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Approval of Healthy PA Proposal Implements Medicaid Expansion, but with Unnecessary Barriers and Potentially Crippling Benefit Cuts

Public Benefits

Approval of Healthy PA Proposal Implements Medicaid Expansion, but with Unnecessary Barriers and Potentially Crippling Benefit Cuts

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Today, the Pennsylvania Department of Public Welfare (DPW) and the federal Centers for Medicare & Medicaid Services (CMS) announced an agreement on DPW’s Healthy Pennsylvania proposal. The agreement extends health coverage to more than 600,000 low-income Pennsylvanians and makes changes to Pennsylvania’s existing Medicaid program.

On behalf of our clients, Community Legal Services (CLS) is very pleased that Pennsylvania will join its neighboring states in extending health coverage to its uninsured residents on January 1, 2015.  Today’s agreement gives Pennsylvanians access to necessary medical care while bringing billions of dollars of federal funding into the Pennsylvania economy.  Many of our clients have gone without health coverage because they are too poor to qualify for subsidized insurance through the Federally Facilitated Marketplace but they do not meet current Medicaid rules.  Today’s agreement means that those clients will qualify for coverage for the first time.

We are relieved that the final agreement largely preserves Pennsylvania’s existing Medicaid program.  The original proposal included a mandatory work program, even for people with disabilities; punitive “lockout” periods of up to nine months if people could not work or afford premiums; and the elimination of important legal protections like appeal rights.  Thousands of health care advocates and consumers spoke out against the original proposal, and CLS applauds CMS and DPW for making substantial changes that will protect our clients.

Even so, we are very concerned about some aspects of today’s agreement. 

1.         High premiums will cause loss of coverage.  The agreement allows Pennsylvania to impose the highest Medicaid premiums of any state in the country beginning in 2016, despite a significant body of research that shows that premiums for low-income people result in loss of coverage, unmet health care needs, and adverse health outcomes.  Our clients will be forced to choose between paying for health care and keeping the lights on or feeding their children.

2.         The new delivery system replicates bureaucratic hurdles that have disenrolled tens of thousands of Pennsylvanians in the past.  The agreement will create a new Medicaid managed care system, separate from the existing Medicaid system.  Pennsylvania has a long history of difficulties in linking health systems, like the Medicaid and CHIP systems for children, and the Medicaid system and the Federally Facilitated Marketplace for adults.  We are very concerned that our clients will lose coverage as they try to move between the systems.

3.         Devastating benefit cuts for all Medicaid recipients remain on the table.  Today’s agreement does not address Pennsylvania’s plans to make deep cuts in existing Medicaid benefits for 1.1 million adults, including many of our clients, 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 urge CMS and DPW to work together with Medicaid advocates, consumers, and health care providers to preserve much-needed Medicaid coverage for the most vulnerable Pennsylvanians.

Kristen Dama, Staff Attorney at CLS, said, “We are very happy that low-income Pennsylvanians will finally get health coverage made available by Medicaid expansion on January 1, 2014.  And today’s agreement is significantly better than the original proposal.  But the high premiums, new bureaucracy, and benefits cuts are going to cause real harm to real people.”