Affordable Care Act, Health Disparities, Health Equity, Health Justice, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania

PA HB 2138 Heads to the Senate

Pennsylvania House Bill 2138 which would allow for work requirements in Medicaid has successfully been voted out of the Health Committee and will come to a full vote by the Senate. It is critical that PA residents contact their state senator now to urge him or her to vote NO on HB 2138.

This bill will unnecessarily punish families and children living in poverty at the administrative expense of taxpayers. Check out our past blog to remind yourself of how the law would work.

The Urban Institute did a comprehensive review of the literature on work requirements in public assistance programs and found that the evidence shows these programs fail to meet their stated goals at the detriment of individuals losing life-saving benefits.

Summary of Work Requirements in TANF, SNAP, and Housing Assistance Programs as of December 2017

This article was cross-posted at http://www.helpmlp.org

Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania, Social Determinants of Health, Uncategorized

Pennsylvania Lawmakers Move Forward with Medicaid Work Requirements

On April 16th the Pennsylvania House of Representatives voted to pass House Bill 2138 providing work requirements as a condition of receiving Medical Assistance (Pennsylvania’s Medicaid program). This bill is one of several currently making their way through the Pennsylvania legislature that would detrimentally affect low-income families and children, cost the state hundreds of millions of dollars to implement, and generally serve no valid public interest other than to deter individuals who need life saving benefits from getting them.

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House Bill 2138 mandates that Medical Assistance enrollees must work 20 hours per week or complete twelve “job training program-related activities” per month in order to maintain the benefit. Individuals who fail to comply with this requirement will lose their eligibility for three months initially, then six months, and then nine months. Individuals who are 19 years and older must verify compliance with the work requirements on a biannual basis and by request from the State. Furthermore, the State can delay enrollment if the individual is found to have failed to comply with these requirements.

Certain populations are exempt from the work requirements including: full-time high school students; individuals receiving temporary or long-term disability benefits; individuals under 18 years of age and 65 and over; pregnant women; individuals receiving Supplemental Security Income (SSI); primary caregivers for dependents six years of age or younger; and primary caregivers for individuals who are permanently disabled or in hospice care. Additionally, individuals who are experiencing a crisis, serious medical condition, or temporary condition that prevents the enrollee from actively seeking employment, including domestic violence and substance use disorder, are exempt.

The process in which individuals seeking exemption must participate in, including paperwork and verification requirements, is unclear based on the bill alone; however, the current Secretary of Human Services, Teresa Miller, reported that it would cost $650 million and an additional 300 staff members to enact these changes in her department. Now that the bill has passed the House, it moves on to the Pennsylvania Senate for a vote.

Policy experts find that work requirements harm families and individuals who are already working the most. Moreover, work requirements rarely lead to additional employment, but often lead to disenrollment, stripping vulnerable individuals of critical benefits and services. One study found, “four to five years after such requirements were implemented, about 70 percent of the welfare recipients who went off welfare because of work requirements had no income, or had income at or below 50 percent of the poverty line.”

Since the Centers for Medicare and Medicaid Services (CMS) changed its policy on work requirements in January 2018, Kentucky, Arkansas, and Indiana have had Medicaid waivers approved that include work requirements. Pennsylvania is among several other states in the process of establishing a pathway for work requirements.

It is critical that Pennsylvania residents and residents of other states seeking to implement these changes reach out to their elected officials urging them to stop their assault on poor families. The Pennsylvania Health Access Network has an easy form to find your State Senator and submit a letter urging her or him to vote NO on work requirements.

*This article was cross-posted on http://www.helpmlp.org.

Affordable Care Act, Health Policy, Medicaid, Philadelphia

Healthy or Unhealthy PA? Advocates Weigh in on Gov. Corbett’s Plan to Reform Medicaid in Pennsylvania

Governor Corbett’s Healthy PA proposal to reform the Medicaid system in Pennsylvania through a Medicaid 1115 Demonstration Waiver has been met with harsh criticism by many and for good reason.  Healthy PA (known fondly by some as Unhealthy PA) would disrupt the current cost-efficient Medicaid program in Pennsylvania by enrolling newly eligible individuals and many currently existing Medicaid beneficiaries into private health insurance plans.

