Providers cite problems with Healthy PA as Wolf promises to simplify program [updated]

Pennsylvania’s Medicaid program, which offers health care to more than a million disabled or low-income adults in the state, is going through a big overhaul right now. It has been controversial, as noted in several lawsuits filed in recent weeks. Some Democratic lawmakers, consumer advocates and health providers are now reporting major problems with the transition.

 

They are concerned that people who are most vulnerable and in need of health care are falling through the cracks, and they’re calling on Gov.-elect Tom Wolf, a Democrat, to move forward with a traditional Medicaid expansion instead, essentially doing away with some of Republican Gov. Tom Corbett’s big changes to the program.

A key member of Wolf’s transition team says these problems are a top priority and plans to drop one of the biggest points of contention, a “healthy low risk” Medicaid benefits plan, once in office.

Two big changes two weeks in: Eligibility and benefits

Corbett’s Medicaid overhaul, known as Healthy Pennsylvania, has a lot of moving parts, but two big changes took effect this month.

Part one has to do with eligibility. As of Jan. 1, Pennsylvania joined more than two dozen other states in tapping into federal funding to expand the number of people who are eligible for Medicaid. They did this by streamlining and broadening the income guidelines to just above the poverty line.

It’s estimated more than half a million residents are newly eligible.

“Healthy PA is going really well,” said Kait Gillis, a spokeswoman for Pennsylvania’s Department of Human Services. “We have about 151,000 households that have applied for health care coverage in the first five weeks, which is really exciting.”

Part two of the Medicaid overhaul has to do with actual benefits. The state has changed Medicaid benefits structure for current enrollees, essentially setting up two categories of coverage (with a separate one for those who are newly eligible). One category is for people who are healthy, so it covers fewer services. The other category is for people who have a lot of health needs, so it covers more.

Some of those benefits changes have taken effect, others are still being worked out with federal officials.

“The system changes seem to be working really well, and people are getting access to health care coverage,” said Gillis.

‘Fraught with glitches and problems’

State Sen. Vincent Hughes, D-Philadelphia, organized a group of local health providers and consumer advocates at City Hall Wednesday, to voice concerns over what they say is turning into an overly-complicated, confusing program. They worry people are wrongly losing benefits, that it’s taking too long to process new applications and that the state is in denial about how badly this transition is going.

“They [Medicaid enrollees] are being told they’re not covered, so some of them aren’t even showing up,” said Michael Harle, president of the behavioral health agency Gaudenzia in Philadelphia. “The ones in treatment already, we’re keeping them and appealing and fighting for them.”

Harle said tens of thousands of beneficiaries who need mental health services are being wrongly placed in a benefits category and losing coverage of needed services, like residential treatment.

The Corbett administration has disputed that number, saying as of Jan. 8, approximately 1,300 impacted individuals were identified.

Harle points to one woman in his program who recently ran out of coverage.

“What am I going to do, put her on the street?” he said. “I mean I can tell her she can leave but where’s she going to go? There’s no logic to this whatsoever.”

Consumer advocates are also reporting sign up problems for people who are newly eligible for Medicaid. They worry Pennsylvania has a huge backlog of applications. Gillis, with the state, says they’ve hired hundreds of more people to address this and that it takes about 45 days to process an application, with coverage kicking in retroactively.

What next (with a new administration next week)?

Harle and others are looking to what will happen when Corbett leaves office, and Wolf takes over on Tuesday.

“What we will do, what the Wolf administration will do when they come in next week is begin to simplify the program,” said Estelle Richman, a former state Department of Welfare director and a part of Wolf’s transition team.

She says as early as Feb. 1, Wolf plans to get rid of that lower benefits category of coverage. It’s budget neutral, she said, or would even save money, so she believes it wouldn’t require any legislative approval.

“This is probably one of the easier steps,” she said. “I’ve met both with the lawyers in DHS and the leadership, and I think everyone’s in accord that this one can happen pretty quickly.”

Richman also said she’s been working with the state on the problems noted by Harle. She says it’s a computer glitch and that she and state workers are trying to fix it. She says providers like Gaudenzia will be reimbursed for those needed services, but she’s not sure how long that will take.

She says a more complex Medicaid issue has to do with coverage for people who are newly eligible. It’s slightly different, compared to traditional Medicaid. For example, it’s slated to require monthly premiums next year.

Richman, who doesn’t think that will happen, said the Wolf administration is reviewing ways to move everyone into a traditional Medicaid plan.

Figuring out that process could take 100 to 120 days.

Regardless, Richman and Gillis with the state, said the goal is that everyone who needs coverage right now is able to get it and that any change is as seamless as possible.