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Pa. Medicaid expansion alternative is approved

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The feds have approved a "portion of" the Healthy Pennsylvania Medicaid expansion alternative plan, Pa. Gov. Tom Corbett announced this afternoon.

The approved plan has two parts: Reforming the current Medicaid program and offering the Healthy PA Private Coverage Option for eligible Pennsylvanians. It does not include work requirements Corbett initially sought.

"The Healthy Pennsylvania plan focuses on personal responsibility and healthy behaviors; aligning benefits to match health care needs; promoting financial independence through access to job training and employment resources; and increasing access to private, commercial coverage for eligible Pennsylvanians," Corbett’s release says.

"As part of the approved waiver, the Healthy Pennsylvania PCO will be created to increase access to health care through the private, commercial market for more than 600,000 eligible Pennsylvanians," it continues. More details on the plan are available here.

Enrollment for the PCO is expected to begin Dec. 1, the release says, with coverage to start no sooner than Jan. 1, 2015.

Healthy PA will be paid for with 100 percent federal funds through 2016. Beginning in 2017 that funding will gradually decline, but never fall below 90 percent of costs, according to the Centers for Medicare & Medicaid Services.

 Corbett’s release makes a point of noting that funding, ending with this sentence: “The Healthy Pennsylvania Private Coverage Option is contingent upon continued funding from the federal government.”

In June, the Corbett administration announced that nine commercial insurers had submitted successful applications to participate in the Private Coverage Option plan, and that negotiations with them would soon begin.

Last year a bill that would have implemented a straight-up Medicaid expansion in Pennsylvania passed the Senate but then was gutted by the House, and this year similar legislation remains in committee.

Responses to news that the alternative plan has been approved will be posted below as they arrive.

Pennsylvania Medical Society

Dr. Bruce A. MacLeod, president of Pennsylvania Medical Society:

"Decision Makes Insurance Available To Many More Pennsylvanians

"Federal officials have approved a waiver to expanding Medicaid that will allow Gov. Tom Corbett’s state-specific health insurance solution to move forward and provide coverage through the state’s Healthy PA initiative. The initiative should aid more than 600,000 Pennsylvanians through private, commercial insurance that includes national standards around essential health benefits, mental health parity, and preventive care. Benefit packages are anticipated to be similar to those provided in the commercial market to working Pennsylvanians through their employers.

"Since the very first mention of health care reform, the Pennsylvania Medical Society has supported efforts to expand access to affordable, quality health insurance. While many have debated the method to expand healthcare at both the federal and state levels, the Pennsylvania Medical Society has focused on the end-result – getting more Pennsylvanians access to health insurance.

"Now, more than ever before, is it important to strengthen health care teams and assure all Pennsylvanians have access to quality care provided by physician-led health care teams. Having health insurance is one thing. Accessing health care is another. The Pennsylvania Medical Society strongly urges the legislature to continue its work to strengthen health care teams and assure all Pennsylvanians have access to the right care, in the right place, at the right time.

"The Pennsylvania Medical Society looks forward to working with Governor Corbett and his administration on the implementation of the Healthy PA waiver and other efforts to expand access to affordable, quality health care across the state."

Pennsylvania Health Access Network

Antoinette Kraus, director of the Pennsylvania Health Access Network:

“Today’s agreement begins to dig Pennsylvania out of the hole Governor Corbett and lawmakers created when they rejected funding to expand health care coverage to half-a-million low-income Pennsylvanians. There never should have been a coverage gap in Pennsylvania, and we share the relief of hundreds of thousands of uninsured Pennsylvanians in knowing it’s finally on track to close.

However, serious concerns remain about the affordability of premiums and new bureaucratic hurdles under Healthy PA, and the drastic cuts Pennsylvania is seeking to make in our existing Medicaid program. These cuts will jeopardize the health of people with disabilities, pregnant women and seniors.

“Unlike all of our neighboring states, which used new funding in the Affordable Care Act to cover low-income individuals and families right away, Pennsylvania took a detour to pursue the complex and controversial Healthy PA. Delaying action on Medicaid Expansion has already cost the Commonwealth $4.8 million per day in federal funding since January 1st that could’ve been creating jobs and strengthening our rural and community hospitals.

“While we applaud CMS for removing the most harmful aspects of Healthy PA, we still believe Medicaid Expansion is the best option for Pennsylvania. Advocates will remain vocal and vigilant to protect quality care and critically important benefits for low-income Pennsylvanians. We look forward to working with State and Federal officials as negotiations over benefits continue and implementation of Healthy PA begins.”

The Commonwealth Foundation

“The Commonwealth Foundation commends Gov. Corbett for refusing to take the politically expedient route of putting more people into Medicaid without first reforming it. Simply giving more people ‘coverage’ is not the same as giving them ‘care.’

“However, the only adequate condition for accepting Medicaid expansion is full state flexibility to reform the Medicaid program. Pennsylvanians -- not federal bureaucrats -- know how to best serve our fellow citizens. Given the federal government’s unwillingness to grant Pennsylvania work search requirements or meaningful cost-sharing, it’s in the best interest of Pennsylvanians to walk away and pursue other avenues to truly expand health care access.

