Wolf’s at­tempt to re­place Healthy Penn­syl­va­nia with his own plan won’t be easy

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

Penn­syl­va­nia Gov.-elect Tom Wolf will face fed­eral, state and con­trac­tual hur­dles should he try to re­place his Repub­li­can pre­de­ces­sor’s al­ter­na­tive Med­i­caid ex­pan­sion ini­tia­tive with the straight ex­pan­sion plan he fa­vors.

The Demo­crat also will con­front a chal­lenge in try­ing to stop the state from re­strict­ing ben­e­fits for those in the stan­dard Med­i­caid pro­gram, another Repub­li­can ini­tia­tive.

Open en­roll­ment be­gan last Mon­day for Healthy Penn­syl­va­nia, out­go­ing Gov. Tom Cor­bett’s al­ter­na­tive ex­pan­sion model for which as many as 600,000 peo­ple may be el­i­gi­ble. As part of the ini­tia­tive, the state built a sec­ond Med­i­caid man­aged-care sys­tem, sep­a­rate from the ex­ist­ing Med­i­caid sys­tem that serves about 1.6 mil­lion res­i­dents.

Un­do­ing Cor­bett’s al­ter­na­tive ex­pan­sion will re­quire CMS ap­proval, said Kati Gillis, a spokes­woman for the state’s Depart­ment of Pub­lic Wel­fare. Also, the state has bind­ing con­tracts with eight health plans to of­fer cov­er­age un­der Healthy Penn­syl­va­nia, and it’s un­clear if those can be bro­ken with­out fi­nan­cial penal­ties, she said.

The state’s Gen­eral Assem­bly has a Repub­li­can majority in both its cham­bers, mean­ing any move by Wolf to push his own Med­i­caid ex­pan­sion will run into op­po­si­tion.

“It is im­por­tant to note that although Gov. Cor­bett was de­feated, the Repub­li­cans in­creased their con­trol of the cham­bers in both the state House and Se­nate. The Leg­is­la­ture is likely to re­sist some of Gov. Wolf’s changes, mak­ing it dif­fi­cult to pre­dict at this point how this will all pan out,” Izanne Leonard-Haak, a man­ag­ing prin­ci­pal in Health Man­age­ment As­so­ciates’ Harrisburg, Pa., of­fice, said in a Novem­ber anal­y­sis on Healthy Penn­syl­va­nia.

Wolf had asked Cor­bett to stop im­ple­ment­ing Healthy Penn­syl­va­nia be­cause he planned to in­sti­tute a sim­ple ex­pan­sion of the state’s ex­ist­ing Med­i­caid pro­gram. The Cor­bett ad­min­is­tra­tion de­clined the re­quest.

Penn­syl­va­nia Gov.-elect Tom Wolf

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