Governor Tom Corbett officially released a draft of Healthy Pennsylvania, his Medicaid expansion proposal that would allow newly eligible adults to enroll in private coverage through the state’s Marketplace. Corbett said, “My Healthy Pennsylvania plan provides a state-based solution to ensure increased access to health care for all Pennsylvanians in a fiscally sustainable manner.” The draft plan, which is in a public comment period until January 13, 2014, will be refined and submitted to CMS early next year for approval. While newly eligible adults would enroll in private coverage, existing enrollees, newly eligible high-risk enrollees, and children would remain in the current Medicaid program.
Under the plan, sliding scale premium payments based on income would be introduced and all copayments would be eliminated except for non-emergency use of an ER. New enrollees would have an opportunity to reduce their premium payments by 25% by participating in healthy behaviors such as paying premiums on time and completing an annual health risk assessment and physical exam. Additionally, enrollees who work more than 30 hours per week would receive an additional 25% premium reduction and individuals who work 20-29 hours per week would receive a 15% reduction. Pregnant women, persons on SSI, dual-eligibles, and institutionalized individuals would be exempt from premium payments. Under the plan, individuals who work less than 20 hours per week would be required to complete work search activities in order to remain eligible. Implementing the plan would provide health insurance coverage to an estimated 500,000 uninsured Pennsylvanians.