“Expanding taxpayer-financed health insurance without fixing the old Medicaid system leaves the most vulnerable behind. In Arkansas, the Private Option is already prioritizing coverage for able-bodied adults over care for truly needy patients like Chloe Jones, a 14-year old with cystic fibrosis, whose drug coverage has been denied due to cost.

“Worse yet, while sick Pennsylvania patients are left behind, private option plans will allow 122,000 adults to sign up for Medicaid even though they are eligible by income for generous exchange subsidies¾that’s 23 percent of the new Medicaid population.

“’Sadly, this plan will only further limit the poor’s access to health care,’ explained Elizabeth Stelle, senior policy analyst for the Commonwealth Foundation. Already, nearly one in three Pennsylvania doctors won’t take Medicaid patients, and the cost of implementing another portion of the Affordable Care Act—which has failed to reduce premiums and raises taxes—is simply too great. Stelle continued, ‘Pennsylvania taxpayers can’t afford to bear an increased financial burden that fails to serve those it’s intended to help. Washington’s idea of Medicaid flexibility doesn’t best serve the poor or taxpayers.’”

“In the meantime, the Governor can pursue real ways to improve low-income adults’ access quality and affordable care. One such way is to foster charity care through legislation like HB 1760 and allow doctors licensed in other states to participate in temporary free clinics.

“Pennsylvanians deserve real Medicaid reform that encourages work and provides patients with robust health care choices.”

The Hospital & Healthsystem Association of Pennsylvania

HAP supports the approval of Healthy Pennsylvania waiver: At least 600,000 more people to be insured in the state under Governor Corbett’s plan

“The Hospital & Healthsystem Association of Pennsylvania (HAP) today commended the Centers for Medicare & Medicaid Services’ (CMS) final approval of the Corbett administration’s Healthy Pennsylvania waiver, which will help provide at least 600,000 people in the state with access to better health care.

“HAP has supported the goals of Healthy Pennsylvania since its introduction, which include increased access, quality, and affordability of health care for Pennsylvanians. HAP has engaged in conversations throughout the approval process to ensure that the details best serve the health care needs of the commonwealth, and give providers the best possible opportunity to deliver timely, quality health care under the plan.

“’On behalf of the state’s hospital and health system community, we are extremely pleased that CMS approved the Healthy Pennsylvania waiver,’ said HAP President and CEO Andy Carter. ‘The plan reflects Governor Corbett’s priority to create a sustainable Medicaid program for future generations, and to give Pennsylvanians more choices, encourage healthy behavior, and deliver critical health care at less cost to the taxpayers.’

“’We now will have more avenues to help those most in need—low-income, working Pennsylvanians and their families. Our goal is to promote and sustain healthier lives, and help create an overall healthier state,’ said Carter. ‘We appreciate all of the group and individual efforts that made this approval possible.’

“’Throughout the approval process, Governor Corbett and his team worked with the hospital community to make sure that the approach Pennsylvania is taking is an effective and workable program,’ said Carter. ‘As a result, the Healthy PA waiver approved today is a significant step forward in enabling the commonwealth to provide affordable health coverage to low-income, non-elderly, working Pennsylvanians and their families.’”

Capital BlueCross

“Capital BlueCross has long supported programs that increase access to health care and health coverage for our community. This tradition of service continues through our work with the Children’s Health Insurance Program and most recently with our involvement in Governor Corbett’s proposed Healthy Pennsylvania plan to cover many uninsured individuals.

“We were proud to be a selected plan by the Commonwealth of Pennsylvania to potentially serve our community through Healthy PA. With the news today the program has been approved by the U.S. Department of Health and Human Services, we congratulate Governor Corbett and Public Welfare Secretary Mackereth on this important milestone.

“Capital BlueCross looks forward to continuing our role to increase access to health care in central Pennsylvania and the Lehigh Valley.”

Pennsylvania Chamber of Business and Industry

“Today’s announcement from the Corbett Administration that the federal government has accepted plans to implement the governor’s Healthy PA program was met with significant applause from the Pennsylvania Chamber of Business and Industry. The approved plan, which will provide more than 600,000 Pennsylvania residents with access to affordable care while also saving taxpayers billions of dollars through Medicaid reforms, has been long supported by state job creators for its responsible approach to reforming healthcare in the Commonwealth.

“‘The approval of Healthy PA represents a significant step toward controlling the rising costs of Medicaid and providing working families with new and affordable healthcare options,’ said PA Chamber Vice President of Government Affairs Sam Denisco. ‘Reforming Medicaid responsibly, while also increasing access to private insurance coverage, is a win-win for everyone.’

“The PA Chamber has been a major proponent of the governor’s Healthy PA program since he first introduced the plan last fall. Given the rising costs of Medicaid over the last decade – a program that now accounts for nearly 30 percent of the state budget – the reform components of the plan are vital in controlling state spending and fighting new taxes on employers.

