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September 17, 2013 | By | Posted in WatchBlog

WATCHBLOG: Three things to know about PA’s alternative to Medicaid expansion

By Melissa Daniels | PA Independent

HARRISBURG — Pennsylvania’s Gov. Tom Corbett plans to provide health care coverage to uninsured residents that doesn’t involve expanding Medicaid.

Corbett said he believes his plan involves “common sense reforms” and state-based solutions.

“This plan works for Pennsylvania,” he said.  ”it preserves the safety net for those who need it most, and provides private coverage for uninsured, newly eligible Pennsylvanians and a pathway to independence.”

HEALTHY NEWS CONFERENCE: Gov. Corbett announced the Health PA plan at a well-attended news conference in a hospital in Harrisburg.

HEALTHY NEWS CONFERENCE: Gov. Corbett announced the Health PA plan at a well-attended news conference in a hospital in Harrisburg.

The administration submitted the plan to the federal government for approval on Monday.  

Here’s three highlights of what the plan, dubbed Healthy Pennsylvania, would do for health care in Pennsylvania:

Insuring at least 520,000 Pennsylvanians:  Instead of using federal money to expand Medicaid to uninsured residents, Healthy Pennsylvania would direct those dollars to the private market.

A person who earns less than $15,282 a year, or a household of four earning less than $20,628 a year, could use federal funds to purchase a health care plan off of the health insurance exchange programs, created as part of the Affordable Care Act.

At least 520,000 residents in Pennsylvania do not have health care but would if the state participated in a Medicaid expansion. Corbett has said an expansion, as outlined in the Affordable Care Act, is too expensive for Pennsylvania, where $19 billion in state and federal tax dollars a year cover 2.2 million residents.

This private option means no new enrollees would join the existing Medicaid program.  The only exception would be those who are “medically frail,” which is generally defined as those with chronic substance abuse problems, disabling mental disorders, or other serious medical conditions.

Co-pays, work requirements for Medicaid beneficiaries:  Perhaps the most unique — and controversial —  tenets of Corbett’s proposal is a work requirement for those receiving Medicaid benefits. “Able-bodied” adults who do not have a job but are enrolled in Medicaid will be required to sign up for some of the state-run job seeking programs, like JobsGateway, an online database, and participate in training programs.

Individuals on Medicaid would pay co-pays of up to $25 per month, or up to $35 for a household. The premiums would be adjusted on a sliding scale based on income and reduced if enrolled individuals were improving their health.

The proposal also limits to two the 14 Medicaid benefit plans available for adults. Benefits for children wouldn’t change.

Industry-based changes: Some of the reforms introduced with the Healthy Pennsylvania plan would change how things work for doctors, pharmacists and the health industry.  That includes attempting to access federal funds for more primary care health clinics and supporting loan forgiveness programs that give incentives for doctors in rural or undeserved areas.

Corbett also said he supports creating a prescription drug database, a type of digital tracking system that sends up red flags to doctors or pharmacists dispensing controlled substances if the patient appears to have a history of abusing drugs. That proposal would require approval of the General Assembly, while the private option insurance and Medicaid reforms require approval from the federal government.

Administration officials have not offered a timeline for approval.

Contact Melissa Daniels at melissa@paindependent.com

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Melissa Daniels is a reporter for PA Independent. She can be reached at 717-350-0962 or Melissa@PAIndependent.com

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