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Comments to DPW - Draft Healthy PA 1115 Demonstration Application

Public Benefits

Comments to DPW - Draft Healthy PA 1115 Demonstration Application

Date Posted: 

January 13, 2014

Pennsylvania Department of Public Welfare Attention: Healthy Pennsylvania Waiver P.O. Box 2675 Harrisburg, Pennsylvania 17105-2675

RE:    Draft Healthy Pennsylvania 1115 Demonstration Application

Dear Sir/Madam:

Thank you for the opportunity to comment on the Draft Healthy Pennsylvania 1115 Demonstration Application.  Community Legal Services of Philadelphia (“CLS”) submits these comments on behalf of the 12,300 low income Philadelphians that we represent each year, as well as the nearly two million adults statewide who are current or future Medicaid recipients and are impacted by the 1115 Demonstration Application.

In addition to helping clients establish and maintain eligibility for public benefits, including public health insurance programs, CLS fights consumer fraud and predatory lending; prevents homelessness; ensures fair treatment in the workplace; and protects women, children, and the elderly.  Many CLS clients fall into the health coverage gap created by the U.S. Supreme Court in National Federation of Independent Business v. Sebelius, which affects very low income people who do not qualify for existing Medicaid programs.

CLS has been a staunch supporter of Medicaid expansion as a means of providing comprehensive health insurance coverage to our clients and other low income uninsured Pennsylvanians.  We remain hopeful that Pennsylvania is on a path to offer meaningful coverage in the coming months.  But we are profoundly troubled by the 1115 Demonstration Application, and we believe that it is a step backward, not a step forward, in covering Pennsylvania’s lowest income residents.

As we discuss in greater detail in Section I, we have eight broad concerns:

    •    The 1115 Demonstration Application would slash benefits for more than 1.2 million Pennsylvania adults who already rely on the Medicaid program, most of whom are pregnant, elderly, sick, or have disabilities.

    •    The 1115 Demonstration Application would create a Pennsylvania Medicaid system that is so complicated and difficult to navigate that it is unworkable.

    •    The 1115 Demonstration Application would impose premiums that are unaffordable for Pennsylvania’s very low income families.

    •    The 1115 Demonstration Application would impose work search requirements that create insurmountable barriers to coverage.

    •    The premiums and work search requirements in the 1115 Demonstration Application would penalize Pennsylvanians simply for being poor.

    •    The premiums and work search requirements in the 1115 Demonstration Application would be costly and difficult to administer.

    •    The penalties in the 1115 Demonstration Application for inability to demonstrate compliance are unduly harsh on Medicaid recipients, and would burden hospitals in particular and Pennsylvania’s health care system in general.

    •    The 1115 Demonstration Application would undermine Pennsylvania’s primary care system by defunding federally qualified and rural health centers.

For these reasons, we believe that Pennsylvania must rethink its proposed plans to alter its Medicaid program via the 1115 Demonstration Application.  

We acknowledge that the Commonwealth is searching for a unique, state-specific way to cover the Medicaid expansion population.  We do not believe that the 1115 Demonstration Application provides the answer.  In addition to the concerns outlined above and below, we believe that Pennsylvania’s proposed application to the Centers for Medicare & Medicaid Services (“CMS”) for 23 distinct waivers of federal Medicaid law will create needless delay of many months.  That delay means that hundreds of thousands of eligible Pennsylvanians will remain uninsured unnecessarily, and that millions of dollars in federal funding will not flow into the Commonwealth in that time.  We urge Pennsylvania to either expand Medicaid immediately as contemplated by the drafters of the Affordable Care Act (“ACA”) or submit a plan to CMS that is likely to receive immediate approval, to allow coverage to begin as soon as possible, and no later than July 1, 2014.

At the same time, we are not dogmatic.  For example, we do not categorically oppose the establishment of a “private option program” that would enable persons eligible for Medicaid expansion to purchase health insurance through the Federally Facilitated Marketplace, provided that the program is consistent with CMS guidance.  
In sum, drawing down millions of dollars in federal funding to provide health insurance coverage to the Medicaid expansion population is both sound fiscal policy and a matter of simple fairness for the low income Pennsylvanians who fall into the health coverage gap.  We hope that the Commonwealth will consider these comments and act quickly to extend coverage to the Medicaid expansion population without erecting unnecessary barriers to coverage or undermining the existing Medicaid program.