Governor Corbett Proposes Medicaid Expansion Alternative

First Quarter 2014Articles Staying Well Within the Law

In March of 2013, we reported that Pennsylvania Governor Tom Corbett had rejected the option to expand Medicaid eligibility under the Affordable Care Act. In his announcement, he asked the Obama administration to consider approving state- specific alternatives.

On September 16, Governor Corbett announced his proposal to reform Medicaid and increase access to health care in Pennsylvania, under a comprehensive plan entitled “Healthy Pennsylvania.”

If accepted by the Obama administration, the plan would establish a hybrid system under which certain low-income individuals who do not currently qualify for Medicaid would be offered access to private insurance coverage using federal funds otherwise earmarked for state Medicaid expansion.

The Medicaid Reforms Proposed Include:

  • Simplification of 14 outdated, complex benefit designs;
  • Improving personal accountability by eliminating most copays and replacing them with an income-based premium subject to credits for participating in wellness programs;
  • Applying work search requirements and a link to job training opportunities;
  • Providing a safety net for the critical care for children, older Pennsylvanians and persons with disabilities;
  • Improving access and quality of care; and
  • Continually emphasizing the reduction of waste, fraud and abuse in all facets of service delivery.

Access would be increased by implementation of a private option program for uninsured individuals currently not eligible for Medicaid with incomes between 0 and 133 percent of the federal poverty level. Coverage would be offered through the federal health insurance exchange.

The program has been compared to proposals on the table from Iowa and Arkansas. The plan will need to be approved by both the Pennsylvania General Assembly and the CMS. CMS has promised to work with Pennsylvania to get the proposal turned around as quickly as possible. The first meeting with CMS was held on September 23, 2013 and a series of public hearings were held by the Department of Public Welfare beginning on January 3, 2014. If approved by CMS, the proposal would take effect
in 2015.

This article first appeared in the Allegheny Medical Society Bulletin.