Post-Gazette Harrisburg Bureau
December 05, 2013
By Karen Langley,
HARRISBURG — After months of discussion, the Corbett administration today will begin seeking approval of its plan to use federal money to provide private health insurance to the working poor.
Instead of making half a million low-income Pennsylvanians eligible for Medicaid, as envisioned by the new federal Affordable Care Act, Gov. Tom Corbett wants to use federal money to pay for private insurance. But his plan also seeks to reform the state’s traditional Medicaid program by requiring monthly premiums and a work search from some recipients.
Mr. Corbett announced the initiative in September, and administration officials have engaged in talks with U.S. Department of Health and Human Services officials. Today, the administration will make public a draft of its application for a federal waiver, kicking off a public comment period that includes a hearing Dec. 20 at the Allegheny County Courthouse in Downtown Pittsburgh.
That will lead to the formal submission of a plan to HHS, a federal comment period and negotiations between federal and state officials.
Fabien Levy, an HHS spokesman, said the department looks forward to working with Pennsylvania.
“We aim to be as flexible as possible with the state’s approach, while ensuring Medicaid beneficiaries in PA receive all of the protections afforded to them under the law,” he said. “We look forward to receiving the state’s ideas and working with them on a compromise that allows the state to expand Medicaid through a solution unique to PA.”
The plan for both Pennsylvanians enrolled in Medicaid and for those with the proposed private option includes monthly premiums for adults earning more than 50 percent of the federal poverty line, with exemptions for pregnant women, people with disabilities, the elderly and residents of institutions. People could reduce those premiums up to 50 percent through a combination of employment and engagement in healthy behaviors, such as receiving a physical exam.
Single adults with incomes between 50 and 100 percent of the poverty line paying a full premium would be charged $13 per month, while those with incomes higher than 100 percent of the limit would pay $25 per month. The charges for adult households would rise to $17 per month for the first category and $35 for the second. In Pennsylvania, the federal poverty guideline is $11,490 for a single-person household.
The proposal eliminates co-payments, with the exception of a $10 fee for a non-emergency visit to an emergency room.
Adults employed fewer than 20 hours a week would be required to complete work-search activities to maintain their eligibility for coverage. Pregnant women, people with disabilities, the elderly, and people in institutions would be exempted.
It remains to be seen what parts of the proposal will ultimately be approved. Joan Alker, executive director of the Center for Children and Families at Georgetown University who studies Medicaid waivers, said federal law does not permit states to make work search a requirement of Medicaid coverage.
“It’s perfectly fine to offer people these services, and that’s a good goal, to make sure they’re connected with services, but you can’t require them to do that in order for them to get their health care,” she said.