Governor Tom Wolf today announced Pennsylvania’s transition to a simple traditional Medicaid expansion plan.
“Today is the first step toward simplifying a complicated process and ensuring hundreds of thousands of Pennsylvanians have greater access to the health insurance they need,” said Governor Wolf. “Our approach will alleviate confusion, remove unnecessary red tape, and streamline the system so that people can see a doctor when they are sick and health care professionals have more time to concentrate on providing quality care.”
Governor Wolf today directed the Department of Human Services (DHS) to submit a letter to the federal government withdrawing the “low-risk” health care package known as the “Healthy” option from further federal consideration.
Complications under Healthy PA resulted in people not receiving important treatment, confusion among recipients, and special populations being placed into the wrong plans, which jeopardized coverage. These problems included:
- Individuals receiving active treatment for drugs and alcohol were moved into the private coverage option (PCO) rather than the appropriate plan due to a glitch in the system. And because most private plans do not cover addiction and mental health treatment, thousands of people did not receive their care. [Inquirer, ’s Medicaid expansion wreaks chaos for addiction and alcohol treatment providers, 1/26/2015]
- There was broad confusion among a large group of applicants as well as a backlog partly due to the Department of Human Services asking people to supply detailed personal information, such as bank statements, vehicle value, and retirement account information, despite this information not being required under Medicaid expansion. [Inquirer, Applying for Pa. Medicaid expansion? Wait in line, 1/15/2015]
- Special populations, such as women receiving breast cancer screenings, were incorrectly moved into the PCO when they should have been placed under a different plan. This resulted in approximately 90,000 women at risk of losing access to women’s health care coverage. [Post-Gazette, Thousands of Pennsylvania women could lose some health coverage, 10/24/2014]
While the state transitions to the less complicated and simpler full Medicaid expansion, the commonwealth will continue to provide individuals with appropriate health care coverage and no coverage will be immediately impacted by the decision. Over time, DHS will eliminate the use of the health screening tool put in place under Healthy PA and restructure benefit packages from three plans to one.
“We are committed to ensuring an orderly and efficient transition for every Pennsylvanian receiving health care coverage through the commonwealth,” said DHS Acting Secretary Ted Dallas. “We are already at work making changes to our eligibility systems that will take effect this spring. This will enable us to transition individuals participating in the General Assistance and SelectPlan programs to the new health plan.”
The department is also working with the commonwealth’s health care providers and hospitals to transition individuals enrolled in the PCO to the Adult package. This transition will occur over a longer period of time to ensure that individuals are clearly informed of these changes and they do not experience any gap in coverage.
Who qualifies for coverage under Medicaid expansion?
In addition to individuals who qualified previously, Pennsylvanians ages 19 to 64 with incomes up to 138% of the Federal Poverty Level (FPL) may be eligible for coverage under Medicaid expansion.
How does Medicaid expansion differ from Healthy PA?
Medicaid expansion will allow for eligible adults to be placed into one streamlined Adult package. This will increase continuity of care and reduce unnecessary processes to make individuals eligible for uncomplicated health care coverage faster.
What does this mean for individuals who are in the Private Coverage Option?
The department is currently working on a plan to transition individuals into one streamlined Adult package without interruption to their coverage and services.
What will happen to the Healthy and Healthy Plus benefit packages?
The department is currently working with the federal government to develop one benefit package for adults. Once that has been finalized, adults in Healthy and Healthy Plus will be transitioned to the new Adult package.
What kind of coverage will be provided?
Medicaid coverage meets national standards for coverage. This includes primary care doctors, preventative care, prescriptions and behavioral health parity.
Who will pay for the expansion?
Federal funds will cover 100 percent of the cost of Medicaid expansion for 2014 to 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and subsequent years.
What do I need to do if I am already covered under Healthy PA?
If you are already covered, you coverage will remain unaffected at this time and you do not have to do anything at this time. As Pennsylvania transitions to the new comprehensive adult package, the Department of Human Services will notify you of any changes prior to those changes taking effect.
What do I do if I want to apply for Health Insurance?
If you do not have health care coverage, you can apply online at www.compass.state.pa.us.