The Obama administration announced Thursday afternoon that it had reached a waiver agreement with Pennsylvania governor Tom Corbett that will expand the state's Medicaid program. The deal makes Pennsylvania the 27th state (including D.C.) to expand the program under the Affordable Care Act, and, notably, was done under a Republican governor.
The feds accepted a modified proposal that will extend coverage to approximately half a million low-income Pennsylvania residents. Under the approved plan, individuals above the federal poverty line may be charged premiums for coverage and the number of available plans may be reduced from 14 to two: one "high risk" option and one "low risk" option.
Other states have sought—and acquired—federal waivers to modify how they expand Medicaid under the ACA. Arkansas is the most notable exception, where in January of this year, the state began using federal funds to pay private payers to insure individuals at or below 138% of the poverty level.
Want to read more? You might enjoy this story about whether the Arkansas 'private option' will sink or save providers.
Pennsylvania's plan is not a "private option" in the same way that Arkansas' plan is. Beneficiaries will receive Medicaid coverage, not a marketplace plan.
Notably absent in the approved plan were a few things Gov. Corbett had originally tried to push through to make the deal more GOP-friendly, including work incentives and requirements. In fact, Gov. Corbett's original proposal asked for 24 different waivers of federal law (for comparison's sake, Arkansas' private option plan required just three). The plan also does not include a "lock out" provision that would have canceled coverage for those who missed a premium payment (although those who fail to pay premiums will still lose coverage after a grace period—but they may later reenroll without a waiting period). Additionally, individuals below the federal poverty line may not be charged a premium.
The Pennsylvania expansion will take effect January 1, 2015, with the federal government footing the bill in its totality until the end of 2016.
Here are the biggest stories in the healthcare industry this week:
Critics cite privacy concerns and consent issues as potential pitfalls of this kind of partnership. How will providers be affected?
...and how does that impact support for the law?
Is the program's "one-size-fits-all" approach to payment to blame?
Healthcare Dive caught up with an IT security expert to learn how other providers can avoid major incidents like the Community Health Systems breach.
Is the agency providing sufficient guidance to providers—and are providers applying for the program?
What are the biggest barriers to progress and how can providers better their chances of attestation?
And here's what we were reading:
- We got a kick out of playing around on this interactive pricing tool on an this Oklahoma provider's website. This is transparency at its best: Hover your mouse over a body part you need operated on, and viola: You can find a price point.
- The Arkansas Times reports that Obamacare premiums are set to decline by 2% in 2015.
- Dan Diamond, throwing down some common sense: Americans. Stop freaking out about Ebola.
- If you haven't checked it out yet and you're interested in the biopharma industry, check out our sister pub, BioPharma Dive.