Two months before Healthy Pennsylvania - Gov. Corbett's private-market version of Medicaid expansion - opens for business, advocates for the low-income uninsured have no idea what benefits packages will be offered or what criteria will be used to place people in plans.
State officials "clearly have been on top of this because they have been getting the delivery system in place," says Leonardo Cuello, director of health policy at the National Health Law Program in Washington. "But I wouldn't be surprised if they haven't figured out a lot of the details."
After months of negotiations over the state's request for 24 waivers, the Obama administration granted four of them in giving Healthy Pennsylvania the green light last month.
The approval clears the way for 600,000 low-income Pennsylvanians - most of whom have never had health insurance - to get coverage under the Affordable Care Act starting Jan. 1.
People can begin applying on Dec. 1 using Compass, the state's online application process - at https://www.compass.state.pa.us/ - or through the healthcare.gov site. You can also use a dedicated call center set up by the ACA - 866-550-4355 - or submit a paper application at any county assistance office.
"It's not our ideal plan, but we are really, really happy to see that hundreds of thousands of Pennsylvanians are going to have an opportunity to get health-care coverage," says Dee Mahan, Medicaid program director for Families USA.
Both programs - traditional Medicaid and Corbett's Healthy Pennsylvania - have the state paying private insurers to provide managed-care coverage to Medicaid recipients.
But the newer plans offer reduced benefits.
The health law gives states the flexibility to design their own benefits package for Medicaid expansion.
Most expansion states have opted to give new enrollees the same benefits as traditional recipients because it's cheaper.
"What most states are saying is, 'We don't want to deal with the hassle of going through the whole population of Medicaid expansion recipients and identifying who are the people we need to shift over,' " Cuello said. "There will be an administrative cost to do that."
Pennsylvania's Medicaid expansion benefits package went in the opposite direction, opting for the lowest amount allowed under the law. This essential benefits package features the 10 basic services that every plan must have.
People in the expansion will be placed in the essential benefits plan and most current recipients will go into a low-risk plan.
Newly eligible or current Medicaid recipients with great medical needs will be put into a high-risk plan.
The high-risk coverage is more generous than its low-risk counterpart but less generous than current Medicaid, says staff attorney Kristen Dama of Community Legal Services in Philadelphia.
One example: Medicaid currently places no limit on hospital visits; the high-risk plan, as previously proposed, allows only three admissions a year.
The folks the ACA calls "medically frail" must be placed in high-risk plans.
So who qualifies as high risk in Pennsylvania? No one knows because the Department of Human Resources, the new name for the state's welfare agency, hasn't said.
"There are a lot of questions about it," Dama said. "It is something that our organization is certainly watching very closely and with a lot of concern to make sure that people who do have medical needs do get the enhanced benefits package."
The agency was unable last week to make anyone available to comment on its new program.
The agency plans a screening process and questionnaire for newly eligible people, followed by a call if necessary to the candidate's medical provider to determine what program the person should be placed in, Dama said.
She also said the agency would study claim histories of current Medicaid recipients to decide their status.
"If someone thinks they have significant medical needs, it is really important that they see the process through," she says. "If they don't get assigned to the high-risk plan and they think they need a more comprehensive package, they should come to Community Legal Services or get help from others."
Dama's other big concern with Healthy Pennsylvania is the state's ongoing discussions with the federal government about reducing benefits for people currently on traditional Medicaid.
"I would say that it has been our biggest concern with Healthy Pennsylvania since the plan was announced more than a year ago," she said. "A cut to benefits is really just closing the door for people who need the care."
The state estimates a cut in traditional Medicaid benefits would affect a small percentage of its recipients.
"We are talking about a program of more than one million people," Dama said. "So even if you impact 3, 5, or 10 percent, you are still affecting tens of thousands of Pennsylvanians."
Of course, if Democrat Tom Wolf wins the gubernatorial election in November, Healthy Pennsylvania - with its waivers and new plans - will likely never take effect.
When asked by the blog "Keystone Politics" what he would do, Wolf tweeted that if elected, he would "do real Medicaid expansion."
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This article was written in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.