Pennsylvania Completes Switch to Traditional Medicaid Expansion

There’s a saying in government, “Elections have consequences.” In Pennsylvania, the consequences of last November’s election of Governor Tom Wolf took hold this week in the commonwealth’s Medicaid program.

Wolf, the only Democrat to oust an incumbent Republican governor last fall, had vowed to toss out then-Governor Tom Corbett’s complex Medicaid expansion effort, called Healthy PA, which was being phased in after long negotiations with CMS. The new governor moved immediately toward a more traditional expansion program, although the process took until September 1, 2015, to complete.

Dubbed HealthChoices, the new program involved the transfer of more than 1 million adult Medicaid enrollees into a single benefits package, which the Department of Human Services (DHS) said has expanded services for primary care, preventive care, and behavioral health.

The original expansion called for different tiers of benefits; the program made a distinction between existing Medicaid beneficiaries and enrollees earning between 100% and 138% of the federal poverty line—the new population added under the Affordable Care Act. Advocacy groups said the Corbett program had too many hurdles to enrollment and was not a good long-term platform.

"Medicaid expansion means that more Pennsylvanians have access to primary and preventative care. As a result, they will be able to see a doctor when they are able to see a doctor when they are sick, have better health outcomes, and be able to avoid costly trips to the emergency room," said DHS Secretary Ted Dallas.

Wolf converted Corbett’s program in phases:

· On April 27, 2015, he announced the transition of 120,000 beneficiaries from the Healthy PA plan to HealthChoices.

· On July 27, 2015, the Department of Human Services moved the remaining beneficiaries from HealthyPA’s private coverage option to HealthChoices. These enrollees had 30 days to select an insurance plan and were given “bridge” coverage until September 1, 2015.

· In a statement, the Pennsylvania DHS said that 440,000 enrollees have taken advantage of Medicaid expansion, and 216,000 newly eligible residents have signed up since April 27, 2015.

Advocates for the poor had protested many of Corbett’s original proposals and even a few that survived CMS scrutiny. Notably, Corbett did not succeed in gaining approval for a requirement that beneficiaries prove they are seeking a job or job training, an element that remains a point of contention among several Southern governors who have pondered expansion but face resistance from their legislatures.