Effective Jan. 1, Pennsylvania will expand its Medicaid guidelines to make an additional 600,000 people eligible for taxpayer-provided health care, while an overhaul of its existing Medicaid program will affect benefits for an estimated 900,000 adults already on Medicaid. Here's a look at the changes:
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— Named Healthy Pennsylvania, there is little difference between Healthy Pennsylvania and a Medicaid expansion, as it was envisioned by the 2010 federal law.
— The expansion will make health care available to childless working adults under 65 with incomes up to $15,500 this year. Until now, they were largely ineligible for Medicaid.
— The expansion also will make health care available to many more low-income parents under 65.
— The basic benefits package is here under the PCO column: http://bit.ly/1ymEHcr.
— Healthy Pennsylvania will not reimburse insurers for dental coverage or renal dialysis, but insurers may offer it anyway, and it will not subsidize nonemergency transportation to help get people to appointments until 2016.
— Copayments are in effect. In 2016, some enrollees will see premiums replace copays, with the exception of an $8 copay for nonemergency use of the emergency room.
— On Monday, people can begin enrolling online or by telephone — www.compass.state.pa.us or 866-550-4355 — or by going into a county assistance office. Find one at www.dhs.state.pa.us/findfacilsandlocs/countyassistanceofficecontactinformation.
— A broker, PA Enrollment Services, will help enrollees pick a plan. The website is www.enrollnow.net and the hotline is 844-465-8137.
— About 900,000 adults who are on Medicaid currently will be sorted into one of two new benefit levels based on the extent of their medical needs. Previously, 14 benefit levels had been available.
— The two new benefit levels are referred to as high risk or low risk. The benefits packages are listed here: http://bit.ly/1ymEHcr.
— Filling out a four-page questionnaire helps sort enrollees into one of the two benefit levels. Afterward, enrollees are to receive a notice indicating which benefit plan they will be placed into.
— Previous eligibility categories will continue to exist for parents, pregnant women, the disabled, workers with long-term disabilities and the elderly.