Legislators look at new Medicaid models

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HARRISBURG -- For months, debate in Harrisburg has focused on whether to expand the state's Medicaid program.

But the discussion has shifted in recent weeks, away from the yes/no debate and toward talks about what such an expansion would look like as part of a broader set of changes to the existing Medicaid program, which provides health care coverage to about 1 in 6 low-income and disabled Pennsylvanians.

"Next week, we're going to spend all week talking to the Legislature," state Secretary of Public Welfare Beverly Mackereth said Friday.

No final decisions have been made, she emphasized. But she said her office has spent months looking at an overhaul of the current Medicaid system, which accounts for about 27 percent of the commonwealth's general fund budget.

Legislators would not need to sign off on changes to the existing Medicaid program, though the state would need a federal waiver for major changes.

No proposed changes have been submitted in writing to the federal Department of Health and Human Services yet.

Ms. Mackereth listed some of what is being considered.

"The governor has said he wants a work-search requirement. That's important to him," she said.

"He's also said that there has to be some sense of personal responsibility," such as co-pays for emergency room visits or other services, she said.

Also on the table: Medicaid expansion proposals similar to what has been put forth in Iowa and Arkansas that give a subsidy to low-income consumers to buy private insurance.

"That's one piece of what we're looking at, but it's much more than that," she said. "We can't do anything without the reforms."

Senator Minority Leader Jay Costa, D-Forest Hills, said last week that he and Senate Democratic colleagues are concerned about what they're hearing could be proposed -- an Arkansas-style model that is more of a hybrid than a true expansion of Medicaid.

Mr. Costa said he believes that might not provide the same level of health care coverage.

"Why do we need to reinvent the wheel? We've already got a model in place," he said.

Senate Democrats have championed the expansion of Medicaid for months, and the Senate passed a budget-related bill that included such an expansion before adjourning for the summer.

The state estimates it would add more than 800,000 new people to Medicaid by expanding eligibility.

Advocates for the expansion have said the infusion of federal funds, job creation and health care coverage for the uninsured are too good of a deal to turn down.

Under a Medicaid expansion, the federal government would pay the full cost of newly eligible Medicaid enrollees for three years. After that, the federal share would gradually decrease to 90 percent in 2020. State expansions are part of the federal Affordable Care Act, also known as Obamacare, although each state has the option of whether or not to expand the program.

"There are several states out there that have pieces that we believe make sense for Pennsylvania," Ms. Mackereth said. "We are in the process now of putting it all together."

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Kate Giammarise: kgiammarise@post-gazette.com, 717-787-4254 or on Twitter @KateGiammarise.


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