HARRISBURG - Gov. Corbett this summer achieved what few thought was possible: Overcoming unlikely odds, the Republican won Obama administration approval for Pennsylvania to run its own version of Medicaid expansion.
With that the program to bring insurance coverage to about 600,000 people gained support from disparate interests - insurance companies, health-care providers, and advocates for the uninsured.
Corbett's reelection loss last week all but doomed his signature program, "HealthyPA," just as it was about to begin. And now confusion may loom for as many as 1.4 million people - those currently enrolled in Medicaid and those uninsured but newly eligible.
Gov.-elect Tom Wolf, a Democrat, has vowed to instead expand traditional Medicaid. That puts the Wolf transition team on a collision course with the outgoing administration.
"It's a bit of a perfect storm, with a lot of changes coming at once," said Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project. "There is a lot of uncertainty."
The Corbett administration this week said it was moving ahead on two tracks: On Dec. 1, enrollment opens for uninsured who meet the eligibility requirements - annual income no higher than 138 percent of poverty level, or just under $33,000 for a family of four. At the same time, the state is still waiting for federal approval on its plan to change Medicaid coverage for almost 900,000 current beneficiaries.
Department of Public Welfare Secretary Beverly Mackereth said Tuesday that said she had not yet met with Wolf, but that the incoming and outgoing governors share a goal: getting people health care starting Jan. 1.
"We're sticking to what we're doing until told otherwise," she said. "I just want people to have health care as soon as possible."
Pennsylvania is one of four states to receive waivers from the Department of Health and Human Services, allowing it to expand coverage for the low-income uninsured through a private model.
At the time the state was granted its waiver in August, it was widely considered the boldest experiment in reshaping Medicaid, coming almost a year after Corbett proposed his Medicaid alternative.
"It was significant that Pennsylvania and Centers for Medicare and Medicaid Services came to an agreement," said Joan Alker, a health policy expert and executive director of the Georgetown University Center for Families and Children. "From a policy perspective it was more rhetoric than reality on what was different [from expanding Medicaid.]"
Under criticism - and facing rejection by the Obama administration - Corbett backed off plans to require job searches for new Medicaid recipients. Another controversial aspect of the plan, insurance premiums, were not to go into effect until 2016.
But on Jan. 20, Wolf will take the reins and has said he will take quick action to shift course and pursue traditional Medicaid expansion.
"I've said all along I want to expand Medicare and Medicaid, and I have to work with both the current administration in the transition, and then eventually with the federal government to see how seamlessly and quickly I can make that happen," he told reporters after his election last week. "But I think that will be a good thing for the citizens of Pennsylvania."
Miller-Wilson said the good news was that seven of the eight managed-care plans selected to cover the newly insured are already Medicaid providers. But the contracts with insurers under the current framework might not be easy to undo and could delay health-care services if the plan changes again, he said.
Some health-care advocates worry that Corbett's plan would create a difficult screening process and could curtail benefits - including caps on lab tests and limits on durable medical equipment - for people with chronic conditions.
"We are worried about drastically limited services," said Antoinette Kraus, director of the Pennsylvania Health Access Network. "Gov. Corbett should stop benefit cuts for those currently enrolled, allow the newly eligible to enroll and get private coverage, and get rid of burdensome health screening."
Mackereth, the public welfare secretary, said the changes are aimed at creating efficiency, not limiting benefits.
"Nobody will not get benefits they need, that's how this is structured," she said. "This is not about cuts, this is about giving people what they need and not paying tax dollars for what they don't use."
Alker said she hopes the Corbett and Wolf teams work together to get Medicaid expansion up and running on schedule.
"It's not insurmountable," she said. "There's a lot at stake for people who have been waiting a long time."