So, why is this a problem? A couple of reasons:

  1. Historically, private health insurance plans do a poor job of providing coverage for specific types of illnesses. For example, the lack of private coverage for mental health and substance use disorders called for the enactment of federal legislation known as the Mental Health Parity and Addiction Equity Act.
  2. Private health insurance companies spend much more money on administrative costs and profits than Medicaid. This means that administering the Medicaid program through the private  insurance industry will mean less bang for the tax payers’ buck.

Additionally, Governor Corbett’s plan includes many controversial provisions that are likely to face close scrutiny by the federal government:

  1. A monthly premium for individuals making as little as 50% of the federal poverty level (less than $6,000/year).
  2. Work search requirements (no other state in the United States has such a provision). As a side note this would apply to certain individuals who meet “medically frail” criteria, but that are otherwise “able bodied.”
  3. A $10 co-payment for “non-emergent” emergency use.
  4. Harsh punitive measures that would disqualify households from Medicaid if the fail to pay their monthly premiums.
  5. Benefit limits that would substantially reduce scope of coverage that is currently offered through Medicaid.

Perhaps, most importantly, the plan is not set to go into effect until January 1, 2015 (assuming it would get approval by the federal government by this time) meaning hundreds of thousands of Pennsylvanians will fall into a “coverage gap” qualifying for neither Medicaid or a tax subsidy through the health insurance marketplace.  These individuals will have no source of meaningful health coverage for the entire year.  Not to mention, delaying expansion until 2015 will cost the Commonwealth 2.5 billion dollars of potential funding.

Advocates representing many different groups and organizations have voiced their opinion on the plan.  Not all of the testimonies provided and comments submitted were adamantly opposed to the plan, but many were. The following is a list of organizations’ comments and/or testimony on the plan:

  1. Community Legal Services of Philadelphia
  2. Project HOME
  3. Public Citizens for Children and Youth
  4. Disability Rights Network of Pennsylvania
  5. Hospital and Healthsystem Association of PA (HAP) 
  6. Delaware Valley Healthcare Council of HAP
  7. Safety Net Association Pennsylvania
  8. Community Behavioral Health of Philadelphia (CBH)
  9. Pennsylvania Association of County Drug and Alcohol Administrators
  10. Pennsylvania Association of County Administrators for Mental Health and Developmental Services
  11.  The Alliance of Community Service Providers (Testimony January 3rd)
  12. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (DBHIDS)
  13. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (Appendix A- Questions to PA DPW on the plan)
  14. The Philadelphia Coalition
  15. Pennsylvania Budget & Policy Center
  16. Todd Keefer, York County resident
  17. Center for Advocacy for the Rights and Interests of  the Elderly (CARIE)
  18. Pennsylvania Partnerships for Children (PPC) 
  19. Rehabilitation and Community Providers Association (RCPA)
  20. The ARC 
  21. Pennsylvania Homecare Association
  22. Public Interest Law Center of Philadelphia (testimony of staff attorney, Benjamin Geffen, on January 3rd)
  23. A coalition of organizations representing individuals with disabilities
  24. Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC)
  25. Juvenile Law Center (JLC)
  26. Pennsylvania Association of Medical Assistance Manged Care Organizations
  27. Women’s Law Project
  28. Greater Philadelphia Chamber of Commerce
  29. Joanne Grossi, Health and Human Services (HHS) Region III (House Democratic Policy Committee Meeting: January 8, 2014)
  30. Joan Alker, Center for Children and Families, Georgetown University (House Democratic Policy Committee)
  31. Jim Willshier, Pennsylvania Association of Community Health Centers (House Democratic Policy Committee)
  32. Sol B. Vazquez-Otero, Disability Rights Network of Pennsylvania (House Democratic Policy Committee)
  33. Jacob Bowling, Mental Health Association of Southeastern PA (House Democratic Policy Committee)

    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commowealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commonwealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
Affordable Care Act

Healthy PA v.2 (a.k.a. Pennsylvania’s Medicaid 1115 Demonstration Proposal)

In mid-September Governor Corbett released a concept paper, Healthy Pennsylvania, outlining his proposed plan to reform the Medicaid program in Pennsylvania. This twelve-page document was a predecessor to a more formal document known as a Medicaid Section 1115 Demonstration Waiver. In order for the Governor to implement his Healthy Pennsylvania plan he must seek and get approval from CMS for the 1115 demonstration waiver. 

