Monday, 01 December 2014 00:00

Enrollment in Pennsylvania's Medicaid expansion kicks off with a few hiccups

Written by Melissa Daniels | Tribune Live
Antoinette Kraus, executive director of the PA Health Access Network, explains the financial penalty for people who don't obtain health insurance, as mandated by the Affordable Care Act. Antoinette Kraus, executive director of the PA Health Access Network, explains the financial penalty for people who don't obtain health insurance, as mandated by the Affordable Care Act.

Busy phone lines and confusing eligibility requirements greeted some seeking health insurance under the state's expanded Medicaid plan on the first day of enrollment Monday, according to a health care nonprofit official who said there was “overwhelming demand.”

Hundreds of thousands of Pennsylvanians are now able to secure government health care through the state's Healthy PA Medicaid alternative. The Corbett administration's plan is Pennsylvania's version of Medicaid expansion under the Affordable Care Act established through a waiver from the federal government.

“This is the first day, and we know there's overwhelming demand,” said Antoinette Kraus, executive director of the PA Health Access Network.

Residents could sign up online, via phone or at a county assistance office. On the phone line, some callers got a message telling them to call back later, Kraus said.

From the state's perspective, Monday ran smoothly, said Kait Gillis, spokeswoman for the Department of Human Services. She said she was not aware of callers running into problems after checking with local offices.

“We built this entire system for people to go in and apply with all 600,000 applying on Day 1 in mind,” Gillis said.

If the call was not immediately answered, a message would respond with the wait time and give the web address for online enrollment, she said.

Gillis did not know when first-day enrollment figures will be available.

The state DHS estimates about 600,000 residents are newly eligible for health care under Healthy PA. Kraus said that includes about 300,000 who formerly fell into a “coverage gap.” During enrollment last year, they earned too much to qualify for Medicaid but not enough to participate in tax credit programs, she said.

Mary Hicks of Murrysville planned to obtain coverage through Healthy PA because she was dropped from Medicaid this year. She said she is grateful for the coverage.

“Without health insurance coverage, you're pretty much up a creek,” Hicks said. “I would've much preferred Gov. (Tom) Corbett just expand regular Medicaid. It would've made a lot more sense. But like I said, I'm happy to get whatever I can.”

The newly eligible population includes those who earn up to 138 percent of the poverty level, or about $16,100 a year for an individual, Kraus said. The state's website advertised it as 133 percent, or an individual income of less than about $15,600 a year.

Those attempting to apply for Healthy PA with an income above 133 percent might have been deemed ineligible when applying online.

“We've asked (the state) to fix that as quickly as possible,” Kraus said.

By early evening, the state had adjusted the enrollment process to ensure anyone who enters an income up to 138 percent is not directed elsewhere.

Part of the discrepancy was because of the way Medicaid eligibility is calculated using a “5 percent income disregard,” Gillis said.

Anyone up to 138 percent is eligible, Gillis said, adding, “133 is the standard number that's used on the federal level. As far as our verbiage is concerned, we tried to keep it consistent so as not to confuse people.”

Under Healthy PA, applicants who are eligible for Medicaid could get a low- or high-risk plan, based on their health conditions. Those who earn too much for Medicaid may be enrolled in a regionally based private coverage option that is subsidized but administered through commercial carriers.

Healthy PA also means residents on Medicaid will have changes in their existing plans.

Kristen Dama, a lawyer with Community Legal Services in Philadelphia, criticized the benefits packages that current Medicaid recipients will receive as of Jan. 1, calling them some of the stingiest in the country.

“They will be facing really dramatic new limits,” Dama said.

Those determined to be in the low-risk pool will have limited plans with offerings such as six lab tests a year and $350 worth of radiology exams.

Dama urged enrollees to appeal their plans to the state “if they have medical problems that are going to make those limits untenable for them in the next year.”

Enrollees will begin receiving letters this week about their plans, she said.

Gov.-elect Tom Wolf, who will be inaugurated Jan. 20, wants to change Healthy PA to a more traditional, streamlined version of Medicaid expansion. His transition team is working on those arrangements with the Corbett administration even as it starts Healthy PA.

No lapses in coverage are expected should Wolf's administration switch policies, said Sharon Ward, executive director for the progressive-leaning Pennsylvania Budget and Policy Center. But she thinks it would improve the program.

“We think Pennsylvania can do better in terms of the benefits package that it offers, or the limits that have been proposed that would make it harder for individuals to get or keep coverage,” Ward said.

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