Major part of Wolf’s Medicaid overhaul goes into effect

A major phase in Pennsylvania Gov. Tom Wolf’s Medicaid overhaul takes effect this week, affecting about 120,000 enrollees.

It’s part of his administration’s efforts to reverse big changes that former Gov. Tom Corbett made to Medicaid last winter as part of his HealthyPA plan.

HealthyPA expanded Medicaid eligibility as part of the Affordable Care Act to individuals earning up to about $16,000 annually, but it also moved people into different categories of coverage, depending on their health needs and income.  

The federal government, which under the ACA pays for most of the Medicaid expansion, agreed after long discussions to Corbett’s alternative plan.

Local health advocates applauded Corbett’s acceptance of the expansion but complained about his new coverage categories – which affected  current and new enrollees.  They termed the categories overly complicated and problematic. 

“Many, many people were misassigned into benefits packages, so they haven’t been able to get the care they needed,” said Kristen Dama, an attorney with Community Legal Services in Philadelphia, adding that some categories lacked important dental and transportation benefits. “And the raise-your-hand process to move from the wrong benefits package to the right package has been extremely cumbersome and extremely wieldy.”

Providers like the Public Health Management Corporation alleged that when coverage changed under Corbett, many enrollees faced challenges accessing needed mental health and drug and alcohol treatment services because provider networks changed.

One of Wolf’s first moves when he took office was eliminating certain coverage changes for current enrollees that Corbett had yet to finalize with the federal government. 

Now State Department of Human Services Acting Secretary Ted Dallas says that, effective on Monday, the “cumbersome” screening tool and other coverage categories are out for new enrollees.

He also says provider networks will be restored, and the state will start moving roughly 120,000 people who are currently in the General Assistance and Select Plan coverage categories into one comprehensive Medicaid plan.

“It’ll be something that’ll be a lot simpler and a lot easier to manage and also for folks who are getting coverage through Medicaid, a lot easier for them to navigate,” he says.

Dallas says the rest of the HealthyPA enrollees – about 120,000 who signed up for Medicaid when eligibility expanded – will be moved into that simplified Medicaid plan by the fall.

Some aspects of the transition still need final federal approval, including the specific benefits under the single Medicaid plan. DHS says a draft of those benefits will be available Monday.