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Pa. Medicaid growth in tug of war between departing Governor Corbett, incoming Wolf

Tribune-Review
| Friday, November 28, 2014 10:57 p.m

The man who will replace Gov. Tom Corbett in January promises to replace his Medicaid expansion plan, leaving thousands of uninsured Pennsylvanians who can sign up starting on Monday facing more changes next year.

Gov.-elect Tom Wolf, a Democrat, promised during his campaign that he would expand Medicaid, the federal health care for low-income people, to about 600,000 uninsured Pennsylvanians. Despite that pledge and Wolf’s victory, outgoing Republican Corbett is pushing to implement Healthy PA, his federally approved program that reforms Medicaid for existing users and provides private-option coverage for 600,000 previously uninsured.

Wolf has asked Corbett, the defeated incumbent, to halt implementation.

“The more Healthy PA moves ahead, the harder in terms of time and money it is to undo,” said spokesman Jeff Sheridan. “The easiest way to move toward a full Medicaid expansion is for Healthy PA to stop moving forward now.”

The Corbett administration has spent approximately $2 million to promote Healthy PA, said Department of Human Services spokeswoman Kait Gillis.

“We are moving forward with the Healthy PA plan to make sure people have access to coverage as soon as possible,” Gillis wrote in an email. “That’s been our goal throughout this entire process.”

Healthy PA enrollment begins on Dec. 1. Plans kick in on Jan. 1. Changes to Medicaid include separate low- and high-risk plans that offer different kinds of coverage based on health condition.

The private coverage option is designed to cover the working poor, applying to those with incomes up to 133 percent of the federal poverty level, which was $15,500 for an individual in 2014.

Those plans, subsidized with federal dollars, are administered through commercial carriers.

With the Corbett administration resisting the change, Wolf’s team has turned toward what happens after he takes office Jan. 20. Estelle Richman, Wolf’s transition team Medicaid adviser, said preventing a lapse in coverage would be paramount in moving individuals from Healthy PA plans to Medicaid and that it could be done at the state level without extra work on the part of enrollees.

“The unfortunate part is that we have to do it at all, because many of these people who are going to be impacted by what happens on Monday are going through a process that will in some ways be redone,” she said. “While it may be invisible to them, in some ways they’re still having anxiety about what it means.”

Under a Medicaid expansion, the division of low- and high-risk plans likely would end, Richman said.

Richman is former chief operating officer at the Department of Housing and Urban Development under President Obama, and former secretary of Public Welfare under Gov. Ed Rendell. She said she has worked with Human Services Secretary Beverley Mackereth to discuss the transition.

The waiver to establish Healthy PA was the result of about a year of negotiations between the Corbett administration and the Centers for Medicare & Medicaid Services. Instead of expanding Medicaid under the Affordable Care Act, Corbett emphasized saving money on existing Medicaid plans before expanding coverage to more users. Right now, the program consumes about 29 percent of the state budget, according to Human Services, and grows by about 3 percent, or $400 million, every year. Under Healthy PA, the department estimates savings of $4.5 billion by the eighth year of implementation.

Wolf’s proposal said Medicaid expansion, funded in full by the federal government through 2016 and at 90 percent thereafter, would bring an estimated $2 billion into the state each year.

A Medicaid expansion, according to estimates by Senate Democrats who long advocated for the proposal, could bring $400 million into the state budget. A RAND Corp. study from March 2013 estimated an economic impact of $3 billion.

Pennsylvania is one of only a few states to receive waivers to Medicaid expansion plans, including Arkansas and Iowa.

Federal CMS spokeswoman Lorraine Ryan could not comment on whether any state can work with the centers to change the terms of an approved waiver.

Antoinette Kraus, director of the Pennsylvania Health Access Network, said the enrollment opening on Monday means Pennsylvanians unable to obtain coverage last year on the federal insurance marketplace will be eligible. Still, she said, Healthy PA makes it difficult for users to understand what plan they belong in and limits benefits.

“At this point, we just really want to fix the most problematic pieces of Healthy PA and as quickly as possible work over the next several months to transition to Medicaid expansion,” Kraus said.

Melissa Daniels is a Trib Total Media staff writer. She can be reached at 412-380-8511 or mdaniels@tribweb.com.

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