Encouraging states to expand their Medicaid programs was a major focus of the Affordable Care Act (ACA). However, the Supreme Court ruled that the federal government could not require a state to expand – instead, each state could choose to expand or not.

Pennsylvania’s state Medicaid was one of many that chose to expand to cover additional lower-income citizens. However, Pennsylvania was a year late in expanding and took an unusual approach. Rather than simply expanding Medicaid as envisioned in the ACA, they chose to use an alternative plan.

Pennsylvania’s State Medicaid Expansion

Then-governor Tom Corbett, a Republican, was concerned that implementing a Medicaid expansion the way the ACA intended would unduly burden the state budget. Like many Republicans, Corbett was concerned that the government would fall through on its promise to fund 90 percent of the expansion into the indefinite future. As a result, Corbett negotiated with Washington to implement an alternative plan, called Healthy PA

The Pennsylvania state Medicaid expansion plan was based on using the federal funds to purchase private policies for lower-income citizens of the state. The plan would require a monthly premium from recipients starting in 2016, not to exceed 2 percent of the household income. The premiums would be on a sliding scale based on income. Premiums can be reduced by engaging in healthy behaviors, such as getting an annual physical or participating in job training programs.

While advocates were generally pleased to have some form of Medicaid expansion in place in Pennsylvania, there were concerns with the benefits being “stingy” and some Republicans called the deal a concession to Obamacare. Because Corbett lost his re-election campaign to a Democrat challenger, more expansive changes could be coming to the state’s Medicaid program.

Issues with 2014-2015 Enrollment In Healthy PA

The rollout of the new Medicaid program in Pennsylvania has faced a host of technical difficulties. Although enrollment opened on December 1, 2014, applicants were told to wait 30-45 days for a response. With many applicants on life-sustaining medication or needing other urgent care, a delay of that length causes serious issues.

There have also been concerns about the way income has been assessed in the application process. Some citizens who worked extra hours over the holidays in December may now have income too high to qualify for Medicaid, while still earning too little to participate in the federal health insurance Marketplace. This discrepancy may exist even in states that expanded Medicaid eligibility because Medicaid considers your current monthly income for eligibility determinations, which the Marketplace considers projected annual income. Other applicants have faced denials and have to go through a lengthy appeals process, not having coverage in the meantime. If an appeal is won, coverage is typically retroactive.

However, human services workers report that many new applicants are happy with the process and are getting enrolled. They say that new enrollees are thrilled to have health insurance coverage – many for the first time in many years.

Things are likely to change as the new governor Tom Wolf transitions into office. Wolf has expressed support for moving Pennsylvania’s Medicaid status to a full traditional expansion, as envisioned in the ACA. However, Wolf’s administration has not laid out a timeline for that change. For now, Healthy PA continues to be the Medicaid expansion plan in Pennsylvania.