Corbett stumping for Medicaid plan

Work-search requirement expected to have a difficult time gaining federal approval

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HARRISBURG -- Out-of-work Medicaid recipients could be required to search for a job as part of a proposed health program overhaul in Pennsylvania -- that is, if the new plan gets the OK from the federal Department of Health and Human Services.

"I think getting it approved by the federal government will be problematic," said Shannon Mace Heller, a public health attorney in Philadelphia, adding that she was not aware of any other state with a similar requirement in its Medicaid program.

"I don't think it would get federal approval," agreed Joan Alker, executive director of the Center for Children and Families at Georgetown University's Health Policy Institute. "I don't think the feds even could approve it."

On Monday, Gov. Tom Corbett unveiled a proposed major overhaul of the state's Medicaid system: cutting the number of benefit plans available from 14 to two, putting in place monthly premiums on a sliding scale and instituting a work-search requirement for unemployed working-age, able-bodied adults.

The governor will be in Pittsburgh today as part of a statewide tour to promote the plan.

"That's a pretty broad proposal, a far-reaching proposal," said Fran Grabowski, a principal with law firm Post & Schell's Health Care Group. Ms. Grabowski spent 35 years as an attorney with the governor's office of general counsel, Department of Public Welfare, serving as lead Medicaid attorney.

Ms. Grabowski said both the idea of premiums and the work search requirement will likely generate a significant amount of attention.

"This is something new," she said, regarding the work search requirement. "Generally, in the past, the federal government has not allowed states to include additional eligibility requirements."

Similarly, Ms. Alker said the idea of forcing participation in something as a condition of eligibility is problematic, and it's why the federal government rejected a proposal from Utah to require Medicaid recipients to participate in community service.

Jen Branstetter, director of policy and planning for the governor, said that since Pennsylvania's proposal is aimed at helping people find work, that's an apples-to-oranges comparison.

That concept -- asking Medicaid recipients to take more personal and financial responsibilities -- is a national trend, said Melissa Hansen, a program principal on Medicaid issues for the National Conference of State Legislatures.

"The idea of personal responsibility, broadly -- increased co-pays, the idea of showing up to appointments -- these are things that many states are looking at, how to engage Medicaid recipients in their own care," she said.

But will the federal government approve what Pennsylvania is proposing? It's hard to say, Ms. Grabowski said.

"In the past, they probably wouldn't have approved something like this, but as part of an overall plan to expand health care services, this may be something they agree to," she said.

The state believes the work-search component will be acceptable to the federal government, said Todd Shamash, deputy chief of staff for Mr. Corbett, speaking in a briefing about the plan with reporters Monday.

Mr. Shamash said work search is an important tool in many different human services programs; it's required for many adults receiving cash assistance through Temporary Assistance for Needy Families, commonly referred to as welfare.

Mr. Shamash conceded that many individuals already have jobs that simply do not provide insurance.

"In many ways, there are folks that are already working, and we're going to help them get access to health care," he said, referring to the state's plan to aid about 520,000 Pennsylvanians in buying insurance on the new health care exchanges, rather than moving them into the Medicaid system.

Administration officials said the requirement would apply only to able-bodied, unemployed, working-age adults, though Department of Public Welfare Secretary Beverly Mackereth could not say to how many recipients the requirement might realistically apply.

Mr. Shamash said: "We are talking about able-bodied. Certainly, we're not talking about children, we're not talking about the disabled, we're not talking about the elderly."

A work search requirement was also part of a Medicaid expansion plan passed by the state Senate in June, though the expansion proposal was stopped in the House before legislators adjourned for the summer.

electionspa - state - health

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


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