Alternative Medicaid expansion approved; area health insurance providers to benefit

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Several Greater Lehigh Valley health insurance providers are one step closer to serving the community in a broader capacity after being included among the nine selected providers for Healthy Pennsylvania.

Healthy Pennsylvania is an alternative Medicaid expansion program proposed by Gov. Tom Corbett’s administration, an initiative approved Thursday by the federal government.

The program is geared to improve and bring financial stability to the state’s Medicaid program so the state can increase access to quality, affordable health care through the private insurance market.

“From the beginning, I said we needed a plan that was created in Pennsylvania for Pennsylvania − a plan that would allow us to reform a financially unsustainable Medicaid program,” Corbett said in a press release. “And increase access to health care for eligible individuals through the private market.”

After submitting to the state a request for acceptance, nine insurance providers have been selected as the insurance companies in the region to be a provider for Healthy Pennsylvania, including Capital BlueCross, Aetna, Independence Blue Cross, Gateway Health, Geisinger, Highmark, United Healthcare, UPMC and Health Partners Plans, but no final contracts have been signed.

“We view this as another opportunity to expand health care coverage to another sector of the population,” Aji Abraham, senior vice president of business development for Capital BlueCross, said this morning.

The Healthy Pennsylvania agreement includes two parts: reforming the Medicaid program and offering the Healthy Pennsylvania Private Coverage Option for eligible residents.

Under the new program, Medicaid will change from 14 benefit plans into low-risk and high-risk benefit packages that include essential health benefits and meet standards for mental health and drug and alcohol coverage uniformity.

To encourage personal responsibility, people enrolled in the programs will participate in cost sharing, which in the first year, eligible individuals will pay the same Medicaid copayments that exist today. In the second year, members with incomes greater than 100 percent of the federal poverty level will be required to pay 2 percent of their income toward a monthly premium, while current copayments are eliminated, except for an $8 copayment for nonemergency use of the emergency room that will be introduced.

Members in the program will have the opportunity to reduce their cost-sharing obligations by engaging in certain healthy behaviors, and the Encouraging Employment program will assist low-income, able-bodied residents to improve overall health and well-being and move out of poverty.

To make the necessary changes to the state’s health care system, the Corbett administration in the past year requested from the federal government a waiver and associated state plan amendments, which were then modified based on a comprehensive public comment process across the state.

Public input included seven public hearings and two webinars statewide with more than 1,000 attendees and 170 live testimonies. The waiver was officially submitted to the U.S. Department of Health and Human Services on Feb. 19.

“The Healthy Pennsylvania plan supports independence for all Pennsylvanians, utilizes the private health care market and increases health care choices for consumers – all without expanding an entitlement program,” Corbett said.

Enrollment for Healthy Pennsylvania is expected to begin Dec. 1, and the Healthy Pennsylvania Private Coverage Option is contingent upon continued funding from the federal government.

“This is truly a Pennsylvania solution,” Corbett said.

Jennifer Glose

Jennifer Glose

Reporter Jennifer Glose covers health care, Berks County and other topics. She can be reached at jenniferg@lvb.com or 610-807-9619, ext. 111. Follow her on Twitter @jenniferg_LVB and read her blog, “Networking,” at http://www.lvb.com/section/networking-blog.

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