“‘We have said for years that the Medicaid program was unsustainable in its current form,’ Denisco added. ‘Changes were definitely needed, and now we are finally moving in the right direction.’

“The Corbett Administration has reported that over the next eight years, the reforms to the Medicaid program included in Healthy PA will save taxpayers more than $4 billion. At a time when the state is facing other major cost drivers, such as our public pension obligations, these reforms and corresponding savings are very much needed.

"Among the reforms applauded by the PA Chamber are the plan’s steps to provide employment incentives to lower-income residents in the program and cost-sharing reductions to promote healthy behaviors. The new plan will also bring Medicaid more closely in line with coverage offered in the private sector by aligning benefits with patient needs. It will also reduce the number of Medicaid benefit plans from 14 to two.

“‘Expanding Medicaid was never a reasonable solution here in Pennsylvania, especially considering the cost impacts it would have on taxpayers,’ Denisco added. ‘Healthy PA does the exact opposite – it provides vital coverage and saves tax dollars. It’s a responsible solution to a complex problem, and the Corbett Administration should be applauded for bringing this program together.’”

SEIU Healthcare Pennsylvania

“In response to the announcement by the Centers for Medicare and Medicaid Services (CMS) that they are expanding coverage for hundreds of thousands of Pennsylvanians while denying the Corbett Administration’s ability to impose punitive lock-out periods and work search requirements, Neal Bisno, President of SEIU Healthcare Pennsylvania, issued the following statement:

“After years of unnecessary delay by the Corbett Administration, The Centers for Medicaid and Medicare Services heeded the concerns of thousands of Pennsylvanians who said the Healthy PA plan’s coverage delays and access barriers were harmful and unnecessary. While this opens the door to expanding coverage to uninsured working Pennsylvanians, the governor’s refusing to expand Medicaid has denied healthcare to hundreds of thousands people for a year, cost taxpayers $522 million in budget savings in 2014, and delayed the creation of over 40,000 new jobs.

“‘As a healthcare worker who has been uninsured for three years and has fought through my union to get the Corbett Administration to expand Medicaid,’ said Angela Williams, a home care worker from Philadelphia, ‘this announcement means I am finally on my way to seeing my doctor regularly and getting care I need. It’s wrong that Governor Corbett delayed acting for years and then tried to cut benefits for those in need. We need a governor who is really committed to ensuring quality, affordable healthcare for everyone in our state – that’s why I will be working hard to elect Tom Wolf in November.’

“CMS’s announcement gave Pennsylvania’s Department of Public Welfare approval to move forward with the Healthy PA plan, which would offer coverage to hundreds of thousands of uninsured Pennsylvanians through a new commercial benefit plan, the Healthy PA Private Coverage Option (PCO). Although today’s announcement creates a pathway for coverage, Corbett’s Healthy PA plan still contains troubling provisions that could restrict access to healthcare coverage including:

• Increased Cost-Sharing: The agreement allows Pennsylvania to impose the highest Medicaid premiums of any state in the country beginning in 2016 which could lead to a loss of coverage for low-income individuals;

• Creation of a New Medicaid Managed Care System: Healthy PA will create a new managed care system, separate from the existing Medicaid system. This could create bureaucratic hurdles that could lead to loss of care;

• Medicaid Benefit Cuts Remain on the Table: Although CMS has not permitted Medicaid cuts in the waiver, potential cuts to the Medicaid program could be pursued through a state amendment plan.

“‘As an individual living with disabilities, the Medicaid program provides me with affordable medical benefits like a wheelchair and attendant care that gives me the opportunity to live an independent life,’ said Germán Parodi, Chair of the Consumer Workforce Council. ‘I’m concerned that the Healthy PA plan continues to leave the door open for potential cuts that will put the independence and freedom of people with disabilities at risk.’

“‘It’s outrageous that it took years of independent studies, bipartisan legislative pressure, and, most of all, grassroots activism to get Corbett to reverse course and finally come up with a plan to accept Federal fund to expand healthcare coverage,’ continued Bisno. ‘While we are pleased that the Federal government has rejected some of the worst aspects Corbett’s proposal, the real solution for Pennsylvania’s uninsured residents, taxpayers, and community hospitals is to elect a governor who is truly committed to putting Pennsylvania’s working families first – Tom Wolf.’”

AARP Pennsylvania

"AARP Pennsylvania is pleased that an agreement has been reached to provide health coverage to more than 500,000 hard-working Pennsylvanians – including 90,000 residents age 50-64 – many of whom are either between jobs or in jobs without health coverage. AARP Pennsylvania was one of many groups encouraging the state over the last two years to close this coverage gap, and we are pleased that so many state residents will not have to wait much longer to get the coverage they need. The final agreement is responsive to many of the concerns AARP Pennsylvania expressed in our comments, but some concerns remain. We look forward to reading the important details of the final agreement and working with state and federal officials as this process moves forward."

Write to the Editorial Department at editorial@cpbj.com

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