• How far will the Obama administration plan bend on Medicaid?

    In Indiana, it appears that Gov. Pence’s administration will only go forward with the Medicaid expansion if they model it on the Healthy Indiana Plan (HIP). I’ve been skeptical that this will be allowed, because HIP involves cost sharing, as well as other things Medicaid traditionally eschews. If you don’t pay into your HSA, you lose the coverage. Medicaid doesn’t work that way.

    But this report on Pennsylvania’s plan isn’t that different:

    The broad framework of Corbett’s private-sector-driven proposal is similar to plans advanced by Arkansas and Iowa, neither of which has been approved by the federal government.

    Corbett’s “Healthy PA” plan will contain additional provisions such as co-pays and work-search requirements for both new and existing Medicaid recipients. Their co-pays would be based on income that would be capped at $25 a month.

    No other state has sought work-search requirements.

    Here’s a comment from HHS:

    “We are encouraged by Pennsylvania’s commitment to helping cover more of the state’s uninsured population. As we have done with other states, we are eager to work with Pennsylvania to provide the best options that work for Pennsylvanians,” HHS spokeswoman Emma Sandoe said in a statement to TPM. “HHS is committed to supporting state flexibility and working with states to design Medicaid programs that work for them, within the confines of the law.”

    By the way, when did Emma Sandoe become HHS spokeswoman? Nice!

    Anyway, as more and more states line up with the intent to expand Medicaid coverage, but with caveats like this, I find myself wondering how far the administration is willing to bend. If it was just Indiana, I bet they’d hold out. But now there’s Arkansas, Iowa, Pennsylvania, and likely more to follow. Will the Obama administration refuse the expansion because they want to attach a small copay to it? I don’t know anymore.


    • “By the way, when did Emma Sandoe become HHS spokeswoman? Nice!”
      July 5th 2012! Thanks Aaron!

    • HHS has struggled with this issue previously, rejecting proposals to impose cost sharing and member/provider liability for excessive emergency room use, for example. Perhaps the solution is to create a new state program similar to Basic health plans, if this can be done within the regulatory latitude HHS has to implement the PPACA.

    • Clearly HHS flexibility towards this issue has grown in the past year, but I would imagine their biggest problem with allowing an expansion via HIP would be the annual and lifetime maximum policy payouts.

    • Work-search requirement?! Are you kidding me? Folks earning so little as to be on Medicaid — including many on welfare — are not working for a reason, perhaps they can’t afford child care. He’s simply trying to turn Medicaid into Welfare Reform 2.0.

      Better Obama ‘veto’ this sadistic ‘innovation’ than allow other states to think it’s acceptable to charge cost-sharing and — worse — work-search for Medicaid.

    • In PA, as I understand it, the plan is more than to add a small co-pay. The Governor wants to overhaul the current Medicaid system before he’ll consider complying in any way with the ACA. http://www.delcotimes.com/general-news/20130917/healthy-pennsylvania-plan-is-unveiled-by-pa-gov-corbett