Medicaid expansion coming to Pennsylvania

Low income working Pennsylvanians were initially shut out of the Affordable Care Act (“Obamacare”) benefits. Because they were working, often working multiple minimum wage jobs, they made too much money to qualify for traditional medical assistance.  But because their families were still below the poverty line despite working parents, they didn’t qualify for subsidized “affordable care.” It was even more frustrating because the cost of the expansion was covered by the federal government, not the state. PA federal income taxes flowed out of the state to pay for ACA benefits, but Pennsylvanians who needed them couldn’t get the help.

The Healthy PA program, an alternative to the medicaid expansion designed by the Corbett administration, went into effect January 1. Instead of simply expanding medicaid to everyone below the poverty line, it was a complicated assortment of benefits provided through a parallel system of private insurance plans. For instance, Independence Blue Cross has offered its Keystone First plan (formerly Keystone Mercy) for years, but the Healthy PA benefits went through a different plan called Keystone Connect. In effect, every insurer providing medicaid HMOs had to create a duplicate product to participate in Healthy PA.

Whether Healthy PA would have been adequate or not is hard to tell. Enrollees weren’t the only ones confused by the program. Many providers didn’t know whether they were enrolled in the special Healthy PA plans, either, nor what benefits patients were eligible for. Many doctors who participated in the private insurers’ regular medicaid products wrongly assumed they were automatically participating in their Healthy PA products. And many patients who had been receiving medicaid were pushed into Healthy PA, too, even though their incomes had not risen.

Fortunately, Gov. Wolf is doing away with the distinction. There will be a single medicaid system for everyone below the poverty line. PA taxpayers will no longer be subsidizing enrollees in other states while their own working poor are uninsured, and there will no longer be the massive expense of maintaining the dual systems. It’s unfortunate this wasn’t done in the first place, as setting up the failed system wasted a great deal of public and private money.

The timeline for the transition is explained at . Anyone who applies for coverage through the website will automatically be referred for medical assistance if their income is low enough. Anyone currently in a Healthy PA plan will automatically be given full medicaid without having to reapply.

We’re happy to say that Urban Health Initiatives not only accepts Keystone First/Keystone Connect, Aetna Better Health,  United Healthcare Community Plan, Health Partners/Health Partners Essential and traditional medicaid, we welcome those plans. We also accept most employer health plans. We hope to make sure you don’t have to have a different doctor just because your insurance changes.