The Pennsylvania Health Law Project released the following statement on August 28, 2014 regarding the Approval of the Healthy Pennsylvania Plan to expand Medicaid:

On behalf of our clients, the Pennsylvania Health Law Project (PHLP) welcomes today’s announcement that Pennsylvania will soon expand Medicaid to cover adults with incomes up to 138 percent of poverty. This is an important step towards all Pennsylvanians realizing the promise of the Affordable Care Act.

The agreement means nearly 600,000 uninsured Pennsylvanians will qualify for Medicaid coverage beginning in January 2015. It will offer tremendous relief to many of our uninsured clients, among them the low-wage workers -- our fast food cooks, cashiers, clerks, and bus drivers, for example – who are not offered or cannot afford work-based insurance.

“We’ve waited a long time for this agreement,” said Laval Miller-Wilson, Executive Director of PHLP. Pennsylvania could have expanded Medicaid as early as January 2014. Instead, in February 2014, the Commonwealth sought federal approval for Healthy Pennsylvania, a plan that would expand Medicaid eligibility by requiring individuals to pay premiums and would condition the amount of a person’s premium on whether they work or engage in work search activities. Many advocates and consumers, including PHLP, called on the federal Centers for Medicare & Medicaid Services (CMS) to reject the plan as submitted because it erected a number of unnecessary barriers to care.

“Thankfully, CMS responded to the concerns voiced by the public and advocates and refused to accept the plan’s worst elements, such as mandatory work requirements, punitive ‘lockout’ periods if people could not work or afford premiums, and reduced avenues of appeal for consumers denied medical services” said Miller-Wilson. Despite these changes, the approved Healthy Pennsylvania demonstration still contains harmful and unnecessary elements:

• The monthly premium created by Healthy Pennsylvania will depress enrollment. Medicaid premiums have been tried in other states (Oregon, for example), where they resulted in widespread disenrollment. Too many low-wage workers cannot afford a $20 premium. Moreover, Medicaid premiums serve no goal: they will neither generate revenue for the state nor improve the likelihood of consumers gaining work-based insurance.
   
• Creating a duplicative managed care system will delay coverage and disrupt care. Healthy Pennsylvania introduces a second managed care system, separate from the existing Medicaid system (known as Health Choices). Changes in a person’s income or health status will require that they shuffle between the two systems. “The way Pennsylvania is expanding coverage is more complex than our neighboring states” said Miller-Wilson. “We preferred a simpler system. We are concerned our clients will lose coverage and services as they move between these two systems.”

The agreement does not address Pennsylvania’s plans to make deep cuts in existing Medicaid benefits for 1.1 million adults most of whom are pregnant, are seniors or have disabilities. Instead, it leaves the door open to further negotiations on cuts in the coming months. “We’re alarmed that these devastating benefits cuts remain on the table,” said Miller-Wilson.
 

Pennsylvania Health Law Project (PHLP) is the state’s oldest health care non-profit law firm exclusively devoted to health access for vulnerable populations. PHLP was founded to advance access to quality health care for vulnerable and disenfranchised communities. In addition to direct legal assistance, we work on policy and practice changes that maximize health coverage and access to care. We are a trusted resource with on-the-ground experience, knowledge of best practices, and an understanding of community perspectives.