy, more provider options and less risk for state programs if the federal government doesn't deliver the promised funding, according to Gov. Corbett's office.

Under the initiative, the state's current Medicaid program will change from 14 benefit plans to low-risk and high-risk benefit packages including essential health benefits, as well as mental health and drug and alcohol coverage uniformity. This shift will better align Medicaid benefits and the needs of enrollees, according to Gov. Corbett's office. Additionally, the Health PA initiative will establish the Encouraging Employment program, which will help low-income, able-bodied people improve their overall health and find work.

Furthermore, under Gov. Corbett's plan, the state will encourage personal responsibility through cost-sharing for enrollees in both the Healthy PA private coverage option and the Medicaid program. During the first year, enrollees will pay the same Medicaid copayments in place before the enactment of Healthy PA. In year two, however, enrollees with incomes greater than 100 percent of the federal poverty level will have to pay 2 percent of their income toward a monthly premium, and current copayments will be eliminated. An $8 copayment for non-emergency use of emergency departments will also kick in during the second year. Individuals who don't pay their premiums for more than 90 days will lose their coverage.

Enrollees will also have the opportunity to reduce their cost-sharing by engaging in certain behaviors, such as job training and work-related activities.

 

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