Today Governor Corbett published the Commonwealth’s draft proposal for a Medicaid Section 1115 Demonstration Waiver. 1115 waivers allow states to be flexible within their Medicaid programs through a demonstration project; however, goals of demonstration project must be congruent to the goals of the Medicaid program overall.  

Governor Corbett is using the 1115 waiver as a mechanism to reform the Medicaid program in Pennsylvania. Even though the Governor’s proposal calls for expanding Medicaid eligibility to individuals with incomes up to 133% of the federal poverty level, his plan should not be confused with traditional Medicaid expansion. The plan would go into effect beginning 2015 and would last for five years prior to renewal. Corbett’s plan involves several controversial provisions including:

  • Providing premium assistance to newly eligible and some currently eligible Medicaid enrollees to purchase health insurance through the private market or new Health Insurance Marketplace rather than providing Medicaid through traditional Medicaid Managed Care Organizations currently operating in the state
  • Imposing a work search requirement on individuals who are eligible for Medicaid
  • Requiring individuals to pay a monthly cost-share on a sliding scale basis. Individuals with incomes as low as 51% of the federal poverty level (less than $6000/year) would be required to pay 
  • Requiring a $10 co-payment for inappropriate emergency room use
  • Consolidating the existing Medicaid benefit plans in the state into two Alternative Benefit Plans that will mirror “commercial-like” coverage (benefits are generally not as comprehensive as those provided through traditional Medicaid, especially for behavioral health services)

Since the proposal was released earlier today, I am still making my way through its details. The state is required to hold a 30 day notice and comment period as well as host public hearings. There will be six public hearings as well as two webinars in which individuals can voice their opinion about the proposal. I encourage everyone take the time to read the proposal and attend a public hearing

Affordable Care Act, Health Reform, Medicaid, Pennsylvania

Advocates weigh in on Corbett’s Healthy PA plan

Pennsylvania is moving forward with seeking approval by the federal government for its Healthy PA plan to reform the Medicaid system and expand Medicaid eligibility in the Commonwealth. The Pennsylvania Department of Public Welfare accepted comments on the plan in its current form as a concept paper.

When he announced the Healthy PA plan in mid-September, Governor Corbett made it clear that he did not view it as Medicaid expansion, but instead, Medicaid reform.  The plan proposes to consolidate the existing Medicaid benefit packages in the state into two alternative benefit plans mirroring commercial-like coverage.  While the plan does call for an expansion of Medicaid eligibility for individuals up to 138% of the federal poverty level, new Medicaid beneficiaries would be enrolled in private health insurance plans offered through the Marketplace.  The Pennsylvania plan contains other controversial proposals such as requiring a work-search requirement, attaching a monthly premium, and imposing a $10 co-payment for “inappropriate” emergency room usage.

Pennsylvania advocates expressed grave concern about the legality and impact the proposed plan would have on individuals:

In its comments, Community Legal Services (CLS) identifies issues with the plan’s proposal to attach a monthly premium on individuals making as little as 50% of the federal poverty level (less than $6000/year).  Additionally, CLS cites guidance from CMS regarding its position on imposing barriers to eligibility including work-search requirements.

Echoing many of the concerns expressed by CLS, the Consumer Sub-Committee of the Medical Assistance Advisory Committee (MAAC), under its counsel, the PA Health Law Project, expressed concerns with the monthly premium, emergency use co-payment, and work-search requirements of the plan. The Consumer Sub-Committee and the Disability Rights Network also called for clarity regarding the process of defining “medically frail” under the proposed plan. 

