Highlight on Pennsylvania: Healthy PA is going away, ACA expansion gets its day

Pennsylvania’s Medicaid program will make the transition to traditional Medicaid expansion by September 30, 2015, according to the Pennsylvania Department of Human Services (DHS). The state Medicaid program is in the process of moving from the alternative Medicaid expansion program known as Healthy PA to an expansion of traditional Medicaid as intended by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

Power Struggle

The outline for the Healthy PA plan came from Pennsylvania’s former governor, Tom Corbett (R). Healthy PA took ACA dollars and used them to subsidize private plans for Pennsylvania’s working poor. According to the Pittsburgh Post-Gazette, the plan received approval from federal regulators in August 2014. Although the approval was received three months before the election and Corbett eventually lost his reelection campaign, the former governor went ahead with Healthy PA’s implementation despite the fact that the Democratic Gov. Tom Wolf indicated his plan to undo Healthy PA when he took office.

Transition

Now that Governor Wolf is in office, Pennsylvania plans to transition out of Healthy PA and into an ACA expansion of Pennsylvania’s existing Medicaid program—HealthChoices.  The Pennsylvania DHS will implement the transition through two phases. The first phase will operate between April 2015 and June 1, 2015. In the first phase, individuals will begin to be transferred from the private coverage option (PCO) into the new adult benefit package under HealthChoices. During the first phase, new applicants will no longer be enrolled in the private coverage option. In the second phase, which is set to take place between July 2015 and September 30, 2015, Pennsylvania will transition all remaining PCO enrollees into HealthChoices. At the end of the transition, Pennsylvania estimates that Wolf’s plan will provide access to health care coverage for hundreds of thousands of Pennsylvanians. The Pennsylvania DHS was clear in its announcement that no gaps in coverage will occur during the transition and that enrollees will be informed by mail prior to the change.

Other Changes

In addition to the move towards a more traditional expansion, Governor Wolf has pushed for other changes to the Medicaid program.  Specifically, the new governor pushed for reforms to allow the state’s elderly poor to receive home and community-based services in place of nursing home based services. The reform is intended to lower the $27.6 billion that Pennsylvania annually spends on Medicaid.