Democratic Gov. Tom Wolf replaced Healthy PA in April with the expansion of conventional Medicaid called HealthChoices.
By Adam Smeltz / Pittsburgh Post-Gazette
Low-income families who might have waited months for medical assistance last winter are enrolling within weeks under Pennsylvania’s Medicaid expansion, sailing through simplified applications that help them see doctors faster.
“People are able to get the care and treatment they need much sooner. Folks are able to get preventive care much sooner,” said Antoinette Kraus, state director at the nonprofit Pennsylvania Health Access Network, which urged policymakers to broaden traditional Medicaid.
Still, critics remain cautious whether the expanded program could overburden the state budget.
Healthy PA — the Medicaid alternative that had been implemented under former Republican Gov. Tom Corbett — began accepting applications in December, with coverage first available in January. Some applicants waited up to four months to hear whether they qualified, in part because the process required health screenings and there was pent-up demand.
Democratic Gov. Tom Wolf replaced Healthy PA in April with the expansion of conventional Medicaid called HealthChoices, which Mr. Wolf said would streamline the low-cost public health insurance and make it easier to enroll.
Now about 2 percent of typical aid applicants wait longer than 30 days for a coverage decision, down from roughly 13 percent when Healthy PA policies began taking effect in January, the state’s Department of Human Services said. Most have an answer within 22 days.
“It’s clearly improved, and it’s improved dramatically. But it’s surely not a consistent result yet or something that I think anybody should celebrate,” said Elizabeth Allen, chief financial officer at North Side-based Allegheny Health Network. She said just over 20 percent of standard Medicaid applications that the health system filed on behalf of patients this year remain unresolved.
Republican lawmakers expect the program switch from Healthy PA to inflate the cost of expanding medical assistance, a central goal of the Affordable Care Act passed in 2010. Federal funds will cover the full expense of the expansion until 2017, when the state will start paying a portion. Pennsylvania’s share will reach 10 percent by 2020.
Healthy PA would have limited costs by grouping aid recipients into benefit packages based on their ability to pay, said Stephen Miskin, a spokesman for state House Republicans. Mr. Corbett said a single coverage plan under full Medicaid expansion would be financially unsustainable.
“Now you just have one cookie-cutter, Rolls-Royce benefit package for everybody,” said Mr. Miskin, who argued Healthy PA “would have protected individuals from being offered programs they didn’t need.”
He said the General Assembly has yet to receive definitive cost projections for expanding Medicaid and the administration under Mr. Wolf did not immediately supply comprehensive estimates to the Post-Gazette. The Kaiser Family Foundation found annual spending on Medicaid in Pennsylvania topped $23 billion a year before the expansion.
Those state and federal dollars covered some 2.2 million adults and children under past guidelines, which limited eligibility largely to those with disabilities, chronic illnesses or incomes around 40 percent of the federal poverty level.
State projections suggest up to 600,000 more Pennsylvanians qualify under the expanded Medicaid — more than 430,000 of whom have signed up for assistance since December. New standards under the Affordable Care Act extend eligibility to residents ages 19 to 64 with incomes up to 138 percent of the poverty level.
“I’m just glad that the program is there,” said Bertha Turner, 61, of Elliott, who applied for Medicaid last month after she lost her job. She said her thyroid condition and high blood pressure make seamless health coverage a necessity.
Medicaid reviewers approved her application about three weeks after she finished the paperwork at the nonprofit Consumer Health Coalition in the North Side, said Miss Turner, who undergoes blood work every six months. The prospect of going a few months without health insurance left her uneasy.
“If I were starting to feel ill, I could go in at any time. Every now and then, the medication needs to be adjusted,” said Miss Turner, who called her Medicaid application “hassle-free.”
Meanwhile, care providers said they’re waiting to see how the influx affects their bottom lines.
Upticks in the insured population should reduce unpaid charity care that health systems provide, but Medicaid reimburses hospitals only about 30 percent of costs for outpatient cases, industry observers said.
“For the economics of hospitals, they’re significantly underpaid for that medical assistance outpatient business. This isn’t going to improve really any hospital’s bottom line materially,” said Denis J. Lukes, chief financial officer at the Healthcare Council of Western Pennsylvania.
Average enrollment delays that reached 70 days in recent months make it tough to gauge the financial impact at Allegheny Health Network, Ms. Allen said.
Downtown-based UPMC might see a spurt of advanced ailments among new enrollees who had put off seeing a doctor, spokeswoman Susan Manko said, but “In the long term, it is a positive for everyone. Patients are getting the care they need, and we are now getting reimbursed at least some.”
Adam Smeltz: firstname.lastname@example.org, 412-263-2625 or on Twitter @asmeltz.
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