Pennsylvania's Republican-controlled General Assembly is considering significant, last-minute changes to the state's Medicaid program.

The changes would come as part of the state's Human Services code, one of a number of code bills legislators must pass to enact the budget.

The bill passed the state House Tuesday in a 102-91 vote

Among the changes: requiring the state's Department of Human Services to seek a waiver for its Medicaid program to impose work requirements on able-bodied recipients, "lock-in" Medicaid recipients in their managed care plans, and request a waiver to the federal government to charge premiums in Medicaid to families with disabled children whose income is above one thousand percent of the federal poverty income limit.

In a statement, the Pennsylvania Health Access Network called the changes — which were added to the bill in a party line vote Monday evening — a "sneak-attack" on the Medicaid program.

"All of these changes to the Human Services Code are being fast tracked. None have been discussed and debated," said a statement from the Pennsylvania Health Law Project before the House floor vote.

Democratic Gov. Tom Wolf allowed the state's $32 billion budget to lapse into law without his signature at midnight Monday. Legislators remain in the Capitol as negotiations continue over the revenue package needed to fund the budget for the fiscal year that began July 1.

Speaking to reporters in the Capitol on Monday, House Majority Leader Dave Reed, R-Indiana, said the bill "provides a couple hundred million dollars in savings depending on the waivers that are submitted to the federal government and what the federal government intends to approve. But certainly it's a reenactment of a lot of the welfare reforms that were actually put into place in the Clinton administration and the Ridge administration that fell to the wayside during the Rendell administration."

Medicaid work requirements for certain recipients is an idea that has come up before from conservatives who say it would save money and preserve the program for the truly needy. Health advocacy groups have countered such measures would keep people from getting needed care, require bureaucracy to determine who is working, and noted that many able-bodied Medicaid recipients work in low-wage jobs that do not provide health insurance.

More than 2.8 million Pennsylvanians are enrolled in Medicaid, although many of those individuals are children, elderly or disabled. The program is a major cost-driver in the state budget.

The federal government has not previously allowed any state to condition Medicaid eligibility on work, though some experts believe that could change under the Trump administration.

Much of the House debate Tuesday centered around the bill's provision to charge premiums in Medicaid to families with disabled children whose income is above 1,000 percent of the federal poverty income limit.

A memo from advocacy group Pennsylvania Partnerships for Children noted that "would be administratively difficult and expensive for the state to administer" such a change.

Speaking on the House floor Monday, supporters of the bill noted that would only apply to families with incomes of approximately $246,000 for a family of four.

Speaking against the bill, State Rep. Dan Miller, D-Mt. Lebanon, said even a small amount of money could be a hardship to a family with a severely disabled child.

"Do you know how my son learned to eat? It wasn't from a service we could get in Pennsylvania. We had to go out of state. We had to rent a home. We had to sit there for weeks on end, for a special service that was not covered [by insurance]," Mr. Miller said on the House floor, speaking of the services that were not covered by private insurance for his son who has autism.

A statement from the governor said he "strongly opposes these backdoor changes that could have widespread and potentially life-changing effects on the health and well-being of millions of Pennsylvanians."

Mr. Wolf's statement also noted the changes were made without input or hearings.

"Beyond the substance of these changes, the process flies in the face of good government and these changes would cost millions of taxpayer dollars just to implement. There was no input from stakeholders or families that would be affected and no formal fiscal analysis."

Karen Langley and Liz Navratil contributed. Kate Giammarise: or 412-263-3909 or on Twitter @Kate Giammarise.

First Published July 11, 2017, 12:39pm