Sent by the Disability Rights Network of Pennsylvania –
On December 6, 2013, the Department of Public Welfare (the Department) released its Healthy Pennsylvania Plan Draft 1115 Waiver Application. The Draft 1115 Waiver details the Department’s proposal to (1) limit the existing Medicaid (Medical Assistance) program, and (2) cover uninsured adults ages 21 to 64 whose income is less than 133% of the federal poverty level, and who do not otherwise qualify for Medicaid, by using Medicaid dollars to pay for private health insurance for them. The Draft 1115 Waiver application can be accessed here.
It is important for the disability community to submit comments and testify at the public hearings that are being held. The deadline to submit comments is Monday, January 13, 2014. Information on how to submit comments and how to register to testify at a public hearing is below. Webinars are also being held, and information on how to register is below.
After the public comment period, the Department still has to submit the 1115 Waiver Application to the Centers for Medicare and Medicaid Services (CMS) for approval.
The Department is proposing the following significant changes, which will affect persons with disabilities:
A health risk screening tool will have to be filled out by the person, family member, or representative. People on Supplemental Security Income (SSI) or deemed eligible for SSI do not have to fill out this tool. The following people will always be enrolled in the High-Risk Plan unless they choose to be enrolled in a different plan: all SSI beneficiaries, pregnant women, people who are dually eligible for Medicare and Medicaid, people in institutions, and people receiving home and community-based services. Other Medicaid-eligible adults will be assigned to a High-Risk Plan or Low-Risk Plan based on the results of the health risk screening tool. If the health risk screening tool is not completed, the person will be enrolled in the Low-Risk Plan.
New Limits on Medicaid Benefits for Adults: Benefits available under the High-Risk Plan and Low-Risk Plans would have new, lower limits. For example, medical supplies and durable medical equipment would have a combined annual limit of $2,500 in the High-Risk Plan and $1,000 in the Low-Risk Plan. Outpatient surgery would be limited to four visits per year in the High-Risk Plan and two visits per year in the Low-Risk Plan. Outpatient mental health visits would be limited to 40 visits per year in the High-Risk Plan and 30 visits per year in the Low-Risk Plan.
Children’s Plan: The Medicaid benefits for children under 21 years of age would not change.
Private Option: Adults ages 21 through 64 with incomes up to 133 percent of the federal poverty level who are not otherwise eligible for Medicaid would receive health insurance coverage through a private, commercial health insurance plan or an employer-sponsored insurance plan. The bulk of the cost sharing for the plan would be paid by Pennsylvania using federal Medicaid funds. These private insurance plans must include at least a minimum set of benefits, known as essential health benefits. Adults in this group who meet at least one of the following criteria would be deemed medically frail and given the choice to enroll in the High-Risk Medicaid Plan instead: disabling mental disorder; active chronic substance use disorder; serious and complex medical condition; physical, intellectual or developmental disability that significantly impairs functioning; or determination of disability based on Social Security Administration (SSA) criteria.
Copayments: Most copayments would be eliminated for Medicaid recipients, with the exception of a new $10 copayment for non-emergency use of emergency rooms. Newly-eligible adults receiving health coverage under the Private Option (described above) who are at least age 21 would also have to pay the $10 copay when they go to the emergency room for non-emergency care.
Premiums: Adults ages 21 through 64, who are in Medicaid or who are in the Private Option, would also have to pay a monthly premium. Premiums would begin for adults with incomes above 50 percent of the federal poverty level. Certain people would not have to pay premiums: people on SSI or deemed eligible for SSI, pregnant women, people who are dually eligible for Medicare and Medicaid, and people in institutions.
Monthly Premium Amounts: There would be two types of premium amounts: “individual” for one adult, and “household” for two or more adults. Single adults with incomes greater than 50 percent of the federal poverty level up to 100 percent of the federal poverty level would pay $13 each month. Households in the same income range would pay $17 each month. Single adults with incomes greater than 100 percent of the federal poverty level up to 133 percent of the federal poverty level would pay $25 each month. Households in the same income range would pay $35 each month. Premiums would be adjusted upward every year. People would lose Medicaid benefits for up to nine months for not paying premiums.
Premium Reductions for Health Habits: Adults who pay premiums on time who complete an annual health risk assessment and have an annual physical examination would pay a monthly premium reduced by 25 percent.
Premium Reductions for Working: Adults who work 30 or more hours per week would pay a monthly premium reduced by 25 percent. Adults who work more than 20 hours but less than 30 hours per week would have a reduction of 15 percent in their premium, after six months of working.
WORK SEARCH REQUIREMENTS:
Work Search Activities: Adults ages 21 through 64 who are in Medicaid or in the Private Option and working less than 20 hours per week would have to register with the JobGateway online program and complete 12 approved work search activities per month. Failure to register or complete the work search activities would result in ineligibility for health coverage.
The following people would not have to enroll with JobGateway and would be exempt from the work search requirements: people on SSI or deemed eligible for SSI, pregnant women, people 65 years of age and older, people under 21 years of age, people in institutions, and people who are dually eligible for Medicare and Medicaid. Full- and part-time students would have to register with JobGateway but are exempt from the work search requirements.
PUBLIC COMMENT PERIOD:
It is important for the disability community to submit comments on the Draft 1115 Waiver application. Written comments must be submitted to the Department by January 13, 2014. Written comments may be emailed to ra-PWHealthyPA1115@pa.gov or mailed to: Department of Public Welfare, Attention: Healthy Pennsylvania Waiver, P.O. Box 2675, Harrisburg, PA 17105-2675. Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at 800-654-5984 (TDD users) or 800-654-5988 (voice users).
The Department is also holding 6 public hearings and 2 public webinars. The schedule for the public hearings and webinars is below. You may register for the hearings and webinars here. Please note that registration is required if you will be providing testimony at the hearing or webinar. Please consider attending at least one of the public hearings or webinars and providing testimony on the Draft 1115 Waiver.
Thursday, December 19, 2013
Friday, December 20, 2013
Friday, January 3, 2014
Monday, January 6, 2014
Tuesday, January 7, 2014
Thursday, January 9, 2014
Monday, December 16, 2013
Wednesday, January 8, 2014
IF YOU HAVE QUESTIONS:
Questions or comments may be directed to Kelly Whitcraft, DRN Policy Coordinator, at firstname.lastname@example.org or 800-692-7443, extension 323.
Disability Rights Network of Pennsylvania