ADEA State Update

State Policy Updates March 2014

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H.B. 395 passed the full House on February 11 by a vote of 62-6. The floor sponsor was Minority Leader, John Rusche, M.D. (D-ID). This legislation restores cuts to Medicaid made during the 2011 Legislative Session by H.B. 260. The services being restored relate to preventative dental services for adults with disabilities or special health needs. According to the fiscal note attached to the bill, there will be a $1,418,100 cost to the state General Fund which is included in the Medicaid budget request for FY15. The bill was sent to the Senate for further consideration, and on March 4, the bill passed the full Senate by a vote of 23-8.


On February 19, Gov. Tom Corbett submitted an 1115 waiver application to the U.S. Department of Health and Human Services (HHS) to reform the state’s Medicaid program and to provide health care to more than 500,000 uninsured Pennsylvanians. With this formal submission, Pennsylvania is seeking federal approval to implement the Healthy Pennsylvania plan. Pennsylvania’s plan includes two critical parts: reforming the current Medicaid program and offering a private coverage option for uninsured Pennsylvanians.

The proposed plan, anticipated to begin in January 2015, encourages personal responsibility, provides benefits that match individuals’ health care needs and promotes healthy behaviors according to the governor. Currently, one in six Pennsylvanians receive Medicaid benefits and the costs of the Medicaid program account for 27% of the commonwealth’s entire general fund budget.

The waiver application delays until 2016 several controversial changes that would apply to all able bodied Medicaid recipients, such as monthly premium payments and work search requirements. Specifically, individuals with incomes greater than 100% of the federal poverty level will be required to pay a nominal payment toward a monthly premium. In addition, adults, between 21 and 64 years of age, who are able to work and working an average of less than 20 hours per week, will be asked to engage in job training and employment-related activities as part of an integrated approach to improving their health and helping them move out of poverty through employment.

However, in a letter dated March 5, Gov. Corbett revised his initial waiver application and offered a proposal changing the work search requirement. The governor is proposing a voluntary, one-year pilot program for individuals over age 18 entering Medicaid and Private Coverage Option health care plans. The pilot program will not be a condition of eligibility, but rather allow those individuals who participate in job training and employment opportunities to receive a discount on premiums and co-payments.

Duggan Dental