Gov. Tom Corbett on Wednesday officially began seeking federal approval for his plan to bring billions of federal Medicaid expansion dollars to Pennsylvania to cover a half-million working poor residents through private health plans, although advocates for the poor and uninsured called it bureaucratic and punitive.
The Corbett administration submitted the plan to the U.S. Centers for Medicare and Medicaid Services, which has given at least partial approval to proposals by other states, including Arkansas and Iowa, which sought some similar modifications to the Medicaid expansion envisioned by the 2010 federal health care law.
Corbett's public welfare secretary, Beverly Mackereth, said the administration is backing off certain elements that have been criticized as barriers to coverage, although not enough to mollify every critic of a draft plan with a long list of conditions the administration issued in December.
In any case, any new coverage is expected to wait until January 2015, when Mackereth has said the administration will have the technology and staff to handle the new program.
Corbett, a critic of Medicaid who calls the five-decade-old program inefficient and bloated, refuses to expand Medicaid coverage. Instead, he wants to use the Medicaid expansion dollars to purchase private insurance policies for about 500,000 newly eligible adults, an idea pioneered by Arkansas.
Neal Bisno, president of SEIU Healthcare Pennsylvania, met the filing with a mixed review.
"Although we are encouraged that the Corbett Administration has made some positive changes to Healthy PA's initial draft plan, Governor Corbett's proposed cuts to the Medicaid program are the wrong direction for ensuring quality healthcare in Pennsylvania,” said Bison in a written statement.
The statement goes on to read:
“Traditional Medicaid Expansion continues to offer the best solution to protecting and expanding Pennsylvania's vital safety net for more than 1.2 million uninsured citizens, while saving taxpayers $522 million in 2014 and keeping us on track to create 35,000 family-sustaining jobs."
Mackereth said Wednesday that the administration is still contacting insurers and trying to figure out how the program of subsidizing private coverage plans will work. For the time being, a quirk in how a U.S. Supreme Court decision affected the federal health care law's rollout means that some of the 500,000 — those whose annual income is $11,500 or more — can seek coverage that is subsidized by tax credits through insurance marketplaces created by the law.
The numbers are all in dispute by those who do not like the plan.
The revised plan would relax usage limits on certain medical services that it wants to require for able-bodied adults in the existing Medicaid program.
It also would ensure that rural health centers and federally qualified community health centers are automatically enrolled under the insurance plans subsidized by the Medicaid dollars. The previous draft had forced them to negotiate with the insurers, but Mackereth said the administration is putting an emphasis on providing access to primary care.
The Pennsylvania Association of Community Health Centers, the Pennsylvania Medical Society, and the Healthcare Association of Pennsylvania said Wednesday that they support the proposal.
“Insurance coverage matter hugely for being able to have access to health care services including hospital services but equally important wellness and preventative care services,” said Hospital and Health System Association of Pennsylvania President Andy Carter.
The administration said it also is backing off most demands that enrollees complete work-search requirements and pay premiums instead of co-pays in the first year as a condition of getting coverage. The HAP is also pleased to see there was a shift in the way coverage can begin.
“We wanted to make sure that when an uninsured person presents at a hospital for care, if they are eligible for this new program, that they become eligible effective that day rather than having to wait until the following month,” Carter said.
However, advocates for the poor and uninsured warned that those elements remained troublesome.
For instance, the work-search and premium requirements carry as a punishment "lockout" periods during which people cannot get coverage if they fail to meet the requirements.
"So you better not get sick during that time," said Richard Weishaupt, a lawyer with Community Legal Services of Philadelphia, a public interest law center that advocates for the poor. "No state has ever gotten a waiver to do the lockouts."
The plan is now open to a 30-day comment period.