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Medicaid Expansion Pennsylvania

Medicaid Expansion Pennsylvania

Pennsylvania Governor Tom Corbett has accepted the Medicaid Expansion provision of the Affordable Care Act on Thursday August 29, 2014. This makes Pennsylvania the 28th State to accept the Medicaid Expansion provision of the Affordable Care Act. Enrollment is set to begin December 1, 2014

According to the Pittsburgh Post-Gazzette Federal regulators approved much of Gov. Tom Corbett’s “;Healthy PA” plan, after the state and federal governments spend months negotiating a modified Medicaid Expansion plan for the state of Pennsylvania.  Governor Corbett’s  Medicaid Expansion Pennsylvania plan was unveiled last year and formally submitted to the federal government for review in February of 2014,  The modified plan proposed by Governor Corbett would not directly expand the state’s Medicaid program, but would instead offer federal subsidies to low-income Pennsylvanians to purchase private insurance.

Additionally Healthy PA will make sweeping and somewhat controversial changes to the existing Medicaid program, this changes include allowing some low-income individuals to be charged premiums for coverage and consolidating most existing benefit plans.

The governor’s proposal to reduce the number of Medicaid plans from 14 to two (a high-risk and low-risk plan) will be permitted, as well as allowing premiums for people earning above 100 percent of the poverty level, starting in 2016.

How many adults in Pennsylvania will become part of the Medicaid Expansion program?

Base on an estimated provided by Federal regulators. The accepted modified proposal from republican Gov. Tom Corbett (R) will offer an estimated 500,000 low-income individuals subsidies to purchase private insurance. This modified plan allows some low-income individuals to be charged premiums for coverage, and permits the number of available benefit plans to be reduced from 14 to two — a “high-risk” option and “low-risk” options

How much will it cost Missouri to partake in the Medicaid Expansion program?

In 2016, The Federal inflows are estimated at $4.7 billion, Taking the inflows over the same period of time with Medicaid expansion is $7.2 billion. The Medicaid expansion in Pennsylvania would result in $2.5 billion additional in federal funds to Pennsylvania. Since the outflow to the federal government will be nearly $6.7 billion in either case (with or without expansion), the net benefit is only positive in 2016 with expansion. From 2014-2020, the cumulative flow of federal dollars will be $16.5 billion higher with the expansion Medicaid.

Details of Pennsylvania Medicaid Expansion

  • With this approval and associated agreements, Pennsylvania will become the 28th state, including the District of Columbia, to adopt the Affordable Care Act’s Medicaid expansion. An estimated 500,000 individuals will gain coverage over the life of the demonstration, according to the Pennsylvania.
  •  Coverage starts in January 2015. No premiums are required for the first year. Premiums begin in 2016 for adults with incomes over 100 percent of the federal poverty level. Premiums must not exceed 2 percent of household income, and no premiums will be charged those whose incomes are below the poverty level.
  • Individuals who fail to pay premiums will lose coverage after a required grace period, but they may subsequently reenroll without a waiting period. Beneficiaries who show they are taking action to improve their health, such as by getting regular preventive care check-ups, will pay less for their coverage and care.
  • Pennsylvania will use managed care health plans to provide coverage for beneficiaries just as it does now in its current statewide managed care program, known as Health Choices. Federal managed care rules have not been waived, although when commercial standards are at least as robust as the federal rules, Pennsylvania can rely on the commercial standards as they contract with health plans.
  • The state will provide benefits that fully comport with federal law; no benefits waiver has been granted. CMS and the state have reached agreement on the overall benefits approach, pending final submission of documents by the state consistent with the agreement that has been reached. Under the law, states have the flexibility to design multiple benefit plans, and Pennsylvania has chosen to establish “high” and a “low” risk benefit plans. People who are medically frail will be enrolled in the high risk plan. Both benefit plans, which will be effectuated through state plan amendments pursuant to agreements reached with the Commonwealth, will meet all applicable federal standards.
  • Work requirements and incentives are not approved as part of this waiver. The state plans to fund and administer a separate program to link people gaining coverage under the waiver to job training and placement services for those who choose to participate. Health coverage will not be affected.
  • The expansion is paid for with 100 percent federal funds through 2016. Federal funding rates gradually decline beginning in 2017, but never fall below 90 percent of costs.

Pennsylvania Medicaid Applications

Need Application Forms, or information on your states Medicaid Application guideline. Please visit our State Centers for Medicaid Page with links to Applications, and Contact information for specific states.


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