For the past year, I have been writing about the barriers low-income Pennsylvanians have faced under Healthy PA, a complex version of expanded Medicaid under the Affordable Care Act created by the Corbett Administration. Next week, at the direction of Governor Tom Wolf, the state will begin removing those harmful barriers, making the road to coverage clearer and easier for low-income Pennsylvanians to navigate.
Here’s what will happen, and how these changes will make enrolling easier and make coverage more comprehensive:
On April 27, new enrollment in the Healthy PA Private Coverage Option (PCO) system will close. All newly eligible Pennsylvanians will be able to join plans in Pennsylvania’s HealthChoices network, and receive a more comprehensive set of benefits, which include dental and transportation to and from medical appointments.
The segregated benefits structure that Healthy PA had established in which some people received more services than others will end. So will the invasive and unnecessary “health screening questionnaire” that was used to determine which benefits an enrollee could receive. Starting April 27th, all adult Medicaid enrollees will receive the same benefits package — and the cuts pushed through under the Corbett Administration, like limits on medical supplies, will be reversed.
All of this is great news for patients with disabilities and chronic health conditions, and for all low-income families, who no longer have to fear that they will be placed in a health plan that does not meet their needs.
Also, on April 27, certain groups of enrollees — those who were covered by Medicaid before January 1 and moved into the Healthy PA PCO this year — will be able to rejoin their old plan and access a more comprehensive set of benefits.
This is the first phase in the transition from Healthy PA to a traditional, streamlined version of expanded Medicaid. The second will occur this summer, when all remaining PCO enrollees will be notified that they, too, will be able to join the HealthChoices network and receive the more generous benefits package. They will be notified via mail in late July and have the opportunity to stay with their current insurance company in the HealthChoices network or change to a new company. Their new, more comprehensive coverage will begin September 1. At no point will anyone who is currently eligible for Medicaid lose coverage or have it interrupted.
By September 30, DHS will terminate Healthy PA entirely.
We know that many Pennsylvanians have had trouble at every step in the process under Healthy PA — from being wrongfully denied benefits based on a misapplication of new eligibility rules, to paperwork errors resulting in their placement in the wrong benefits package, to extreme delays in processing their applications — and we are optimistic that simplifying the system to a traditional expansion of Medicaid will alleviate these barriers.
With the impending change, this is a good time for a reminder of who is eligible for coverage under the Medicaid expansion. It is anyone whose household income falls below 138% of the federal poverty level (see the chart below). Legal immigrants qualify, but they must have had legal status for at least five years. Those recently released from incarceration also qualify upon release from jail.
Medicaid coverage in Pennsylvanians is about to become better and a whole lot easier to enroll in. You can apply by calling 1-866-550-4355. If you need help, you can call the Pennsylvania Health Access Network at 1-877-570-3642.
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