Massive expansion of Medicaid, overhaul of benefits levels is launching in Pennsylvania

Economic IndicatorsAssociated Press

Hundreds of thousands of Pennsylvania residents left out of coverage under the 2010 federal health care law now have a chance to get insurance as the state undertakes a massive overhaul to health care for the poor.

On Monday, enrollment begins in the Healthy Pennsylvania program, the name given to Pennsylvania's Medicaid expansion by outgoing Republican Gov. Tom Corbett. Coverage will begin Jan. 1, and state officials say some 600,000 people — primarily low-income, single working adults — are newly eligible for coverage under guidelines set by the 2010 law.

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The application process comes as the Corbett administration is overhauling benefits in Pennsylvania's existing Medicaid program. That will affect coverage for approximately 900,000 other adults who already are covered by the program, primarily the elderly, disabled, low-income parents or low-income pregnant women.

All can pick from among plans offered by private insurers that the state pays to administer the managed-care coverage.

"This is an extremely complicated policy for the state to implement," said Joan Alker, who follows state Medicaid policies closely as the executive director of the Georgetown Center for Children and Families in Washington. "That's a lot of work to get those complicated benefits packages sorted out and figure out who's going into which plan. And the managed care plans have to know who is getting which benefits package. That's a heavy lift."

Medicaid benefits for children under 21 will not be affected. But for the adults, the changes take effect Jan. 1.

Democratic Gov.-elect Tom Wolf has said he opposes what he views as an unnecessarily complicated process and bureaucracy being set up by Corbett, and Wolf could gradually unwind some elements of Corbett's plan after he takes office Jan. 20.

Under the existing Medicaid program, adult enrollees have had have a choice of plans that seven approved insurers across 14 benefit levels divided up among five geographic regions of Pennsylvania. The Corbett administration is sorting them into one of two new benefit levels — low risk and high risk — based on the extent of their medical needs, according to the state Department of Human Services.

The federal government has not approved the new benefit levels, and it could still order changes to Corbett's plans.

Kristen Dama, a lawyer with Community Legal Services of Philadelphia, a public interest law center that helps the poor get access to services, said the overhaul will mean a cut in benefits for every adult, some a little and others a lot. She questioned whether enrollees will end up in the right benefits level, understand the new coverage limits or get the care they need.

Under the expansion of Medicaid's income guidelines, many more people will be eligible for coverage. Now, childless adults making up to $15,600 a year — that's 133 percent of the federal poverty level this year — can apply for coverage. Some parents also will become eligible, depending on income and children.

The coverage plans they can choose from are divided up among nine geographic regions and are offered by eight insurers. Not all are expected to apply right away.

The Medicaid expansion gets particularly complicated for some people.

People who earned about $11,500 to $15,300 last year were eligible to buy subsidized coverage through the federally run marketplace that opened last Jan. 1 as part of the 2010 federal law, but they must switch into Pennsylvania's Medicaid system now that its income guidelines are expanding, officials say.

Federal and state officials were unable to say how many people that might affect, but health care advocates worry that the switch could sow confusion.

The expanded Medicaid subsidy became available to states in 2014, but it was delayed a year in Pennsylvania because Corbett had sought federal approval to make changes to it. In broad terms, though, there is little difference between Healthy Pennsylvania and Medicaid.

Both will cover visits to the physician, emergency room and specialists, and prescription drugs.