Governor Corbett released his much anticipated Healthy PA waiver earlier today. Today’s release triggers a 30-day public comment period where providers, advocates, recipients and others will have an opportunity to weigh in on the details of the plan. While the plan extends coverage to hundreds-of-thousands of Pennsylvanians, it does so outside of the structures usually found in Medicaid.
It’s difficult to distill nearly 100 pages in a short post, but here it goes:
MEDICAID: First and foremost, Governor Corbett proposes to reform the existing Medicaid program. Medicaid serves millions of different people, and generally takes a one-size-fits-all approach. It matters little whether you’re poor, but otherwise healthy, or chronically ill; you get the same benefits. The Healthy PA approach takes a different tact, one more likely to be found in the commercial world. While preserving the full array of benefits for children, seniors, persons with disabilities and those with serious or chronic illness, it puts some of the remaining Medicaid population in a “Low Risk” benefit plan. These are adults between the ages of 21-64 who are on Medicaid because they’re poor, but otherwise relatively healthy. The benefits provided to this population will still be robust, it just won’t be the full panoply previously received. This population, which doesn’t face limits due to age or illness, can more easily transition from Medicaid to Employer Sponsored Coverage (ESI) or the Exchange from the “Low Risk” package. It will more closely mirror what other people receive on their own or through their employer and what the federal government mandates for Qualified Health Plans (QHPs).
In addition to transitioning low-risk adults to this new benefit package, the waiver proposes to move away from co-pays and in favor of premiums. The premiums are nominal, but exceed what Medicaid traditionally allows. Recipients can obviate the need to pay the full premium by actively engaging in certain activities, including work search and healthy behavior. The waiver is designed to provide incentives for people to do things to better their situation, in this case, reducing premiums by as much as 50% for those who engage in these activities.
PRIVATE COVERAGE OPTION: Instead of expanding Medicaid, Governor Corbett proposes to leverage federal dollars to assist people in purchasing coverage through the Federally Facilitated Marketplace (FFM) or Exchange. The plan does not use Medicaid health plans, does not include Medicaid provider networks, has different cost-sharing requirements than allowed by Medicaid, requires people to actually sign up and pick a plan, etc, etc. In other words, it’s not Medicaid. Like the low-risk plan above, the coverage is robust. Persons can only buy what the federal government determines to be Qualified Health Plans (QHPs). This means coverage includes essential health benefits, mental health parity and more. While there is some debate about the willingness of the federal government to approve benefits packages that don’t meet Medicaid standards, it should be noted that the federal government has said these benefits are good for the rest of the citizenry of the Commonwealth and the nation.
Another thing that is different about this approach is that the default is Employer Sponsored Coverage (ESI). If someone has access to ESI then that’s what they’re going to get. If they don’t, then the default is the Exchange. In today’s world, or the scheme that would be in place if Governor Corbett simply opted for the Medicaid State Plan option, Medicaid would be the default, followed by CHIP, followed by heavily subsidized Exchange coverage, and so forth. The Governor’s plan reverses the pecking order and makes ESI the default and then moves from there. Again, the goal (as stated in the waiver) is to move able bodied, healthy adults to health care that more closely mirrors what other people get in the individual/small group or employer markets, and align incentives to make them active consumers.
There is much more than can and will be said, but in a nutshell these are some of the elements of the Healthy PA waiver.