Pa. unravels Corbett's health-plan mess

Healthy Pennsylvania was supposed to be former Gov. Tom Corbett's signature effort, a private-market plan designed to qualify the state for millions in Medicaid expansion dollars while mollifying foes of the Affordable Care Act.

But when Corbett lost his reelection bid in November to Democrat Tom Wolf, who had vowed to replace Healthy Pennsylvania with traditional Medicaid expansion, many people thought the Republican would shelve the complex hybrid program.

Corbett didn't and the result was chaos.

"It has been a mess for our clients for the last few months," said Kristen Dama, a staff attorney with Community Legal Services in Philadelphia. "A lot of our clients are getting placed into the wrong benefits package."

The mess should be coming to an end. Last week, the state Department of Human Services announced that it had transferred 121,234 people from Healthy Pennsylvania's private coverage option to HealthChoices, a traditional Medicaid expansion program.

The next goal: Finding the estimated 400,000 Pennsylvanians believed to be eligible for Medicaid under the new guidelines who may not realize they can qualify now that income guidelines are less stringent.

The move away from Corbett's plan also closed the private coverage option. All new applicants - about 5,700 so far - are being enrolled in HealthChoices, DHS Secretary Ted Dallas said.

Beginning in July, DHS will start the final phase of the transition, transferring the nearly 138,000 people remaining in the private coverage option whose situations are "a little more complicated."

"They have different information we need to get from them," Dallas said. "So we wanted to do it gradually so we don't disrupt people's lives more than they have been been already.

The transition to HealthChoices is expected to be completed by Sept. 1.

Notices began going out last week to people in the first wave, who will continue their present coverage until June 1, when HealthChoices kicks in.

"Folks should understand that if they are receiving coverage through the DHS they can continue to go to the same doctor and continue to access health care the same way you did before," Dallas said. "You don't have to do anything until we notify you, and we will notify you before anything happens."

Among the new benefits people will receive under HealthChoices is medical-assistance transportation.

"People can get rides to the doctor if they can't get there by themselves," Dama said. "They can also get dental coverage."

The transition unravels Corbett's complicated program, which took months of effort by state officials to negotiate with the federal government.

The three-tier program was too difficult even for some DHS field employees to understand. As a result, they were asking consumers for personal financial information that wasn't required under federal Medicaid expansion rules. A logjam of rejected and delayed applications began to build.

A computer glitch exacerbated the problem by placing Pennsylvanians who needed substance-abuse and mental-health services in health plans that didn't include those benefits. The result: Thousands of people were locked out of treatment centers.

That's all in the past, Dallas said. The new system - from the consumer-oriented computer screens and tools through enhanced coverage for physical and behavioral health, has been streamlined into a comprehensive package that is simpler to use.

"Folks won't get lost in the system like they got lost with Healthy Pennsylvania," Dallas said. "We got a lot of the bureaucratic red tape out of the way and a lot of the administrative hurdles that were in Healthy Pennsylvania are out."

Dama said people in the second phase of the transition who have significant health needs can call the Philadelphia Customer Service Center (215-560-7226) and ask to be moved sooner.

"People do not have to remain in the [private coverage option] if they lack transportation, lack dental coverage, or lack a broad provider network that is not meeting their needs," she said. "There is a process in place to be moved."

Dama said the nearly 138,000 people newly qualified for Medicaid demonstrate the need for the program's expansion in Pennsylvania. But that number, even when combined with the 121,000 people who were already covered, is still far from the 400,000 to 600,000 people estimated to be eligible. Dallas said his goal was to make sure people who couldn't get Medicaid in the past because income limits were more stringent know they now may qualify for benefits.

"It's getting the word out and making sure people understand what it means for them," he said. "It's also making it simple enough that they don't get discouraged in the application process."

Medicaid, which has no premiums, now covers legal residents earning up to 138 percent of the federal poverty level ($33,465 for a family of four). To find out if you qualify, go to HealthChoicesPa.com and choose the How To Apply tab. There, you can find instructions to apply online, by mail, by telephone (866-550-4355), or in person at your local county assistance office. In New Jersey, go to this site: www.njfamilycare.org. EndText