On September 16, 2013, the current administration announced that Pennsylvania is willing to expand Medicaid coverage to low income adults only if the federal government agrees to modify the current Medicaid law by adding additional hurdles for people who want coverage. Under the proposal, Pennsylvania would provide Medicaid services to low income adults under the following conditions:
- Applicants would have to demonstrate that within some (as yet unspecified) time they tried to find paid employment;
- Instead of becoming eligible for Medicaid, these adults would be required to apply for private medical insurance through insurance exchanges set up under the Affordable Care Act; and
- Even though current Medicaid law does not allow the state to charge a premium, newly-covered low income adults would be required to pay a monthly premium,.
The administration’s plan must undergo a lengthy process before it can go into effect, and it may never go into effect. It must first submit a detailed “waiver” application; no such application has been published. The administration has announced that it will accept comments on the application and once it is submitted to the federal government, the Center for Medicare and Medicaid Services must review and approve it.
The Law Center strongly believes that the current plan is a delaying tactic and is not designed to assist the hundreds of thousands of low income people in Pennsylvania who lack health care.
First, the process itself will take a very long time and may likely end with the federal government rejecting the waiver application because it requests a change in the Medicaid law. During this time, if the state administration simply agreed to the expansion of Medicaid, hundreds of thousands of low income people could already have health insurance with the accompanying positive economic benefits to the Pennsylvania economy.
Second, even if the federal government eventually approves the administration’s waiver application, studies have shown that the conditions will deter people from enrolling.
Third, the proposed conditions will require more manpower to administer the programs, particular to verify that applicants have attempted to find employment. Given that state agencies are already operating under severe budget constraints, an additional workload is likely to lead to longer delays for all Medicaid recipients, even further discouraging enrollment and participation.