The PA Coalition of MCOs’ 12-page list of questions illustrates the considerable need for clarity regarding the plan’s proposals.  The Coalition’s comprehensive list of questions range from inquiring about the state’s timeline to the range of benefits and options that will be available to Medicaid-eligible individuals enrolled in private health insurance plans.

The next procedural step Pennsylvania must take in order to implement an alternative Medicaid expansion plan is seeking CMS approval of a Section 1115 waiver. Once the waiver is drafted, Pennsylvania must hold public hearings and have a formal notice and comment period of at least 30 days.  To date, the only state to receive approval by CMS to implement an alternative Medicaid expansion plan is Arkansas.

Links to other organizations’ submitted comments:

Affordable Care Act, Health Equity, Health Reform, Medicaid, Pennsylvania

Healthy Pennsylvania? Not exactly.

Tuesday afternoon the nation stood by waiting for Pennsylvania Governor, Tom Corbett, to announce that Pennsylvania would opt in to the Medicaid expansion provision of the Affordable Care Act.  The news viewers received instead was something very different.  Corbett made it clear that he was not “expanding Medicaid”, but providing a “common sense” plan to reform the state’s Medicaid program. The plan’s title, Healthy Pennsylvania, is quite the misnomer when one looks at the details.

The Healthy Pennsylvania objectives are threefold: reform Medicaid, increase access, and stabilize financing.  Reforming Medicaid is at the heart of the plan and includes many controversial proposals such as condensing the 14 existing Medicaid benefit plans into two alternative benefit packages; applying a $10 co-payment for “inappropriate” emergency room use; requiring applicants and beneficiaries to comply with work search requirements; and attaching a monthly premium for individuals who have incomes as little as 50% of the federal poverty level.

For the reasons below and others, I do not support Governor Corbett’s Healthy Pennsylvania plan.  It is unlikely that the federal government will approve it as well due to the many provisions presented in the plan that are contrary to the laws and regulations governing the Medicaid program. Instead of taking meaningful action to help improve access to care and health of Pennsylvanians, this proposal will act as a needless delay prohibiting hundreds of thousands of Pennsylvanians from getting comprehensive, affordable health coverage as set forth by the Affordable Care Act.

Consolidation

While it is true that the Medicaid program in Pennsylvania is complex, it serves a variety of different populations. For example, there is a plan for women who make slightly higher incomes to receive coverage for certain OBGYN services known as the Women’s Select Plan.  Another existing benefit in Pennsylvania is the Medical Assistance for Workers with Disabilities (MAWD).  This plan provides health coverage for workers with disabilities whose income would otherwise make them ineligible for the traditional Medicaid program in Pennsylvania.  The Governor’s proposal to consolidate the existing Medicaid programs leaves advocates questioning the fate of programs like these that serve specific groups.  Even more troubling is  that in addition to consolidation, the Governor would like the services covered by the plans to reflect that of employer-sponsored coverage.  The traditional Medicaid plan in Pennsylvania offers  coverage for a wide-range of coverage including comprehensive services for mental health and substance use challenges.  If this proposal were implemented it would significantly reduce the scope of services individuals would receive to keep them well.

Expansion

Within the Healthy Pennsylvania plan the Governor does agree to expand Medicaid eligibility for individuals up to 133% of the federal poverty level. He proposes to do this by enrolling those individuals into private health insurance plans on the Marketplace.  While this expansion of eligibility would increase access to some type of health coverage for individuals, it would do so in a way that is more costly and less efficient than enrolling individuals into traditional Medicaid.  The fact is that it is less costly to insure individuals through Medicaid than it does through the private health insurance market.

Cost Containment

In an effort, under the guise of cost savings and promoting personal responsibility, Corbett proposes to mandate several requirements under the Healthy Pennsylvania plan. Among the most controversial is the work search requirement. While the Governor stated that this requirement would only apply to “able bodied” individuals capable of working, his plan does not clearly define how this requirement would be applied and enforced.  Currently, no other states in the nation apply a work requirement to its Medicaid benefit.

