Another state is being offered a federal waiver to expand Medicaid on its own terms, hoping to bring the efficiency of private insurance and new value incentives to the public payer program.
Pennsylvania Governor Tom Corbett has secured an agreement with the federal government to offer Medicaid coverage to about 600,000 residents via an alternative to the Affordable Care Act's eligibility expansion.
Along with using private insurers to cover Medicaid beneficiaries, Corbett, a Republican, had sought flexibility to try out a range of new policies, such as work search requirement and the ability to charge beneficiaries earning below the poverty line premiums. Of the 24 specific waivers requested, however, only four were approved and included in the agreement with the Centers for Medicare & Medicaid Services.
But the main idea of the proposal -- using the private sector -- remains, with the ability to enroll Medicaid beneficiaries in managed care, either through the state's existing program or through the public exchange.
Other parts of Corbett's "Healthy PA" plan include an employment assistance program, new cost-sharing and value-based incentives.
In the first year of the program, which could be 2015, Healthy PA beneficiaries will be responsible for the same, minimal copayments already in existence, but in year two, those above 100 percent of the federal poverty level will pay up to 2 percent of their income in monthly premiums and $8 copays for seeking non-emergency care in ER settings.
Many of those cost-sharing items could be reduced, though, in what the Corbett administration believes is a way to engage Healthy PA and other Medicaid beneficiaries in their health and personal finances.
Medicaid and Healthy PA enrollees who pay their cost-sharing in time and receive annual wellness visits will be eligible for cost-sharing reductions the following year.
"The Healthy Pennsylvania plan supports independence for all Pennsylvanians, utilizes the private healthcare market, and increases health care choices for consumers, all without expanding an entitlement program," Corbett said in a media release.
Pennsylvania's healthcare industry is also embracing the program as a solution to solving the problem on continuing uninsurance and uncompensated care.
"The plan reflects Governor Corbett's priority to create a sustainable Medicaid program for future generations, and to give Pennsylvanians more choices, encourage healthy behavior, and deliver critical healthcare at less cost to the taxpayers," said Andy Carter, president and CEO of the Health System and Hospital Association of Pennsylvania. "We now will have more avenues to help those most in need -- low-income, working Pennsylvanians and their families."
Medicaid plans represented by the Pennsylvania Coalition of Medical Assistance MCOs also support the idea, though had some concerns with administering the program. In public comments earlier this year, the Coalition's lead coordinator Michael Rosenstein recommended a "specialized marketplace as the sole vehicle for the private option," with existing managed care plans offering Medicaid plans through an exchange.