Another controversial provision is the premium that individuals will need to pay for coverage. Individuals with incomes as low as 50% of the federal poverty level ($5,745/year) will be asked to pay a premium. The maximum premium an individual will pay will be $25 per month.  While $25 per month does not seem like much money to individuals who have steady incomes, for low-income individuals, it will act as a significant barrier to coverage and care.

One of the more alarming provisions set forth in the plan without any clarification or description is a $10 co-payment for “inappropriate” emergency room usage.  The plan fails to define or describe situations when using the emergency room would be inappropriate as opposed to appropriate.  The plan also fails to explain how this co-payment would be collected or who would be responsible for determining when the co-payment should be imposed on an individual.  Individuals and families who might be experiencing serious medical conditions could delay seeking emergency treatment due to this co-payment.  The Emergency Medical Treatment and Labor Act (EMTALA) was enacted to ensure all individuals had access to necessary health services in times of crises regardless of ability to pay.  Enacting a policy such as this can confuse individuals about their right to receive care in these settings.  If implemented this provision will unjustifiably penalize the poor.

The Governor’s plan can be accessed here: http://www.dpw.state.pa.us/healthypa/index.htm.

Comments on the plan can be submitted via email to: RA-PWHealthyPA@pa.gov or by mail to:

Department of Public Welfare,
Office of the Secretary,
Health & Welfare Building,
625 Forster Street,
Harrisburg, PA 17120

Uncategorized

Thoughts on Governor Corbett’s coming announcement re: Medicaid expansion in Pennsylvania

Public health advocates in Pennsylvania have been working tirelessly to influence Governor Corbett to “opt in” to Medicaid expansion since the U.S. Supreme Court made its surprising decision on June 28, 2012 regarding the Affordable Care Act (ACA).  The Governor’s office has leaked to the press that tomorrow we will get the news we have been waiting for during a big announcement the Governor is set to deliver.  One would think that advocates should welcome this news; however instead of celebrating, many of us are gearing up for our next challenge: explaining to the public and the legislature why we will not support Governor Corbett’s Medicaid expansion proposal.

For months Governor Corbett adamantly opposed expanding Medicaid eligibility citing misleading financial analyses, over reliance on the Medicaid program, and unsubstantiated fears that the federal government will “break its promise” regarding the 100% federal matching rate for the program for years 2014, 2015, and 2016.  More recently, as the Governor’s political popularity continues to dwindle, he has moved from adamantly opposing expansion to considering options within expansion.  Based on recent statements by the Governor, the Pennsylvania Department of Welfare Secretary, Beverly Mackereth, and the Insurance Commissioner, Michael Consedine, it is very likely that the Governor’s proposal will be similar to those of Arkansas and Iowa.  Governor Corbett favors privatization and it is likely he will propose expanding Medicaid eligibility for individuals, but instead of enrolling them into the traditional Medicaid program, the newly eligible individuals will be enrolled into the private health insurance plans on the Marketplace. In addition to this, the Governor will likely request a waiver from moving children in households with incomes up to 138% of the federal poverty level from CHIP into the Medicaid program; a provision of the ACA to which the Governor has expressed great opposition.  Other items the Governor might propose as part of the Medicaid expansion in Pennsylvania could include work requirements and increased co-payments for services. With the maintenance of effort requirement of the ACA expiring at the end of the year, advocates also fear Governor Corbett’s expansion plan will unfortunately come with a reduction in the current Medicaid benefit, negatively impacting our most vulnerable residents.

Governor Corbett is making the issue of Medicaid expansion in Pennsylvania needlessly complex in order to satisfy both a Republican base and to improve his popularity overall.  In doing so, the Governor will continue to delay the opportunity for approximately 600,000 residents to get comprehensive health coverage.  Some of the messages we need to get across are clear: (1) The current Medicaid program in Pennsylvania is efficient and works to provide comprehensive coverage to those who need it most; and (2) Pennsylvania residents will pay for Medicaid expansion through income tax regardless of whether we expand or not.  The government should expand in a way that provides the best services to individuals, not the highest profits for corporations.